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ORIGINAL RESEARCH article

Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1347764
This article is part of the Research Topic Women in Science: Infectious Diseases: Epidemiology and Prevention 2023 View all 15 articles

Hospitalised patients as stewards of their own antibiotic therapy: a qualitative analysis informing the strategic design of interventions to encourage shared decision-making in tertiary hospital settings in Singapore

Provisionally accepted
Huiling Guo Huiling Guo 1David Chien Lye David Chien Lye 2,3,4,5Tat Ming Ng Tat Ming Ng 6Jyoti Somani Jyoti Somani 7Andrea Lay Hoon Kwa Andrea Lay Hoon Kwa 8,9Shimin Jasmine Chung Shimin Jasmine Chung 10,4Angela Chow Angela Chow 1,11,5*
  • 1 Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
  • 2 Infectious Disease Research and Training Office, National Centre for Infectious Diseases (NCID), Singapore, Singapore
  • 3 Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
  • 4 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • 5 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  • 6 Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
  • 7 Division of Infectious Diseases, National University Hospital, Singapore, Singapore
  • 8 Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
  • 9 Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
  • 10 Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
  • 11 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

The final, formatted version of the article will be published soon.

    Shared decision-making (SDM) on antibiotic therapy may improve antibiotic use in tertiary hospitals, but hospitalised patients are apprehensive about being involved in it. Understanding the facilitators and barriers to SDM can inform the design and implementation of interventions to empower these patients to engage in SDM on their antibiotic therapies.We conducted qualitative interviews with 23 adult patients purposively sampled with maximum variation from the three largest tertiary-care hospitals in Singapore (April 2019─October 2020).Thematic analysis was conducted using the Theoretical Domains Framework and Capability, Opportunity, Motivation, Behaviour (COM-B) model to identify areas for intervention.Hospitalised patients lacked comprehensive knowledge of their antibiotic therapies and the majority did not have the skills to actively query their doctors about them. There was a lack of opportunities to meet and interact with doctors, and patients were less motivated to engage in SDM if they had a selfperceived paternalistic relationship with doctors, trusted their doctors to provide the best treatment, and had self-perceived poor knowledge to engage in SDM. To empower these patients, they should first be educated with antibiotic knowledge. Highlighting potential side effects of antibiotics could motivate them to ask questions about their antibiotic therapies. Environment restructuring, as facilitated by nurses and visual cues to nudge conversations, could create opportunities for interactions and motivating patients into SDM on their antibiotic therapies.Education and environmental restructuring should be explored to empower hospitalised patients to engage in SDM on their antibiotic therapies.

    Keywords: antimicrobial resistance, Antibiotic prescribing, shared decision-making, Hospitalised patients, Tertiary hospital

    Received: 01 Dec 2023; Accepted: 22 Jul 2024.

    Copyright: © 2024 Guo, Lye, Ng, Somani, Kwa, Chung and Chow. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Angela Chow, Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.