# Antibiotic Knowledge and Attitudes among Nursing Home Patients, Family and Staff.

> **NIH NIH R21** · JOHNS HOPKINS UNIVERSITY · 2020 · $204,688

## Abstract

Infections caused by multidrug resistant organisms [MDROs] are an urgent global threat.
MDROs are highly prevalent in post-acute skilled nursing facilities [SNF] and long term care
facilities [LTCF], and much of this is fueled by antibiotic overuse in these settings. A key
influence on provider prescribing in SNF/LTCFs is family and/or facility resident (i.e., patient)
pressure to prescribe antimicrobials, even when not clinically indicated. Our preliminary data
suggest that >75% of SNF/LTCF providers have been influenced by this demand. To address
this issue, we propose using a systematic approach to assessing and developing SNF/LTCF
based educational interventions aimed at residents and family members that clearly delineate
the risks associated with antibiotics and the need for their judicious use.
 This R21 is the initial effort of a phased approach, partnering with a Baltimore SNF/LTCF
network. We will use two complementary models to inform formative research and to develop a
survey instrument which will ultimately guide an intervention: (1) Knowledge, Attitudes and
Behavior (KAB) which is individual-focused; and, (2) Systems Engineering Initiative for
Patient Safety (SEIPS), a Human Factors and Systems Engineering model, which defines the
interactions among humans and other elements in complex sociotechnical work systems.
Integrating both models will identify both knowledge gaps for the educational intervention and
facilitators and barriers within the work system that may require structural modification.
 This is an NIA-defined Stage 0 Behavioral Intervention. The formative research phase
of Aim 1 will include in-depth qualitative research with resident, family, and staff stakeholders in
SNF/LTCFs. This will include 30 in-depth interviews with residents and/or their family members,
10 interviews with facility staff, and 3 focus group interviews with patient/family advisory board
members. The interview domains will address both KAB and human factors issues including
intervention facilitators and barriers. This will inform development of a survey instrument in Aim
2, which combines the KAB and SEIPs approaches and which will be piloted in 50
residents/family and 20 staff members, to include post-hoc feasibility assessments. Data
obtained from the formative research and pilot surveys will support the ultimate objective of
developing an interactive intervention in Aim 3 based on behavioral science and human factors
engineering principles, which will inform a subsequent R01 clinical trial intervention.

## Key facts

- **NIH application ID:** 9991712
- **Project number:** 5R21AG061482-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Jonathan M Zenilman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $204,688
- **Award type:** 5
- **Project period:** 2019-08-15 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9991712

## Citation

> US National Institutes of Health, RePORTER application 9991712, Antibiotic Knowledge and Attitudes among Nursing Home Patients, Family and Staff. (5R21AG061482-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9991712. Licensed CC0.

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