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Effect of Antimicrobial Resistance Education on Antibiotic-Seeking Practices among Young Adults in Nigeria

Abstract

Antimicrobial resistance (AMR) is an important public health concern in Nigeria because inappropriate and excessive use of antibiotics can contribute to the development and spread of resistant microorganisms, making infections more difficult and costly to treat. Young adults may contribute to inappropriate antibiotic use through self-medication, obtaining antibiotics without appropriate medical consultation, requesting antibiotics for illnesses that may not require them, using leftover medicines, sharing antibiotics, or discontinuing treatment when symptoms improve. Limited knowledge of AMR, misconceptions about antibiotics, previous experiences with antibiotic treatment, easy access to medicines, and inadequate awareness of appropriate antibiotic use may influence antibiotic-seeking behaviours. Antimicrobial resistance education provides an opportunity to improve knowledge of antibiotic use, explain the consequences of resistance, distinguish bacterial from non-bacterial illnesses, and promote appropriate healthcare-seeking and antibiotic-use practices. Against this background, this study investigates the effect of antimicrobial resistance education on antibiotic-seeking practices among young adults in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Social Cognitive Theory. The Health Belief Model explains how young adults' perceptions of the risks associated with antimicrobial resistance, perceived severity of resistant infections, perceived benefits of appropriate antibiotic use, perceived barriers, and cues to action may influence antibiotic-seeking behaviour. The Theory of Planned Behavior emphasizes attitudes toward antibiotic use, subjective norms, perceived behavioural control, and behavioural intentions as determinants of antibiotic-seeking practices. Social Cognitive Theory emphasizes observational learning, social influence, self-efficacy, reinforcement, and behavioural skills in developing responsible antibiotic-use behaviours. Collectively, these theoretical perspectives provide a suitable framework for explaining how antimicrobial resistance education may influence antibiotic-seeking practices among young adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise young adults aged 18–35 years residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, universities, workplaces, and eligible young adults. Antimicrobial resistance education will be assessed using indicators such as exposure to AMR education sessions, frequency and duration of educational activities, knowledge of antibiotic resistance, appropriate indications for antibiotic use, differences between bacterial and viral infections, dangers of self-medication, risks associated with incomplete or inappropriate antibiotic use, antibiotic stewardship, prescription requirements, healthcare-seeking, medicine-sharing, use of leftover antibiotics, and availability of educational materials and practical examples. Antibiotic-seeking practices will be assessed using indicators such as seeking professional medical assessment before obtaining antibiotics, requesting antibiotics for symptoms without a confirmed need, purchasing antibiotics without appropriate prescription, self-medication, use of leftover antibiotics, sharing antibiotics with others, obtaining antibiotics from informal sources, adherence to prescribed treatment instructions, and willingness to accept non-antibiotic treatment when antibiotics are not indicated. Data will be collected using structured questionnaires, standardized AMR knowledge and antibiotic-use practice assessment tools, scenario-based antibiotic-seeking assessments, pharmacy records where available, and relevant public health programme documents. Descriptive statistics will be used to summarize participants' characteristics, sources of antibiotics, exposure to AMR education, knowledge levels, and antibiotic-seeking patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of antimicrobial resistance education on antibiotic-seeking practices. Where a quasi-experimental design is adopted, antibiotic-seeking practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that antimicrobial resistance education has a significant positive effect on antibiotic-seeking practices among young adults in Nigeria. Young adults exposed to structured AMR education are expected to demonstrate more appropriate antibiotic-seeking behaviours than young adults without comparable exposure. Education may improve understanding of antimicrobial resistance, the appropriate role of antibiotics, and the risks associated with unnecessary antibiotic use. It may discourage self-medication, purchasing antibiotics without appropriate professional assessment, using leftover antibiotics, sharing medicines, and requesting antibiotics for illnesses that may not require them. Education may also encourage young adults to seek appropriate healthcare assessment and accept alternative treatment when antibiotics are not clinically indicated. Practical education using real-life scenarios may strengthen decision-making and reduce misconceptions regarding the effectiveness of antibiotics for common illnesses. However, easy access to antibiotics, informal medicine markets, financial barriers to healthcare consultations, previous positive experiences with self-medication, peer influence, limited enforcement of prescription regulations, and inadequate access to qualified healthcare professionals may reduce the effectiveness of education alone. The study therefore expects accessible, practical, evidence-based, and sustained AMR education, supported by responsible antibiotic dispensing and accessible healthcare services, to contribute significantly to improved antibiotic-seeking practices among young adults in Nigeria. The study is expected to contribute to the literature on antimicrobial resistance, antibiotic use, antibiotic-seeking behaviour, health education, antibiotic stewardship, self-medication, infectious disease prevention, young-adult health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Agency for Food and Drug Administration and Control, Pharmacy Council of Nigeria, state ministries of health, healthcare professionals, pharmacists, community health workers, universities, youth organizations, development partners, and policymakers regarding strategies for reducing inappropriate antibiotic use. The study will also provide evidence-based recommendations for strengthening AMR education among young adults, integrating antibiotic-stewardship education into university and community health programmes, improving public awareness of responsible antibiotic use, strengthening regulation of antibiotic dispensing, expanding access to appropriate healthcare consultations, and promoting effective public health communication on antimicrobial resistance across Nigeria.

Keywords: Antimicrobial resistance education, antibiotic-seeking practices, antibiotic use, antibiotic stewardship, self-medication, young adults, health education, antimicrobial resistance, infectious disease prevention, Nigeria, public health.