Abstract
Aim
This study aims to examine the impact of a training course in improving mothers’ awareness and opinion of antibiotic use and antimicrobial resistance (AMR) among their children.
Methodology
Nonequivalent control group design (quasi-experimental), was used to examine the effectiveness of a training course on mothers’ awareness, and opinion of antibiotic use and AMR among their children. A total of 161 mothers participated in the study were divided into 82 training group, and 79 control group.
Results
The overall awareness scores indicate improvement post-training, with the mean scores increasing from pre-training 24.7(6.7) to post-training 30(6.4). The total awareness shift is statistically significant (t-test = -12.83, df = 160, p < 0.0011). The overall opinion increasing from pre-training 18.4(4.81) to post-training23.3(4.42). The total opinion shift is statistically significant (t-test = -8.99, df = 160, p < 0.0011).
Conclusion
Depending on the findings of this study, the antibiotic training course was found to be beneficial in improving mother’s awareness and opinion of antibiotic use and AMR, as well as providing an effective training course for mothers. Replicating these training initiatives within the community can empower mothers to proactively prevent infections, address their child’s health issues, and actively participate in treatment decisions, thereby fostering a collaborative approach to healthcare within the community it became imperative to improve the mothers’ awareness and opinion of antibiotic use and AMR among their children.
Keywords: AMR, Mothers, Awareness, Opinion, Practice
Introduction
According to the CDC, it is estimated that 1.27 million deaths worldwide are directly affected by antimicrobial resistance (AMR) and has indirect role in death of 4.95 million [1]. The improper prescription of antibiotics is considered a major threat that leads to AMR causing serious complications such as severe infections, complicated medical conditions, and even fatalities among children [2]. If AMR continues spreading without implementing strategies and correct antibiotic use to reduce AMR it is believed in 2050, 700,000 children could die annually from AMR-related complications [3].
One of the major causes of this high mortality rate is related to respiratory infections among children in developing countries because of the unnecessary antibiotic prescriptions and limited resources [4]. It is important to highlight the importance of antibiotic medications in treating respiratory infections among children, but individuals also need to highlight the importance of preventing inappropriate antibiotic use [5]. Mothers have a vital role because of their close contact with their children in providing appropriate care when using antibiotics [6, 7]. Despite their key role, there is few studies regarding their knowledge and practices of antibiotic, both in Jordan and globally [6, 8, 9].
Antibiotic use for children in developed and developing countries for non-established infection or due to viral infection is considered an international problem that leads to AMR [10]. According to United Nations International Children’s Emergency Fund(UNICEF) in Jordan, children represent 37% of the population in 2022 [11]. This age group is described as a vulnerable age for comorbidities and infections with high mortality and morbidity rates [11]. A study by UNICEF revealed that the mortality rate was 3,217 per 1000 live births in children under five years old [11]. By 2050, the WHO reports that 10 million fatalities annually due to AMR Although [12]. Antibiotics play a crucial role in child health [13]. AMR has a huge impact on the health of children [14], AMR makes infections worse, lasting longer, becoming more complicated and required hospitalization [15]. When bacteria become resistant to standard treatments, children are at a higher risk of getting more complicated diseases and even die [16]. This issue leads to longer hospital stays, higher medical bills, and the need for more expensive treatments that often come with serious side effects [17–19]. Both mothers and other caregivers could actively contribute in preventing AMR in children, particularly those receiving care from bedside mother play a significant role in achieving daily care objectives [20]. Thus, the rapid increase in AMR incidence has led to increased concern among World Health Organization [21]. Numerous approaches to reduce antibiotic misuse are more successful and impactful, better than single initiatives [6, 9, 21]. Interventions should include implementing Antimicrobial Stewardship (AMS) programs, following evidence-based procedures and standards, improving communication skills with pediatric patients and parents, and providing training resources [22, 23]. A study suggests providing frequent, up-to-date training sessions for mothers to enhance their knowledge awareness, opinions, and practice while using antibiotics for their children [24].
Previous studies show the effectiveness of antibiotic training course on mothers’ knowledge in preventing AMR and how to manage it including adjusting antibiotic use, hygiene and other infection control principles, and AMR surveillance [6]. Having this education program provides mothers with the necessary experience to recognize AMR infections, comprehend resistance mechanisms, and implement effective infection control strategies. In addition, these programs consider capping antibiotic usage, decreasing the duration of dosing, combining medications, enhancing infant well-being, and decreasing hospital budgets [6]. Consequently, our study aims to examine the effectiveness of a training course in enhancing mothers’ awareness and opinions toward antibiotic use and the prevention of AMR spreading.
Method
The non-equivalent control group design (quasi-experimental) was used to assess the effectiveness of the training course on mother’s knowledge, awareness, opinion, and practice regarding antibiotic use. Eligibility criteria included mothers with children under five years old who were willing to participate. Exclusion criteria included mothers who withdrew from study, those with mental illnesses, and mothers of children with chronic diseases.
Participants were recruited using purposive sampling via social media platforms and clinic visits to ensure a diverse sample. Efforts were made to include mothers from various socioeconomic background. The place left according to the participant’s preference to be online or face to face. The survey consists of two parts that include awareness and opinion toward antibiotic usage.
Mother’s awareness toward antibiotics among their children
The awareness survey, adapted from the WHO public awareness survey, assessed maternal practices in preventing antibiotic resistance that modified by [25]. This part is about how to prevent antibiotic resistance by mothers, physicians, and farmer’s practices. Also, the role of governments and pharmaceutical companies in aiding antibiotic resistance. This part consists of eight questions valid by a multi-country by. which consist of eight questions used 5-point Likert scale, the responses ranged from five (SA) to one (SD). An awareness score of less than four is considered as a poor awareness, score four or more to eight is considered good awareness. Validation data included Cronbach’s alpha values (original: 0.89; study: 0.854 ) [25].
Mother’s opinion toward antibiotic use
this part is the opinion toward antibiotic use and antibiotic resistance and it used multi-country public awareness survey tool that adopted from [25]. This part is about antibiotic resistance facts, the responsibilities of mothers when using antibiotics to decrease antibiotic resistance, and the role of medical experts in solving the spreading of antibiotic resistance. This part consists of six questions on a 5-point Likert scale. e. The responses ranged from five (SA) to one (SD). The reliability was measured with Cronbach’s alpha value was 0.89 [25]. and the reliability in this study was 0.736.
Data collection
Consent forms were obtained from the mothers after receiving Institutional Review Board (IRB) approval from Jordan University of Science and Technology. Data collection occurred between April and June 2024. To achieve a 100% response rate, the researchers utilized personalized communication, multichannel outreach, and clear expectation setting to engage participants effectively. Automation and follow-up processes addressed nonresponse, while continuous monitoring ensured high-quality data. These strategies highlight the importance of adaptable and participant-focused methods in research.
The mothers were divided into a training group and a control group. Both groups completed a pre-training questionnaire, after which the timing and location of the training sessions were arranged according to the mothers’ preferences. The training sessions consisted of a 30-minute PowerPoint presentation, a supplementary video shared via WhatsApp, and a 15-minute Q&A session. A post-training questionnaire was administered immediately following the sessions to assess opinions and awareness, while follow-up surveys two weeks later evaluated practical application, allowing sufficient time for practices to be implemented.
The control group also completed the pre-training questionnaire concurrently with the training group. Their second questionnaire was administered simultaneously with the training group’s post-session evaluations. No training or interventions were provided to the control group during this phase. After completing data collection from the control group, the training sessions were delivered to the training group, ensuring consistent methodological rigor.
Interventions
The educational program is structured according to the Center for Disease Control (CDC) basics using a program called “Moms Talk: Antibiotics”, which comes from “Be Antibiotic Aware Program” A World Antibiotic Awareness Week, it focuses on educating mothers about the appropriate use of antibiotics for themselves and their children. It focuses on educating mothers about the appropriate use of antibiotics for themselves and their children, and covers various topics such as understanding how to optimize usage of antibiotics appropriately for their children including antibiotic indications, where antibiotics are inappropriately prescribed, antibiotic initiation and how to take them correctly, antibiotic time outs, allergy history, adverse effects highlighting the significance of using antibiotics only when needed without overuse or misuse to prevent antibiotics resistance.It has also showed the importance of completing the full course of antibiotics prescribed by healthcare providers, emphasized the role of mothers in ensuring their families use antibiotics responsibly to help combat antibiotic resistance by using a pamphlet from CDC about antibiotics and a video in title Antibiotics are not always the answer translated to the Arabic. The educational sessions were presented by the researcher who prepared and got training, using PowerPoint presentations presented through the laptop in Arabic language, the WhatsApp application was used to distribute the educational session to the mothers and supported with videos.
Ethical considerations
The study was approved by the Institutional Review Board (IRB) of Jordan University of Science and Technology (# 20240188). It was in accordance with the Declaration of Helsinki. Recruited mothers were informed about the study’s purpose and procedures before providing written consent. To ensure confidentiality and anonymity, participants were assigned identification numbers instead of using names. Written informed consent was obtained from each mother in the study. The study posed no physical, social, psychological, or economic risks to the participants, and they were free to withdraw at any time without repercussions. For ethical considerations, mothers in the control group received the teaching materials, including a PowerPoint presentation, after completing the study procedures.
Data analysis
The data collected from participants were coded, entered into SPSS version 28, and validated prior to analysis. Continuous variables were summarized using means, medians, standard deviations, and minimum/maximum values. Categorical variables were described using frequencies and percentages. A bivariate chi-square test was conducted to compare baseline characteristics between the educational and control groups. For comparisons involving continuous variables, an independent t-test was employed. The significance level (alpha) was set at 0.05. Pearson’s correlation coefficient (r²) was used to assess the relationships between mothers’ knowledge, awareness, opinions, and practices.
Results
Demographic characteristics
The acceptance rate in this study was 100%. All the participants were female. The mean age was 30 + 4.7 See Table 1.
Table 1.
Comparison of the mothers’ socio-demographic characteristics between the two groups of mothers. N = 160
| Variable | Category | Control (N) | Control (%) | Intervention (N) | Intervention (%) | χ² | df | p-value |
|---|---|---|---|---|---|---|---|---|
| Age | 16–18 | 3.00 | 3.80 | 3.00 | 3.70 | 9.47 | 5.00 | 0.09 |
| 19–24 | 13.00 | 16.46 | 12.00 | 14.81 | ||||
| 25–34 | 40.00 | 50.63 | 30.00 | 37.04 | ||||
| 35–44 | 17.00 | 21.52 | 18.00 | 22.22 | ||||
| 45–54 | 6.00 | 7.59 | 12.00 | 14.81 | ||||
| 55–65 | 0.00 | < 0.001 | 6.00 | 7.41 | ||||
| Residential Location | Urban | 43.00 | 43.00 | 43.00 | 53.09 | 0.29 | 1.00 | 0.86 |
| Rural | 36.00 | 36.00 | 38.00 | 46.91 | ||||
| Highest Educational level of Mothers | No Formal Education | 17.00 | 17.00 | 15.00 | 18.52 | 4.47 | 4.00 | 0.35 |
| Vocational Training | 16.00 | 16.00 | 19.00 | 23.46 | ||||
| Bachelor’s degree | 43.00 | 43.00 | 40.00 | 49.38 | ||||
| Masters/professional degree | 3.00 | 3.00 | 3.00 | 3.70 | ||||
| Doctorate degree | 0.00 | < 0.001 | 4.00 | 4.94 | ||||
| Income of the family (1 JD = 1.35 USD) | Less than 300 JD | 12.00 | 12.00 | 13.00 | 16.05 | 6.37 | 3.00 | 0.10 |
| 300–500 JD | 39.00 | 39.00 | 35.00 | 43.21 | ||||
| 500–700 JD | 24.00 | 24.00 | 19.00 | 23.46 | ||||
| More than 700 JD | 4.00 | 4.00 | 14.00 | 17.28 | ||||
| Marriage Status | Married | 22.00 | 22.00 | 29.00 | 35.80 | 1.17 | 1.00 | 0.28 |
| Single/divorced or widow | 57.00 | 57.00 | 52.00 | 64.20 | ||||
| Number of Children | Less than two | 27.00 | 34.18 | 29.00 | 35.80 | 2.94 | 2.00 | 0.23 |
| (2–4) children | 40.00 | 50.63 | 32.00 | 39.51 | ||||
| More than four | 12.00 | 15.19 | 20.00 | 24.69 | ||||
| Having Chronic Disease | No | 43.00 | 54.43 | 38.00 | 46.91 | 0.90 | 1.00 | 0.34 |
| Yes | 36.00 | 45.57 | 43.00 | 53.09 |
Footnote for Table 1: χ2 = Chi-Square Test, df = Degrees of Freedom, p = p-value. Values with p < 0.05 indicate statistically significant differences. Results with p > 0.05 indicate no statistically significant differences
The differences between the two groups in the pre-training scores of mothers awareness toward antibiotic use and AMR
The awareness scores for both groups were 24.7(5.9) and control group 25.7(6.7). This indicates no significant difference between both groups in awareness before having training course (t = 1.042, df = 158, p = 0.239). None of the items showed differences between both groups. See Table 2.
Table 2.
Comparison of mother’s questions of Awareness at pre-training between the two analyzed groups
| Items | control | % | intervention | % | df | p-value | ||
|---|---|---|---|---|---|---|---|---|
| Use antibiotics only when prescribed | SD | 15.00 | 19.0% | 12.00 | 14.81 | 6.553a | 4.00 | 0.16 |
| D | 20.00 | 25.3% | 19.00 | 23.46 | ||||
| N | 14.00 | 17.7% | 19.00 | 23.46 | ||||
| A | 15.00 | 19.0% | 16.00 | 19.75 | ||||
| SA | 15.00 | 19.0% | 15.00 | 18.52 | ||||
| Farmers to reduce antibiotics in animals | SD | 17.00 | 21.5% | 13.00 | 16.05 | 5.268a | 4.00 | 0.26 |
| D | 20.00 | 25.3% | 19.00 | 23.46 | ||||
| N | 17.00 | 21.5% | 18.00 | 22.22 | ||||
| A | 16.00 | 20.3% | 16.00 | 19.75 | ||||
| SA | 9.00 | 11.4% | 15.00 | 18.52 | ||||
| Avoid saving antibiotics for later use | SD | 19.00 | 24.1% | 18.00 | 22.22 | 1.663a | 4.00 | 0.80 |
| D | 23.00 | 29.1% | 23.00 | 28.40 | ||||
| N | 13.00 | 16.5% | 13.00 | 16.05 | ||||
| A | 14.00 | 17.7% | 15.00 | 18.52 | ||||
| SA | 10.00 | 12.7% | 12.00 | 14.81 | ||||
| Ensure children’s vaccinations are up-to-date | SD | 6.00 | 7.6% | 5.00 | 6.17 | 9.909a | 4.00 | 0.42 |
| D | 22.00 | 27.8% | 16.00 | 19.75 | ||||
| N | 11.00 | 13.9% | 12.00 | 14.81 | ||||
| A | 14.00 | 17.7% | 20.00 | 24.69 | ||||
| SA | 26.00 | 32.9% | 28.00 | 34.57 | ||||
| People should wash their hands regularly | SD | 8.00 | 10.1% | 7.00 | 8.64 | 6.705a | 4.00 | 0.15 |
| D | 10.00 | 12.7% | 8.00 | 9.88 | ||||
| N | 10.00 | 12.7% | 11.00 | 13.58 | ||||
| A | 18.00 | 22.8% | 19.00 | 23.46 | ||||
| SA | 33.00 | 41.8% | 36.00 | 44.44 | ||||
| Physicians should only prescribe antibiotics when they are needed | SD | 20.00 | 25.3% | 15.00 | 18.52 | 10.819a | 4.00 | 0.29 |
| D | 21.00 | 26.6% | 17.00 | 20.99 | ||||
| N | 13.00 | 16.5% | 20.00 | 24.69 | ||||
| A | 14.00 | 17.7% | 16.00 | 19.75 | ||||
| SA | 11.00 | 13.9% | 13.00 | 16.05 | ||||
| Governments should reward the development of new antibiotics | SD | 11.00 | 13.9% | 15.00 | 18.52 | 6.150a | 4.00 | 0.13 |
| D | 20.00 | 25.3% | 13.00 | 16.05 | ||||
| N | 16.00 | 20.3% | 17.00 | 20.99 | ||||
| A | 11.00 | 13.9% | 13.00 | 16.05 | ||||
| SA | 21.00 | 26.6% | 23.00 | 28.40 | ||||
| Pharmaceutical companies should develop new antibiotics | SD | 6.00 | 7.6% | 8.00 | 9.88 | 12.892a | 4.00 | 0.12 |
| D | 21.00 | 26.6% | 20.00 | 24.69 | ||||
| N | 10.00 | 12.7% | 11.00 | 13.58 | ||||
| A | 19.00 | 24.1% | 20.00 | 24.69 | ||||
| SA | 23.00 | 29.1% | 22.00 | 27.16 | ||||
| Overall, awareness, mean (SD) | 25.7(5.9) | 24.7(6.7) |
t-test = 1.042 |
158.00 | 0.24 | |||
| Overall Mean Awareness Score (SD) | Control: 25.7 (5.9) | Intervention: 24.7 (6.7) |
Legend: SD = SD, D = D, N = N, A = A, SA = SA
Note: Chi-square test results indicated no significant differences between groups pre-training (p > 0.05)
Note: χ2 = Chi-Square Test, df = Degrees of Freedom, p = p-value. Values with p < 0.05 indicate statistically significant differences. Borderline results (e.g., p = 0.063) suggest trends but are not statistically significant
The differences between the two groups in the pre-training scores of mothers opinion toward antibiotic use and AMR
The overall mean opinion for the training 18.4(4.81) and control group 18.8(4.82). This indicates that there is no significant difference between both groups in opinion before having training course groups (t = 0.545, df = 158, p = 0. 548). None of the items showed differences between both groups. See Table 3.
Table 3.
Comparison of mother’s questions of Opinion at pre-training between the two analyzed groups
| Items | control | % | intervention | % | df | p-value | ||
|---|---|---|---|---|---|---|---|---|
| Antibiotic resistance is a global issue | SD | 15.00 | 19.0% | 13.00 | 16.05 | 1.977a | 4.00 | 0.74 |
| D | 21.00 | 26.6% | 21.00 | 25.93 | ||||
| N | 11.00 | 13.9% | 11.00 | 13.58 | ||||
| A | 18.00 | 22.8% | 20.00 | 24.69 | ||||
| SA | 14.00 | 17.7% | 16.00 | 19.75 | ||||
| Experts will address antibiotic resistance | SD | 9.00 | 11.4% | 17.00 | 20.99 | 12.036a | 4.00 | 0.17 |
| D | 19.00 | 24.1% | 18.00 | 22.22 | ||||
| N | 20.00 | 25.3% | 22.00 | 27.16 | ||||
| A | 16.00 | 20.3% | 15.00 | 18.52 | ||||
| SA | 15.00 | 19.0% | 9.00 | 11.11 | ||||
| Responsible antibiotic use is everyone’s duty | SD | 16.00 | 20.3% | 15.00 | 18.52 | 10.253a | 4.00 | 0.36 |
| D | 17.00 | 21.5% | 14.00 | 17.28 | ||||
| N | 17.00 | 21.5% | 19.00 | 23.46 | ||||
| A | 19.00 | 24.1% | 21.00 | 25.93 | ||||
| SA | 10.00 | 12.7% | 12.00 | 14.81 | ||||
| Individuals can make a difference in resistance | SD | 9.00 | 11.4% | 21.00 | 25.93 | 8.907a | 4.00 | 0.06 |
| D | 20.00 | 25.3% | 14.00 | 17.28 | ||||
| N | 16.00 | 20.3% | 18.00 | 22.22 | ||||
| A | 14.00 | 17.7% | 18.00 | 22.22 | ||||
| SA | 20.00 | 25.3% | 10.00 | 12.35 | ||||
| Worried about resistance impact on family health | SD | 11.00 | 13.9% | 13.00 | 16.05 | 15.026a | 4.00 | 0.12 |
| D | 15.00 | 19.0% | 17.00 | 20.99 | ||||
| N | 18.00 | 22.8% | 17.00 | 20.99 | ||||
| A | 19.00 | 24.1% | 17.00 | 20.99 | ||||
| SA | 16.00 | 20.3% | 17.00 | 20.99 | ||||
| I am not at risk of getting an antibiotic-resistant infection, as long as I take my antibiotics Correctly. | SD | 14.00 | 17.7% | 14.00 | 17.28 | 8.158a | 4.00 | 0.86 |
| D | 16.00 | 20.3% | 14.00 | 17.28 | ||||
| N | 12.00 | 15.2% | 12.00 | 14.81 | ||||
| A | 20.00 | 25.3% | 22.00 | 27.16 | ||||
| SA | 17.00 | 21.5% | 19.00 | 23.46 | ||||
| Overall, opinion, mean (SD) | 18.8(4.82) | 18.4(4.81) | t-test = 0.545 | 158.00 | 0.55 | |||
| Overall Opinion Score (Mean ± SD) | Control: 18.8 ± 4.82 | Intervention: 18.4 ± 4.81 | ||||||
| Overall Opinion Score (Mean ± SD) | Control: 18.8 ± 4.82 | Intervention: 18.4 ± 4.81 |
Legend for Table 3: SD = SD, D = D, N = N, A = A, SA = SA
Footnote: χ2 = Chi-Square Test, df = Degrees of Freedom, p = p-value. Values with p < 0.05 indicate statistically significant results. Results with p > 0.05 indicate no statistically significant differences
The differences in the training group between pre-training and scores of mothers’ awareness
The overall awareness increases in pre-training 24.7(6.7) compared to post-training 30(6.4). The total awareness shift is statistically significant. The increase in awareness scores was statistically significant (t = -12.83, df = 160, p < 0.001). All the items showed differences between both groups. Table 4 presents a comparison of participants’ responses before (pre-education) and after (post-training) in awareness toward antibiotic use and AMR.
Table 4.
Comparison of mothers’ awareness toward antibiotic use and prevention of antibiotic resistance in the pre-post training time
| Items | pre | % | post | % | df | p-value | ||
|---|---|---|---|---|---|---|---|---|
| People should use antibiotics only when they are prepared | SD | 12.00 | 14.81 | 1.00 | 1.23 | 63.079a | 4.00 | < 0.001 |
| D | 19.00 | 23.46 | 3.00 | 3.70 | ||||
| N | 19.00 | 23.46 | 4.00 | 4.94 | ||||
| A | 16.00 | 19.75 | 9.00 | 11.11 | ||||
| SA | 15.00 | 18.52 | 64.00 | 79.01 | ||||
| Farmers should give fewer antibiotics to food production | SD | 13.00 | 16.05 | 0.00 | < 0.001 | 49.033a | 4.00 | < 0.001 |
| D | 19.00 | 23.46 | 3.00 | 3.70 | ||||
| N | 18.00 | 22.22 | 8.00 | 9.88 | ||||
| A | 16.00 | 19.75 | 18.00 | 22.22 | ||||
| SA | 15.00 | 18.52 | 52.00 | 64.20 | ||||
| People should not keep antibiotics and use them la… | SD | 18.00 | 22.22 | 0.00 | < 0.001 | 48.557a | 4.00 | < 0.001 |
| D | 23.00 | 28.40 | 7.00 | 8.64 | ||||
| N | 13.00 | 16.05 | 10.00 | 12.35 | ||||
| A | 15.00 | 18.52 | 16.00 | 19.75 | ||||
| SA | 12.00 | 14.81 | 48.00 | 59.26 | ||||
| Parents should make sure all of their children’s v… | SD | 5.00 | 6.17 | 0.00 | < 0.001 | |||
| D | 16.00 | 19.75 | 2.00 | 2.47 | 33.706a | 4.00 | < 0.001 | |
| N | 12.00 | 14.81 | 8.00 | 9.88 | ||||
| A | 20.00 | 24.69 | 9.00 | 11.11 | ||||
| SA | 28.00 | 34.57 | 62.00 | 76.54 | ||||
| People should wash their hands regularly | SD | 7.00 | 8.64 | 0.00 | < 0.001 | 26.691a | 4.00 | < 0.001 |
| D | 8.00 | 9.88 | 5.00 | 6.17 | ||||
| N | 11.00 | 13.58 | 7.00 | 8.64 | ||||
| A | 19.00 | 23.46 | 4.00 | 4.94 | ||||
| SA | 36.00 | 44.44 | 65.00 | 80.25 | ||||
| Physicians should only prescribe antibiotics when… | SD | 15.00 | 18.52 | 0.00 | < 0.001 | 64.519a | 4.00 | < 0.001 |
| D | 17.00 | 20.99 | 5.00 | 6.17 | ||||
| N | 20.00 | 24.69 | 5.00 | 6.17 | ||||
| A | 16.00 | 19.75 | 9.00 | 11.11 | ||||
| SA | 13.00 | 16.05 | 62.00 | 76.54 | ||||
| Governments should reward the development of new a… | SD | 15.00 | 18.52 | 0.00 | < 0.001 | 39.029a | 4.00 | < 0.001 |
| D | 13.00 | 16.05 | 5.00 | 6.17 | ||||
| N | 17.00 | 20.99 | 5.00 | 6.17 | ||||
| A | 13.00 | 16.05 | 15.00 | 18.52 | ||||
| SA | 23.00 | 28.40 | 56.00 | 69.14 | ||||
| Pharmaceutical companies should develop new antibi… | SD | 8.00 | 9.88 | 0.00 | < 0.001 | 42.482a | 4.00 | < 0.001 |
| D | 20.00 | 24.69 | 3.00 | 3.70 | ||||
| N | 11.00 | 13.58 | 3.00 | 3.70 | ||||
| A | 20.00 | 24.69 | 16.00 | 19.75 | ||||
| SA | 22.00 | 27.16 | 59.00 | 72.84 | ||||
| Overall, awareness, mean (SD) | 24.7(6.7) | 30(6.4) |
t-test = -12.83 |
160.00 | < 0.001 | |||
| Overall, awareness, mean (SD) | 24.7(6.7) | 30(6.4) | t-test = -12.83 | 160.00 | < 0.001 | |||
| Overall Awareness Score (Mean ± SD) | Pre: 24.7 ± 6.7 | Post: 30 ± 6.4 |
Legend for Table 4: SD = SD, D = D, N = N, A = A, SA = SA
Footnote: χ² = Chi-Square Test, df = Degrees of Freedom, p = p-value
Table 4: Significant improvements in awareness and opinion scores are highlighted. Results with p < 0.001 are highly significant
The differences in the training group between pre-training and post-training scores of mothers’ opinion toward antibiotic use and AMR
The overall opinion scores were increasing from pre-training 18.4(4.81) to post-training 23.3(4.42). The total opinion shift is statistically significant (t-test = -8.99, df = 160, p < 0.001). All the items showed differences between both groups before and after training. Table 5 presents a comparison of participants’ responses before (pre-education) and after (post-training) in awareness toward antibiotic use and AMR.
Table 5.
Comparison of mothers’ Opinion toward antibiotic use and prevention of antibiotic resistance in the pre-post training time
| Items | pre | % | post | % | df | p-value | ||
|---|---|---|---|---|---|---|---|---|
| Antibiotic resistance is one of the biggest proble… | SD | 13.00 | 16.05 | 0.00 | < 0.001 | 48.04 | 4.00 | < 0.001 |
| D | 21.00 | 25.93 | 3.00 | 3.70 | ||||
| N | 11.00 | 13.58 | 8.00 | 9.88 | ||||
| A | 20.00 | 24.69 | 16.00 | 19.75 | ||||
| SA | 16.00 | 19.75 | 54.00 | 66.67 | ||||
| Medical experts will solve the problem of antibiot… | SD | 9.00 | 11.11 | 2.00 | 2.47 | 43.756a | 4.00 | < 0.001 |
| D | 15.00 | 18.52 | 33.00 | 40.74 | ||||
| N | 22.00 | 27.16 | 8.00 | 9.88 | ||||
| A | 18.00 | 22.22 | 0.00 | < 0.001 | ||||
| SA | 17.00 | 20.99 | 38.00 | 46.91 | ||||
| Everyone needs to take responsibility for using an… | SD | 15.00 | 18.52 | 1.00 | 1.23 | 89.067a | 4.00 | < 0.001 |
| D | 14.00 | 17.28 | 3.00 | 3.70 | ||||
| N | 19.00 | 23.46 | 6.00 | 7.41 | ||||
| A | 21.00 | 25.93 | 0.00 | < 0.001 | ||||
| SA | 12.00 | 14.81 | 71.00 | 87.65 | ||||
| There is not many people like me can do to stop an… | SD | 10.00 | 12.35 | 3.00 | 3.70 | 37.553a | 4.00 | < 0.001 |
| D | 18.00 | 22.22 | 1.00 | 1.23 | ||||
| N | 18.00 | 22.22 | 6.00 | 7.41 | ||||
| A | 14.00 | 17.28 | 24.00 | 29.63 | ||||
| SA | 21.00 | 25.93 | 47.00 | 58.02 | ||||
| I am worried about the impact that antibiotic resi… | SD | 13.00 | 16.05 | 2.00 | 2.47 | 36.581a | 4.00 | < 0.001 |
| D | 17.00 | 20.99 | 4.00 | 4.94 | ||||
| N | 17.00 | 20.99 | 6.00 | 7.41 | ||||
| A | 17.00 | 20.99 | 21.00 | 25.93 | ||||
| SA | 17.00 | 20.99 | 48.00 | 59.26 | ||||
| I am not at risk of getting an antibiotic-resistan… | SD | 14.00 | 17.28 | 7.00 | 8.64 | 28.971a | 4.00 | < 0.001 |
| D | 14.00 | 17.28 | 6.00 | 7.41 | ||||
| N | 12.00 | 14.81 | 5.00 | 6.17 | ||||
| A | 22.00 | 27.16 | 10.00 | 12.35 | ||||
| SA | 19.00 | 23.46 | 53.00 | 65.43 | ||||
| Overall, Opinion, mean (SD) | 18.4(4.81) | 23.3(4.42) | t-test = -8.99 | 160.00 | < 0.001 | |||
| Overall, Opinion, mean (SD) | 18.4(4.81) | 23.3(4.42) | t-test = -8.99 | 160.00 | < 0.001 | |||
| Overall Opinion Score (Mean ± SD) | Pre: 18.4 ± 4.81 | Post: 23.3 ± 4.42 |
Legend for Table 5: SD = SD, D = D, N = N, A = A, SA = SA. Note for Table 5: Pre-post training comparisons indicate significant improvements in opinion scores (p < 0.001). Results demonstrate the effectiveness of the intervention
Discussion
This study aims to examine the impact of a training course in improving mothers’ awareness and opinion of antibiotic use and antimicrobial resistance (AMR) among their children using quasi-experimental design. Our study validated there were no significant mean differences between the pre-training between groups regarding the mother’s awareness of antibiotic use among their children. Similarly, two studies were conducted in India regarding mother’s awareness, and opinion toward antibiotic use and AMR [26, 27]. Firstly, Chinnasami et al. [27] found more than half expect the physician to prescribe antibiotics to them. The majority of mothers suppose using antibiotics for fever and ear infections is necessary. and almost 86.3% of mothers believed using antibiotics for colds would speed up recovery. Secondly, Revathi & Pandurangan [26] found almost half of the mother’s purchase antibiotics without a physician’s prescription. Also, more than half of the mothers give a higher dose than the prescribed dose. Moreover, two studies were conducted in developing countries to investigate mother’s awareness and opinions toward antibiotics [22, 28]. Firstly, Paredes et al. [28] conducted a study in Pure among 231 mothers of under-five children to assess their awareness, and opinion toward antibiotics. They found that more than half had inadequate awareness, and opinions for example, the majority 80.1% were not satisfied if physicians do not prescribe antibiotics and they want that, and 72.2%Ad antibiotics will accelerate cold infection cure. Secondly, Saeed & Awadalla [29] found more than half of 154 mothers had negative awareness, opinions awareness, opinion example, near to one quarter, chose to use antibiotics at home. 13.7% prefer to use antibiotics which are already found at home.
In Africa, three studies were conducted in Africa regarding awareness, and opinion toward antibiotics [30–32]. Firstly, Geta & Kibret [32] found more than half had poor awareness, and opinions regarding antibiotic use and AMR for example, nearly one-quarter of them believed that the physician should prescribe a combination of antibiotics for severe flu, and nearly half preferred expensive antibiotics. Secondly, Mutagonda et al. [31] conducted a study in Tanzania that found more than half 56% of mothers had a negative awareness or opinion toward antibiotic use and AMR for example, the majority of them 83.8% give antibiotics without a physician’s prescription, and, more than two-fifths give antibiotics without indication. Thirdly, Okide et al. [30] in Nigeria found the majority of mothers 91% mentioned they needed more information about antibiotic use and one quarter preferred parental tablet antibiotics and, around one-third preferred using newer antibiotics. The results support the importance of such training program in improving awareness and opinion regarding antibiotics and AMR among mothers regardless of country and culture.
In Saudi Arabia, two studies were conducted in Saudi Arabia regarding parent’s awareness, and opinions toward antibiotics [22] (Al-Ayed, 2019; Alzaid et al., 2020). Firstly, Al-Ayed [22] found that the majority of mothers have a negative awareness, and opinion toward antibiotics such as a child’s condition is not dangerous to get the child to a clinic or lacking the time. Also, half of the mothers did not get advice from physicians for antibiotics use for their children. Almost 68.6% of mother’s purchase antibiotics without a prescription from the pharmacy. The most common reason for getting antibiotics directly from the pharmacy that consulting the physician, it is easier to have it. Secondly, Alzaid et al. [33] conducted a study to assess mother’s awareness, and opinions toward antibiotic use and AMR. They found most mothers had a negative awareness, and opinion toward antibiotics for example, Mothers give antibiotics for earache, fever, cold, and vomiting. When asking mothers about the most alternative treatments for infection, 75% of them used antibiotics. The results support the importance of such training program in improving awareness and opinion regarding antibiotics and AMR among mothers.
In Middle East, three studies were conducted regarding mother’s awareness, and opinions toward antibiotics [34–36]. Firstly, Mallah et al. [35] found half of the participants stored antibiotics as leftovers for future use and, when their children get sick, they get antibiotics from relatives. Secondly, Mukattash et al. [34] conducted found that 24% believed that previous prescriptions of antibiotics could be reused with the same symptoms for their child. Thirdly, Zyoud et al. [36] in Palestine found most of the mother’s prompt physicians to prescribe antibiotics for their child if they have these symptoms earache (68%) fever (64%) cold (52%) cough (34%) or vomiting (30%) and, nearly half of these mother’s mention that they use antibiotics because they believe these symptoms are not dangerous. To implement this training in other settings such as western culture, it can be adapted to the local context by considering cultural, linguistic, and logistical factors. Collaboration with community leaders and stakeholders, along with the use of accessible resources and technology, ensures scalability and relevance across diverse population.
Our study showed that the training group improved in awareness and opinion. Notably, there is a gap in the literature regarding the importance and the effectiveness of training course among parent’s awareness and opinion toward antibiotic use to their children. Only five studies were conducted about the impact of training course on knowledge, awareness, opinion and practice toward AMR [24, 37–40] For example, two quasi-experimental studies were conducted in Egypt [24, 37]. Firstly, Abd El-Kader & Mohammed [37] found only 5.3% had good knowledge regarding antibiotic use and AMR among children as pre-intervention, which increased significantly to (81.6% and 75.5%) as post-intervention, and 3 months of follow-up respectively. Related to the awareness, and opinions subheading, only 18.5% had good awareness, and opinion toward antibiotic use and AMR among their children, which increased significantly to 88.5%) after intervention, then decreased to 78.2% as a follow-up. Regarding antibiotic use and subjective AMR practice, only one quarter had good practice with antibiotics for their ill child; however, this percentage increased after the intervention to 81.5%, then declined to 77.3%) during the follow-up period. The results support the importance of such training program in improving awareness and opinion regarding antibiotics and AMR among mothers. Secondly, Abozed et al. [24] found the learning package showed significant effectiveness in all subheadings. Almost 82.5% of the majority of mother lack knowledge regarding antibiotic use and AMR for their children with upper respiratory tract infections which significantly increased toward positive knowledge directly in practical knowledge of antibiotic use and AMR before the learning package, poor practice among mothers regarding antibiotic use and AMR for their children with upper respiratory tract infections increased from 67.8 to 94.4% immediately after the intervention. Also, mothers had incomplete practice of antibiotic use and AMR, which diminished immediately after the learning package. To implement this training in other settings, it can be adapted to the local context by considering cultural, linguistic, and logistical factors. Collaboration with community leaders and stakeholders, along with the use of accessible resources and technology, ensures scalability and relevance across diverse population.
Limitation
This designs (pre-post control and educational groups) have several limitations. When combined with self-reported questionnaires to measure knowledge, awareness, opinion, and practice, additional considerations arise. The quasi-experimental designs lack the random assignment of participants to groups, making it challenging to establish a cause-and-effect relationship. The quasi-experimental designs may limit the generalizability of findings. The use of self-reported questionnaires is susceptible to social desirability bias, where participants respond that they believe, are socially acceptable rather than accurate. This bias can impact on the validity of knowledge, awareness, opinion, and practice measures.
Implication
This study highlights the vital role of antibiotic education programs for mothers in combating antimicrobial resistance (AMR) in children. By enhancing knowledge, awareness, and practices, these programs equip mothers with the skills to use antibiotics responsibly and manage infections effectively, contributing to reduced AMR-related morbidity and mortality. Integrating such initiatives into routine healthcare practices ensures sustainability and impact, empowering mothers to make informed decisions and play an active role in their children’s health.
Policymakers can leverage these findings to evaluate and scale these programs, ensuring their benefits reach more communities. By offering workshops, training sessions, and community-driven activities, these programs foster proactive infection prevention and treatment approaches. Expanding such initiatives can empower mothers to address their children’s healthcare needs collaboratively, transforming AMR prevention efforts and improving public health outcomes in Jordan and beyond.
Conclusion
The training course significantly enhanced mothers’ awareness and attitudes toward antibiotic use and antimicrobial resistance (AMR), highlighting its potential as a scalable public health intervention. Its effectiveness stemmed from the combination of evidence-based content and interactive, practical methods that engaged participants and improved their understanding of antibiotic-related topics. By targeting specific knowledge gaps and reinforcing key concepts through hands-on activities, the program enabled participants to retain and apply the information effectively.
Future research should focus on assessing the long-term retention of knowledge and attitudes following the training and exploring the effectiveness of similar interventions in other demographic groups. Expanding such efforts could provide valuable insights into optimizing educational strategies for combating AMR across diverse populations.
Author contributions
Authors Contributions: Sawsan Abuhammad, Tasneem Daood2, Heba Hijazi, Hossam Alhawatmeh, Shaher Hamaideh, Abedalziz Hendy, Amat-Alkhaleq Mehrass, Nabeel Al Yateem and Zelal Kharaba, Maryam El-zubi and Bilal Naja was participated in writing and analyzing data. All the participants were participated in all steps of this study.
Funding
No funding was received for this study.
Data availability
Data will be avaliable upon reasonable request.
Declarations
Ethical approval
The study was approved by the Institutional Review Board (IRB) of Jordan University of Science and Technology (# 20240188). It was in accordance with the Declaration of Helsinki. Written informed consent was obtained from each mother in the study.
Consent to participate
All participants sign consent to participate in the study.
Consent for publication
Not Applicable.
Consent to publish
Not Applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
Data will be avaliable upon reasonable request.