A survey assessing antimicrobial prescribing at UNRWA primary health care centers in Jordan

Abstract Antimicrobial resistance (AMR) is a public health emergency. There is insufficient information on AMR in the context of humanitarian settings. An understanding of behavioural and institutional level factors can strengthen antimicrobial stewardship. This study used a semi-structured questionnaire to assess both knowledge, attitudes and practices (KAP) on antimicrobial use, resistance and stewardship, and options to improving prescribing, among prescribers at the Primary Healthcare facilities of the UNRWA Jordan field office. Responses to the KAP questions were evaluated using the Capability, Opportunity, Motivation, Behaviour (COM-B) framework and Bloom’s cutoffs. For each framework component, Blooms cutoffs and interpretations were: >80%, “good”; 60-79%, “moderate”; and <60%’ “poor”. Fourteen options to improve prescribing were each assessed using 5-point Likert scales from very unhelpful to very helpful, aggregated by helpful and very helpful and ranked as: >90%, best/most acceptable; >80-90%, as acceptable; and, 70-80% as maybe acceptable/good. The questionnaire response rate was 59% (37/63) with a completion rate of 92% (34/37). Aggregate scores for real knowledge on AMR was 97%; opportunity to improve prescribing 88%; and motivation 16% - participants did not believe that there was a connection between their prescribing and AMR or that they had a key role in helping control AMR. Good options (74% aggregate score) to improving prescribing were the availability of guidelines and resistance data. There was good knowledge of AMR and good opportunities, but poor motivation for rational prescribing or behavioral change. There is a clinical need for antimicrobial resistance data to promote rational antibiotic prescribing.