Cross-Border Differences in Public Knowledge, Awareness, Behaviours and Beliefs related to Antibiotics and Antimicrobial Resistance across the island of Ireland

Background Antimicrobial resistance (AMR) is predicted to be liable for 10 million annual deaths worldwide by 2050, driven significantly by public cognitions and behaviours. Given the frequent social and economic interactions between people from Northern Ireland (NI) and Ireland (IRL), the cross-border spread of antibiotic-resistant bacteria is a concern. Little research compares public knowledge, awareness, beliefs and behaviours across the island of Ireland. This study aimed to address this gap in a post-COVID-19 era to inform targeted interventions. Methods A cross-sectional, nationally representative online survey with adults in NI and IRL assessed public knowledge, awareness, behaviours and beliefs related to antibiotics and AMR. Questions were taken from the World Health Organization (WHO) multi-country public awareness survey and four relating to ESKAPE pathogens were derived from literature. Statistical analyses of difference compared results between NI and IRL. Results Among 811 respondents, 415 (51.2%) were from NI and 396 (48.8%) were from IRL. Total knowledge of appropriate antibiotic use and antibiotic resistance was slightly higher in NI. Nearly two fifths (37.9%) in both countries incorrectly identified ‘cold and flu’ as treatable with antibiotics. Awareness of AMR-related terms was consistent across countries and lowest for ‘ESKAPE pathogens’(11%), and ‘AMR’ (21.5%). The media was the source of awareness stated by most respondents (41.2%) while specific campaigns was stated by the least (3.9%). Antibiotic use behaviours were consistent across countries, with over half (57%) having taken them within the last year. Those in NI were more agreeable with appropriate antibiotic use in addressing AMR, e.g., doctors only prescribing antibiotics when they are needed (U = 73520, p = 0.001, r = 0.12). More respondents in IRL reported that there is not much they can do to stop antibiotic resistance (U = 74747.50, p = 0.02, r = 0.08). Conclusions This study is among the first to explore cross-border differences in public knowledge, awareness, beliefs and behaviours related to antibiotic use and AMR across the island of Ireland. Despite differences emerging, there is room for improvement in both countries which requires an all-island approach to curb the spread of AMR across the island of Ireland.