{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:07:03Z","timestamp":1793394423747,"version":"4.5.0"},"reference-count":66,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T00:00:00Z","timestamp":1747440000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T00:00:00Z","timestamp":1747440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["72004066 & 71904053"],"award-info":[{"award-number":["72004066 & 71904053"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>To understand the reasons for the public\u2019s irrational use of antibiotics based on the health belief model (HBM). A questionnaire survey was conducted based on cluster random sampling in Chongqing, China. The public\u2019s antibiotic use behaviors, knowledge, perceived threat of diseases [both short-term upper respiratory tract infections (URTIs) and long-term antibiotic resistance (AR)], perceived value of antibiotic use (benefits and harm), self-efficacy, antibiotic availability and social influences were measured. Structural equation modeling (SEM) was applied to test the fitness of the survey data with the theoretical framework based on the HBM. A total of 815 respondents were enrolled. The irrational use of antibiotics was prevalent among the public (mean: 2.95, SD\u2009=\u20092.12). The public had limited knowledge about antibiotic use (average 29.17% correct answers to 8 questions), a high perceived threat of AR (mean\u2009=\u20092.46, SD\u2009=\u20090.64) and a moderate perceived threat of URTIs (mean\u2009=\u20092.13, SD\u2009=\u20091.04). They also perceived high benefits (mean\u2009=\u20092.57, SD\u2009=\u20090.68) and moderate harm (mean\u2009=\u20092.16, SD\u2009=\u20090.83) from antibiotic use. In addition, respondents had easy access to antibiotics (mean\u2009=\u20092.38, SD\u2009=\u20090.80), perceived a high prevalence of use of antibiotics by relatives (mean\u2009=\u20092.40, SD\u2009=\u20090.65) and had a moderate level of self-efficacy in using antibiotics (mean\u2009=\u20091.97, SD\u2009=\u20090.75). The SEM results showed that higher levels of the perceived threat of URTIs, perceived benefits of antibiotic use, self-efficacy, antibiotic availability and social influence were associated with more irrational antibiotic use behavior (p\u2009&lt;\u20090.005). Moreover, higher knowledge indirectly led to irrational use of antibiotics by promoting self-efficacy (p\u2009&lt;\u20090.001) and the perceived threat of URTIs (p\u2009&lt;\u20090.005). To curb the irrational use of antibiotics, improving knowledge alone is insufficient. A \u200b\u200bsystematic approach addressing multiple dimensions of health beliefs\u200b\u200b is critical. This includes: (1) \u200b\u200btargeted public education campaigns\u200b\u200b emphasizing the limited efficacy of antibiotics for viral infections and reframing perceptions of antibiotic \u201cbenefits\u201d; (2) \u200b\u200bregulatory measures to restrict non-prescription antibiotic sales\u200b\u200b in pharmacies; (3) \u200b\u200bclinical guidelines and training\u200b\u200b to reduce unnecessary antibiotic prescriptions by healthcare providers; and (4) \u200b\u200bcommunity-level interventions\u200b\u200b leveraging social norms to discourage inappropriate antibiotic use. Policymakers should prioritize interventions that address both individual perceptions (e.g., fear of untreated infections) and systemic drivers (e.g., antibiotic accessibility).<\/jats:p>","DOI":"10.1038\/s41598-025-01767-9","type":"journal-article","created":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T17:55:22Z","timestamp":1747504522000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The public\u2019s irrational use of antibiotics for upper respiratory tract infections: a cross-sectional study based on the health belief model"],"prefix":"10.1038","volume":"15","author":[{"given":"Xi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenxi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangjiang","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rujiao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixia","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianning","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,17]]},"reference":[{"key":"1767_CR1","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/s1473-3099(16)30127-x","volume":"16","author":"LJV Piddock","year":"2016","unstructured":"Piddock, L. J. V. Reflecting on the final report of the O\u2019Neill review on antimicrobial resistance. Lancet Infect. Dis. 16, 767\u2013768. https:\/\/doi.org\/10.1016\/s1473-3099(16)30127-x (2016).","journal-title":"Lancet Infect. Dis."},{"key":"1767_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2096","volume":"340","author":"C Costelloe","year":"2010","unstructured":"Costelloe, C., Metcalfe, C., Lovering, A., Mant, D. & Hay, A. D. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 340, c2096. https:\/\/doi.org\/10.1136\/bmj.c2096 (2010).","journal-title":"BMJ"},{"key":"1767_CR3","doi-asserted-by":"publisher","first-page":"1722","DOI":"10.3201\/eid1411.070467","volume":"14","author":"N van de Sande-Bruinsma","year":"2008","unstructured":"van de Sande-Bruinsma, N. et al. Antimicrobial drug use and resistance in Europe. Emerg. Infect. Dis. 14, 1722\u20131730. https:\/\/doi.org\/10.3201\/eid1411.070467 (2008).","journal-title":"Emerg. Infect. Dis."},{"key":"1767_CR4","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/s0140-6736(05)17907-0","volume":"365","author":"H Goossens","year":"2005","unstructured":"Goossens, H., Ferech, M., Vander Stichele, R. & Elseviers, M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365, 579\u2013587. https:\/\/doi.org\/10.1016\/s0140-6736(05)17907-0 (2005).","journal-title":"Lancet"},{"key":"1767_CR5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0117710","volume":"10","author":"W Mao","year":"2015","unstructured":"Mao, W., Vu, H., Xie, Z., Chen, W. & Tang, S. Systematic review on irrational use of medicines in China and Vietnam. PLoS ONE 10, e0117710. https:\/\/doi.org\/10.1371\/journal.pone.0117710 (2015).","journal-title":"PLoS ONE"},{"key":"1767_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.prevetmed.2019.104858","volume":"175","author":"OJ Dyar","year":"2020","unstructured":"Dyar, O. J. et al. Knowledge, attitudes and practices relating to antibiotic use and antibiotic resistance among backyard pig farmers in rural Shandong province, China. Prev. Vet. Med. 175, 104858. https:\/\/doi.org\/10.1016\/j.prevetmed.2019.104858 (2020).","journal-title":"Prev. Vet. Med."},{"key":"1767_CR7","doi-asserted-by":"publisher","first-page":"3259","DOI":"10.2147\/idr.S219287","volume":"12","author":"J Wang","year":"2019","unstructured":"Wang, J. et al. Shanghai parents\u2019 perception and attitude towards the use of antibiotics on children: A cross-sectional study. Infect. Drug Resist. 12, 3259\u20133267. https:\/\/doi.org\/10.2147\/idr.S219287 (2019).","journal-title":"Infect. Drug Resist."},{"key":"1767_CR8","doi-asserted-by":"publisher","first-page":"1287334","DOI":"10.1080\/16549716.2017.1287334","volume":"10","author":"Z Zhang","year":"2017","unstructured":"Zhang, Z. et al. Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions. Glob. Health Action 10, 1287334. https:\/\/doi.org\/10.1080\/16549716.2017.1287334 (2017).","journal-title":"Glob. Health Action"},{"key":"1767_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0225499","volume":"14","author":"GF Aljayyousi","year":"2019","unstructured":"Aljayyousi, G. F., Abdel-Rahman, M. E., El-Heneidy, A., Kurdi, R. & Faisal, E. Public practices on antibiotic use: A cross-sectional study among Qatar University students and their family members. PLoS ONE 14, e0225499. https:\/\/doi.org\/10.1371\/journal.pone.0225499 (2019).","journal-title":"PLoS ONE"},{"key":"1767_CR10","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1016\/s1473-3099(19)30324-x","volume":"19","author":"J Chang","year":"2019","unstructured":"Chang, J. et al. Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. Lancet Infect. Dis. 19, 1345\u20131354. https:\/\/doi.org\/10.1016\/s1473-3099(19)30324-x (2019).","journal-title":"Lancet Infect. Dis."},{"key":"1767_CR11","first-page":"30","volume":"8","author":"H Gelbrand","year":"2015","unstructured":"Gelbrand, H. et al. The state of the world\u2019s antibiotics 2015. Wound Heal. South. Afr. 8, 30\u201334 (2015).","journal-title":"Wound Heal. South. Afr."},{"key":"1767_CR12","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/s1473-3099(14)70780-7","volume":"14","author":"TP Van Boeckel","year":"2014","unstructured":"Van Boeckel, T. P. et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect. Dis. 14, 742\u2013750. https:\/\/doi.org\/10.1016\/s1473-3099(14)70780-7 (2014).","journal-title":"Lancet Infect. Dis."},{"key":"1767_CR13","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/s1473-3099(11)70054-8","volume":"11","author":"DJ Morgan","year":"2011","unstructured":"Morgan, D. J., Okeke, I. N., Laxminarayan, R., Perencevich, E. N. & Weisenberg, S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect. Dis. 11, 692\u2013701. https:\/\/doi.org\/10.1016\/s1473-3099(11)70054-8 (2011).","journal-title":"Lancet Infect. Dis."},{"key":"1767_CR14","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1186\/s12889-015-2109-3","volume":"15","author":"M Ocan","year":"2015","unstructured":"Ocan, M. et al. Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries. BMC Public Health 15, 742. https:\/\/doi.org\/10.1186\/s12889-015-2109-3 (2015).","journal-title":"BMC Public Health"},{"key":"1767_CR15","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.puhe.2018.11.018","volume":"168","author":"NF Torres","year":"2019","unstructured":"Torres, N. F., Chibi, B., Middleton, L. E., Solomon, V. P. & Mashamba-Thompson, T. P. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public Health 168, 92\u2013101. https:\/\/doi.org\/10.1016\/j.puhe.2018.11.018 (2019).","journal-title":"Public Health"},{"key":"1767_CR16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003599","author":"L Lin","year":"2020","unstructured":"Lin, L., Sun, R., Yao, T., Zhou, X. & Harbarth, S. Factors influencing inappropriate use of antibiotics in outpatient and community settings in China: a mixed-methods systematic review. BMJ Glob. Health. https:\/\/doi.org\/10.1136\/bmjgh-2020-003599 (2020).","journal-title":"BMJ Glob. Health."},{"key":"1767_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodcont.2022.109198","volume":"141","author":"DT da Cunha","year":"2022","unstructured":"da Cunha, D. T. et al. Knowledge, attitudes and practices model in food safety: Limitations and methodological suggestions. Food Control 141, 109198. https:\/\/doi.org\/10.1016\/j.foodcont.2022.109198 (2022).","journal-title":"Food Control"},{"key":"1767_CR18","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1093\/jac\/dkl558","volume":"59","author":"CA McNulty","year":"2007","unstructured":"McNulty, C. A., Boyle, P., Nichols, T., Clappison, P. & Davey, P. Don\u2019t wear me out\u2014the public\u2019s knowledge of and attitudes to antibiotic use. J. Antimicrob. Chemother. 59, 727\u2013738. https:\/\/doi.org\/10.1093\/jac\/dkl558 (2007).","journal-title":"J. Antimicrob. Chemother."},{"key":"1767_CR19","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.985188","volume":"10","author":"L Duan","year":"2022","unstructured":"Duan, L. et al. The vicious cycle of the public\u2019s irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review. Front. Public Health 10, 985188. https:\/\/doi.org\/10.3389\/fpubh.2022.985188 (2022).","journal-title":"Front. Public Health"},{"key":"1767_CR20","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1080\/10826084.2023.2181035","volume":"58","author":"JC David","year":"2023","unstructured":"David, J. C., Piednoir, E., Nadarajah, K. & Delouv\u00e9e, S. Attitudes, knowledge, risk perception of antimicrobial resistance and antibiotic use behaviors: A cross-sectional survey in a young adult population. Subst. Use Misuse 58, 698\u2013703. https:\/\/doi.org\/10.1080\/10826084.2023.2181035 (2023).","journal-title":"Subst. Use Misuse"},{"key":"1767_CR21","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.cmi.2021.10.017","volume":"28","author":"R Sun","year":"2022","unstructured":"Sun, R., Yao, T., Zhou, X., Harbarth, S. & Lin, L. Non-biomedical factors affecting antibiotic use in the community: a mixed-methods systematic review and meta-analysis. Clin. Microbiol. Infect. 28, 345\u2013354. https:\/\/doi.org\/10.1016\/j.cmi.2021.10.017 (2022).","journal-title":"Clin. Microbiol. Infect."},{"key":"1767_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2021.106302","volume":"57","author":"L Lin","year":"2021","unstructured":"Lin, L., Harbarth, S., Hargreaves, J. R., Zhou, X. & Li, L. Large-scale survey of parental antibiotic use for paediatric upper respiratory tract infections in China: implications for stewardship programmes and national policy. Int. J. Antimicrob. Agents 57, 106302. https:\/\/doi.org\/10.1016\/j.ijantimicag.2021.106302 (2021).","journal-title":"Int. J. Antimicrob. Agents"},{"key":"1767_CR23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-039332","volume":"10","author":"L Lin","year":"2020","unstructured":"Lin, L. et al. Decisions to use antibiotics for upper respiratory tract infections across China: a large-scale cross-sectional survey among university students. BMJ Open 10, e039332. https:\/\/doi.org\/10.1136\/bmjopen-2020-039332 (2020).","journal-title":"BMJ Open"},{"key":"1767_CR24","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s13756-021-00954-3","volume":"10","author":"X Yin","year":"2021","unstructured":"Yin, X. et al. Prevalence of self-medication with antibiotics and its related factors among Chinese residents: a cross-sectional study. Antimicrob. Resist. Infect. Control 10, 89. https:\/\/doi.org\/10.1186\/s13756-021-00954-3 (2021).","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"1767_CR25","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1080\/14787210.2021.1882303","volume":"19","author":"J Wu","year":"2021","unstructured":"Wu, J. et al. Prevalence of antibiotic self-medication behavior and related factors among children aged 0 to 5 years. Expert. Rev. Anti Infect. Ther. 19, 1157\u20131164. https:\/\/doi.org\/10.1080\/14787210.2021.1882303 (2021).","journal-title":"Expert. Rev. Anti Infect. Ther."},{"key":"1767_CR26","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1093\/jac\/dkw519","volume":"72","author":"J Chang","year":"2017","unstructured":"Chang, J. et al. Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey. J. Antimicrob. Chemother. 72, 1235\u20131242. https:\/\/doi.org\/10.1093\/jac\/dkw519 (2017).","journal-title":"J. Antimicrob. Chemother."},{"key":"1767_CR27","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10050497","author":"L Duan","year":"2021","unstructured":"Duan, L., Liu, C. & Wang, D. The general population\u2019s inappropriate behaviors and misunderstanding of antibiotic use in China: A systematic review and meta-analysis. Antibiotics (Basel) https:\/\/doi.org\/10.3390\/antibiotics10050497 (2021).","journal-title":"Antibiotics (Basel)"},{"key":"1767_CR28","unstructured":"National Bureau of Statistics of China. http:\/\/www.stats.gov.cn\/english\/ (2022)."},{"key":"1767_CR29","volume-title":"Using Indicators to Measure Country Pharmaceutical Situations: Fact Book on WHO Level I and Level II Monitoring Indicators","author":"World Health Organization","year":"2006","unstructured":"World Health Organization. Using Indicators to Measure Country Pharmaceutical Situations: Fact Book on WHO Level I and Level II Monitoring Indicators (World Health Organization, 2006)."},{"key":"1767_CR30","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1186\/s12889-018-6047-8","volume":"18","author":"M Ancillotti","year":"2018","unstructured":"Ancillotti, M. et al. Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions. BMC Public Health 18, 1153. https:\/\/doi.org\/10.1186\/s12889-018-6047-8 (2018).","journal-title":"BMC Public Health"},{"key":"1767_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/109019818401100101","volume":"11","author":"NK Janz","year":"1984","unstructured":"Janz, N. K. & Becker, M. H. The health belief model: a decade later. Health Educ. Q. 11, 1\u201347. https:\/\/doi.org\/10.1177\/109019818401100101 (1984).","journal-title":"Health Educ. Q."},{"key":"1767_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/phe\/phaa033","volume":"14","author":"M Ancillotti","year":"2021","unstructured":"Ancillotti, M., Eriksson, S., Godskesen, T., Andersson, D. I. & Nihl\u00e9n Fahlquist, J. An effort worth making: A qualitative study of how swedes respond to antibiotic resistance. Public Health Ethics. 14, 1\u201311. https:\/\/doi.org\/10.1093\/phe\/phaa033 (2021).","journal-title":"Public Health Ethics."},{"key":"1767_CR33","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ijid.2015.12.019","volume":"43","author":"E Castro-S\u00e1nchez","year":"2016","unstructured":"Castro-S\u00e1nchez, E., Chang, P. W. S., Vila-Candel, R., Escobedo, A. A. & Holmes, A. H. Health literacy and infectious diseases: why does it matter?. Int. J. Infect. Dis. 43, 103\u2013110. https:\/\/doi.org\/10.1016\/j.ijid.2015.12.019 (2016).","journal-title":"Int. J. Infect. Dis."},{"key":"1767_CR34","unstructured":"Statulator. Sample Size Calculator for Estimating a Single Mean. http:\/\/statulator.com\/SampleSize\/ss1M.html."},{"key":"1767_CR35","doi-asserted-by":"publisher","first-page":"ofw112","DOI":"10.1093\/ofid\/ofw112","volume":"3","author":"RR Carter","year":"2016","unstructured":"Carter, R. R., Sun, J. & Jump, R. L. A survey and analysis of the American public\u2019s perceptions and knowledge about antibiotic resistance. Open Forum Infect. Dis. 3, ofw112. https:\/\/doi.org\/10.1093\/ofid\/ofw112 (2016).","journal-title":"Open Forum Infect. Dis."},{"key":"1767_CR36","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/1472-6920-13-163","volume":"13","author":"Y Huang","year":"2013","unstructured":"Huang, Y. et al. Knowledge, attitude and practice of antibiotics: a questionnaire study among 2500 Chinese students. BMC Med. Educ. 13, 163. https:\/\/doi.org\/10.1186\/1472-6920-13-163 (2013).","journal-title":"BMC Med. Educ."},{"key":"1767_CR37","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/0272989x14553472","volume":"35","author":"DA Broniatowski","year":"2015","unstructured":"Broniatowski, D. A., Klein, E. Y. & Reyna, V. F. Germs are germs, and why not take a risk? Patients\u2019 expectations for prescribing antibiotics in an inner-city emergency department. Med. Decis. Making 35, 60\u201367. https:\/\/doi.org\/10.1177\/0272989x14553472 (2015).","journal-title":"Med. Decis. Making"},{"key":"1767_CR38","doi-asserted-by":"publisher","first-page":"942","DOI":"10.3399\/096016407782605027","volume":"57","author":"JW Cals","year":"2007","unstructured":"Cals, J. W. et al. Public beliefs on antibiotics and respiratory tract infections: an internet-based questionnaire study. Br. J. Gen. Pract. 57, 942\u2013947. https:\/\/doi.org\/10.3399\/096016407782605027 (2007).","journal-title":"Br. J. Gen. Pract."},{"key":"1767_CR39","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1093\/jac\/dkn054","volume":"61","author":"L Grigoryan","year":"2008","unstructured":"Grigoryan, L. et al. Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system. J. Antimicrob. Chemother. 61, 1172\u20131179. https:\/\/doi.org\/10.1093\/jac\/dkn054 (2008).","journal-title":"J. Antimicrob. Chemother."},{"key":"1767_CR40","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1111\/tmi.12322","volume":"19","author":"B Lv","year":"2014","unstructured":"Lv, B. et al. Knowledge, attitudes and practices concerning self-medication with antibiotics among university students in western China. Trop. Med. Int. Health 19, 769\u2013779. https:\/\/doi.org\/10.1111\/tmi.12322 (2014).","journal-title":"Trop. Med. Int. Health"},{"key":"1767_CR41","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1186\/s12889-019-7796-8","volume":"19","author":"MK Byrne","year":"2019","unstructured":"Byrne, M. K. et al. The drivers of antibiotic use and misuse: the development and investigation of a theory driven community measure. BMC Public Health 19, 1425. https:\/\/doi.org\/10.1186\/s12889-019-7796-8 (2019).","journal-title":"BMC Public Health"},{"key":"1767_CR42","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18052580","author":"GC Feng","year":"2021","unstructured":"Feng, G. C., Lin, Z., Ou, W., Su, X. & Yan, Q. A model-based meta-analysis of willingness to participate in cancer screening. Int. J. Environ. Res. Public Health. https:\/\/doi.org\/10.3390\/ijerph18052580 (2021).","journal-title":"Int. J. Environ. Res. Public Health."},{"key":"1767_CR43","unstructured":"Cambridge Handbook of Psychology, Health and Medicine. 2 edn, (Cambridge University Press, 2007)."},{"key":"1767_CR44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","volume":"6","author":"L Hu","year":"1999","unstructured":"Hu, L. & t. & Bentler, P. M.,. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct. Equ. Model. Multidiscip. J. 6, 1\u201355. https:\/\/doi.org\/10.1080\/10705519909540118 (1999).","journal-title":"Struct. Equ. Model. Multidiscip. J."},{"key":"1767_CR45","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1037\/0033-2909.107.2.238","volume":"107","author":"PM Bentler","year":"1990","unstructured":"Bentler, P. M. Comparative fit indexes in structural models. Psychol. Bull. 107, 238\u2013246. https:\/\/doi.org\/10.1037\/0033-2909.107.2.238 (1990).","journal-title":"Psychol. Bull."},{"key":"1767_CR46","unstructured":"Kline, R. B. Principles and Practice of Structural Equation Modeling, 4th ed. (Guilford Press, 2016)."},{"key":"1767_CR47","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/s0738-3991(02)00017-4","volume":"48","author":"R Deschepper","year":"2002","unstructured":"Deschepper, R., Vander Stichele, R. H. & Haaijer-Ruskamp, F. M. Cross-cultural differences in lay attitudes and utilisation of antibiotics in a Belgian and a Dutch city. Patient Educ. Couns. 48, 161\u2013169. https:\/\/doi.org\/10.1016\/s0738-3991(02)00017-4 (2002).","journal-title":"Patient Educ. Couns."},{"key":"1767_CR48","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12875-020-01196-9","volume":"21","author":"S Mortazhejri","year":"2020","unstructured":"Mortazhejri, S. et al. Understanding determinants of patients\u2019 decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study. BMC Fam. Pract. 21, 119. https:\/\/doi.org\/10.1186\/s12875-020-01196-9 (2020).","journal-title":"BMC Fam. Pract."},{"key":"1767_CR49","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00130-5","author":"J Li","year":"2023","unstructured":"Li, J. et al. Worldwide dispensing of non-prescription antibiotics in community pharmacies and associated factors: a mixed-methods systematic review. Lancet. Infect. Dis https:\/\/doi.org\/10.1016\/S1473-3099(23)00130-5 (2023).","journal-title":"Lancet. Infect. Dis"},{"key":"1767_CR50","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001239","volume":"4","author":"B Huttner","year":"2019","unstructured":"Huttner, B. et al. How to improve antibiotic awareness campaigns: findings of a WHO global survey. BMJ Glob. Health 4, e001239. https:\/\/doi.org\/10.1136\/bmjgh-2018-001239 (2019).","journal-title":"BMJ Glob. Health"},{"key":"1767_CR51","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/s1473-3099(20)30596-x","volume":"21","author":"H Zhao","year":"2021","unstructured":"Zhao, H. et al. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. Lancet Infect Dis. 21, 847\u2013857. https:\/\/doi.org\/10.1016\/s1473-3099(20)30596-x (2021).","journal-title":"Lancet Infect Dis."},{"key":"1767_CR52","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/s1473-3099(09)70305-6","volume":"10","author":"B Huttner","year":"2010","unstructured":"Huttner, B., Goossens, H., Verheij, T. & Harbarth, S. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect. Dis. 10, 17\u201331. https:\/\/doi.org\/10.1016\/s1473-3099(09)70305-6 (2010).","journal-title":"Lancet Infect. Dis."},{"key":"1767_CR53","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015308","volume":"7","author":"MK Hawking","year":"2017","unstructured":"Hawking, M. K. et al. Attitudes and behaviours of adolescents towards antibiotics and self-care for respiratory tract infections: a qualitative study. BMJ Open 7, e015308. https:\/\/doi.org\/10.1136\/bmjopen-2016-015308 (2017).","journal-title":"BMJ Open"},{"key":"1767_CR54","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics9100704","author":"LY Chen","year":"2020","unstructured":"Chen, L. Y. et al. A qualitative study of pregnant women\u2019s perspectives on antibiotic use for mom and child: Implications for developing tailored health education interventions. Antibiotics (Basel) https:\/\/doi.org\/10.3390\/antibiotics9100704 (2020).","journal-title":"Antibiotics (Basel)"},{"key":"1767_CR55","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.copsyc.2015.03.012","volume":"5","author":"R Ferrer","year":"2015","unstructured":"Ferrer, R. & Klein, W. M. Risk perceptions and health behavior. Curr. Opin. Psychol. 5, 85\u201389. https:\/\/doi.org\/10.1016\/j.copsyc.2015.03.012 (2015).","journal-title":"Curr. Opin. Psychol."},{"key":"1767_CR56","doi-asserted-by":"publisher","first-page":"125","DOI":"10.3109\/03009734.2014.905664","volume":"119","author":"C St\u00e5lsby Lundborg","year":"2014","unstructured":"St\u00e5lsby Lundborg, C. & Tamhankar, A. J. Understanding and changing human behaviour-antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour. Ups J. Med. Sci. 119, 125\u2013133. https:\/\/doi.org\/10.3109\/03009734.2014.905664 (2014).","journal-title":"Ups J. Med. Sci."},{"key":"1767_CR57","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.idnow.2022.03.004","volume":"52","author":"JC David","year":"2022","unstructured":"David, J. C., Piednoir, E. & Delouv\u00e9e, S. Knowledge and perceptions of antibiotic resistance in the French population. Infect. Dis. Now 52, 306\u2013310. https:\/\/doi.org\/10.1016\/j.idnow.2022.03.004 (2022).","journal-title":"Infect. Dis. Now"},{"key":"1767_CR58","doi-asserted-by":"publisher","first-page":"767","DOI":"10.15585\/mmwr.mm6428a5","volume":"64","author":"LK Francois Watkins","year":"2015","unstructured":"Francois Watkins, L. K., Sanchez, G. V., Albert, A. P., Roberts, R. M. & Hicks, L. A. Knowledge and attitudes regarding antibiotic use among adult consumers, adult hispanic consumers, and health care providers\u2014United States, 2012\u20132013. MMWR Morb. Mortal. Wkly. Rep. 64, 767\u2013770. https:\/\/doi.org\/10.15585\/mmwr.mm6428a5 (2015).","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"1767_CR59","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/s0924-8579(02)00272-8","volume":"21","author":"A Cagri Buke","year":"2003","unstructured":"Cagri Buke, A., Ermertcan, S., Hosgor-Limoncu, M., Ciceklioglu, M. & Eren, S. Rational antibiotic use and academic staff. Int. J. Antimicrob. Agents 21, 63\u201366. https:\/\/doi.org\/10.1016\/s0924-8579(02)00272-8 (2003).","journal-title":"Int. J. Antimicrob. Agents"},{"key":"1767_CR60","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/004947550003000105","volume":"30","author":"J Halfvarsson","year":"2000","unstructured":"Halfvarsson, J. et al. Knowing when but not how!\u2013mothers\u2019 perceptions and use of antibiotics in a rural area of Viet Nam. Trop. Doct. 30, 6\u201310. https:\/\/doi.org\/10.1177\/004947550003000105 (2000).","journal-title":"Trop. Doct."},{"key":"1767_CR61","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.sapharm.2010.01.002","volume":"7","author":"P Norris","year":"2011","unstructured":"Norris, P., Va\u2019ai, C., Fa\u2019alau, F., Churchward, M. & Arroll, B. Pain, infection, and colds and flu: Samoan people\u2019s views about antibiotics. Res. Soc. Adm. Pharm. 7, 81\u201392. https:\/\/doi.org\/10.1016\/j.sapharm.2010.01.002 (2011).","journal-title":"Res. Soc. Adm. Pharm."},{"key":"1767_CR62","doi-asserted-by":"publisher","first-page":"632","DOI":"10.3390\/antibiotics3040632","volume":"3","author":"A Kandeel","year":"2014","unstructured":"Kandeel, A. et al. Patient attitudes and beliefs and provider practices regarding antibiotic use for acute respiratory tract infections in Minya, Egypt. Antibiotics (Basel) 3, 632\u2013644. https:\/\/doi.org\/10.3390\/antibiotics3040632 (2014).","journal-title":"Antibiotics (Basel)"},{"key":"1767_CR63","doi-asserted-by":"publisher","first-page":"128","DOI":"10.7326\/0003-4819-133-2-200007180-00012","volume":"133","author":"J Avorn","year":"2000","unstructured":"Avorn, J. & Solomon, D. H. Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann. Intern. Med. 133, 128\u2013135. https:\/\/doi.org\/10.7326\/0003-4819-133-2-200007180-00012 (2000).","journal-title":"Ann. Intern. Med."},{"key":"1767_CR64","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1186\/s12913-019-4359-8","volume":"19","author":"TG Jacobs","year":"2019","unstructured":"Jacobs, T. G. et al. Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review. BMC Health Serv. Res. 19, 536. https:\/\/doi.org\/10.1186\/s12913-019-4359-8 (2019).","journal-title":"BMC Health Serv. Res."},{"key":"1767_CR65","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1016\/j.cmi.2021.03.030","volume":"27","author":"E Nabovati","year":"2021","unstructured":"Nabovati, E., Jeddi, F. R., Farrahi, R. & Anvari, S. Information technology interventions to improve antibiotic prescribing for patients with acute respiratory infection: a systematic review. Clin. Microbiol. Infect. 27, 838\u2013845. https:\/\/doi.org\/10.1016\/j.cmi.2021.03.030 (2021).","journal-title":"Clin. Microbiol. Infect."},{"key":"1767_CR66","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-062688","volume":"13","author":"MZ Raban","year":"2023","unstructured":"Raban, M. Z. et al. Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review. BMJ Open 13, e062688. https:\/\/doi.org\/10.1136\/bmjopen-2022-062688 (2023).","journal-title":"BMJ Open"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-01767-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-01767-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-01767-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T17:55:24Z","timestamp":1747504524000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-01767-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,17]]},"references-count":66,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1767"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-01767-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,17]]},"assertion":[{"value":"10 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study adhered to the Declaration of Helsinki, and the study obtained ethics approval from the Research Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No [2020]-S099). Informed consent was obtained from all subjects involved in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participant"}},{"value":"This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Accordance"}}],"article-number":"17220"}}