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Antibiotic Utilisation Amongst Australian Chinese Migrants

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Antibiotic Utilisation Amongst Australian Chinese Migrants Antibiotic utilisation amongst Australian Chinese migrants: a web-based bilingual health survey Jie Hu Postgraduate Diploma in Public Health A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2016 School of Medicine Abstract Background: Antibiotic resistance is a global public health threat, which is related to antibiotic consumptions worldwide. Migrants may have different perceptions and practices regarding antibiotic utilisation because of previous experience and cultural values. The purpose of the present project was firstly, to investigate the knowledge, attitudes and perceptions of antibiotic use in a group of Australian Chinese migrants and secondly, to examine the inappropriate practices of antibiotic use in this special cultural group. Methods: The participants in this project were recruited through several Chinese social network sites to complete a bilingual questionnaire regarding antibiotic use, health related actions and psychological related wellbeing. The characteristics of the participants recruited in this survey were compared with those of a sample of Chinese migrants recruited through a postal survey. The prevalence of storing antibiotics at home, importing antibiotics from overseas and self-medicating with antibiotics in this sample were investigated. The associations between knowledge, attitude and perception factors and the above inappropriate behaviour of antibiotic utilisations were examined using bivariate and multivariate logistic regressions. The associations between health services utilisation factors and the practice of self- medication with antibiotics were also explored. All data analyses were performed using Stata version 12 or 13. Results: The online survey recruited 469 Chinese participants ranging from 14 to 63 years old. The mean (SD) age of this sample was 33 (8) years. The gender proportion (Female: Male) of the total participants was 55: 45. Participants resided in five states of Australia, 45% of them were living in Queensland. Compared to Chinese migrants recruited via a postal survey, participants of this online health survey were younger, with a higher education level or had resided in Australia for less time. Our data reveal that the inappropriate practices of antibiotic use were prevalent in this population. Nearly half of the participants self-reported having antibiotics stored at home at the point of our survey. One third of the participants admitted having brought antibiotics into Australia during their latest trip to China or other countries. In i this sample of Chinese migrants, one in four participants used antibiotics for URTIs. Among the antibiotic users, half of them used antibiotics without a prescription in the last 12 months. This thesis identifies some misperceptions about antibiotic use in the Chinese migrant community. Although self-reported awareness of antibiotic resistance and antibiotic side effects was adequate, the majority of participants indicated that they would stop taking antibiotics when symptoms improved and use leftover antibiotics if they had similar symptoms. Around 40% of the participants believed that antibiotics should be legally available for purchase over-the-counter. The misperceptions and irrational practices of antibiotics were significantly associated with self-medicating antibiotics in this population. Also, a negative experience with or perceived barriers of primary health services use marked a higher risk of self-medication with antibiotics. Conclusion: Although antibiotics are legally unavailable without a prescription in Australia, the findings of the present project indicate that storing antibiotics at home, importing antibiotics and self-medicating with antibiotics are prevalent amongst Chinese migrants. Also, a list of knowledge, attitude and perception factors was identified to be significantly associated with such inappropriate practices of antibiotic use. These behaviours and risk factors should be better acknowledged when developing interventions for promoting awareness of antibiotic resistance and rational antibiotic use in the community. In addition to antibiotic utilisations discussed in details, this project provides some evidence of needs for further health research on mental wellbeing and health services access and use in this population. Education programs facilitating a better understanding of the Australian health system and the available services would be beneficial to the growing number of migrant populations. ii Declaration by author This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis. I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance, survey design, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the policy and procedures of The University of Queensland, the thesis be made available for research and study in accordance with the Copyright Act 1968 unless a period of embargo has been approved by the Dean of the Graduate School. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis. iii Publications during candidature Peer-reviewed papers and letters: 1. Hu, J., & Wang, Z. (2014). In-home antibiotic storage among Australian Chinese migrants. Int J Infect Dis, 26, 103-106. doi: 10.1016/j.ijid.2014.04.017. 2. Hu, J., & Wang, Z. (2014). Bringing antibiotics from overseas and self- medication amongst Australian Chinese migrants. The Internet Journal of Infectious Disease, 14(1). doi: 10.5580/IJID.20324. 3. Wang Z, Dong B, Adegbija O, Sina M, Arnold L, Pan T, Hu J. (2014). Data sharing: a decade since the publication of the first cohort profile. International Journal of Epidemiology, 43(6):1986-7. doi: 10.1093/ije/dyu154 4. Hu, J., Wong, K. C., & Wang, Z. (2015). Recruiting migrants for health research through social network sites: An online survey among Chinese migrants in Australia. JMIR Res Protoc, 4(2), e46. doi: 10.2196/resprot.3960. 5. Hu, J., & Wang, Z. (2015). Knowledge, attitudes and perceptions regarding antibiotic use and self-medication: A cross-sectional study amongst Australian Chinese migrants. Healthcare Infection, 20(1), 6. 6. Hu, J., & Wang, Z. (2015). Exploring the associated factors of elevated psychological distress in a community residing sample of Australian Chinese migrants. Australian Journal of Psychology, n/a-n/a. doi: 10.1111/ajpy.12099 7. Hu, J., & Wang, Z. (2015). Non-prescribed antibiotic use and general practitioner service utilisation amongst Chinese migrants in Australia. Australian Journal of Primary Health, n/a-n/a. doi: 10.1071/PY15076 8. Wang Z, Dong B, Hu J, Adegbija O, & Arnold LW. (2016). Exploring the non- linear association between body mass index and mortality in adults with and without diabetes: The US National Health Interview Survey (NHIS). Diabetic Medicine, n/a-n/a. doi: 10.1111/dme.13111 iv Publications included in this thesis 1. Hu, J., Wong, K. C., & Wang, Z. (2015). Recruiting migrants for health research through social network sites: An online survey among Chinese migrants in Australia. JMIR Res Protoc, 4(2), e46. doi: 10.2196/resprot.3960. Incorporated as Chapter 4. Contributor Statement of contribution Jie Hu Developed the research question (80%) Collected data (70%) Analysed data (80%) Wrote the paper (100%) Edited the paper (70%) Kam Cheong Wong Collected data (20%) Edited paper (10%) Zhiqiang Wang Developed the research question (20%) Collected data (10%) Analysed data (20%) Edited the paper (20%) v 2. Hu, J., & Wang, Z. (2015). Knowledge, attitudes and perceptions regarding antibiotic use and self-medication: A cross-sectional study amongst Australian Chinese migrants. Healthcare Infection, 20(1), 6. Incorporated as Chapter 5. Contributor Statement of contribution Jie Hu Developed the research question (80%) Collected data (90%) Analysed data (80%) Wrote the paper (100%) Edited the paper (80%) Zhiqiang Wang Developed the research question (20%) Collected data (10%) Analysed data (20%) Edited the paper (20%) 3. Hu, J., & Wang, Z. (2014). In-home antibiotic storage among Australian Chinese migrants. Int J Infect Dis, 26, 103-106. DOI: 10.1016/j.ijid.2014.04.017. Incorporated as Chapter 6. Contributor Statement of contribution Jie Hu Developed the research question (80%) Collected data (90%) Analysed data (80%) Wrote the paper (100%) Edited the paper (80%) Zhiqiang Wang Developed the research question (20%) Collected data (10%) Analysed data (20%) Edited the paper (20%) vi 4. Hu, J., & Wang, Z. (2014). Bringing antibiotics from overseas and self-
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