Date of Award

Spring 5-21-2021

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Dr. Genevieve P Zipp, P.T., Ed (Chair)

Committee Member

Dr. Annette Kirchgessner, Ph.D.

Committee Member

Dr. Fortunato Battaglia, MD , Ph.D.

Keywords

physicians’, non-physician prescribing practitioners, knowledge, attitudes, practices, beliefs, Antibiotic Resistance & Antimicrobial Stewardship Assessment Tool (ABRASAT), antibiotic resistance, antimicrobial stewardship, Antimicrobial Stewardship Programs, Centers for Disease Control and Prevention, Social Cognitive Theory, World Health Organization

Abstract

ABSTRACT

Exploring Antibiotic Resistance and the Effect of Antimicrobial Stewardship on Physicians’ and Non-Physician Prescribing Clinicians through Knowledge, Attitudes, Practices and Beliefs (KAPB) Utilizing the Social Cognitive Theory (SCT)

Tamika Carty

Seton Hall University, 2021

Dissertation Chair: Genevieve Pinto Zipp, PT, EdD, FNAP

Background: Antibiotics are one of the greatest medical discoveries, revolutionizing the field of medicine. However, antimicrobial and antibiotic over usage has become a prevalent issue among outpatients, leading to antibiotic resistance (AR) (Ventola, 2015). As a result of, its widespread usage and associated concerns, the World Health Organization (WHO) has cited AR as a growing concern for many nations (WHO, 2015). This in turn has led to the development of management programs such as stewardships which are often led by health professionals and clinicians to address this growing issue. One would argue that stewardship programs are only as effective if those leading them are adequately prepared. Therefore, it is imperative to identify physicians’ and prescribing non-physician practitioners’ knowledge, attitudes, practices, and beliefs regarding AR and the incorporation of Antimicrobial Stewardship Programs (ASPs) to combat AR.

Purpose: The purpose of this study was threefold: first to create, validate and test the reliability of the novel instrument “Antibiotic Resistance & Antimicrobial Stewardship Assessment Tool (ABRASAT)”. The second purpose was to test the valid and reliable tool in physicians’ and non-physician prescribing practitioners. The final purpose was to use the valid and reliable tool in the population of interest to understand physicians’ and non-physician prescribing practitioners’ knowledge, attitudes, practices, and beliefs with regard to antibiotic resistance and ASPs as combative method for AR.

Methods: This study employed a mixed methods research approach, utilizing specifically an explanatory mixed methods design. The study can also further be categorized as non-experimental, descriptive, cross sectional, correlational and explanatory. The study consisted of two practitioner groups (physicians’ and non-physician prescribing practitioners) in which their knowledge, attitudes, practices, and beliefs were explored utilizing the ABRASAT instrument which was rooted in the available “evidenced based” literature, KAPBs theory and the Social Cognitive Theory (SCT). The ABRASAT consisted of 10 demographic questions and 25 questions relating to KAPBs, expectations, suggestions and thoughts on AR and ASPs.

Data Collection and Analysis: Data was collected from both practitioner groups. Participants were recruited via social media (Facebook, WhatsApp, Twitter, Reddit and LinkedIn) and research platform (Research Gate), in addition to convenience sampling.

The PI utilized descriptive statistics in addition to statistical analysis tests (ANOVA, T-Test, MANOVA and Pearson’s Correlation) to analyze quantitative data. The PI employed an inductive approach utilizing descriptive and in vivo coding to analyze qualitative data. Both the quantitative and qualitative data helped to form an inclusive overview of KAPBs of physicians’ and non-physician prescribing practitioners.

Results: A total of 234 participants completed the survey. The study results for both the quantitative and qualitative data for descriptive research questions (RQ) 1 -5 resulted in the following: for RQ1, the quantitative and the qualitative data shows overall both practitioner groups had high knowledge on AR. For RQ2, the quantitative and the qualitative data shows overall both practitioner groups had high knowledge on what ASPs were. For RQ3, the quantitative and the qualitative data shows overall both practitioner groups had favorable attitudes with regards to ASPs. For RQ4, the quantitative and the qualitative data shows overall both practitioner groups had good ASP practices. For RQ5, the quantitative and the qualitative data shows overall both practitioner groups had favorable beliefs with regards to ASPs.

The study results for both the quantitative and qualitative data for relational research questions (RQ) and hypotheses 6 -13 resulted in the following: for RQs 6 & 7, there was no significant difference in practitioner groups on knowledge, resulting in failure to reject the null hypothesis. For RQs 8 - 11, there was a significant difference in practitioner groups on attitudes and beliefs resulting in rejection of the null hypothesis. Finally, for RQ 12 & 13, like RQs 6 & 7, there was no significant difference in practitioner groups on practices, resulting in failure to reject the null hypothesis. While the overall instrument had a high reliability of .843 and successfully measured attitudes, practices and beliefs, knowledge had a poor reliability. While knowledge had poor reliability, it did not affect the overall reliability of the tool. However, it will need to be reassessed for future use as an individual construct.

Conclusion: Though knowledge scored poorer in reliability it does not dispute the fact that physicians’ and non-physician prescribing clinicians have knowledge of AR, and displayed positive attitudes and beliefs towards ASPs. As a result, practitioners are generally in favor of ASPs yet improvements should still be made to ensure maximum benefits, thus society must continue to implement and refine these programs.

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