Eliciting parents' decision-making to antibiotic use for upper respiratory tract infections: A discrete choice experiment.

Background: Addressing antibiotic resistance is important for reducing parents' self-medication of antibiotics for children's upper respiratory tract infections (URTIs). However, the decision-making process for parents who irrationally use such antibiotics is still unclear. In this study, we aimed to explore the reasons why parents self-medicate antibiotics for children's URTIs based on a discrete choice experiment.

Methods: We conducted a systematic review and in-depth interviews to identify the key attributes of choices when parents self-medicate antibiotics for children's URTIs. We developed and applied a discrete choice experiment in Wuhan and Chongqing, China. We used a mixed logit model to determine the impact of various attributes on parents' decisions, while we applied latent class logit models to explore different decision-making patterns within populations.

Results: A total of 400 valid responses were returned from parents. It was shown that symptom severity was the most important in parents' decision-making to self-medicate antibiotics for children's URTIs, followed by risk of side effects or resistance, duration, total cost, onset time of antibiotic, and antibiotic effectiveness. More severe and longer symptoms, perceived higher effectiveness, and fewer side effects of antibiotics consistently were significantly associated with parents' more likely to self-medicate with antibiotics for children's URTIs. There are also different patterns of decision-making of parents, including 'symptoms-oriented,' 'safety-oriented,' and 'comprehensive consideration.' Parents' gender and educational level were associated with decision-making patterns.

Conclusions: Parents' self-medication of antibiotics for children's URTIs was mainly driven by symptoms, followed by perceived antibiotic value. We recommend a multi-faceted intervention strategy to enhance parents' ability to differentiate mild from severe URTIs, as well as their knowledge of antibiotics.