Saudi Cultural Missions Theses & Dissertations
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Item Restricted The application of the Necessity-Concerns Framework in understanding inappropriate demand for antibiotics in upper respiratory tract infections and COVID-19 vaccine hesitancy(Saudi Digital Library, 2024) Almeshal, Nouf; Horne, Rob; Chan, Amy; Foot, HollyThe National Institute for Health and Care Excellence (NICE) Medicines Adherence Guidelines recommend personalised support to address both practical issues, enhancing patients’ abilities and perceptions that influence motivation to engage with, and adhere to treatment. The perceptions and practicalities approach (PaPA) operationalises key adherence-related beliefs through the Necessity-Concerns Framework (NCF). The NCF proposes that adherence is influenced by patients’ perceptions of their personal need for medication relative to concerns about adverse consequences. Studies across diseases, cultures, and healthcare systems have demonstrated the validity of the NCF in explaining variation in treatment engagement. This PhD thesis aims to examine the application of the NCF to address two behavioural challenges related to respiratory illnesses: vaccine hesitancy and demand for antibiotics to treat upper respiratory tract infections (URTIs). The research includes a scoping review of determinants influencing patients’ demand for antibiotics, a qualitative study involving patients with URTIs, a cross-sectional survey investigating beliefs about antibiotics and AMR, a review of COVID-19 vaccine hesitancy literature, a cross-sectional cohort survey examining differences in beliefs between COVID-19-vaccinated and unvaccinated individuals, and an exploratory analysis of the antecedents of beliefs about COVID-19 vaccine necessity and concerns. The scoping review identified patient demand as an important driver of unnecessary antibiotic prescriptions, influenced by factors that shape the perceived need for antibiotics and are associated with low concerns regarding their use. The qualitative study (n=32) identified determinants influencing perceived need for antibiotics (e.g., type and severity of symptoms) and concerns (e.g., frequent administration of antibiotics), impacting inappropriate demand for and unnecessary use of antibiotics. The cross-sectional study (n=1105) found that intention to request antibiotics was significantly predicted by beliefs about antibiotic necessity (β=0.475, p<0.001), and concerns (β=-.133, p<0.001). The COVID-19 vaccine hesitancy literature review was suggestive of the applicability of the NCF as an effective framework to understand and address this public health issue. The following cohort cross-sectional survey (n = 1012) reported that beliefs about vaccine necessity outweighed concerns about the vaccine and strongly predicted vaccination decisions [OR=1.616, 95% CI (3.001, 8.440)]. This research highlighted the adaptability of the NCF as a theoretical framework for comprehending inappropriate demand for antibiotics and COVID-19 vaccine hesitancy. The findings indicate the potential applicability of a reverse NCF approach in understanding and addressing inappropriate antibiotic demand. It further identified that COVID-19 vaccine hesitancy demonstrated patterns commonly observed in medication non-adherence, specifically characterised by low perceived necessity and increased concerns regarding treatment. The thesis findings potentially laid the foundation that the NCF can effectively inform the design of interventions targeting vaccine hesitancy and patients’ inappropriate demand for antibiotics in the management of URTIs.17 0Item Restricted The application of the Necessity-Concerns Framework in understanding inappropriate demand for antibiotics in upper respiratory tract infections and COVID-19 vaccine hesitancy(Saudi Digital Library, 2024) Almeshal, Nouf; Rob, Horne; Amy, Chan; Holly, FootThe National Institute for Health and Care Excellence (NICE) Medicines Adherence Guidelines recommend personalised support to address both practical issues, enhancing patients’ abilities and perceptions that influence motivation to engage with, and adhere to treatment. The perceptions and practicalities approach (PaPA) operationalises key adherence-related beliefs through the Necessity-Concerns Framework (NCF). The NCF proposes that adherence is influenced by patients’ perceptions of their personal need for medication relative to concerns about adverse consequences. Studies across diseases, cultures, and healthcare systems have demonstrated the validity of the NCF in explaining variation in treatment engagement. This PhD thesis aims to examine the application of the NCF to address two behavioural challenges related to respiratory illnesses: vaccine hesitancy and demand for antibiotics to treat upper respiratory tract infections (URTIs). The research includes a scoping review of determinants influencing patients’ demand for antibiotics, a qualitative study involving patients with URTIs, a cross-sectional survey investigating beliefs about antibiotics and AMR, a review of COVID-19 vaccine hesitancy literature, a cross-sectional cohort survey examining differences in beliefs between COVID-19-vaccinated and unvaccinated individuals, and an exploratory analysis of the antecedents of beliefs about COVID-19 vaccine necessity and concerns. The scoping review identified patient demand as an important driver of unnecessary antibiotic prescriptions, influenced by factors that shape the perceived need for antibiotics and are associated with low concerns regarding their use. The qualitative study (n=32) identified determinants influencing perceived need for antibiotics (e.g., type and severity of symptoms) and concerns (e.g., frequent administration of antibiotics), impacting inappropriate demand for and unnecessary use of antibiotics. The cross-sectional study (n=1105) found that intention to request antibiotics was significantly predicted by beliefs about antibiotic necessity (β=0.475, p<0.001), and concerns (β=-.133, p<0.001). The COVID-19 vaccine hesitancy literature review was suggestive of the applicability of the NCF as an effective framework to understand and address this public health issue. The following cohort cross-sectional survey (n = 1012) reported that beliefs about vaccine necessity outweighed concerns about the vaccine and strongly predicted vaccination decisions [OR=1.616, 95% CI (3.001, 8.440)]. This research highlighted the adaptability of the NCF as a theoretical framework for comprehending inappropriate demand for antibiotics and COVID-19 vaccine hesitancy. The findings indicate the potential applicability of a reverse NCF approach in understanding and addressing inappropriate antibiotic demand. It further identified that COVID-19 vaccine hesitancy demonstrated patterns commonly observed in medication non-adherence, specifically characterised by low perceived necessity and increased concerns regarding treatment. The thesis findings potentially laid the foundation that the NCF can effectively inform the design of interventions targeting vaccine hesitancy and patients’ inappropriate demand for antibiotics in the management of URTIs.4 0Item Restricted Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the primary care settings in England: a population-based, segmented interrupted time series analysis(Saudi Digital Library, 2023) Almutairi, Najla; Kurdi, AmanjBackground: Antimicrobial resistance (AMR) is a public health threaten driven by inappropriate use of antibiotics. During covid-19 there were concerns of increased AMR, but the evidence is limited. this study assessed the impact of Covid-19 on the quantity and quality of antibiotic utilization in primary care in England. Research design and methods: A population-based segmented interrupted time series analysis was conducted to monthly dispensed antibiotics prescriptions using the prescription cost analysis (PCA) of England from March 2019 to March 2023. Antibiotic quantity was measured using the number of antibiotics items dispensed (TID)/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day. during and after the first and second lockdown (March 2020, Novembre 2020) stratified to 11 groups based on British National Formulary (BNF) antibiotics classification. While the quality of antibiotics was evaluated using 3 quality indicators: WHO AWaRe classification, and 4C antibiotics, and proportion of broad-spectrum antibiotics. Results: For all antibiotics, there was a non-significant increased TID Before the first lockdown but, non-significant decrease in the level after the first and second lockdown. However, a significant increase in the trend after the second lockdown for all antibiotic classes was observed, with an average increase of .56, and .315 for (DDD). For the quality outcomes, there were no impact of covid 19 on WHO AWaRe antibiotics classes (Access antibiotics increased from 77% in March 2019 to 86% in March2023) and broad-spectrum antibiotics. The proportion of 4C antibiotics decreased significantly after the first lockdown (β3 = -.886, p=.019). Conclusion: The study concludes that, Covid-19 has not significantly impacted the utilization of antibiotics. Also, the quality of the utilization remains unaffected. This study supports further investigation into the impact of remote consultation during Covid-19 and use detailed patient and prescription information. Keywords: Antibiotics, COVID-19, Antimicrobial stewardship, primary healthcare, England9 0