Predictors of Antibiotic Misuse

Predictors of Antibiotic Misuse Using the Health Belief Model and Social Cognitive Theory

Antibiotics are drugs used to treat microbial infections which are caused by bacteria. They were first introduced to the public in the 1940s and quickly became the “wonder drugs” of the middle 1900s. However, within the first decade of public use, it became clear that bacteria have the ability to mutate and change to resist inhibition by antibiotics (Nicolaou & Rigol, 2018). As a result, global health professionals now predict the onset of a post-antibiotic era, where antibiotics are no longer available for routine health concerns.

While antibiotics are maintained through prescription, providers cite “patient demand” as the primary cause for antibiotic misuse (Kardas, et al, 2005). Providers are far more likely to prescribe antibiotics when they perceive that parents expect a prescription. What is particularly noteworthy is that parents do not have to actually demand a prescription; the perception of patient demand is actually what drives prescription rates.

The Study

"Identification of Predictors of Antibiotic Misuse Using the Health Belief Model and Social Cognitive Theory"


Data for this study were collected in 2015 from private medical practices located in Franklin, Tennessee, and Murfreesboro, Tennessee. To participate, individuals were required to be an adult, consenting age, and the primary caregiver of a child ten years or younger.

A total of 141 individuals participated in this study. Of those participants, 38 were unable to identify that "the common cold should be treated with antibiotics" is an inaccurate statement.

Findings: Predictors of Antibiotic Misuse

According to this analysis, the constructs which are the most useful for a health behavior intervention are the Health Belief Model construct of perceived benefits and the Social Cognitive Theory construct of expectations (Rosenstock, et al, 1988; Bandura, 2001). These constructs relate to the belief that regular antibiotic use, whether related to the treatment of an illness or not, may somehow benefit a child’s growth and development. They also relate to the belief that antibiotics may prevent complications from a cold and that a cold is caused by a virus.

The Social Cognitive Theory construct of emotional arousal also emerged as a predictor. The concern that antibiotics also kill "friendly" bacteria was found to discriminate between the patients in the second clinic who do and do not believe that the common cold should be treated with antibiotics.

This study demonstrates the role of needs assessment using health behavior theories to target specific constructs for health promotion programs. Knowledge about the limitations of antibiotics and emphasis on emotional arousal are more effective than simple campaigns to stop antibiotic overuse.

Dig Deeper

Bandura A. (2001). Social cognitive theory: an agentic perspective. Annual review of psychology52, 1–26.

Kardas, P., Devine, S., Golembesky, A., & Roberts, C. (2005). A systematic review and meta-analysis of misuse of antibiotic therapies in the community. International journal of antimicrobial agents26(2), 106–113.

Nicolaou, K. & Rigol, S. (2018). A brief history of antibiotics and select advances in their synthesis. J Antibiotics, 71, 153–184.

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health education quarterly15(2), 175–183.