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Conducting Mixed-Methods Studies in Low-Income Countries: Understanding Factors Leading to Inappropriate Antibiotic Prescribing in India

By: , & Published: 2020 | Product: SAGE Research Methods Cases: Medicine and Health
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We used a mixed-methods design to better understand the factors that drive inappropriate dispensing of antibiotics among pharmacy employees in India’s rural village communities. Health care access is limited in many parts of India, where overall there are very few physicians as most are located in urban centers, which results in considerable disparity between patient–provider ratios in the most and least medicalized areas of the country. Pharmacies fill a critical void as front-line health care providers, especially in village settings. However, staffing at pharmacies is highly variable and employees often lack health care–-related education. Although they provide essential services to underserved communities, these pharmacies also contribute to inappropriate antibiotic dispensing and misuse, which, in turn, promotes antibiotic resistance. We used semi-structured interviews (qualitative data) and a pilot cross-sectional survey (quantitative data) to collect information from both pharmacy employees and patients. Both types of data collected were transcribed and translated from Hindi to English and coded for recurring themes. Most pharmacy employees and patients appeared to have had little formal knowledge about antibiotics and antibiotic resistance and all pharmacy employees had previously dispensed antibiotics without prescriptions. Dispensing practices appeared to be the result of limited physician access and patient financial constraints. Study results highlight the need for short-term, antibiotic training programs that encompass realities of working with clientele with limited access to health care. This study also highlights the strength of using a mixed-methods approach to answer questions that neither quantitative nor qualitative methods could answer alone.

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