Self medication with antibiotics in Yogyakarta City Indonesia.

In Indonesia, legislation mandates a medical prescription for purchase of antibiotics. However, people can, in fact, purchase antibiotics without prescription which may be used inappropriately. Therefore, a comprehensive understanding of why people self medicate with antibiotics is essential to develop intervention programs for improving the safe use of antibiotics in the community. The aims of the research were to identify the prevalence and patterns of self medication with antibiotics (SMA) in Yogyakarta City Indonesia; to explore individuals’ knowledge and beliefs about antibiotics; to identify factors that influence individuals’ intentions to SMA; to explore underlying reasons of why individuals self medicate with antibiotics; and to explore stakeholders’ perspectives about how to improve the safe use of antibiotics in the community. The research applied a mixed-method approach and involved adults (over 18 years) of Yogyakarta City, Indonesia. The theory of planned behaviour (TPB) was applied as a conceptual framework to assist in identifying psychological factors associated with SMA at the individual level i.e. attitudes, subjective norms, and perceived behavioural control. The research was initiated by interviews with 25 participants to explore common beliefs about SMA practice among Indonesians. The interviews were informed by the TPB. Results of the interviews were used to structure TPB questions for a population-based survey. The survey had a sample size of 625 adults and applied a cluster random sampling technique. Following the survey, in-depth interviews with a group of the respondents in the survey, who had experience in using antibiotics for self medication, were conducted to explore underlying reasons of SMA practice. The overall results were then discussed with a group of stakeholders in Yogyakarta Province to formulate recommendations on how to improve the safe use of antibiotics in the community. The methods described above were approved by the Human Research Ethics Committee (HREC) at the University of Adelaide and the City Government of Yogyakarta Indonesia. A range of beliefs about SMA practice is highlighted through the interviews includes advantages, disadvantages, approvals, disapprovals, facilitators and barriers of such practice. The survey results in a 90% of response rate and 7.3% period prevalence of SMA. Although information and advice about antibiotics are mainly derived from doctors and pharmacists, the patterns of SMA indicate that antibiotics are used inappropriately. Misconceptions about antibiotic use also exist. Most of the survey respondents are aware of the disadvantages of SMA; and therefore, they are not in favour of practicing SMA. They also reported pressures from their social networks to not practice SMA, and noted that practicing SMA is not easy. However, experience in using antibiotics and the ease of obtaining antibiotics without prescription make the practice of SMA easier. To reduce SMA practice it is required to increase the provision of accurate information about antibiotics especially for improving people’s awareness regarding the risks of using antibiotics inappropriately. It is imperative to improve antibiotic prescription policy and to optimize the role of health professionals especially in providing reliable advice about antibiotics. It is also urgent to decrease access to antibiotics without prescription.Thesis (Ph.D.) -- University of Adelaide, School of Population Health, 201