title: Knowledge and understanding of antibiotic resistance and the risk of becoming a carrier when travelling abroad: a qualitative study of Swedish travellers.
abstract: BACKGROUND
  Increasing globalisation, with the migration of people, animals and food across national borders increases the risk of the spread of antibiotic-resistant bacteria. To avoid becoming a carrier of antibiotic-resistant bacteria when travelling, knowledge about antibiotic resistance is important.
  
  
  METHODS
  We aimed to describe the knowledge and understanding of antibiotic-resistant bacteria, and of the risk for becoming a carrier of such bacteria, among Swedish travellers before their travel to high-risk areas. A questionnaire with three open-ended questions was distributed to 100 individuals before departure.
  
  
  RESULTS
  The travellers' answers were analysed using content analysis, resulting in the theme 'To be an insecure traveller who takes control over one's own journey'. Our results showed that the travellers were aware of what the term 'antimicrobial resistance' meant, but did not understand its real significance, nor the consequences for the individual nor for society. They also distanced themselves from the problem. Few thought that their travel would entail a risk of becoming a carrier of resistant bacteria. The lack of knowledge caused an uncertainty among the travellers, whom tried to master the situation by using coping strategies. They proposed a number of measures to prevent carriership. The measures were general and primarily aimed at avoiding illness abroad, particularly acute gastro-intestinal infection.
  
  
  CONCLUSIONS
  In health care and vaccination clinics, there is a need for improved information for persons intending to travel to high-risk areas, both about the risks of contracting antibiotic-resistant bacteria and about effective preventive measures.
authors.affiliation: Department of Infection Control and Hospital Hygiene, Stockholm County Council, Stockholm, Sweden Department of Medicine, Karolinska Institutet, Stockholm, Sweden susanne.wiklund@ki.se.
authors.forename: S
authors.initials: S
authors.lastname: Wiklund
authors.affiliation: Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Fagerberg
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden.
authors.forename: Å
authors.initials: Å
authors.lastname: Örtqvist
authors.affiliation: Clinical Microbiology, MTC, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Vading
authors.affiliation: Clinical Microbiology, MTC, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C G
authors.initials: CG
authors.lastname: Giske
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Broliden
authors.affiliation: Department of Infection Control and Hospital Hygiene, Stockholm County Council, Stockholm, Sweden Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Tammelin
mesh_terms: D000328:Adult; D000368:Aged; D002353:Carrier State; D024881:Drug Resistance, Bacterial; D004352:Drug Resistance, Microbial; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D012306:Risk; D013548:Sweden; D014195:Travel; D055815:Young Adult
keywords: Antibiotic resistance; antibiotic-resistant bacteria; bacterial carrier; extended spectrum beta lactamases; health education; infectious disease; prevention; qualitative methods; risk; travel