The Health Care Professional Antibiotic Resistance Awareness Scale v1: report on development and testing

As the threat of antimicrobial resistance (AMR) grows, multilateral bodies are mobilising support for national and global action. A cornerstone of action plans is to increase awareness of resistance amongst different groups, including human and animal health care professionals. Understanding current levels of awareness is required for targeting interventions as well as for assessing change. This project designed a questionnaire tool to assess awareness of AMR amongst HCPs in different low- and middle-income countries. The content of the questionnaire was developed through qualitative research, review of literature and existing tools, and expert consultations in a range of settings. The resulting set of 88 questions – to assess awareness, practice and context – were then piloted from April to September 2018 with human and animal health care professionals in six countries. A total of 1091 participants completed the survey online or on paper – 43 in Peru (human HCPs, in Spanish), 122 in Peru (animal HCPs, in Spanish), 112 in Nigeria (human HCPs, in English), 106 in Ghana (human HCPs, in English), 124 in Tanzania (human HCPs, in English) 40 in Tanzania (human HCPs, in KiSwahili), 253 in Vietnam (human HCPs, in Vietnamese), 183 in Vietnam (animal HCPs, in Vietnamese), and 43 in Thailand (animal HCPs, in Thai). The 49 items in the questionnaire intended to capture awareness and awareness-in-practice were evaluated using the psychometric analytic approach of Rasch Measurement Theory. A total of 23 items were retained after less well-performing items were removed, and the Rasch analysis was then re-run. The 23 items constitute the Health Care Professional (HCP) Antibiotic Resistance (ABR) Awareness Scale v1, to include four domains: awareness of mechanisms of antibiotic resistance; the ways antibiotic use drives antibiotic resistance; the ways antibiotic resistant infections can be transmitted and controlled; and how antibiotic resistance can be recognised. Overall, the 23-item HCP ABR Awareness Scale v1 performed sufficiently well to be used within certain parameters – in the languages tested and to perform within-country rather than between-country comparisons. It is also recommended that awareness is measured alongside practice and context indicators to capture practice in relation to antibiotic use as well as contextual factors that may explain levels of awareness.