Antibiotic knowledge among ethnic minority groups in high-income countries: A mixed-methods systematic review.

Objectives: Antimicrobial resistance (AMR) is a major global public health concern. Although low-income countries are disproportionately affected by AMR, certain underserved groups in high-income countries (HICs), such as migrants and ethnic minorities, disproportionately bear the burden of AMR. This may be driven by socio-cultural factors including differences in health literacy. This review aimed to investigate the level of antibiotic knowledge amongst different ethnic minority groups in HICs. Study design: This was a mixed-methods systematic literature review. Methods: We searched four databases (MEDLINE, EMBASE, the Cochrane library, CINAHL) to May 5, 2023, for primary studies on knowledge of antibiotics in different ethnic groups in HICs. We included studies in English using qualitative, quantitative and/or mixed-methods approaches and reporting on antibiotic knowledge by ethnicity. We used the convergent integrated approach for data synthesis and the Mixed-Methods Appraisal tool for quality assessment. Results: 3935 articles were screened and 24 studies (17 quantitative, 5 qualitative, and 2 mixed-methods) were included, comprising 52778 participants from 8 countries (USA, UK, Australia, New Zealand, Netherlands, Greece, Sweden, Germany). Overall, participants from ethnic minority groups were able to identify common names of antibiotics and were aware of risks of antibiotics and side effects. However, participants thought antibiotics would treat viral-type illnesses. Ethnic minority groups generally had lower levels of knowledge compared to ethnic majority groups. Conclusions: Although ethnic minority communities possessed good levels of knowledge on certain aspects of antibiotics (e.g. being able to identify names of antibiotics), there were gaps in other areas (e.g. misperception that antibiotics are used for viral infections). The lower level of knowledge in ethnic minority groups compared to majority groups may be a contributing factor to health inequalities, which calls for co-designed, culturally competent, educational interventions.