Influences on healthcare providers' and parents' behaviours with respect to the use of antibiotics for children: An exploratory study in urban China

Background: Antimicrobial resistance is a global public health threat, with antibiotic resistance (ABR) increasing rapidly. In China, the high rate of antibiotic use is a key contributor to the country’s ABR problems, and the paediatric use of antibiotics by healthcare providers and parents has been identified as a particular challenge. However, limited research has examined providers’ and parents’ antibiotic-related behaviour, with particularly few qualitative studies having been conducted, and none in urban China. This research examines influences on healthcare providers’ and parents’ behaviour regarding the use of antibiotics for children in urban China. Methods: Informed by a review of English-language and Chinese-language studies, a qualitative study of healthcare providers and a multi-method study of parents were conducted in Chinese to explore factors influencing their antibiotic-related behaviour. The study site was Taiyuan city, a medium-sized city in central China. Qualitative data were transcribed verbatim, translated from Chinese to English, and analysed using framework analysis. Quantitative data were analysed using difference tests and regression analysis. Results: The two key influences on the paediatric antibiotic-related behaviour of healthcare providers were: (i) parental influences, including public understandings of disease and treatment within traditional Chinese medicine (TCM) and Western medicine, and maintaining trust and good relationships with parents, and (ii) the organisational context relating to China’s healthcare system and national policies. The main influences on the paediatric antibiotic-related behaviour of parents related to their lack of antibiotic-related knowledge, their understandings of TCM and Western medicine, and their access to and interactions with healthcare providers. Conclusions: Although it is a small-scale study located in one urban setting, this research highlights influences on healthcare providers’ and parents’ paediatric antibiotic-related behaviour operating from individual to organisational and cultural levels. Promoting more appropriate paediatric use of antibiotics in China will require better understanding of the provider-patient relationship and the wider cultural and healthcare contexts, especially in relation to the relative influence of TCM and Western medicine