Work Package 6: Antibiotics in social science context – between users and prescribers

Main partners: 

  • Peter Gundelach, Inge Kryger, Carsten Strøby Jensen (Department of Sociology)
  • Morten Nissen (Department of Psychology)
  • Jann Scheuer (Department of Scandinavian Research)
  • Søren Bech Nielsen (Department of Scandinavian Studies and Linguistics)
  • Michele De Oliveira, Kirsten Kragh, Nieves Hernandez-Flores, Sandi Michele De Oliveira, and  Erling Strudsholm (Department of English, German and Romance Studies)

Main objectives:

  1. Between users and prescribers – How antibiotics are used in Human and Veterinarian context.
  2. Using Antibiotics – Governance and national regulation in a comparative perspective (in Human and Veterinarian context).

Task 6.1. Communicative Pressure for Antibiotics: Conversational Negotiation in ‘Out-of-Hours’-settings
Responsible scientist: Søren Bech Nielsen

Recent studies in the U.S. have demonstrated that antibiotics are prescribed excessively as a result of patients' communicative pressure. Most likely, the state of affairs is similar within the Danish health care system. Therefore, this sub project, based at the Faculty of Humanities, University of Copenhagen, aims to investigate if indeed, to which extent, and in which ways, such communicative processes take place in Danish contexts.

The goal of the sub project is to make transparent the forms of communicative pressure and the negotiations they entail. This may help doctors become better equipped to resist pressure; it may also raise public awareness of patients’ behaviour – perhaps with the benefit that some patients, accordingly, act in more responsible ways. The project is based on discourse-oriented methodologies, notably the approach labelled Conversation Analysis (CA).

CA refers to the detailed study of naturally occurring talk-in-interaction, using carefully conducted transcriptions of video and audio recordings to illuminate how participants employ conversational organisation to make sense of one another’s contributions.

Task 6.2. Users and prescribers in an relational and governmental perspective.

Responsible scientist: Carsten Strøby Jensen

The research project will focus on two different levels of analysis. The first part will mainly be oriented toward the micro-level and study interactions between prescribers and users on a micro level using the different types of rationality as a frame for understanding the differences in prescribing.

The project focus on identifying how different types of rationality influence the prescription of antibiotics among veterinarians and doctors and how interaction with and expectations among users (patients/farmers) frame the decision making process (Gillespie 1983, O’Neill 2011).

Among other things the project will try to identify how prescription of antibiotics is framed by medical/clinical, economic and normative expectations among prescribers and users. One way to do that is to analyze concrete decision making processes among doctors/veterinarians. How is the decision making process organized (formally as well as informally).

The second part will mainly focus on macro level and will analyze how different national traditions for antibiotic governance influence the use of antibiotics and how this interact with governmental initiatives at European level (EU-level). The research project focus on identifying governmental regimes within the European Union.

Is it possible to identify different patterns of uses of antibiotics in different parts of Europe? Are the patterns similar for uses of antibiotics in humans as well as farm animals? If so what are the explanations for the differences in frequencies of prescription of antibiotics?

Task 6.3. Prescribers and users in Southern Europe
Responsible scientist: Erling Strudsholm

Taking as a starting point the statistical evidence that antibiotic resistance is greater in Southern Europe as compared to Northern, the aim of this study is to shed light on underlying cultural reasons for this difference. The study takes a comprehensive approach, examining the actions and attitudes of the three groups of “interested parties” in the way antibiotics are prescribed:

This sub-project is housed within the WP on Societal issues and dissemination, which has as its goal the analysis of “relations and interactions between prescribers…and antibiotic users…as well as on how legislation, technology and organizational structures influence antibiotic usage.”

Task 6.4. Control of antibiotic resistance - forms of knowledge, standards and technologies in general practice
studying clinical guidelines' translation from science practices to its enactment in clinical practices and their relevance to rational antibiotic use

Responsible scientist: Mads Bank and Morten Nissen
Student assistants: Anne Rogne and Heidi Gabriel Hansen

The project will be focusing on different forms of knowledge, standards and technologies, the practical encounter, and the affected bodies, as these are perceived, negotiated and enacted in practice by both professionals and patients, as part of their conduct of everyday life. Through qualitative descriptions and analysis, the aim is to explore how knowledge and standards implied in clinical protocols are translated from research practices to general medical practices and in which ways these are enacted in and interact with other forms of knowledge and standards prevailing in the actual clinical encounter with the individual patient, his embodiment, self-understanding and everyday life.

In collaboration with The Danish College of General Practitioners (DSAM) the intention is to study governance of antibiotics in general medical practices, framed as a process of negotiation between professionals and users. Simultaneously the project strives for a continuous dialogue with DSAM, who is present working on a new strategy for clinical protocols, from the consideration that results from both projects can benefit each other.

For elaborate information please go to UC-Care: Control of antibiotic resistance at Aarhus University.

Human resources:

  • Task 6.1: Ph.d. 1/10-2013 - 1/10-2016
  • Task 6.2: Ph.d. 1/4-2014 – 1/4-2017
  • Task 6.4: Post Doc. 1/1-2015 - 1/1–2017
  • Task 6.2: Post Doc. 1/1-2015 - 1/1–2017