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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Developing structured, theory-based educational interventions and exploring sources of medications available without prescriptions are important steps for successful interventions to reduce inappropriate use of antibiotics among Latinos
Time for a Multinational Campaign to Control Antibiotic Resistance?
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Amanda M. Loya, El Paso, TX, USA University of Texas at El Paso/Austin Cooperative Pharmacy Program, Jose O. Rivera
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In the article by Mainous, Diaz and Carnemolla, an educational campaign to change attitudes among Latinos toward using antibiotics without a prescription was shown to be ineffective.(1) Although the need for such education is necessary, several aspects of the educational intervention require comment. One important consideration would be to use a rigorous and structured intervention grounded in a theoretical model that facilitates change in health beliefs and knowledge in order to influence change in behavior. Additionally, the educational intervention might be delivered using a more direct approach to ensure that the target population receives the educational message in its entirety. One strategy might incorporate the use of promotores de salud, or lay-community health educators, to deliver the intervention directly to Latinos in various community settings. This strategy might help address cultural, community, and environmental factors that contribute to health practices by Latinos.(2) In addition, the health literacy level of the educational material should be appropriate for the target population and it should appeal to different styles of learning.(3) Once developed, these structured interventions should ideally be tested using a randomized, controlled study design. The authors’ comments that usual forms of health education may not be sufficient to overcome the influence of past behavior may be reconsidered after testing structured interventions using some of the aforementioned strategies. As mentioned by the authors, strategies to decrease the availability of antibiotics without a prescription are integral parts of a comprehensive intervention and the question of why antibiotics are available without prescriptions in these communities should be considered. In the U.S., federal law prohibits dispensing antibiotics without a prescription. If antibiotics are sold through stores, or tiendas, the question of where these businesses obtain the antibiotics is raised. Based on personal accounts from residents in our U.S/Mexico border community, we know that one possibility is that these products are purchased across the border in Mexico and mailed to relatives or friends in other parts of the country. It is also possible that medicines from outside the U.S. are shipped directly to tiendas or that consumers and/or businesses are purchasing medications without prescriptions on the Internet.(4) These practices introduce many potential dangers to consumers, including the use of counterfeit medications.(5) In addition to educational interventions targeted to Latinos, further exploration of the sources of these medications is an important step in addressing the problematic use of antibiotics without a prescription in these communities. References: 1. Mainous III AG, Diaz VA, Carnemolla M. A community intervention to decrease antibiotics used for self-medication among Latino adults. Ann Fam Med 2009;7(6)520-526. 2. Wilson K, Brownstein JN, Blanton C. “Community Health Advisor Use: Insights from a National Survey.” In: US Department of Human Services, Centers for Disease Control: Community Health Advisors/Community Health Workers: Selected Annotations and Programs in the United States, Vol III, June 1998. 3. Weiss, B. Health literacy and patient safety: help patients understand - a manual for clinicians. 2nd Edition. American Medical Association Foundation, 2007. 4. Mainous III AG, Everett CJ, Post RE, Diaz VA, Hueston WJ. Availability of antibiotics for purchase without a prescription on the internet. Ann Fam Med 2009; 7:431-435. 5. Counterfeit Medicines - Filled With Empty Promises [Internet]. Silver Spring (MD): U.S. Food and Drug Administration; 2009 [cited 2009 Dec 04]. Available from http://www.fda.gov/Drugs/ResourcesForYou/ucm079278.htm Competing interests: None declared |
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Ralph Gonzales, San Francsco, USA Physician, Kitty Corbett, Hortensia Reyes Morales
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We applaud the long-standing interest and commitment of Dr Mainous and colleagues in understanding and improving antibiotic use among Latinos in South Carolina. In the Minimizing Antibiotic Resistance in Colorado (MARC) Project, we obtained similar results from our formative research with Spanish-speaking, primarily Mexican immigrant populations in Denver with regard to knowledge, attitudes and awareness of appropriate antibiotic use. First, we learned that we had to change the English name of our mass media campaign from “Get Smart. Use Antibiotics Wisely” to “Use los antibióticos solo si un doctor se los receta” (Use antibiotics only if a doctor prescribes them to you). This change was required for all of the same reasons elucidated by Dr Mainous and colleagues, particularly the frequent report of self-medication with antibiotics . In addition, we also found that Spanish speaking Latinos had less accurate knowledge about antibiotic appropriateness for colds, and greater dissatisfaction if an antibiotic was not prescribed for a respiratory illness compared with whites and English-speaking Latinos. Although we have not analyzed our data with regard to its impact specifically on the Latino community in Denver, we found that our bilingual mass media campaign led to an overall decrease in antibiotic prescriptions and office visits among children with cough and cold illnesses. This effect was consistent with the key target of our campaign: mothers with young children. Based on these collective experiences, however, we believe it’s unlikely that the educational strategies designed for the mainstream American public will have the same effect on self-medication with antibiotics by Latinos for several reasons. First, the problem is based within a deeper cultural, social and ecological context whose roots are in Latin American countries. Second, intervention strategies to date have not addressed the community/environmental factors contributing to the problem. And third, effective educational messages need to be tailored to the individual’s health care needs in time and place. Thus, we believe unidimensional educational interventions delivered solely in the US are unlikely to affect self-medication behaviors among Latinos. Instead, we need to develop strategies that reach beyond borders, and that address the pharmaceutical policies, retail pharmacy practices, antibiotic information exchange and social norms that exist in Mexico and other Latin American countries where purchase of antibiotics without a prescription is commonplace. Programs within the US will need to be multidimensional, targeting not only the public and providers, but also the commercial sector and communities that provide access to antibiotics to the Latino community. We need to engage these communities, and include them in the planning and implementation of intervention strategies. Finally, effective educational messaging and decision support need to be tailored to the patient’s illness, and available when people are sick with a respiratory illness. In summary, if the US and Latin American countries are ready to commit to a multinational campaign, then the solutions will need to seamlessly cross national boundaries, just as antibiotic resistance does. References Corbett KK, Gonzales R, Leeman-Castillo BA, Flores E, Maselli J, Kafadar K. Variation in knowledge, attitudes, and awareness about appropriate antibiotic use by Hispanic ethnicity and language preference. Preventive Medicine, 2005;40:162-69. Gonzales R, Corbett KK, Wong S, Glazner J, Deas A, Leeman-Castillo BA, Maselli JH, Sebert-Kuhlman A, Wigton RS, Flores E, Kafadar K. “Get Smart Colorado”: Impact of a mass media campaign to improve community antibiotic use. Medical Care 2008;46:597-605 Competing interests: None declared |
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