Motivating Physicians To Prevent Antimicrobial Resistance in Hospitalized Children Using the Health Belief Model as a Framework

BACKGROUND/OBJECTIVES: Antimicrobial resistance (AR) is a threat to hospitalized children and more information is needed to determine the background factors, personal perceptions, and cues to action of physicians regarding the prevention of AR in hospitalized children. METHODS: Using the Health Belief Model (HBM) as a framework, we conducted three national focus groups in August 2003, with 25 physicians who treat hospitalized children. RESULTS: Participating physicians worked primarily in teaching (80%) and urban (92%) hospitals and had a range of 2–31 (median 10) years in practice. Their subspecialties included general pediatrics (20%), neonatology (20%), hematology/oncology (16%), intensive care/critical care (16%), general surgery (12%), and other (16%). All perceived they had cared for a patient with methicillin-resistant Staphylococcus aureus; 84%, vancomycin-resistant Enterococci; and 76%, an extended-spectrum beta lactamase-producing organism. Many also perceived having treated a patient with vancomycin-resistant S. aureus or vancomycin-intermediate S. aureus. Physicians perceived that AR was more of a problem nationally (92%) than in their institution (76%) or practice (60%). Furthermore, physicians reported that issues such as the nursing shortage, cost of healthcare, and lack of specialty services (median ranks: 1.0, 1.5, and 2.0, respectively [scale 1–5, 1=most challenging, 5=least challenging]) presented more of a challenge to the care of hospitalized children than AR (median rank 3.0). Reported preferences of methods and cues to learn about AR included journal articles (80%), infectious disease experts (76%), and colleagues (52%). Preferences for who or what most influences them to prevent AR included data (39%), infection control programs (28%), and hospital policy (17%). CONCLUSIONS: Physicians were more likely to perceive AR as a problem on a national level than in their practice, but not as challenging as other issues in hospitalized children, which is divergent in theory from the exceedingly high percentages of physicians reporting treating patients with AR organisms. Using the HBM as a framework provides insight into these factors, and results about physiciansʹ perceptions and preferences should be considered for future interventions to motivate them to prevent AR.