PERCEPTIONS OF HEALTHCARE PROFESSIONALS TOWARDS ANTIMICROBIAL RESISTANCE AND STEWARDSHIP: A MULTI-CENTRE CROSS-SECTIONAL STUDY FROM PAKISTAN

Abstract

Background: Antimicrobial resistance (AMR) poses an escalating threat to global public health, with inappropriate prescribing as its most modifiable driver. Healthcare professional perceptions of AMR are a critical determinant of prescribing behaviour, yet data from Pakistan, where stewardship infrastructure remains nascent, are largely absent from the literature.

Objectives: To determine the prevalence of positive AMR perceptions among healthcare professionals at a tertiary care hospital in Pakistan, examine associations with demographic characteristics, and identify subgroups requiring targeted educational intervention.

Methods: A cross-sectional study enrolled 259 healthcare professionals (physicians, nurses, pharmacists, and dentists) with an 84.1% response rate. A validated 10-item Likert scale assessed AMR perceptions; a mean item score of 3.5 or above defined positive perception. Non-parametric tests (Mann-Whitney U, Kruskal-Wallis H with Bonferroni post-hoc correction, Spearman rank correlation) were used following confirmed non-normality of the total score (Shapiro-Wilk W=0.790, p<0.001).

Results: The scale demonstrated excellent internal consistency (Cronbach's alpha=0.963). Overall, 176 respondents (68.0%; 95% CI: 62.3 to 73.6%) held positive AMR perceptions. Nurses recorded the lowest mean score (24.45 vs 38.13 for physicians; H=48.92, p<0.001; Cramer's V=0.458), with only 41.0% classified as positive perceivers. Males scored significantly higher than females (mean 39.17 vs 27.91; U=11647.5, p<0.001; r=0.343). Younger respondents (18 to 30 years) demonstrated the most positive perceptions (82.0%; H=37.99, p<0.001), and a significant inverse correlation was observed between age and total score (Spearman rho=-0.374, p<0.001). Perception scores followed a non-linear pattern across experience categories, declining through the 3 to 6 year range before recovering among those with seven or more years of experience (85.3% positive).

Conclusion: Positive AMR perceptions were present in approximately two-thirds of the surveyed workforce, with nurses consistently scoring lowest across all analyses. Professional category was the strongest demographic predictor, followed by age and gender. Profession-specific educational interventions targeting nursing staff and structured stewardship integration at tertiary care facilities in Pakistan are urgently warranted.