Release date: 7 February 2022
Following the recommendations of the Hong Kong Strategy and Action Plan on Antimicrobial Resistance, the Infection Control Branch (ICB) of the Centre for Health Protection of the Department of Health (DH) has regularised training to nursing students since the school year of 2019/20. A knowledge, attitude and practice (KAP) survey of nursing students on antimicrobial resistance (AMR) was conducted targeting nursing students eligible to attend training in school year 2020/21, using web-based questionnaire.
A total of 1 750 completed questionnaires were received, with a response rate of 61.0%. Over 90% respondents replied correctly that people should use antibiotics only when they are prescribed by a doctor, while substantial proportion were found to have misinterpretations that antibiotics were useful for treating viral infections (38.6%), people could stop taking antibiotics prior to the completion of the full course if they feel better (12.1%), and people could keep unconsumed antibiotics for future use against other illnesses (14.1%).
In terms of practice, around one quarter (26.9%) of the respondents indicated that they would ask for antibiotics from a doctor during a consultation for upper respiratory tract infection, whereas around 20% (19.4%) of the respondents indicated that they would ask a doctor not to do so. Large proportions of respondents wanted doctor to discuss and share decision making with them on antibiotics prescription (89.4%), would complete the full course of antibiotic treatment (94.2%), and would not give antibiotics to their family member if they are sick (95.8%).
For awareness on AMR, over 60% of respondents had heard of the term “antibiotic resistance / 抗生素耐藥性” (95.8%) and “antimicrobial resistance (AMR) / 抗菌素耐藥性” (63.3%). Over 60% gave correct answers on the impact of AMR in relation to treatment options (75.6%), duration of hospital stay (62.6%), and mortality (66.6%). Over 90% of respondents agreed that AMR could lead to a severe problem both in Hong Kong (95.9%) and over the world (96.8%). When asked to give rating on the impact of antibiotic resistance or AMR at a personal level, vast majority of respondents worried about the impact of antibiotic resistance or AMR on their health (94.9%) and the health of their family (95.6%).
Over half of the respondents perceived not much they could do to stop antibiotic resistance or AMR (53.3%), they were not at risk as long as they took antibiotics correctly (62.5%), and medical experts would solve the problem before it becomes too serious (62.5%). On the other hand, majority (95.1%) of respondents correctly pointed out that nurse does play a role to ensure proper use of antibiotics.
When being asked about measures to control antibiotic resistance or AMR, majority of respondents gave correct answers on questions addressing infection control measures and vaccination under this category. Majority of respondents agreed that “promoting hand hygiene” and “influenza vaccination for the elderly / young children” could be beneficial in controlling antibiotic resistance or AMR (83.3% and 82.1% respectively). Around three quarters (73.4%) of respondents disagreed that “keeping antibiotics and use them later for other illnesses is a measure to control antibiotic resistance or AMR”.
On the other hand, only one in five (19.9%) of respondents correctly indicated the correct answer for the question “using broad-spectrum antibiotics for bacterial infections as a means to control antibiotic resistance or AMR” which should be false.
Most respondents considered it would be useful to promote proper use of antibiotics with social media (e.g. Facebook /YouTube) messages (95.1%), followed by videos (90.8%), website (87.7%), printed materials such as poster and/or pamphlet (83.1%) and articles such as columns in newspaper (58.1%). When asked if they had encountered with various promotion materials by the DH related to AMR in the past 12 months, comparatively more respondents recalled website (33.1%), printed materials (28.5%) and video (23.4%), whereas less than 20% (16.2%) and less than one in seven (13.5%) had encountered AMR-related Facebook messages and articles in the past year.
Compared with respondents who were undergoing pre-enrolment nursing training (i.e., to serve as EN after graduation), those under pre- or post- registration nursing training (i.e., to serve as RN after graduation) were more likely to provide correct answers for questions about proper use of antibiotics, heard of the terms “antibiotic resistance” and AMR, being aware of and worry about the impact of AMR. On the other hand, no statistically significant difference was observed between the two groups on their practice related to the use of antibiotics, perceived role of nurses in ensuring proper use of antibiotics, perceived effectiveness of promotion methods and recall of encountering promotion materials related to AMR.
Nurses are one of the key players in the battle of AMR. The results of the study indicated a need to continue educating nursing students for awareness raising and capacity building, in particular to correct misconceptions and emphasise the appropriate behaviours. With relatively low proportion of respondents recalling publicity initiatives by DH, more effort on publicity should be made with the use of platforms that were considered effective by higher proportion of respondents. It is also recommended to make use of the survey findings to facilitate future training of nursing students.