Public knowledge, beliefs and behaviours related to antimicrobial resistance and antibiotics: a systematic review of studies in high-income countries

Abstract

Abstract Background Antimicrobial resistance (AMR) is a growing public health concern, influenced by public behaviours. This study aimed to systematically review and synthesize qualitative and quantitative studies on public knowledge, beliefs and behaviours related to antibiotics and AMR, and explore gender differences, in high-income countries. Materials and methods Eleven databases including Web of Science Core Collection, Medline and PsycINFO were searched for primary studies published between August 2014 and 12 June 2026. This article reports the high-income country subset of a larger global review; other results will be reported separately. We carried out a descriptive, non-meta-analytic synthesis at study- and country-level by calculating the mean, SD, median and range of the proportion of participants whose data demonstrated incorrect knowledge, misconceptions, and positive or negative behaviours. Gender differences were synthesized narratively. Qualitative data were synthesized under each outcome using deductive thematic analysis. Results Of 12 338 records identified, 121 were globally eligible. Thirty-three high-income country studies were included in this article (29 quantitative and 4 qualitative, with 33 252 participants). Cross-country variability was found in knowledge, beliefs and behaviours. Misunderstandings were prominent around the definition of AMR and its implications for health. Narrative gender differences were inconsistent and qualitative data were limited, but gave insight into potential drivers of behaviours. Conclusions Despite international variations, knowledge gaps, misconceptions and counterproductive behaviours were widespread. Findings show that AMR is a system-wide issue that requires attention from all One Health stakeholders, and a unified, multi-faceted, multidisciplinary approach that can help tackle the continuing public health threat, and change behaviour to protect health.