The level of self-medication with antibiotics amongst Eastern European immigrant population in Leeds, U.K.: Averting harms at an individual and population level.
Aims and objectives
This dissertation will present a proposal for a research project. The aims of the research are to identify the use of antibiotics by eastern European immigrants, residing in the city of Leeds UK.
Specifically, the objectives are to conduct a cross sectional survey to:
- Determine their knowledge on antibiotics;
- Determine when they would seek these drugs;
- Determine whether they would seek drugs without consulting a health professional,. And thereby to obtain from friends (having left over drugs), online purchases, or, from physical shops in the local area (i.e. illegal trading);
- To investigate factors associated with this behaviour;
5) Explore barriers to accessing existing healthcare (registration with NHS / GP, post
Brexit blue card, language, increasing use of digitalisation) for treatment and cultural
element amongst the targeted population.
Methods
After identifying a possible association between immigrants and misuse of AB, a literature search in OVID-MEDLINE and grey literature will be conducted to review current knowledge about AB and AMR amongst eastern European immigrant population in the UK. This is fully discussed in Section 2. The relevant literature includes only studies about the British population and
attempts have been made to find studies about the eastern European immigrant population
but very little supporting evidence. Consequently, the authors will contact Leeds City
Council, the local Connecting Roma Community in order to be able to reach out to eastern
European residents in Leeds and conduct face to face conversations based on a qualitative
questionnaire available in English, Romanian and Slovakian. Additionally, an interpreter in their own native language will be available for those who have only little understanding of English and don’t know Romanian or Slovakian. (Appendix 1).
SECTION 2
Research Methodology
As mentioned above, the authors will develop a qualitative approach which will estimate
possible determinants of misuse and overuse of antibiotics amongst the eastern European
immigrant population in the UK with or without a prescription, and where do they have
access to antibiotics from.
The question was formulated after conducting a literature analysis on the WHO official
website on the AMR page, a list of topics which need further research was published, after the investigation the research team concluded that self-medication with antibiotics is a global public health burden and an obstacle in tackling AMR. Being aware of the present practices related to over-the-counter antibiotic purchase in the West Yorkshire (and not only) amongst eastern European population, a detailed literature search has been conducted in OVID-MEDLINE, Google Scholar and grey literature, which gave zero results in OVID-MEDLINE and only 4 studies found in Google scholar; however, not addressing the eastern European population in the UK. (…) The full PICOS concept is presented in Appendix 2 (or should I include it in this paragraph?) As a result of the literature review, the team identified few key points which require further investigation and are thought to be relevant for obtaining answers to the research question; these have been presented as aims and objectives in the previous section. Consequently, the research team decided that it is of high importance that in this case is elaborated a descriptive (or analytic) ??? cross-sectional study, over a three month period (will describe further when will know exactly which cross-sectional study). The descriptive cross-sectional study will give authors the possibility to ……….
It is considered that the convenience sampling will be best for the recruitment process, as the authors decided already who will be enrolled in the study (only the eastern European population residing in Leeds). The primary focus of the study will be E.E immigrants residing in Leeds because there is a high number of them in this area which will ease the data collection process.
Relevant participants will be identified from multiple sources such as non-profit organisations which work for the eastern European immigrant population in Leeds (Connecting Roma). Besides that, delegated members of the team will connect with Leeds City Council for further support in reaching out to the relevant groups. The team will sure that decisions at all stages of research, especially for recruitment, are free from discrimination and respect participants’ equality and diversity. All reasonable steps will be taken to make sure that people eligible to participate in a project are given equal access to take part and the opportunity to benefit from this research study. Where appropriate, authors might use patients and public involvement groups at all stages of the project to help make sure that the research is well designed and conducted. After the recruitment stage, the team will conduct face to face conversation (one-to-one or in small groups, depending on the participants’ comfort and ability to answer the questions) based on a qualitative questionnaire, the participants will have the ability to choose the format of the questionnaire they prefer- paper-based or online. It will be available in English, Romanian, Slovakian and an interpreter in their own native language will be present for those who have only little understanding of English and don’t know Romanian or Slovakian. (Appendix 1) The questionnaire will be designed and focus on questions grouped around each of the study objectives. It will be distributed by the researcher, who speaks fluent and will help those not fluent enough in English to complete the questionnaire or with the interpreter’s help.
Existing questionnaires that have been used to collect similar data effectively, from wider general populations, will be used where possible. (Do I need to reference these?) This will be determined by the validity and reliability of such tools. Then, it will pass a pilot testing to identify possible problems and check each questions’ validity and reliability before the implementation of the full survey. Furthermore, it will help researchers predict the response patterns of participants and make any required changes to the research. The actual piloting process will begin once there will be a first draft of the questionnaire and will end when the team will have a final, translated questionnaire. It will involve three main phases as the early stage of questionnaire development, stage two- structured filed piloting and the third stage- filed implementation practice. This phase will predominantly be carried out by senior field staff, with perhaps 1-2 additional enumerators, before they complete the necessary training.
However, as the population size is unknown, first it will be necessary to calculate the needed sample size, this will be done by using the following sample size formula :
Necessary sample size formula =
The inclusion criteria of the study subjects’ are: age 18 or older, eastern European ethnicity and willingness to participate and provide a signed consent form in accordance with principles of good research practice. The exclusion criteria are based on participants’ age, ethnicity and home address.
