A Mixed Methods Study Of Self-medication With Antibiotics And Its Influencing Factors In Rural Elderly In Anhui Province

Objective: Taking the rural elderly in Anhui province as the research object,this study explored the problems and influencing factors in the knowledge,attitude and selfmedication behavior with antibiotics of the elderly in rural areas,and put forward policy suggestions for promoting the rational use of antibiotics and controlling the development of bacterial resistance in the rural elderly.Methods: Based on the mixed research method,on the basis of reviewing domestic and foreign studies,the questionnaire and interview outline were designed by ourselves in combination with Chinese national conditions.The quantitative study adopted the multistage conceptual sampling method.According to geographical location,Anhui Province was divided into three regions to select eligible elderly people.SPSS26.0 software was used for statistical analysis,including general descriptive analysis,Wilcoxon rank sum test,Kruskal-Wallis test,univariate Chi-Square test and binary Logistic regression analysis.General descriptive analysis was performed on the general demographic characteristics,antibiotic knowledge and attitude toward antibiotic use of the elderly.Wilcoxon rank sum test and Kruskal-Wallis test were used to compare the score distribution differences among different characteristic groups.Univariate Chi-square test and binary logistic regression analysis were performed for the general use behavior of antibiotics and the use behavior in the last year.The qualitative research adopted nonprobabilistic sampling method.The old people with high willingness to talk and good communication ability were selected to receiving quantitative investigation for interview.The interview data were coded and classified by Nvivo12 software,and the data were sorted and analyzed by subject analysis method.Results: 1.Quantitative investigation found that: In terms of antibiotic knowledge,the median score(IQR)of antibiotic knowledge of the elderly was 2(1-3),and the number of people who correctly answered "Are antibiotics effective against viruses" and "Do you know what antibiotic resistance is" was the least,less than 10%.The score of antibiotic knowledge level of the elderly was higher in male,the higher the education level,the higher the family members engaged in medical-related occupation,and the higher the family per capita monthly income.In terms of the attitude to use,the median score of the attitude to use antibiotics(IQR)was 2(1-4),and the elderly with a positive attitude to the question "whether the efficacy of multiple antibiotics combined is better than that of single use" were the least,accounting for 29.8%.In addition,the older the male,aged 60-80 years old,the higher the education level,the higher the per capita monthly family income,the purchase of commercial medical insurance and the elderly without chronic diseases,the higher the attitude score of antibiotic use.In terms of general antibiotic use habits,463(46.8%)of the elderly would choose to stop taking antibiotics when the symptoms get better,88(9.5%)of the elderly said they would increase the dosage to enhance the curative effect,and 104(11.2%)of the elderly said they had the habit of changing drugs frequently.380(40.8%)of the elderly self-reported that they kept antibiotics at home.Logistic regression analysis showed that females,the elderly with primary school education and positive attitude towards antibiotic use were easy to stop taking antibiotics when their symptoms improved.The elderly whose per capita family income is more than 1000 yuan and who buy commercial medical insurance are prone to frequent drug changes;The elderly aged 60-80 years old,with higher education level,family members engaged in medical-related occupations,per capita household income of more than 1000 yuan,and without commercial medical insurance are more likely to keep antibiotics at home.In the latest year of antibiotic self-use behavior,280 elderly people decided to use antibiotics by themselves,accounting for 36.8% of all self-reported elderly people with symptoms,accounting for 73.5% of all elderly people using antibiotics,among which 166(59.3%)used antibiotics stored at home.There were 235(83.9%)people who bought antibiotics from pharmacies and 121(43.2%)people who used both methods.Logistic regression analysis showed that the elderly aged 60-80 years old,the education level of primary school,the per capita monthly income of the family > 1000 yuan,the distance from home to the nearest medical and health institution ≥1km,and the antibiotics at home were more likely to self-use antibiotics.The elderly aged 60-80 years old,the family per capita income > 1000 yuan,purchase commercial medical insurance,do not suffer from chronic diseases,and keep antibiotics at home are more likely to use antibiotics at home.The elderly aged 60-80 years old,whose per capita household income was more than 1000 yuan,whose home was more than 1km away from the nearest medical and health institution,and who kept antibiotics at home were more likely to go to the pharmacy to buy antibiotics.2.The qualitative study found that most of the elderly people in Anhui province did not deal with "minor problems",some of them would choose to self-treatment,and a few chose to seek medical treatment.The main reasons for the self-medication of antibiotics in the elderly were less severe disease,their own medication experience and habits,lack of antibiotic related knowledge,wrong attitude towards antibiotic use,recommendations from friends or family,time cost and drug price,and treatment needs cannot be met.Conclusion and suggestions: In Anhui province,the elderly in rural areas had a low level of antibiotic knowledge,an unsatisfactory attitude towards antibiotic use,some selfmedication behaviors with antibiotics,improper treatment of diseases and family drug storage behaviors were also common.It is necessary to popularize antibiotic related knowledge actively for the elderly,improve their medical awareness,provide high-quality medical and pharmaceutical services,increase the accessibility of medical services,improve the antibiotic management system,and standardize the antibiotic sales behavior.