Are threat perceptions associated with patient adherence to antibiotics? Insights from a survey regarding antibiotics and antimicrobial resistance among the Singapore public

Public health strategies to improve patient adherence to antibiotics rely mostly on raising awareness of the threat of antimicrobial resistance (AMR) and improving knowledge about antibiotics. We aimed to evaluate how adherence to antibiotics relates to knowledge and the threat perceptions proposed by the Protection Motivation Theory (PMT). A cross-sectional online survey was conducted in September-December 2020 with 1002 participants aged 21-70 years in Singapore. Two items, which were reverse coded, evaluated adherence to antibiotics: 'how often do you obtain antibiotics that were left over from the previous prescription' and 'how often did you treat yourself with antibiotics in the past year'. Questions about the PMT-related constructs, and knowledge regarding antibiotics and AMR knowledge were also included. Hierarchical regression models were performed at a 5% significance level. Adherence to antibiotics was associated with knowledge level (β = 0.073, p