Dilemmas of care: Healthcare seeking behaviours and antibiotic use among women in rural communities in Nam Dinh Province, Vietnam.

Antimicrobial resistance is a silent pandemic to cause an estimated ten million deaths by 2050. Self-medication with antibiotics in low- and middle-income countries has been identified as a driver of antibiotic resistance. Interventions targeting solely individual behaviour change around antibiotic practices are often unsuccessful as they fail to address socio-cultural and structural causes of the problem. Understanding the context of antibiotic use in communities will better inform interventions addressing the misuse and overuse of antibiotics. Vietnam faces a growing threat of antimicrobial resistance due to inappropriate use of antibiotics in the healthcare system, farming and food production, and in the community. To understand the roots of this problem, we conducted qualitative research in 2020, with one component focusing on the community. This included fifteen in-depth interviews with women and four months of participant observation in three districts in Nam Dinh Province to explore the healthcare seeking practices and perceptions of medicine and antibiotic use. We argue that even when participants understood antibiotic resistance and were willing to adjust their care practices with antibiotics, there were cultural and structural challenges demotivating changes. The participants faced what we term "dilemmas of care". For example, while public health messaging promoted appropriate antibiotic practices, the healthcare system did not provide a suitable environment to support appropriate use. Besides, the introduction of biomedicines into the long-standing traditional medical system caused confusions in community health practices, leading to issues such as poor adherence to treatment. At an individual level, participants faced challenges in accessing healthcare knowledge, adhering to social expectations surrounding care, and financial issues. We argue that the misuse of medicines and antibiotics in communities are responses to a deficient healthcare system and unequal access to quality healthcare.