Method: A prospective experimental study was conducted using a structured data-collection instrument to manipulate perceived barriers and perceived benefits using four scenarios and keep other factors of Health Belief Model constant. Scenarios were developed with the help of pediatricians and by conducting elicitation survey among parents of young children. Each subject viewed four scenarios. Parents’ expectation to receive antibiotic prescription associated with each scenario was measured on a scale of 0 (‘No Expectation’) to 100 (‘High Expectation’); a 100mm visual-analog-scale was used. Data were collected at public places (Houston, TX) from subjects who had at least one child (age≤5 years) during the study and who could speak, read and write English. Psychometric properties of the instrument were tested; descriptive and repeated measures mixed method covariance adjusted analyses were performed using SAS®9.3 with a 0.05 significance level.
Result: A total of 300 completed surveys were analyzed. Mean age of the sample was 30.3±7 years. The mean general expectation score (before reading any scenario) to receive antibiotic prescription for children was 53.6±25.7. The repeated measure mixed methods analyses indicated that there was 12-point reduction (p<0.0001) in expectation score after removing perceived barriers from the situational scenarios; 16-point decrease (p<0.0001) in expectation score was observed after removing perceived benefits and 18-point decrease (p<0.0001) in expectation score after removing both perceived barriers and perceived benefits. Some covariates (general expectation toward an antibiotic prescription, training in the healthcare field and parents’ preference for communication) had significant effect on parents’ expectation.
Conclusion: There was significant effect of perceived barriers and perceived benefits on expectation scores. When both perceived barriers and perceived benefits were removed from the scenarios there was the highest decrease in the expectation score indicating the successful manipulation of both variables. Policy makers and intervention programs should consider these factors to enhance successful reduction of antibiotic expectations.