Background
Materials and method
Search strategy
Eligibility criteria
Study selection
Study designs
Quality assessment
Data extraction and description
Results
Article selection and characteristics of selected articles
Culture-related results
Overview of categories of identified cultural determinants
Cultural determinant | Description | References |
---|---|---|
Patient related determinants | ||
Illness perception/behaviour and health-seeking behaviour | Attitudes, knowledge and beliefs towards URTI symptoms (serious or self-limiting, belief in the healing power of the body, fear of complications), initial coping strategies, threshold for consulting a GP, in particular for self-limiting diseases. | |
Individual experience | Previous experience of similar episodes. | [27] |
Antibiotic awareness | Attitudes, knowledge, beliefs and perceptions towards antibiotics (their effectiveness in speeding recovery and preventing complications, their adverse effects, antibiotic resistance). | |
Drug perception | Perception towards antibiotics and symptomatic medication: scepticism towards medications and fear of toxicity, or considered as accelerators of the healing process with fear of complications if no medicines were used. | |
Labelling of diagnosis | Perception of what is considered as a real symptom and use of labels. | [27] |
Work ethos | Behaviour towards work: continue working in spite of illness or stop working to let the body recover and avoid transmitting infection to others. | |
Practitioner perception | Perception of their practitioner’s competence, trust in the practitioner. | |
Practitioner related determinants | ||
RTI management | Attitudes towards RTI, management, including decision-making. | |
Initial training | Orientation of initial medical training (hospital-centred or outpatient-centred). | [28] |
Antibiotic awareness | Attitudes towards and beliefs concerning antibiotics. | |
Legal complaints | Antibiotic prescription to avoid legal complaints. | [28] |
Practice context | Perceived patients’ expectations, patient education strategies, prescription patterns. |
Relation between identified cultural determinants and Hofstede’s cultural dimensions in a primary care setting concerning antibiotics
High | Low | References |
---|---|---|
Patients look up to the GP. | Patients see themselves as equal to the GP. | [12] |
Less shared decision making: “Doctor knows best” attitude (Less discussion, information, counselling and negotiation during the consultation). | More shared decision making (more discussions, information, counselling and negotiation in the consultation). | |
GP cannot acknowledge he is unsure of diagnosis (fear of inspiring less confidence). | GP can acknowledge he is unsure of diagnosis (inspires confidence anyway). | [12] |
Antibiotic prescription symbolic sign of power and expertise. | Antibiotic has a less symbolic importance. | [12] |
High | Low | References |
---|---|---|
Patients have high risk perception of the threat of the disease and possible complication. | Patients have low risk-perception of the threat of the disease and of possible complications. | |
Patients feel confident only if they have a disease with a clear cause, label and treatment (defensive medicine). | Patients feel confident even in case of uncertainty, accepting that the GP has no specific diagnosis or that no treatment can be given. | [12] |
Patients prefer a “rather safe than sorry” attitude. | Patients accept a “wait and see” attitude. | |
The illness is perceived as an evil phenomenon against which you should fight. | The illness is perceived as a natural phenomenon with a natural history to be respected. | [24] |
GPs feel uncomfortable and are anxious of making mistakes. | GPs are aware of the dangers of a defensive attitude. | [12] |
GPs see themselves as experts and feel the inner urge to “do something”; prescribe what’s considered to be the less risky for the patient on a short term basis. | GPs accept a degree of uncertainty and a “wait and see” approach. | [12] |
Prescribing antibiotics decreases the fear linked to uncertainty of both the GP and the patient. | Prescribing antibiotics does not decrease uncertainty-related fear of the GP nor of the patient. |
Masculine societies | Feminine societies | References |
---|---|---|
The patient should not be ill, the patient needs to return to work/activity very quickly. | The patient can be ill and this can excuse absence from work/activity | [13] |
Antibiotics are regarded as a vital medicine to get back to work as quickly as possible which is felt as a priority. | Antibiotics are not regarded as a vital medicine and getting back to work as quickly as possible is not felt as a priority. | [13] |