title: Physicians' attitudes and knowledge concerning antibiotic prescription and resistance: questionnaire development and reliability.
abstract: BACKGROUND
  Understanding physicians' antibiotic-prescribing behaviour is fundamental when it comes to improving antibiotic use and tackling the growing rates of antimicrobial resistance. The aim of the study was to develop and validate--in terms of face validity, content validity and reliability--an instrument designed to assess the attitudes and knowledge underlying physician antibiotic prescribing.
  
  
  METHODS
  The questionnaire development and validation process comprised two different steps, namely: (1) content and face validation, which included a literature review and validation both by physicians and by Portuguese language and clinical psychology experts; and (2) reliability analysis, using the test-retest method, to assess the questionnaire's internal consistency (Cronbach's alpha) and reproducibility (intraclass correlation coefficient--ICC). The questionnaire includes 17 items assessing attitudes and knowledge about antibiotic prescribing and resistances and 9 items evaluating the importance of different sources of knowledge. The study was conducted in the catchment area covered by Portugal's Northern Regional Health Administration and used a convenience sample of 61 primary-care and 50 hospital-care physicians.
  
  
  RESULTS
  Response rate was 64% (49% to retest) for primary-care physicians and 66% (60% to retest) for hospital-care physicians. Content validity resulted in 9 changes to professional concepts. Face validity assessment resulted in 19 changes to linguistic and interpretative terms. In the case of the reliability analysis, the ICC values indicated a minimum of fair to good reproducibility (ICC > 0.4), and the Cronbach alpha values were satisfactory (α > 0.70).
  
  
  CONCLUSIONS
  The questionnaire developed is valid--in terms of face validity, content validity and reliability--for assessing physicians' attitudes to and knowledge of antibiotic prescribing and resistance, in both hospital and primary-care settings, and could be a very useful tool for characterising physicians' antibiotic-prescribing behaviour.
authors.affiliation: Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, 3810-193, Portugal. at.afonso@outlook.com.|Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal. at.afonso@outlook.com.
authors.forename: António
authors.initials: A
authors.lastname: Teixeira Rodrigues
authors.affiliation: Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, 3810-193, Portugal. monica.ferreira@ua.pt.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ferreira
authors.affiliation: Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, 3810-193, Portugal. froque@ipg.pt.|Research Unit for Inland Development, Polytechnic Institute of Guarda, Guarda, Portugal. froque@ipg.pt.
authors.forename: Fátima
authors.initials: F
authors.lastname: Roque
authors.affiliation: Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal. acfalcao@ff.uc.pt.|Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal. acfalcao@ff.uc.pt.
authors.forename: Amílcar
authors.initials: A
authors.lastname: Falcão
authors.affiliation: Hospital Infante D. Pedro, EPE, Aveiro, Portugal. elmano.ramalheira@hdaveiro.min-saude.pt.
authors.forename: Elmano
authors.initials: E
authors.lastname: Ramalheira
authors.affiliation: University of Santiago de Compostela, Santiago de Compostela, Spain. adolfo.figueiras@usc.es.|Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública -CIBERESP), Santiago de Compostela, Spain. adolfo.figueiras@usc.es.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Figueiras
authors.affiliation: Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, 3810-193, Portugal. teresaherdeiro@ua.pt.|CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal. teresaherdeiro@ua.pt.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Herdeiro
mesh_terms: D000900:Anti-Bacterial Agents; D001291:Attitude of Health Personnel; D024881:Drug Resistance, Bacterial; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010820:Physicians; D011174:Portugal; D055656:Prescriptions; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents