Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. 698-706 (doi:10.1542/peds.2006-2600)
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ARTICLE

Parental Knowledge About Antibiotic Use: Results of a Cluster-Randomized, Multicommunity Intervention

Susan S. Huang, MD, MPHa,b,c, Sheryl L. Rifas-Shiman, MPHa, Ken Kleinman, ScDa, Jamie Kotch, MSa, Nancy Schiff, MPHd, Christopher J. Stille, MD, MPHe,f, Ron Steingard, MDg and Jonathan A. Finkelstein, MD, MPHa,h

a Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
b Channing Laboratory
c Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
d MassHealth, Boston, Massachusetts
e Departments of Pediatrics
g Psychiatry
f Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
h Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts

OBJECTIVE. The goal was to determine the impact of a community-wide educational intervention on parental misconceptions likely contributing to pediatric antibiotic overprescribing.

METHODS. We conducted a cluster-randomized trial of a 3-year, community-wide, educational intervention directed at parents of children <6 years of age in 16 Massachusetts communities to improve parental antibiotic knowledge and attitudes and to decrease unnecessary prescribing. Parents in 8 intervention communities were mailed educational newsletters and exposed to educational materials during visits to local pediatric providers, pharmacies, and child care centers. We compared responses from mailed surveys in 2000 (before the intervention) and 2003 (after the intervention) for parents in intervention and control communities. Analyses were performed on the individual level, clustered according to community.

RESULTS. There were 1106 (46%) and 2071 (40%) respondents to the 2000 and 2003 surveys, respectively. Between 2000 and 2003, the proportion of parents who answered ≥7 of 10 knowledge questions correctly increased significantly in both intervention (from 52% to 64%) and control (from 54% to 61%) communities. We did not detect a significant intervention impact on knowledge regarding appropriate antibiotic use in the population overall. In a subanalysis, we did observe a significant intervention effect among parents of Medicaid-insured children, who began with lower baseline knowledge scores.

CONCLUSIONS. Although knowledge regarding appropriate use of antibiotics is improving without additional targeted intervention among more socially advantaged populations, parents of Medicaid-insured children may benefit from educational interventions to promote judicious antibiotic use. These findings may have implications for other health education campaigns.

Key Words: antibiotic use • parent education • randomized • prospective trial

Abbreviations: OR—odds ratio • CI—confidence interval

Accepted Dec 12, 2006.


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