ORIGINAL RESEARCH
Lindsey Laytner, PhD, MPH; Patricia Chen, PhD; Susan Nash, PhD; Michael K. Paasche-Orlow, MD, MPH; Richard Street, PhD; Roger Zoorob, MD, MPH; Barbara Trautner, MD, PhD; Larissa Grigoryan, MD, PhD
Corresponding Author: Lindsey Laytner, PhD, MPH; Department of Family and Community Medicine, Baylor College of Medicine.
Email: Lindsey.Laytner@bcm.edu
DOI: 10.3122/jabfm.2022.220416R1
Keywords: Access to Health Care, Antibacterial Drug Resistance, Antimicrobial Stewardship, Behavioral Science, Community-Based Research, Culturally Sensitive Research, Family Medicine, Health Behavior, Health Care Seeking Strategies of Patients, Health Communication, Health Disparities, Health Literacy, Hispanics, Minority Health, Patient-Oriented Research, Primary Health Care, Public Health, Qualitative Research
Dates: Submitted: 12-08-2022; Revised: 02-05-2023; Accepted: 02-10-2023
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BACKGROUND: Non-prescription antibiotic use includes taking an antibiotic without medical guidance (e.g., leftovers, from friends/relatives, or purchased without a prescription). Non-prescription use contributes to antimicrobial resistance, adverse drug reactions, interactions, superinfection, and microbiome imbalance. Qualitative studies exploring perspectives regarding non-prescription use among Hispanic patients are lacking. We used the Kilbourne Framework for Advancing Health Disparities Research to identify factors influencing patients’ non-prescription use and organize our findings.
METHODS: Our study includes Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semi-structured interviews explored the factors promoting non-prescription use in Hispanic adults. Interviews were conducted remotely, in English or Spanish, between May 2020-October 2021. Inductive coding and thematic analysis identified motives for non-prescription use.
RESULTS: Participants (N=35) were primarily female (68.6%), and aged between 27-66. Participants reported obtaining antibiotics through trusted persons, sold under-the-counter in US markets, and purchased without a prescription abroad. Factors contributing to non-prescription use included beliefs that the doctor visit was unnecessary, limited access to healthcare (due to insurance constraints, costs, and clinic wait time), and communication difficulties (e.g., language barriers with clinicians and perceived staff rudeness). Participants expressed confidence in medical recommendations from pharmacists and trusted community members.
CONCLUSIONS: Patient, healthcare system, and clinical encounter factors contribute to non-prescription use in Hispanic communities. Antibiotic stewardship interventions that involve pharmacists and trusted persons, improve access to care, and address communication barriers and cultural competency in the clinic may help reduce non-prescription use in these communities.