Surveys of knowledge and awareness of antibiotic use ... - PLOS

Page 1

RESEARCH ARTICLE

Surveys of knowledge and awareness of

antibiotic use and antimicrobial resistance in

general population: A systematic review

Hathairat KosiyapornID1*, Sunicha Chanvatik1, Tibet Issaramalai1,

Wanwisa Kaewkhankhaeng1, Anond KulthanmanusornID1, Nithiwat Saengruang1,

Woranan Witthayapipopsakul1, Shaheda Viriyathorn1, Supapat Kirivan1,

Watinee KunpeukID1, Rapeepong Suphanchaimat1,2, Angkana Lekagul1,

Viroj TangcharoensathienID1

1 International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand, 2 Division of

Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand

* [email protected]

Abstract

Background

Currently, various tools exist to evaluate knowledge and awareness of antibiotic use and

antimicrobial resistance (AMR) and are applied by various organizations. Previous system-

atic reviews have focused mainly on study findings such as levels of knowledge and AMR

awareness. However, the survey procedures and data instruments used ought to be scruti-

nized as well, since they are important contributors to credible results. This review aims to

assess the study methods and procedures of existing population-based surveys and explore

key components which determine the general population’s levels of knowledge and aware-

ness of antibiotic use and AMR.

Methods

We searched existing literature for population -based surveys which sought knowledge and

awareness of antibiotic use or AMR in the general population. Databases searched included

Ovid, MEDLINE and EMBASE, PsycINFO and Scopus, domestic journals and gray litera-

ture sources. Population-based cross-sectional studies published in English or Thai from

January 2000 to December 2018 were included in the review. Quality assessment was con-

ducted using the ‘Appraisal Tool for Cross-Sectional Studies’ (AXIS).

Results

All 22 studies included in the analysis had clear objectives focusing on assessing people’s

levels of knowledge, awareness, attitudes and behavior relating to antibiotic use and aware-

ness of AMR. These studies had employed appropriate methodologies for population-based

cross-sectional surveys relative to research questions. More than half of studies (14 out of

22) had scientifically soundly designed methodologies which captured the representative-

ness of the population; whereas the remaining studies had unclear sample size estimations,

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 1 / 27

a1111111111

a1111111111

a1111111111

a1111111111

a1111111111

OPEN ACCESS

Citation: Kosiyaporn H, Chanvatik S, Issaramalai T,

Kaewkhankhaeng W, Kulthanmanusorn A,

Saengruang N, et al. (2020) Surveys of knowledge

and awareness of antibiotic use and antimicrobial

resistance in general population: A systematic

review. PLoS ONE 15(1): e0227973. https://doi.

org/10.1371/journal.pone.0227973

Editor: Wen-Jun Tu, Chinese Academy of Medical

Sciences and Peking Union Medical College,

CHINA

Received: August 2, 2019

Accepted: January 3, 2020

Published: January 16, 2020

Copyright: © 2020 Kosiyaporn et al. This is an

open access article distributed under the terms of

the Creative Commons Attribution License, which

permits unrestricted use, distribution, and

reproduction in any medium, provided the original

author and source are credited.

Data Availability Statement: All relevant data are

found within the manuscript.

Funding: Funded by WHO Country-Cooperation

Strategy on Antimicrobial Resistance 2017-2021,

Thailand.

Competing interests: The authors have declared

that no competing interests exist.

Page 2

inappropriate sample frames and selection biases. Half of the studies had tested the validity

and reliability of the questionnaire. The common questions used by these surveys were cat-

egorized into four themes: behavior related to antibiotic use, knowledge and awareness of

antibiotic use, knowledge and awareness of AMR and others such as receiving information

about antibiotic use and AMR or cross-cutting issues like self-medication.

Conclusion

This review identified four key features of good practices in antibiotic use and awareness

surveys: a) clear survey objective; b) scientifically sound sampling techniques ensuring rep-

resentativeness; c) strategies for recruitment of samples and survey administration meth-

ods; and d) credible measurement to prevent non-sampling biases. During questionnaire

design, the health systems context in terms of access to health services and antibiotics

should be taken into account. In conclusion, to maximize the use of surveys, the application

of findings in surveys and associated factors related to antibiotic use and AMR should pri-

marily generate public health interventions and target specific groups to make progress in

solving AMR problems.

Introduction

Global efforts to assess public knowledge and awareness of antibiotic use and antimicrobial

resistance (AMR) are underway. In 2015, the World Health Organization (WHO) developed a

questionnaire survey to assess current public knowledge and awareness and behaviors related

to antibiotic use in six WHO regions [1]. Similarly, multi-country surveys exist in Europe

which use a common protocol, questionnaire and interview methodology [2,3,4]. These popu-

lation-based surveys are part of the monitoring and evaluation framework proposed by the

WHO Global Action Plan on Antimicrobial Resistance (AMR).

In recent years the quest to halt AMR has been materialized in many countries. Thailand

is amongst the exemplary countries that made substantial effort to counter AMR. One of the

five goals of Thailand’s National Strategic Plan on Antimicrobial Resistance (2017–2021) is to

increase public knowledge and awareness of antibiotic use and AMR by 20% before 2021 [5].

The Thai working group on Health Systems and Policy Research on AMR has developed an

AMR module and embedded it into the existing biennial Health Welfare Survey (HWS) con-

ducted by National Statistical Office. The aims are to assess among Thai adults the volume of

antibiotic use, levels of knowledge on antibiotic use and AMR, exposure to information related

to antibiotic use and AMR, and awareness of the use of antibiotics in farm animals. The HWS

in 2017 has provided a baseline level of knowledge and AMR awareness in adult populations

as required by the National Strategic Plan for monitoring progress against the target [6].

Embedding an AMR module in national surveys has various advantages, such as the possi-

bility for long-term monitoring and opportunities to assess factors associated with knowledge

and awareness; it also saves costs compared with conducting independent surveys. Moreover,

the merit of survey provides better understanding on behavioral pattern on antibiotic use

(either misuse or overuse) in the population, which is one of the key contributing factors to

the emergence of AMR. Survey information can serve as a basis to demonstrate an association

between knowledge/awareness/practices on antibiotic use and AMR. Thus, it is necessary to

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 2 / 27

Page 3

establish suitable antibiotic use surveys with associated factors such as knowledge and aware-

ness, in order to tackle with the rising of AMR trends.

However, the national survey on AMR almost always face some difficulties and limitations

such as difficulties in the analysis to claim causal relationships, the presence of limited number

of independent parameters and information bias when respondents do not understand the

questions. This module was adapted from international survey tools such as the Eurobarom-

eter survey in 2009, 2013 and 2016 [2,3,4] and the WHO tool [1], which also present challenges

around generalizability and measurement bias, especially in different country contexts. Also,

recently published systematic reviews relating to knowledge and awareness of antibiotic use

and AMR focused on the results of the surveys [7,8] rather than presenting a review and rec-

ommendation of the survey methods and tools, which ultimately influenced the credibility of

results.

In attempts to fill existing knowledge gaps pertaining to survey instruments, this review

aims to assess the procedures of population-based surveys that ensures representativeness and

minimizes biases. It also explores common contents in the questions used by these population-

based surveys and categorizes them into thematic areas. The review findings are useful for

countries seeking to develop methods and tools to monitor population knowledge and aware-

ness of antibiotic use and AMR in response to the Global Action Plan on AMR.

Material and methods

This review was registered with PROSPERO database (CRD42019123385) to review protocol:

search strategy, inclusion and exclusion criteria, quality assessment and data extraction.

Search strategy

Search terms were developed along three domains: a) antibiotics or antimicrobial resistance;

b) knowledge or awareness; and c) survey or questionnaire. Four international databases

(Ovid MEDLINE, Ovid EMBASE, PsycINFO and Scopus) were searched using the search

terms as detailed in Table 1. The search terms for international publications were applied to

title, abstract, keyword, and full text. Three domestic journals (Health System Research Insti-

tute Journal, Thai Journal Citation Index Center, and Thai Journal Online) and gray literatures

were manually searched.

Eligible criteria

The inclusion criteria comprised publications on population-based cross-sectional surveys in

the general population which had investigated either knowledge or awareness of antibiotic use

or AMR. Publications in English or Thai from international and domestic peer reviewed jour-

nals, and gray literature sources which were published between January 2000 and December

2018 were included. Studies on specific population groups, clinical research or studies which

could not be electronically retrieved were excluded from the review.

Study selection

Four researchers (HK, SC, TI and WK) were responsible for abstract screening and full paper

review for eligibility. Two researchers screened titles and abstracts to see if they met eligible

criteria. The abstracts were included by a consensus between the two researchers and a third

opinion was sought if they disagreed. The same process was conducted for the full paper

review to select the papers related to research question in term of household-based surveys.

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 3 / 27

Page 4

Quality assessment

The quality of the eligible publications was assessed using the “Appraisal Tool for Cross-Sec-

tional Studies (AXIS)”. AXIS is a descriptive quality assessment tool designed for critical

assessment of cross-sectional surveys [9,10]. Using AXIS, the studies were appraised based on

five main components: objective, methods, results, discussion and ethics and funding. At this

stage, nine researchers (five new—AK, NS, WW, SV, SK—and the four who worked in the

study selection process) were grouped into three teams of two or three members to assess the

Table 1. Search terms.

Database Search term

Antibiotics/antimicrobial resistance Knowledge/awareness Survey/questionnaire

Ovid MEDLINE/

Ovid Embase/

PsycINFO

"antibiotic�".m_titl. OR "anti-bacter�".m_titl.

OR "antibacter�".m_titl. OR "antimicrobe�".

m_titl. OR

"antibacterial drug� ".m_titl. OR

"anti-bacterial drug� ".m_titl. OR

"antimicrobial drug� ".m_titl. OR

"antibacterial agent� ".m_titl. OR

"anti-bacterial agent� ".m_titl. OR

"antimicrobial agent� ".m_titl. OR

(antibiotic� adj3 resistan�).m_titl. OR

(anti-bacter� adj3 resistan�).m_titl. OR

(antibacter� adj3 resistan�).m_titl. OR

(antimicrob� adj3 resistan�).m_titl. OR

("bacterial drug�" adj3 resistan�).m_titl. OR

("microbial drug�" adj3 resistan�).m_titl. OR

Anti-Bacterial Agents/ or Drug Resistance,

Bacterial/) OR

(antibiotic� adj3 us�).m_titl. OR

(antibiotic� adj3 misuse�).m_titl. OR

(antibiotic� adj3 overuse�).m_titl. OR "self-

medicat�".m_titl. OR Self Medication/

AND "knowledge�".m_titl. OR "understand�".m_titl.

OR "aware�".m_titl. OR "perception�".m_titl.

OR "perceiv�".m_titl. OR "attitud�".m_titl. OR

"view�".m_titl. OR "opinion�".m_titl. OR

"belie�".m_titl. OR "concern�".m_titl. OR

"fear�".m_titl. OR "accept�".m_titl. OR

"perspectiv�".m_titl. OR "worr�".m_titl. OR

"concept�".m_titl. OR

KNOWLEDGE/ or HEALTH KNOWLEDGE,

ATTITUDES, PRACTICE/ or PATIENT

MEDICATION KNOWLEDGE/ OR

PERCEPTION/ or SOCIAL PERCEPTION/

OR Attitude to Health/ OR Attitude/ or

PUBLIC OPINION/ or "Surveys and

Questionnaires"/ OR FEAR/

AND "assess�".m_titl. OR "evaluat�".

m_titl. OR "determin�".m_titl.

OR "explor�".m_titl. OR

"apprais�".m_titl. OR "estimat�".

m_titl. OR "analy�".m_titl. OR

"examin�".m_titl. OR

"measure�".m_titl. OR "survey�".

m_titl. OR "questionnaire�".

m_titl. OR "inspect�".m_titl. OR

"Surveys and Questionnaires"/

Scopus TITLE-ABS (antibiotic� OR

anti-bacter� OR

antibacter� OR

antimicrob� OR

{antibacterial drug�} OR

{antimicrobial drug�} OR

{antibacterial agent�} OR

{anti-bacterial agent�} OR

{antimicrobial agent�} OR

anti-bacter� W/3 resistan� OR

antibiotic� W/3

resistan� OR

antimicrob� W/3

resistan� OR

{bacterial drug�} W/3

resistan� OR

{microbial drug�} W/3

resistan� OR

antibiotic� W/3

usage� OR

antibiotic� W/3

misuse� OR

antibiotic� W/3

overuse� OR

self-medicat�)

AND TITLE-ABS (knowledge� OR aware� OR

understand� OR

attitude� OR

view� OR

perception� OR

perceiv� OR

opinion� OR

belie� OR

concern� OR

fear� OR

accept� OR

perspectiv� OR

worr� OR

concept�)

AND TITLE-ABS (evaluat� OR

determin� OR

explor� OR

apprais� OR

estimat� OR

analy� OR

examin� OR

measure� OR

survey� OR

questionnaire� OR

inspect�)

(EXCLUDE (PUBYEAR, 1999) OR EXCLUDE (PUBYEAR, 1998) OR EXCLUDE (PUBYEAR, 1997) OR EXCLUDE (PUBYEAR, 1993)) AND

(LIMIT-TO (LANGUAGE, "English"))

https://doi.org/10.1371/journal.pone.0227973.t001

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 4 / 27

Page 5

full texts. If there was a disagreement among members of each team, the principal investigator

(HK) was responsible for making a final decision.

Data extraction

Data extraction was conducted into three sets: a) characteristics of studies: author, year of pub-

lication, objective, country, study design, sample size, eligible criteria, administration and tool

development; b) themes emerging from common questions asked in the surveys to determine

level of knowledge and awareness of antibiotic use and AMR or any relevant issues; and c) key

findings in the studies.

Results

An electronic search comprising the four international databases and hand search of three

domestic databases and international and domestic gray literature sources yielded a total of

2,761 records (2,740 from the databases and 21 from other sources). After duplicate removal,

there were 2,663 papers for abstract screening. 2,537 papers were excluded as they were not rel-

evant leaving 120 records to be searched for full texts. Thirteen full papers that were not elec-

tronically available and thirteen duplicates were excluded. 94 full papers were reviewed for

eligibility and 72 publications were excluded for not being relevant or pertinent to the review

objectives. Finally, 22 studies met the eligible criteria and were included for analysis.

A PRISMA flow describing the study recruitment process of this systematic review is

shown in Fig 1.

Characteristic of 22 studies

Almost all (19 studies) were published articles in peer-reviewed journals while 3 were reports

[1,5,11]. Of 22 studies, 20 were published in international peer-reviewed journals while 2 pub-

lished in domestic journals [6,11].

Table 2 summarizes characteristics of the 22 studies. There were 19 out of 22 papers pub-

lished from 2010 to 2018.

The majority of the studies (20 studies) were conducted as single-country studies while 2

studies were multi-country studies at global and regional levels [1,4]. Among the 20 single-

country studies, 8 studies were conducted at national level [6,12,13,14,15,16,17,18] while the

remaining 12 studies were conducted at sub-national level

[11,19,20,21,22,23,24,25,26,27,28,29]. It should be noted that no study was conducted in the

African region.

Regarding study design, 3 out of 22 studies were interventional studies which assessed

the outcomes of campaign and educational interventions on the proper use of antibiotics

[13,17,28]. The remaining 19 publications were observational studies. Only one study [15] was

conducted by using mixed methods while the other 21 studies applied quantitative methods.

Sample size varied depending on the sampling frame and approaches employed by each

study. More than half of the studies [1,4,6,11,12,13,15,17,18,21,24,27,29] mentioned that sam-

ple size was calculated based on statistical method and population data. Sample size varied

from less than 400 [11] to more than 27,000 individuals [4,6].

For sampling criteria, nearly half of studies (10 out of 22) recruited only adults over 15, 18

or 21 years old [1,4,6,13,14,17,18,21,22,25]. Some studies [11,12,15,16,24,26,27,28,29] had

additional criteria such as respondents’ understanding of local languages, familiarity with

the term “antibiotics” or whether they had lived in households or the geographical area for

a certain period. Almost all studies (21 studies) described specific administration methods

[1,4,6,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,28,29]. Nine out of twenty-one applied

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 5 / 27

Page 6

only randomized sampling techniques with face-to-face interviews using a structured inter-

view questionnaire [4,6,11,13,18,20,21,28,29]. Other administration methods were less com-

mon, such as telephone interview surveys, and self-administered questionnaire surveys using

mail and online channels [1,12,14,15,16,17,19,22,23,24,25,26].

Quality assessment of 22 studies

The results of the quality assessment of 22 eligible studies by using the AXIS tool are shown in

Tables 3 and 4.

Our analysis found that all publications had clear study objectives which focused on assess-

ing the levels of knowledge and awareness or attitudes and behavior related to antibiotic use

and AMR and associated factors.

All studies employed the appropriate methodology of cross-sectional survey related to

objectives. There were 14 studies [1,4,6,11,12,13,14,15,17,18,21,24,28,29] that reported an esti-

mation of sample size using justified statistical methods. All studies clearly defined the refer-

ence population but two studies [20,26] had inappropriate sample frame and five studies

[12,13,14,26,29] had selection process that tended to be non-representative.

Half of the studies [11,12,15,16,18,21,22,24,26,27,29] tested both the validity and reliability

of the questionnaire and provided the statistical significance of key variables. Only one study

[23] insufficiently described the method which was difficult to repeat.

Regarding the reporting of survey results, almost all studies presented adequate basic data

and all results for the described methods, except three studies [1,4,23] which did not show

basic data. The results in two studies [25,28] were not internally consistent and one study [1]

could not be identified due to showing only percentage data. Vallin M. et al (2016) was the

only study which addressed and categorized non-responders and which reported profiles of

non-respondents to the survey. Widayati A. et al (2012) did not categorize data of non-

Fig 1. PRISMA flow of systematic review of the survey tools for determining level of knowledge and awareness of

antibiotic use and antimicrobial resistance in general population.

https://doi.org/10.1371/journal.pone.0227973.g001

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 6 / 27

Page 7

Ta

ble

2.

Ch

ara

cter

isti

cso

f2

2in

clu

ded

stu

die

s.

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

1P

arim

iN

.

etal

.

20

02

To

det

erm

ine

the

gen

eral

pu

bli

c’s

per

cep

tio

ns

and

use

of

anti

bio

tics

inT

rin

idad

and

To

bag

o,

atw

o-i

slan

d

rep

ub

lic

inth

eC

arib

bea

n

Ob

serv

atio

nal

stu

dy

Tri

nid

adan

d

To

bag

o

Ho

use

ho

ldm

emb

ers

wh

ow

ere

atle

ast

18

yea

rso

ldan

dta

ke

care

of

fam

ily

mem

ber

s

wh

enth

eyw

ere

ill

NA

75

3/8

00

Ran

do

m

sam

pli

ng

Tel

eph

on

e

surv

eys

NA

•9

3%

of

the

resp

on

den

ts

kn

ewth

ete

rm“a

nti

bio

tic”

.

•P

enic

illi

nw

asco

rrec

tly

iden

tifi

edas

com

mo

n

anti

bio

tic

bu

t3

6%

of

the

resp

on

den

tsin

corr

ectl

y

iden

tifi

edB

enad

ryl

(dip

hen

hyd

ram

ine)

,a

com

mo

no

ver

-th

e-co

un

ter

dru

gfo

rco

ug

han

dco

ld

form

ula

tio

n,

was

anti

bio

tic.

•B

eta-

lact

ams

wer

eth

em

ost

freq

uen

tly

use

dan

tib

ioti

cs

inth

ep

rev

iou

syea

r,an

d

20

%o

fan

tib

ioti

csu

sers

use

dm

ult

iple

anti

bio

tics

.

•A

qu

arte

ro

fth

e

resp

on

den

tsh

adas

ked

a

do

cto

rfo

ran

tib

ioti

c

pre

scri

pti

on

s.

•2

9%

of

the

resp

on

den

tssa

id

that

anti

bio

tics

are

dru

gs

for

trea

tin

gb

acte

rial

infe

ctio

ns.

•R

esp

on

den

tsw

ho

hav

e

com

ple

ted

tert

iary

edu

cati

on

(un

iver

sity

)w

as

sig

nif

ican

tly

asso

ciat

edw

ith

corr

ect

kn

ow

led

ge

of

the

safe

tyo

fan

tib

ioti

cs.

•R

esp

on

den

ts,

wh

oh

ad

pri

vat

eh

ealt

hin

sura

nce

,

wer

em

ore

lik

ely

tosa

yth

at

anti

bio

tics

are

safe

and

do

no

th

ave

sid

eef

fect

s,an

d

inco

rrec

tly

clas

sifi

edas

pir

in

and

Ben

adry

las

anti

bio

tics

com

par

edto

tho

sew

ith

ou

t

pri

vat

eh

ealt

hin

sura

nce

.

2E

ng

JV.et

al.

20

03

To

pro

vid

ea

gli

mp

seo

fth

e

curr

ent

kn

ow

led

ge,

atti

tud

es,

and

pra

ctic

es

reg

ard

ing

anti

bio

tic

use

amo

ng

pat

ien

ts

Ob

serv

atio

nal

stu

dy

Co

nn

ecti

cut,

Min

nes

ota

,

Ore

go

n,an

d

sele

cted

cou

nti

esin

Cal

ifo

rnia

,G

eorg

ia,

Mar

yla

nd

and

New

Yo

rk,U

SA

Ho

use

ho

ldm

emb

ers

NA

12

,75

5/N

AS

ing

le-s

tag

e

ran

do

m

sam

pli

ng

Tel

eph

on

e

surv

eys

NA

•1

2%

of

the

resp

on

den

tsh

ad

rece

ntl

yta

ken

anti

bio

tics

in

the

pas

t4

wee

ks.

•2

7%

of

the

resp

on

den

ts

bel

iev

edth

atta

kin

g

anti

bio

tics

wh

enth

ey

suff

ered

fro

ma

com

mo

n

cold

mad

eth

emfe

elb

ette

r

mo

req

uic

kly

.

•3

2%

of

the

resp

on

den

ts

bel

iev

edth

atta

kin

g

anti

bio

tics

hel

ped

pre

ven

tin

gm

ore

seri

ou

s

illn

esse

s.

•4

8%

of

the

resp

on

den

ts

exp

ecte

da

pre

scri

pti

on

for

anti

bio

tics

wh

enth

eyw

ere

ill.

•5

8%

of

resp

on

den

tsw

ere

no

taw

are

of

hea

lth

dan

ger

s

asso

ciat

edw

ith

tak

ing

anti

bio

tics

.

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 7 / 27

Page 8

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

3M

cNu

lty

CA

M.

etal

.

20

07

To

asse

ssth

ere

spo

nd

ents

’

kn

ow

led

ge

and

atti

tud

esto

anti

bio

tics

,th

eir

rep

ort

ed

anti

bio

tic

use

and

the

rela

tio

nsh

ipw

ith

ho

use

ho

ld

and

resp

on

den

t

char

acte

rist

ics,

and

inves

tig

ate

wh

atso

rto

f

per

son

was

mo

reli

kel

yto

be

awar

eo

fth

eA

nti

bio

tic

cam

pai

gn

Inte

rven

tio

nal

stu

dy

Gre

atB

rita

in

(En

gla

nd

,W

ales

and

Sco

tlan

d)

Ho

use

ho

ldm

emb

ers

wh

oag

edo

ver

16

yea

rso

ld

NA

7,1

20

/10

,98

1S

trat

ifie

d

ran

do

m

sam

pli

ng

wit

h

pro

po

rtio

nal

to

size

Fac

e-to

-fac

e

inte

rvie

ws

NA

•A

bo

ut

40

%o

fth

e

resp

on

den

tsn

eith

erk

new

that

anti

bio

tics

do

no

tw

ork

agai

nst

mo

stco

ug

hs

or

cold

sn

or

kn

ewth

at

anti

bio

tics

.ca

nk

ill

no

rmal

flo

rao

nsk

inan

din

the

gu

t.

•7

9%

of

the

resp

on

den

ts

wer

eaw

are

of

anti

bio

tic

resi

stan

cein

Bri

tish

ho

spit

als.

•R

esp

on

den

tsw

ith

low

er

level

of

edu

cati

on

wer

ele

ss

kn

ow

led

gea

ble

abo

ut

anti

bio

tics

.

•K

no

wle

dg

ew

asp

osi

tivel

y

asso

ciat

edse

lf-s

eek

ing

of

anti

bio

tics

.

•B

ette

rk

no

wle

dg

eo

f

anti

bio

tics

did

no

tal

way

s

lead

tolo

wer

anti

bio

tic

pre

scri

pti

on

,b

ut

was

asso

ciat

edw

ith

the

com

ple

tio

no

fa

cou

rse

of

anti

bio

tic

pre

scri

bed

.���

4A

nd

re´

M.

etal

.

20

10

To

exam

ine

the

level

of

kn

ow

led

ge

abo

ut

anti

bio

tic

trea

tmen

tan

daw

aren

ess

of

anti

bio

tic

resi

stan

ceam

on

g

the

gen

eral

pu

bli

cin

Sw

eden

Ob

serv

atio

nal

stu

dy

Sw

eden

Ag

ed2

1–

80

yea

rso

ldN

A7

47

/1,0

00

Ran

do

m

sam

pli

ng

Tel

eph

on

e

surv

eys

NA

•1

9%

of

the

resp

on

den

ts

agre

edth

atan

tib

ioti

cscu

re

com

mo

nco

lds

mo

re

qu

ick

ly;

bu

tm

ost

resp

on

den

tsb

elie

ved

that

bac

teri

aca

nb

eco

me

resi

stan

tto

anti

bio

tics

.

•T

he

resp

on

den

tssh

ow

ed

som

eco

nfu

sio

no

ver

the

term

s‘b

acte

ria’

and

‘vir

use

s’,

and

this

con

fusi

on

par

tly

infl

uen

ces

the

dec

isio

nto

tak

ean

tib

ioti

cs.

5B

arah

F.

and

Go

nca

lves

V.

20

10

To

pro

vid

ean

insi

gh

to

fth

e

curr

ent

kn

ow

led

ge

and

pra

ctic

esre

gar

din

g

anti

bio

tic

use

amo

ng

ind

ivid

ual

sli

vin

gin

the

Sy

rian

Ara

bR

epu

bli

c

Ob

serv

atio

nal

stu

dy

Kal

amo

on

,S

yri

an

Ara

bre

pu

bli

c

ho

use

ho

ldm

emb

ers

Ag

edu

nd

er1

8yea

rs

old

and

un

able

to

un

der

stan

dA

rab

ic

lan

gu

age

44

5/5

56

Ran

do

m

sam

pli

ng

Fac

e-to

-fac

e

inte

rvie

ws

En

gJV

.et

al.(2

00

3)��

•8

5%

of

the

resp

on

den

tsh

ad

tak

enan

tib

ioti

csin

the

pas

t

4w

eek

s;m

ost

lyfr

om

ph

ysi

cian

(43

%).

•5

7%

of

the

resp

on

den

ts

use

dle

fto

ver

anti

bio

tics

or

too

kso

meo

ne

else

’sad

vic

e.

•3

4%

of

the

resp

on

den

ts

wer

en

ot

awar

eo

fth

e

dan

ger

so

fan

tib

ioti

cs.

•M

ales

,y

ou

ng

erag

e,an

d

tho

sew

ith

low

and

med

ium

inco

me

and

low

erle

vel

of

edu

cati

on

sho

wed

po

ore

r

pra

ctic

ean

dlo

wer

lev

elo

f

kn

ow

led

ge

on

anti

bio

tics

and

awar

enes

so

fth

eh

ealt

h

dan

ger

sas

soci

ated

wit

h

anti

bio

tics

.

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 8 / 27

Page 9

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

6K

imS

S.

etal

.2

01

1T

oex

amin

ep

ub

lic

level

of

kn

ow

led

ge

and

atti

tud

es

reg

ard

ing

anti

bio

tic

use

and

po

ten

tial

dru

gre

sist

ance

in

So

uth

Ko

rea

Ob

serv

atio

nal

stu

dy

Gan

gw

on

-do

,

Seo

ul,

Bu

san

,

Dae

gu

,In

cheo

n,

Dae

jeo

n,

Gw

ang

ju,

So

uth

Ko

rea

aged

over

18

yea

rso

ldN

A1

,17

7/1

,50

0ra

nd

om

sam

pli

ng

wit

h

pro

po

rtio

nal

to

size

face

-to

-fac

e

inte

rvie

ws

US

CD

C(2

01

0)

•7

0%

of

the

resp

on

den

tsd

id

no

tk

no

wth

atan

tib

ioti

cs

are

no

tef

fect

ive

intr

eati

ng

cou

gh

and

cold

.

•T

wo

thir

ds

of

the

resp

on

den

tsw

ere

un

awar

e

of

the

con

dit

ion

su

nd

er

wh

ich

anti

bio

tic

resi

stan

ce

cou

ldo

ccu

r.

•L

ow

erle

vel

of

edu

cati

on

and

old

erag

ew

ere

sig

nif

ican

tly

asso

ciat

edw

ith

inad

equ

ate

kn

ow

led

ge

of

anti

bio

tics

.

•L

ow

erle

vel

of

edu

cati

on

,

old

erag

e,in

adeq

uat

e

kn

ow

led

ge

and

abse

nce

of

exp

osu

reto

anti

bio

tic

safe

ty

cam

pai

gn

wer

esi

gn

ific

antl

y

asso

ciat

edw

ith

po

or

atti

tud

eto

war

ds

anti

bio

tics

.���

7S

irij

oti

K.

20

12

To

des

crib

eth

eso

cio

-

dem

og

rap

hic

char

acte

rist

ics

and

asse

ssth

ele

vel

of

kn

ow

led

ge,

atti

tud

ean

d

pra

ctic

ere

gar

din

gan

tib

ioti

c

use

amo

ng

adu

lts

in

Ku

anth

ani

sub

dis

tric

t

Kan

tan

gd

istr

ict,

Tra

ng

,

Th

aila

nd

Ob

serv

atio

nal

stu

dy

Ku

anth

ani

Su

bd

istr

ict,

Kan

tan

gD

istr

ict,

Tra

ng

,T

hai

lan

d

1.

Ag

ed1

8y

ears

old

and

abo

ve

2.

Peo

ple

wh

ow

ere

livin

gin

Ku

anth

ani

Su

bd

istr

ict,

Kan

tan

gD

istr

ict,

Tra

ng

,T

hai

lan

dfo

r

mo

reth

an6

mo

nth

s

3.

Peo

ple

wh

oco

uld

list

en,

spea

k,

read

and

wri

tein

Th

ai

lan

gu

age

4.

Peo

ple

wh

ow

ere

wil

lin

gto

par

tici

pat

ein

the

stu

dy

1.

Peo

ple

wh

ow

ere

wo

rkin

gas

hea

lth

pro

fess

ion

als

2.

Peo

ple

wh

ow

ere

inca

pab

leo

f

resp

on

din

gto

surv

eyq

ues

tio

ns

bec

ause

of

psy

chia

tric

or

neu

rolo

gic

al

dis

ord

er

3.

Peo

ple

wh

ow

ere

no

tav

aila

ble

at

the

tim

eo

fsu

rvey

4.

Peo

ple

wh

ow

ere

tem

po

rary

inth

e

city

for

vac

atio

n

39

6/3

96

Syst

emat

ic

ran

do

m

sam

pli

ng

wit

h

pro

po

rtio

nal

to

size

Fac

e-to

-fac

e

inte

rvie

ws

En

gJV

.et

al.(2

00

3)��,B

uk

e

etal

.(2

00

3),

Hsi

aoet

al.

(20

06

),D

arm

anin

Ell

ul

etal

.

(20

08

),Y

ou

etal

.(2

00

8),

Pan

agak

ou

etal

.(2

00

9,

20

11

),L

eoch

ico

etal

.(2

01

0),

Oh

etal

.(2

01

1),

Ro

uso

un

idis

etal

.(2

01

1),

Sh

ehad

ehet

al.(2

01

1),

Ku

nn

ee(1

99

5),

Sir

iras

sam

ee

(19

97

),N

aN

ako

rn(2

00

2),

Su

wan

(20

06

),S

uk

som

sin

(20

08

),K

aen

jan

(20

08

)an

d

Kae

wm

ang

(20

10

),

Kal

iyap

eru

mal

(20

04

)an

d

WH

O(2

00

8)

•M

ean

sco

reo

fk

no

wle

dg

e

was

10

.43±2

.84

(min

=3

,

max

=1

6).

•M

ean

atti

tud

esc

ore

was

2.4

9±0

.39

(min

=1

.27

,

max

=3

).

•M

ean

pra

ctic

esc

ore

was

2.6

8±0

.22

(min

=1

.81

,

max

=3

).

•F

emal

e,yo

un

ger

age,

bei

ng

sin

gle

,h

igh

edu

cati

on

lev

els

and

hig

hin

com

ew

ere

sig

nif

ican

tly

asso

ciat

edw

ith

bet

ter

kn

ow

led

ge

and

atti

tud

es.

•T

her

ew

assi

gn

ific

ant

asso

ciat

ion

bet

wee

n

kn

ow

led

ge

and

atti

tud

es,

and

pra

ctic

esre

gar

din

g

anti

bio

tic

use

.

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 9 / 27

Page 10

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

8W

iday

ati

A.

etal

.

20

12

To

des

crib

ek

no

wle

dg

ean

d

bel

iefs

abo

ut

anti

bio

tic

use

amo

ng

peo

ple

inan

urb

an

area

of

Ind

on

esia

Ob

serv

atio

nal

stu

dy

Yo

gyak

arta

,

Ind

on

esia

Ag

edo

ver

18

yea

rso

ldN

A5

59

/64

0C

lust

er

ran

do

m

sam

pli

ng

Sel

f-

adm

inis

trat

ion

Saw

air

FA

.et

al.(2

00

9)��,

Ch

etle

yA

.et

al.(2

00

7),

Pan

agak

ou

SG

.et

al.(2

00

9),

Sah

oo

KC

.(2

00

8)

and

Had

i

U.et

al.

(20

08

)

•8

5%

of

the

resp

on

den

tsh

ad

app

rop

riat

ek

no

wle

dg

e

reg

ard

ing

anti

bio

tic

resi

stan

ce;

70

%h

ad

app

rop

riat

ek

no

wle

dg

e

abo

ut

alle

rgic

reac

tio

ns

and

76

%h

adap

pro

pri

ate

kn

ow

led

ge

abo

ut

anti

bio

tics

’ef

fect

iven

ess

for

bac

teri

alin

fect

ion

s.

•H

alf

of

the

resp

on

den

ts

kn

ewth

atan

tib

ioti

cso

ug

ht

no

tto

be

use

dim

med

iate

ly

wh

enca

tch

ing

fever

.

•7

1%

of

the

resp

on

den

tsh

ad

inco

rrec

tk

no

wle

dg

e

reg

ard

ing

anti

bio

tic

ben

efit

for

vir

alin

fect

ion

s.

•2

4%

of

the

resp

on

den

ts

bel

iev

edth

atan

tib

ioti

csh

ad

no

sid

eef

fect

s.

•T

her

ew

asa

po

siti

ve

asso

ciat

ion

bet

wee

n

kn

ow

led

ge

and

bel

iefs

esp

ecia

lly

inth

ose

wh

oar

e

mal

e,y

ou

ng

erag

e,h

ave

hig

her

level

of

edu

cati

on

,

and

hig

her

inco

me.

9W

un

YT

.et

al.

20

12

To

exam

ine

the

pu

bli

c’s

per

spec

tiv

eso

nan

tib

ioti

c

resi

stan

cein

ou

rst

ud

yo

f

the

pu

bli

c’s

kn

ow

led

ge,

atti

tud

ean

dp

ract

ice

wit

h

anti

bio

tics

inH

on

gK

on

g

Ob

serv

atio

nal

stu

dy

(mix

ed

met

ho

d)

Ho

ng

Ko

ng

Ho

use

ho

ldm

emb

ers

aged

18

yea

rso

ldo

r

abo

ve

wh

oar

eH

on

g

Ko

ng

resi

den

ts

spea

kin

glo

cal

dia

lect

s

Per

son

sw

ith

com

mu

nic

atio

n

dif

ficu

ltie

s

2,4

71

/2,4

01

Ran

do

m

sam

pli

ng

Tel

eph

on

e

surv

eys

NA

•9

%o

fth

ere

spo

nd

ents

had

nev

erh

eard

the

term

‘an

tib

ioti

cre

sist

ance

’.

•A

bo

ut

8%

of

the

resp

on

den

tsh

adev

er

acq

uir

edn

on

-pre

scri

bed

anti

bio

tics

.

•A

bo

ut

7%

of

the

resp

on

den

tsh

adev

erk

ept

the

left

over

anti

bio

tics

wh

ile

aro

un

d7

0%

of

the

resp

on

den

tsh

adal

way

s

fin

ish

edth

efu

llco

urs

eo

f

anti

bio

tics

.

•A

bo

ut

75

–7

7%

of

the

resp

on

den

tsag

reed

that

the

pu

rch

ase

of

anti

bio

tics

wit

ho

ut

pre

scri

pti

on

and

inco

mp

lete

cou

rses

of

anti

bio

tics

wil

lle

adto

un

des

irab

leco

nse

qu

ence

s.

•A

bo

ut

39

%o

fth

e

resp

on

den

tsag

reed

that

they

cou

ldh

elp

the

pre

ven

tio

no

fre

sist

ance

.

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 10 / 27

Page 11

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

10

Ah

mad

H.

etal

.

20

13

To

add

ress

the

atti

tud

e,

kn

ow

led

ge

and

per

cep

tio

n

of

Pes

haw

aran

dM

ard

an

inh

abit

ants

tow

ard

sse

lf-

med

icat

ion

Ob

serv

atio

nal

stu

dy

Pes

haw

aran

d

Mar

dan

,P

akis

tan

NA

NA

50

0/N

AR

and

om

sam

pli

ng

Sel

f-

adm

inis

trat

ion

NA

•7

8%

of

the

resp

on

den

tsh

ad

use

dan

tib

ioti

csw

ith

ou

t

pre

scri

pti

on

s.

•A

bo

ut

26

%o

fth

e

resp

on

den

tsn

ever

chec

ked

the

exp

iry

dat

eo

n

anti

bio

tics

they

use

dfo

r

self

-med

icat

ion

.

•A

bo

ut

64

%o

fth

e

resp

on

den

tsb

elie

ved

that

they

kn

ewth

ein

dic

atio

no

f

anti

bio

tics

tak

en;h

ow

ever

,

on

ly3

4%

of

the

resp

on

den

tsre

po

rted

that

anti

bio

tics

can

be

use

dto

trea

td

eng

ue

fev

er.

11

Jose

J.et

al.

20

13

To

asse

ssp

ub

lic

kn

ow

led

ge,

bel

ief

and

beh

avio

ro

f

anti

bio

tic

use

intw

o

rep

rese

nta

tive

go

ver

no

rate

s

ou

to

fth

ete

ng

over

no

rate

s

inO

man

Ob

serv

atio

nal

stu

dy

Al

Bat

nah

and

Al

Dak

hli

yah

go

ver

no

rate

s,

Om

an

Mem

ber

so

fth

ep

ub

lic

aged

bet

wee

n1

8–

60

yea

rso

ldw

ho

un

der

stan

dth

ete

rm

anti

bio

tic

and

had

use

dan

anti

bio

tic

at

leas

tth

ree

tim

esin

thei

rli

feti

me

Hea

lth

care

pro

fess

ion

als

or

stu

den

tsfr

om

any

med

ical

/hea

lth

rela

ted

fiel

d

71

8/6

00

Qu

ota

ran

do

m

and

con

ven

ien

ce

sam

pli

ng

Sel

f-

adm

inis

trat

ion

and

face

-to

-fac

e

inte

rvie

ws

McN

ult

yC

AM

.et

al.

(20

07

)��,

Pec

hèr

eJC

.et

al.

(20

07

),K

and

akai

TL

.et

al.

(19

96

)an

dC

rury

M.et

al.

(20

06

)

•M

od

erat

ek

no

wle

dg

ean

d

beh

avio

rsc

ore

wer

e

ob

serv

ed,

wh

ile

the

bel

ief

sco

reo

fth

ere

spo

nd

ents

was

low

.

•A

sig

nif

ican

td

iffe

ren

cew

as

ob

serv

edin

the

med

ian

tota

lsc

ore

inre

spo

nd

ents

fro

md

iffe

ren

tag

eg

rou

ps,

edu

cati

on

level

san

d

emp

loym

ent

stat

us.

12

Gu

J.et

al.

20

15

To

exp

lore

the

dif

fere

nce

s

inth

ek

no

wle

dg

eo

f,

atti

tud

eto

war

ds

and

use

of

anti

bio

tics

bet

wee

nu

rban

and

rura

lp

op

ula

tio

ns

inth

e

Hei

lon

gji

ang

Pro

vin

ceo

f

Ch

ina

and

revie

wth

e

fact

ors

that

wer

eas

soci

ated

wit

hth

ek

no

wle

dg

eo

f,

atti

tud

eto

war

ds

and

use

of

anti

bio

tics

inth

is

po

pu

lati

on

Ob

serv

atio

nal

stu

dy

Su

ihu

a,Y

ich

un

(Tie

liC

ity

Co

un

ty

area

)an

dH

arb

in

reg

ion

so

f

Hei

lon

gji

ang

Pro

vin

ce,

Ch

ina

Ag

edo

ver

18

yea

rso

ldN

A3

,63

1/N

AR

and

om

sam

pli

ng

Sel

f-

adm

inis

trat

ion

or

wit

has

sist

ance

of

inves

tig

ato

rs

NA

•M

ore

than

60

%o

fth

e

resp

on

den

tsw

ere

awar

e

that

anti

bio

tics

can

be

use

d

totr

eat

bac

teri

alin

fect

ion

s

and

that

bac

teri

aca

nb

e

resi

stan

tto

anti

bio

tics

.

•A

bo

ut

40

–6

0%

of

the

resp

on

den

tsw

ere

awar

e

that

anti

bio

tic

resi

stan

ce

had

bec

om

ea

maj

or

pro

ble

min

Ch

ina.

•U

rban

par

tici

pan

tsre

po

rted

gre

ater

level

of

kn

ow

led

ge

of

and

atti

tud

eto

war

ds

use

of

anti

bio

tics

than

rura

l

par

tici

pan

ts.

•L

og

isti

cre

gre

ssio

n

ind

icat

edth

atu

rban

resi

den

cy,

fem

ale

and

edu

cati

on

level

sw

ere

asso

ciat

edw

ith

kn

ow

led

ge

of,

atti

tud

esto

war

ds

and

use

of

anti

bio

tics

.���

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 11 / 27

Page 12

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

13

Mo

uh

ied

din

e

TH

.et

al.

20

15

To

asse

ssth

ecu

rren

t

kn

ow

led

ge,

atti

tud

esan

d

pra

ctic

es,

reg

ard

ing

anti

bio

tic

usa

ge

ina

Leb

anes

esa

mp

lean

d

iden

tify

dem

og

rap

hic

char

acte

rist

ics

asso

ciat

ed

wit

hth

eh

igh

est

risk

of

atta

inin

gre

sist

ance

Ob

serv

atio

nal

stu

dy

Bei

rut,

Leb

ano

n1

.A

ged

atle

ast

18

yea

rso

ld

2.

Liv

edin

Leb

ano

n

for

atle

ast

the

pas

t

5yea

rsto

ensu

re

that

they

hav

e

adap

ted

to

Leb

anes

eh

abit

s

that

affe

ctth

e

kn

ow

led

ge,

atti

tud

e

and

pra

ctic

eo

f

anti

bio

tic

con

sum

pti

on

3.

Aw

are

of

the

term

‘an

tib

ioti

cs’

or

any

of

its

mar

ket

ed

equ

ival

ents

Res

po

nd

ents

wh

o

did

no

tm

eet

all

crit

eria

49

5/5

00

Ran

do

man

d

con

ven

ien

ce

sam

pli

ng

Sel

f-

adm

inis

trat

ion

An

dre

´M

.et

al.(2

01

0)��,

Kim

SS

.et

al.(2

01

1)��

and

Lin

hO

A.

etal

.(2

01

1)��

•6

8%

of

the

resp

on

den

ts

use

dan

tib

ioti

cs1

–3

tim

es

per

yea

r.

•A

bo

ut

80

%o

fth

e

resp

on

den

tsco

nsi

der

ed

anti

bio

tics

asan

ti-b

acte

rial

agen

tsw

hil

e7

4%

of

the

resp

on

den

tsd

idn

ot

kn

ow

that

anti

bio

tics

are

no

tan

ti-

vir

alag

ents

.

•A

pp

rox

imat

ely

67

%o

fth

e

resp

on

den

tsre

aliz

edth

at

abu

sin

gan

tib

ioti

csca

nle

ad

tore

sist

ance

.

•In

com

e,ed

uca

tio

nle

vel

s,

pla

ceo

fre

sid

ence

,h

avin

g

hea

lth

insu

ran

ce,h

isto

ryo

f

wo

rkin

gin

the

hea

lth

sect

ors

and

spen

din

ga

yea

r

ou

tsid

eL

eban

on

wer

e

sig

nif

ican

tly

asso

ciat

edw

ith

bet

ter

kn

ow

led

ge

and

atti

tud

eto

war

ds

anti

bio

tics

.

14

WH

O2

01

5T

op

rov

ide

asn

apsh

ot

of

curr

ent

pu

bli

caw

aren

ess

and

com

mo

nb

ehav

iors

rela

ted

toan

tib

ioti

csin

a

ran

ge

of

cou

ntr

ies

Ob

serv

atio

nal

stu

dy

12

cou

ntr

ies

fro

m

all

six

WH

O

reg

ion

s�

Ag

edo

ver

16

yea

rso

ldN

A9

,77

2/9

,77

2Q

uo

tara

nd

om

sam

pli

ng

Fac

e-to

-fac

e

inte

rvie

ws

or

on

lin

esu

rvey

s

NA

•3

5%

of

the

resp

on

den

ts

rep

ort

edh

avin

gta

ken

anti

bio

tics

wit

hin

the

pas

t

mo

nth

;m

ost

lyfr

om

dru

g

sto

res

(93

%),

and

ph

ysi

cian

so

rn

urs

es(8

1%

).

•6

4%

of

the

resp

on

den

ts

inco

rrec

tly

bel

iev

edth

at

vir

use

ssu

chas

cold

san

dfl

u

can

be

trea

ted

wit

h

anti

bio

tics

.

•8

7%

agre

ein

gth

atp

eop

le

sho

uld

use

anti

bio

tics

on

ly

wh

enp

resc

rib

ed.

•3

2%

of

the

resp

on

den

ts

thin

kth

atth

eysh

ou

ldst

op

tak

ing

anti

bio

tics

wh

enth

ey

feel

bet

ter.

•7

2%

of

the

resp

on

den

ts

corr

ectl

yb

elie

ved

that

man

yin

fect

ion

sar

e

bec

om

ing

incr

easi

ng

ly

resi

stan

tto

trea

tmen

tb

y

anti

bio

tics

.

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 12 / 27

Page 13

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

15

Al-

Nag

gar

RA

.et

al.

20

16

To

exam

ine

the

level

of

kn

ow

led

ge,

atti

tud

ean

dth

e

asso

ciat

edfa

cto

rso

f

anti

bio

tic

use

amo

ng

urb

an

com

mu

nit

yin

Mal

aysi

a

Ob

serv

atio

nal

stu

dy

Su

ban

gB

esta

ri,

Sh

ahA

lam

,

Sel

ang

or,

Mal

aysi

a

1.

Res

iden

tso

f

Su

ban

gB

esta

ri

2.

aged

over

18

yea

rs

old

3.

able

tore

adan

d

un

der

stan

dM

alay

lan

gu

age

NA

45

0/4

50

Ran

do

m

sam

pli

ng

NA

Bas

edo

nli

tera

ture

s(n

o

refe

ren

ces)

•A

bo

ut

79

%o

fth

e

resp

on

den

tsre

po

rted

that

anti

bio

tics

use

dto

trea

t

bac

teri

alin

fect

ion

wh

ile

abo

ut

53

%o

fth

ose

rep

ort

ed

that

anti

bio

tics

use

dto

trea

t

vir

alin

fect

ion

s.

•A

bo

ut

62

%o

fth

e

resp

on

den

tsw

ere

awar

eo

f

anti

bio

tic

resi

stan

cein

rela

tio

nto

the

ov

eru

seo

f

anti

bio

tics

.

•A

bo

ut

35

%o

fth

e

resp

on

den

tsre

po

rted

that

wh

enth

eyg

ot

cold

,th

ey

wo

uld

tak

ean

tib

ioti

csto

hel

pth

emg

etb

ette

rm

ore

qu

ick

ly.

•E

du

cati

on

level

s,

hea

lth

care

-rel

ated

occ

up

atio

nan

dfa

mil

y’s

occ

up

atio

nre

late

dto

hea

lth

care

wer

e

sig

nif

ican

tly

asso

ciat

edw

ith

kn

ow

led

ge

of

anti

bio

tics

.

•H

ealt

hca

re-r

elat

ed

occ

up

atio

n,

mar

ital

stat

us

and

inco

me

wer

e

sig

nif

ican

tly

asso

ciat

edw

ith

bet

ter

atti

tud

e.

•K

no

wle

dg

esc

ore

was

po

siti

vel

yas

soci

ated

wit

h

atti

tud

esc

ore

.

16

Eu

rop

ean

Co

mm

issi

on

20

16

1.

To

iden

tify

the

use

of

anti

bio

tics

amo

ng

the

EU

pu

bli

c

2.

To

mea

sure

the

level

so

f

pu

bli

ck

no

wle

dg

eab

ou

t

the

nat

ure

and

effe

ctiv

enes

so

f

anti

bio

tics

and

the

risk

s

asso

ciat

edw

ith

thei

r

un

nec

essa

ryu

se

3.

To

det

erm

ine

the

imp

act

of

the

info

rmat

ion

Eu

rop

ean

sh

ave

rece

ived

4.

To

ob

tain

per

cep

tio

ns

of

the

mo

stap

pro

pri

ate

po

licy

resp

on

seto

anti

bio

tic

resi

stan

ce;

5.

To

asse

ssk

no

wle

dg

eo

f

and

atti

tud

esto

war

ds

the

use

of

anti

bio

tics

in

agri

cult

ure

and

the

env

iro

nm

ent

Ob

serv

atio

nal

stu

dy

28

EU

mem

ber

stat

es

Ag

edo

ver

15

yea

rso

ldN

A2

7,9

69

/28

,00

0M

ult

i-st

age

ran

do

m

sam

pli

ng

wit

h

pro

po

rtio

nal

to

size

Fac

e-to

-fac

e

inte

rvie

ws

NA

•3

4%

of

the

resp

on

den

tssa

id

that

they

too

kan

tib

ioti

cs

wit

hin

the

pre

vio

us

yea

r;

mo

stly

fro

mh

ealt

hca

re

pro

vid

ers

(93

%)

and

for

con

dit

ion

ssu

chas

bro

nch

itis

(18

%),

flu

(16

%)

and

sore

thro

at(1

4%

).

•4

3%

of

the

resp

on

den

ts

kn

ewth

atan

tib

ioti

csar

e

inef

fect

ive

agai

nst

vir

use

s

and

56

%o

fth

ose

kn

ewth

at

anti

bio

tics

are

also

inef

fect

ive

agai

nst

cold

san

d

flu

.

•8

4%

of

the

resp

on

den

ts

kn

ewth

atu

nn

eces

sary

use

of

anti

bio

tics

mak

esth

em

bec

om

ein

effe

ctiv

e.

•8

2%

of

the

resp

on

den

ts

thin

kth

eysh

ou

ldst

op

tak

ing

anti

bio

tics

on

ceth

ey

beg

un

aco

urs

eo

f

trea

tmen

t.

•3

3%

of

the

resp

on

den

ts

rem

emb

ered

that

they

rece

ived

info

rmat

ion

abo

ut

the

un

nec

essa

ryu

seo

f

anti

bio

tics

inth

ela

st1

2

mo

nth

s;m

ost

lyfr

om

hea

lth

pro

fess

ion

als. (Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 13 / 27

Page 14

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

17

Val

lin

M.et

al.

20

16

To

pro

vid

ean

up

dat

eo

nth

e

kn

ow

led

ge

and

atti

tud

esto

anti

bio

tic

use

and

resi

stan

ce

of

the

Sw

edis

hp

op

ula

tio

n

and

iden

tify

wh

ich

gro

up

s

wit

hin

the

po

pu

lati

on

are

in

par

ticu

lar

nee

do

fim

pro

ved

kn

ow

led

ge

or

atti

tud

es

Ob

serv

atio

nal

stu

dy

Sw

eden

Ag

edb

etw

een

18

and

74

yea

rso

ldw

ho

lived

inS

wed

enin

clu

din

g

Sw

edis

han

dfo

reig

n

citi

zen

s

NA

1,4

26

/2,5

00

Ran

do

m

sam

pli

ng

Mai

lA

nd

re´

M.

etal

.(2

01

0)��

•9

4%

of

the

resp

on

den

ts

kn

ewth

atb

acte

ria

cou

ld

bec

om

ere

sist

ant

to

anti

bio

tics

.

•M

ale,

yo

un

ger

age

and

edu

cate

dp

eop

lew

ere

mo

re

lik

ely

tob

ek

no

wle

dg

eab

le

bu

tm

ale

had

ale

ss

rest

rict

ive

atti

tud

e

•T

he

resp

on

den

tsw

ith

hig

h

level

of

kn

ow

led

ge

on

anti

bio

tics

wer

em

ore

lik

ely

toh

ave

app

rop

riat

e

rest

rict

ive

atti

tud

esto

war

ds

anti

bio

tics

.���

18

Maz

ińsk

aB

.

etal

.

20

17

To

asse

ssk

no

wle

dg

eb

yth

e

gen

eral

pu

bli

cin

Po

lan

d

reg

ard

ing

anti

bio

tics

,A

MR

,

and

the

imp

act

of

the

Eu

rop

ean

An

tib

ioti

c

Aw

aren

ess

Day

cam

pai

gn

s

Inte

rven

tio

nal

stu

dy

Po

lan

dA

ged

over

18

yea

rsN

A5

,00

4/5

,00

0M

ult

i-st

age

and

stra

tifi

ed

ran

do

m

sam

pli

ng

Tel

eph

on

e

surv

eys

Eu

rob

aro

met

erS

urv

ey3

38

(20

14

)��

•3

8%

of

the

resp

on

den

tsh

ad

use

dan

tib

ioti

csw

ith

inth

e

pas

t1

2m

on

ths;

mo

stly

fro

mp

hysi

cian

s(9

0%

)

•A

bo

ut

40

%o

fth

e

resp

on

den

tsex

pec

ted

a

pre

scri

pti

on

for

an

anti

bio

tic

agai

nst

flu

.

•8

0%

of

the

resp

on

den

ts

kn

ewth

atan

tib

ioti

csk

ill

bac

teri

aw

hil

e6

0%

of

tho

se

bel

ieved

anti

bio

tics

kil

l

vir

use

s.

•2

9%

of

the

resp

on

den

ts

dec

lare

dto

hav

eco

me

acro

ssin

form

atio

no

nth

e

pru

den

tu

seo

fan

tib

ioti

csin

the

pre

ced

ing

12

mo

nth

s

and

48

%o

fth

ose

dec

lare

d

that

the

info

rmat

ion

resu

lted

inth

ech

ang

eo

f

atti

tud

eto

war

ds

anti

bio

tic

use

.

19

Zaj

mi

D.et

al.

20

17

To

asse

ssth

ele

vel

of

kn

ow

led

ge,

atti

tud

esan

d

pra

ctic

esab

ou

tan

tib

ioti

c

use

amo

ng

the

gen

eral

pu

bli

cin

Ko

sovo

Ob

serv

atio

nal

stu

dy

Ko

sov

oA

ged

over

15

yea

rso

ldN

A8

11

/77

0S

trat

ifie

d

ran

do

m

sam

pli

ng

wit

h

pro

po

rtio

nal

to

size

Fac

e-to

-fac

e

inte

rvie

ws

Sp

ecia

lE

uro

bar

om

eter

40

7

(20

13

)��

•A

bo

ut

59

%o

fth

e

resp

on

den

tsu

sed

anti

bio

tics

wit

hin

the

pre

vio

us

yea

r,m

ost

lyfo

r

con

dit

ion

ssu

chas

flu

(24

%),

sore

thro

at(2

0%

),

cold

(13

%)

and

com

mo

n

cold

(8%

).

•A

bo

ut

43

%o

fth

e

resp

on

den

tso

pin

edth

at

anti

bio

tics

are

effe

ctiv

e

agai

nst

vir

alin

fect

ion

s.

•4

7%

of

the

resp

on

den

ts

rece

ived

info

rmat

ion

abo

ut

the

un

nec

essa

ryu

seo

f

anti

bio

tics

and

33

%o

fth

ose

rep

ort

edth

atit

chan

ged

thei

rvie

ws

and

beh

avio

rs

afte

rre

ceiv

ing

the

info

rmat

ion

. (Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 14 / 27

Page 15

Ta

ble

2.

(Co

nti

nu

ed)

No

Au

tho

rY

ear

of

pu

bli

cati

on

Ob

ject

ive

of

stu

dy

Stu

dy

des

ign

Co

un

try

Incl

usi

on

crit

eria

Ex

clu

sio

n

crit

eria

Nu

mb

ero

f

resp

on

den

ts/

Sa

mp

lesi

ze

Sa

mp

lin

g

tech

niq

ue

Ad

min

istr

ati

on

Ref

eren

ceo

fto

ol

dev

elo

pm

ent

Key

fin

din

gs

20

Ch

anvat

ikS

.

etal

.

20

18

To

bet

ter

un

der

stan

dth

e

app

rop

riat

eu

seo

f

anti

bio

tics

and

mo

nit

or

as

wel

las

eval

uat

eo

f

imp

lem

enti

ng

the

Nat

ion

al

Str

ateg

icP

lan

on

An

tim

icro

bia

lR

esis

tan

ce

20

17

–2

02

1

Ob

serv

atio

nal

stu

dy

Th

aila

nd

Ag

edo

ver

15

yea

rso

ld

wh

ore

spo

nse

to

qu

esti

on

nai

res

by

them

selv

es

NA

27

,76

2/2

7,9

60

Str

atif

ied

two

-

stag

era

nd

om

sam

pli

ng

Fac

e-to

-fac

e

inte

rvie

ws

Sp

ecia

lE

uro

bar

om

eter

44

5

(20

16

)��

•A

bo

ut

8%

of

the

resp

on

den

tsre

ceiv

ed

anti

mic

rob

ial

dru

gs

inth

e

last

mo

nth

;m

ost

lyfo

r

resp

irat

ory

sym

pto

ms

(63

%)

and

hea

lth

faci

liti

es

(70

%).

•A

bo

ut

3%

of

the

resp

on

den

tssh

ow

edco

rrec

t

answ

ers

toal

lst

atem

ents

and

mo

stin

corr

ect

answ

ers

wer

e“a

nti

mic

rob

ials

can

kil

lv

iru

ses”

and

“an

tim

icro

bia

lsar

eef

fect

ive

agai

nst

cold

san

dfl

u”.

•A

bo

ut

18

%o

fth

e

resp

on

den

tsre

ceiv

ed

info

rmat

ion

abo

ut

pro

per

use

of

anti

mic

rob

ials

inth

e

last

12

mo

nth

s;m

ost

lyfr

om

hea

lth

pro

fess

ion

als.

21

Hae

nss

gen

MJ.

etal

.

20

18

To

info

rmth

eaw

aren

ess

agen

da

fro

ma

soci

al

scie

nce

sp

ersp

ecti

ve

by

asse

ssin

gth

eo

utp

uts

,

ou

tco

mes

,an

db

ehav

iora

l

imp

acts

of

anan

tib

ioti

c

resi

stan

ce-t

hem

ed

edu

cati

on

alac

tivit

yin

the

low

-in

com

ese

ttin

go

f

So

uth

ern

Lao

PD

R

Inte

rven

tio

nal

stu

dy

Sal

avan

,L

aoP

DR

aged

over

18

yea

rw

ho

wer

eL

aos

vil

lag

ers

and

liv

edin

this

area

mo

reth

ansi

xm

on

ths

ado

lesc

ents

and

chil

dre

n,

peo

ple

wh

o

un

able

top

arti

cip

ate

inth

est

ud

yaf

ter

two

atte

mp

tsto

arra

ng

ein

terv

iew

2,4

80

(12

64

in

rou

nd

Ian

d

12

16

inro

un

d

II)/

2,4

80

con

sen

sus

face

-to

-fac

e

inte

rvie

ws

Hae

nss

gen

,MJ

etal

.

(20

18

)��

•A

ctiv

ity-r

elat

eded

uca

tio

nal

acti

vit

ies

cou

ldp

osi

tivel

y

infl

uen

ceth

eaw

aren

ess

and

un

der

stan

din

go

f“d

rug

resi

stan

ce”,

wh

erea

sit

s

effe

cts

on

atti

tud

esw

ere

min

or.

•T

he

evid

ence

on

the

beh

avio

ral

imp

acts

was

spar

sean

dm

ixed

.O

ne

of

the

po

ssib

lein

flu

ence

s

incl

ud

eda

dis

pro

po

rtio

nat

e

up

tak

eo

fan

tib

ioti

csfr

om

form

alh

ealt

hca

rep

rovid

ers.

22

Sal

mF

.et

al.

20

18

To

inv

esti

gat

eth

eh

isto

ryo

f

anti

bio

tic

use

inth

eg

ener

al

po

pu

lati

on

and

to

char

acte

rize

con

sum

ers

in

term

so

fh

ealt

hli

tera

cyan

d

kn

ow

led

ge

Ob

serv

atio

nal

stu

dy

Ber

lin

,G

erm

any

1.

Ag

edo

ver

35

yea

rs

old

2.

Su

ffic

ien

tG

erm

an

lan

gu

age

skil

ls

3.

Res

iden

to

f

Ger

man

y

No

97

7/2

00

0S

trat

ifie

d

ran

do

m

sam

pli

ng

Fac

e-to

-fac

e

inte

rvie

ws

WH

O(2

01

5)��

and

Gu

alan

oet

al.(2

01

5)

•A

bo

ut

33

%o

fth

e

resp

on

den

tsin

dic

ated

hav

ing

had

anan

tim

icro

bia

l

pre

scri

pti

on

du

rin

gth

e

pre

vio

us

12

mo

nth

s.

•In

div

idu

als

wit

hsu

ffic

ien

t

hea

lth

lite

racy

wer

eo

nly

0.5

7ti

mes

less

lik

ely

toh

ave

had

are

cen

th

isto

ryo

f

anti

bio

tic

use

than

ind

ivid

ual

sw

ith

insu

ffic

ien

t

hea

lth

lite

racy

.���

No

te:

�B

arb

ado

s,C

hin

a,E

gyp

t,In

dia

,In

do

nes

ia,

Mex

ico

,Nig

eria

,R

uss

ian

Fed

erat

ion

,Ser

bia

,S

ou

thA

fric

a,S

ud

an,V

ietn

am

��

Mee

tin

clu

sio

ncr

iter

iao

fth

isp

aper

���M

ult

ivar

iate

anal

ysi

s,al

ld

ata

abo

ut

asso

ciat

ion

was

sig

nif

ican

tat

p-v

alu

e<0

.05

htt

ps:

//doi.o

rg/1

0.1

371/jo

urn

al.p

one.

0227973.t002

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 15 / 27

Page 16

Ta

ble

3.

Qu

ali

tya

sses

smen

to

f2

2in

clu

ded

stu

die

su

sin

gA

pp

rais

al

To

ol

for

Cro

ss-S

ecti

on

al

Stu

die

s(A

XIS

).

Intr

od

uct

ion

Met

ho

ds

Au

tho

r(Y

ear

of

pu

bli

cati

on

)

Wer

eth

e

aim

s/

ob

ject

ives

of

the

stu

dy

clea

r?

Wa

sth

e

stu

dy

des

ign

ap

pro

pri

ate

for

the

sta

ted

aim

(s)?

Wa

sth

e

sam

ple

size

just

ifie

d?

Wa

sth

e

targ

et/

refe

ren

ce

po

pu

lati

on

clea

rly

def

ined

?(I

s

itcl

ear

wh

o

the

rese

arc

h

wa

sa

bo

ut?

)

Wa

sth

esa

mp

le

fra

me

tak

en

fro

ma

n

ap

pro

pri

ate

po

pu

lati

on

ba

se

soth

at

itcl

ose

ly

rep

rese

nte

dth

e

targ

et/r

efer

ence

po

pu

lati

on

un

der

inv

esti

ga

tio

n?

Wa

sth

e

sele

ctio

np

roce

ss

lik

ely

tose

lect

sub

ject

s/

pa

rtic

ipa

nts

tha

t

wer

e

rep

rese

nta

tiv

eo

f

the

targ

et/

refe

ren

ce

po

pu

lati

on

un

der

inv

esti

ga

tio

n?

Wer

e

mea

sure

s

un

der

tak

en

toa

dd

ress

an

d

cate

go

rize

no

n-

resp

on

der

s?

Wer

eth

eri

sk

fact

ors

an

d

ou

tco

me

va

ria

ble

s

mea

sure

d

ap

pro

pri

ate

toth

ea

ims

of

the

stu

dy

?

Wer

eth

eri

sk

fact

ors

an

d

ou

tco

me

va

ria

ble

s

mea

sure

d

corr

ectl

yu

sin

g

inst

rum

ents

/

mea

sure

men

ts

tha

th

ad

bee

n

tria

led

,p

ilo

ted

or

pu

bli

shed

pre

vio

usl

y?

Isit

clea

r

wh

at

wa

su

sed

tod

eter

min

ed

sta

tist

ica

l

sig

nif

ica

nce

an

d/o

r

pre

cisi

on

esti

ma

tes?

(e.g

.,p

va

lues

,

CIs

)

Wer

eth

e

met

ho

ds

(in

clu

din

g

sta

tist

ica

l

met

ho

ds)

suff

icie

ntl

y

des

crib

edto

ena

ble

them

tob

e

rep

eate

d?

Par

imi

N.

etal

(20

02

)

YY

YY

YN

NY

YY

Y

En

gJV

.et

al.

(20

03

)

YY

NY

YY

NN

NY

Y

McN

ult

y

CA

M.

etal

.

(20

07

)

YY

YY

YY

NN

NY

Y

An

dre

´M

.

etal

(20

10

)

YY

NY

YY

NN

YY

Y

Bar

ahF

.an

d

Go

nca

lves

V.

(20

10

)

YY

NY

NY

NC

TY

YY

Kim

SS

.et

al

(20

11

)

YY

YY

YY

NY

YY

Y

Sir

ijo

tiK

.

(20

12

)

YY

YY

YY

NY

YY

Y

Wid

ayat

iA

.

etal

(20

12

)

YY

NY

YY

CT���

YY

YY

Wu

nY

T.

etal

.(2

01

2)

YY

YY

YY

NY

YY

Y

Ah

mad

H.

etal

(20

13

)

YY

NY

YN

NN

NN

N

Jose

J.et

al

(20

13

)

YY

YY

YN

NY

YY

Y

Gu

J.et

al

(20

15

)

YY

NY

YY

NN

NY

Y

Mo

uh

ied

din

e

HT

.et

al

(20

15

)

YY

NY

NN

NY

YY

Y

WH

O(2

01

5)

YY

YY

YY

NN

NN

Y

Al-

Nag

gar

AR

.et

al

(20

16

)

YY

YY

YY

NY

YY

Y

(Con

tinued)

Systematic review of surveys of knowledge and awareness of antibiotic use and AMR in general population

PLOS ONE | https://doi.org/10.1371/journal.pone.0227973 January 16, 2020 16 / 27