Journal Article

Using the Q-method to explore pregnant and breastfeeding women’s perceptions of antibiotic use in Mahajanga, Northwest Madagascar

Ravololomihanta, Voahirana, Razafindrabesa, Timothée, Kapesa, Laurent, Rakotosamimanana, Sitraka, Mattern, Chiarella, Kassié, Daouda, Harimanana, Aina

2025

Overview

Background The Q-method is a research approach that combines quantitative and qualitative techniques to study people’s subjectivity on a given theme. In Madagascar, antibiotic usage practices remain largely unstudied, particularly among pregnant and breastfeeding women. This study aims to use the Q-method to document the opinions of pregnant and breastfeeding women on antibiotic use practices in the Northwest region of Madagascar. Methods The Q-method was applied to 115 pregnant and breastfeeding women from two districts, one urban and one rural, in Northwest Madagascar. The participants ranked 36 statements about antibiotic use on a 7-point scale ranging from − 3 (strong disagreement) to + 3 (strong agreement). Principal component analysis (PCA) was used to analyze the rankings and identify groups of women with differing or similar viewpoints. The Wilcoxon and Kruskal-Wallis rank sum tests were employed to assess significant differences among participants in each group and to evaluate the differences between these groups. Additionally, semistructured interviews were conducted to explore the participants’ reasoning behind their rankings and to complement the quantitative findings. Results Among the 115 women, 51% (59/115) resided in urban areas, while 49% (56/115) lived in rural regions. PCA identified two main groups of women with distinct viewpoints on antibiotic use. Group 1 comprised 55.6% (64/115) of the women and consisted of women who only complied with medical indications and instructions by being vigilant. Group 2 represented 35.6% (41/115) of the respondents and included women who believed in antibiotic usage based on receiving information first from multiple sources (medical staff or personal experience or other nonmedical relatives). 10 women (8.8%) could not be classified under either of the two groups. Differences in opinions were observed in Group 1 based on age ( p = 0.004), marital status ( p = 0.013), educational level ( p = 0.007), gravidity ( p = 0.062), and area of residence ( p = 0.125), and in Group 2 based on educational level ( p = 0.065) and gravidity ( p = 0.127). Insights from the semistructured interviews enriched the interpretation of these groups’ classification. Conclusions Pregnant and breastfeeding women surveyed in Northwest Madagascar believe that the best approach to antibiotic use is to follow the recommendations of health care professionals. However, some rely on advice from others, whether medical or nonmedical. To improve adherence to antibiotic treatments based solely on medical prescriptions and ensure their proper use in Madagascar, the communication between health care providers and patients must be strengthened.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Anti-Bacterial Agents - therapeutic use / Antibiotics / Biostatistics / Breast feeding / Breast Feeding - psychology / Breastfeeding & lactation / Data analysis / Data collection / Dosage and administration / Drug resistance in microorganisms / Education / Environmental Health / Epidemiology / Female / Health aspects / Health care / Health Knowledge, Attitudes, Practice / Humans / Improving social inequities in health in the Global South / Inclusion / Interviews / Life Sciences / Madagascar / Medicine / Medicine & Public Health / Methods / Perceptions / Pregnancy / Pregnant and breastfeeding women / Pregnant People - psychology / Pregnant women / Prevention / Principal components analysis / Public Health / Q-method / Qualitative Research / Rural areas / Rural Population / Urban areas / Vaccine / Womens health / Young Adult