Cross-border differences in public knowledge, awareness, behaviours and beliefs related to antibiotics and antimicrobial resistance across the island of Ireland

Background: Antimicrobial resistance (AMR) is predicted to be liable for 10 million annual deaths worldwide by 2050, driven significantly by public cognitions and behaviours. Given the frequent social and economic interactions between people from Northern Ireland (NI) and Ireland (IRL), there is potential for cross-border spread of antibiotic-resistant bacteria. Little research compares public knowledge, awareness, beliefs and behaviours across the island of Ireland. This study aimed to address this gap in a post-COVID-19 era to inform targeted interventions.

Methods: A cross-sectional, nationally representative online survey with adults in NI and IRL assessed public knowledge, awareness, behaviours and beliefs related to antibiotics and AMR. Questions were taken from the World Health Organization (WHO) multi-country public awareness survey and four relating to ESKAPE pathogens were derived from literature. Statistical analyses of difference compared results between NI and IRL.

Results: Among 811 respondents, 415 (51.2%) were from NI and 396 (48.8%) were from IRL. Those from NI showed better knowledge and understanding across most topics compared to those from IRL. However, effect sizes were small, suggesting consistency. Total knowledge of appropriate antibiotic use and antibiotic resistance was moderate in both countries. Nearly two fifths (37.9%) in both countries incorrectly identified ‘cold and flu’ as treatable with antibiotics. Awareness of AMR-related terms was consistent across countries and lowest for ‘ESKAPE pathogens’(11%), and ‘AMR’ (21.5%). The media (41.2%) and a doctor or nurse (27.1%) were the most frequent sources of awareness. Antibiotic use behaviours were consistent across countries, with over half (57%) having taken them within the last year. More respondents in IRL reported that there is not much they can do to stop antibiotic resistance (U=74747.50, p=0.02, r=0.08).

Conclusions: Knowledge, awareness, beliefs and behaviours around AMR and antibiotics are broadly consistent across the island of Ireland. Community-based initiatives could be used in both countries to educate the public on AMR and appropriate antibiotic use. Campaigns should refrain from using acronyms and employ multi-channel strategies to foster shared responsibility and encourage positive AMR-related behaviours across the island of Ireland.