Community knowledge, attitudes, practices, and antibiotic-use misconceptions regarding antimicrobial resistance in a rural municipality of Cebu, Philippines: A One Health cross-sectional study

Abstract

Background and Aim: Antimicrobial resistance (AMR) is a growing One Health challenge driven by inappropriate antimicrobial use across human, animal, and environmental sectors. Community knowledge and behaviors are essential determinants of antimicrobial stewardship; however, local evidence from rural Philippine communities remains limited. This study assessed community knowledge, attitudes, practices, antibiotic-use misconceptions, and demographic correlates related to AMR among residents of Barili, Cebu, Philippines, and evaluated the reliability and construct validity of the survey instrument. Materials and Methods: A cross-sectional online survey was conducted between March and April 2026 among 391 eligible community respondents. The questionnaire collected demographic information, antibiotic-use characteristics, and responses to 24 AMR-related perception statements. Descriptive statistics summarized respondent characteristics and response patterns. Pearson chi-square tests explored associations between categorical variables, while HC3-robust multiple linear regression identified demographic predictors of continuous domain scores. Psychometric evaluation included Cronbach’s alpha, Kaiser-Meyer-Olkin (KMO) measure, Bartlett’s test of sphericity, and exploratory factor analysis. Results: Most respondents were female (68.5%), aged ≤25 years (78.0%), single (85.2%), and had vocational, technical, or college-level education (80.1%). Participants demonstrated favorable attitudes toward professional guidance, responsible antibiotic-use, and infection-prevention, with strong confidence in healthcare professionals and high compliance with preventive behaviors. Nevertheless, 77.2% incorrectly believed that antibiotics are effective against both bacterial and viral infections, highlighting a major knowledge gap. The questionnaire demonstrated excellent internal consistency (Cronbach’s alpha = 0.925) and strong construct validity (KMO = 0.929; Bartlett’s test, p < 0.001), yielding four interpretable factors that explained 58.84% of the total variance. Respondents aged 26–35 years had significantly higher knowledge and perceived threat scores. Male respondents showed lower attitude and professional guidance scores, while lower educational attainment was associated with poorer attitude, practice, and professional guidance outcomes. PhilHealth insurance coverage was positively associated with infection-prevention behaviors. Conclusion: Rural communities demonstrated generally favorable AMR-related attitudes and preventive practices but retained substantial misconceptions regarding appropriate antibiotic indications. Targeted educational interventions should prioritize distinguishing bacterial from viral infections while strengthening professional guidance-seeking and integrating AMR awareness with barangay health promotion, sanitation, vaccination, veterinary outreach, and multisectoral antimicrobial stewardship within a One Health framework. Keywords: antimicrobial resistance, antibiotic stewardship, community survey, health literacy, One Health, Philippines, public health, rural population.