Abstract
Inappropriate antibiotic use in food animals is considered a significant contributor to increasing antibiotic resistance. Consumers can play a critical role in reducing it through purchasing choices, demand, and policy advocacy. This systematic review aimed to synthesize all published literature investigating consumers’ perspectives (i.e., knowledge, perceptions, and attitudes) on antibiotic use and antibiotic resistance in food animals. We conducted a comprehensive literature search in PubMed, Web of Science, Scopus, and Google Scholar on November 14, 2022, and an updated search on April 30, 2024. We limited findings to original peer-reviewed journal articles published up to 2023 (inclusive), were written in English, and focused on knowledge/perceptions/attitudes of antibiotic use and antibiotic resistance in food animals. Of the 3815 articles identified, 39 were included. The findings suggested that consumers were concerned about antibiotic use in food animals, thus they were willing to pay more for food products with antibiotic-free or reduced-antibiotic use. However, consumers lacked deep understanding of antibiotic use practice and antibiotic stewardship in food animals as well as transmission risks of antibiotic-resistant bacteria. These findings offer valuable insights for policymakers and livestock industries to implement policy and practice changes to ensure responsible antibiotic use in food animals.
Generated Summary
This systematic review synthesized published literature investigating consumers’ perspectives (i.e., knowledge, perceptions, and attitudes) on antibiotic use and antibiotic resistance in food animals. The review included 39 articles, and a comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Google Scholar, with an updated search on April 30, 2024. The study aimed to understand consumers’ perspectives (i.e., knowledge, perceptions, and attitudes) on antibiotic use and antibiotic resistance in food animals to provide insights for policymakers and livestock industries to implement policy and practice changes to ensure responsible antibiotic use in food animals. The methodology included a detailed search strategy and specific inclusion and exclusion criteria. The study design and data collection methods varied across the included studies, with quantitative descriptive studies being the most prevalent approach. The review identified seven key themes related to consumers’ perspectives on antibiotic use and antibiotic resistance in food animals.
Key Findings & Statistics
- A total of 3815 records were identified in the literature search.
- 39 articles were included in the review.
- Most included studies (n = 32, 82.1%) were published from 2020 to 2023.
- The US had the most studies (n = 15), followed by the UK (n = 4), Switzerland (n = 3), and Iran (n = 3).
- Overall, 34 studies (87.2%) applied a quantitative approach and 5 applied a qualitative approach (12.8%).
- The most used quantitative study design was quantitative descriptive study (n = 31, 79.5%).
- Approximately two thirds of the studies targeted either the public/consumers or consumers of certain animal-derived food products (i.e., meat, dairy, pork, and poultry).
- The studies covered 31,161 participants.
- The sample size of qualitative studies ranged from 14 to 779.
- The sample size of quantitative studies ranged from 80 to 5693, with most of them (58.8%) having a sample size >500.
- Over one third of studies (n = 14, 35.9%) did not report sampling technique.
- Random (25.6%) and quota (20.5%) sampling were the most used ones among the studies who reported sampling technique.
- Only 6 studies (15.4%) reported response rate, which varied from 17% to 74%.
- 15 studies investigated consumers’ perceived benefits and risks of antibiotic use in food animals.
- 8 studies provided results related to the use of antibiotics for preventing disease and/or promoting growth.
- 23 studies (59.0%) of the included studies provided results on consumers’ perceptions of, attitudes and purchase behaviours towards, or willingness to pay for various antibiotic-free or reduced-antibiotic use labelled food products.
- 15 studies investigated consumers’ willingness to pay for antibiotic-free or reduced-antibiotic use labelled food products.
- 15 studies investigated consumers’ willingness to pay for antibiotic-free or reduced-antibiotic use labelled food products.
- In general, most consumers were only willing to pay a small premium (e.g., <10% or 20% more than conventional products) for these labelled food products.
- A greater intention/likelihood to buy or higher willingness to pay was associated with higher awareness, positive perceptions (e.g. of higher quality and animal welfare standards), favourable attitudes, and purchase habits of the labelled food products.
Other Important Findings
- Consumers were concerned about antibiotic use in food animals, and they were willing to pay more for food products with antibiotic-free or reduced-antibiotic use.
- Consumers lacked deep understanding of antibiotic use practice and antibiotic stewardship in food animals as well as transmission risks of antibiotic-resistant bacteria.
- Consumers agreed antibiotic use in food animals can improve animals’ health, reduce pain for sick animals, help to manage infectious diseases, and maintain food safety.
- Consumers believed that antibiotic use in food animals poses threats to human health, hampers animal welfare, leads to antibiotic-resistant bacteria in the environment, and results in less effective antibiotic treatments in both animals and humans.
- Consumers were not aware that antibiotics can stimulate the growth of animals and can be used for preventing diseases in food animals.
- Consumers’ knowledge about regulations on antibiotic use in livestock industries was low.
- Common information sources for consumers included traditional media (e.g., newspaper, TV, and radio), social media (e.g., Facebook and YouTube), the internet, health professionals/doctors, family and friends, teachers/schools/universities.
- Consumers’ demand for banning subtherapeutic use and were willing to pay an average of $ 125 tax for the ban.
Limitations Noted in the Document
- The review only included peer-reviewed journal articles in English, which may have led to the exclusion of relevant research in other languages and in grey literature.
- The included studies varied widely in settings, designs, sample characteristics, data collection and analysis methods, limiting the ability to conduct statistical synthesis of the findings or make comparisons across studies.
- Most included studies did not specify and separate the purposes of antibiotic use in food animals (i.e., therapeutic and subtherapeutic use).
- Most reviewed studies were conducted in developed countries.
- Most included studies used cross-sectional quantitative approaches without the adoption of established theoretical frameworks.
Conclusion
The review highlights that consumers generally lack a deep understanding of antibiotic use and antibiotic resistance in food animals, leading to misconceptions and a low perception of risk. Despite these knowledge gaps, consumers recognize the benefits of therapeutic antibiotic use for animal welfare and food safety. They also express concerns about the risks of inappropriate use and support measures to reduce it. The review emphasizes the need for livestock industries to change farming practices, with consumer demand for products with reduced or no antibiotic usage. The review also emphasizes the need for transparent information and communication on antibiotic use in food animals. “Consumers’ demands and preferences can also influence industry strategies as well as government policies and regulations.” The study concludes by highlighting the importance of responsible antibiotic use, improved governance, and consumer education in addressing the challenges of antibiotic resistance in food animals. “Future food labelling initiatives should focus on promoting responsible antibiotic use rather than completely antibiotic free.” The need for a multi-faceted approach involving regulatory control, incentive schemes, and consumer education is crucial for effectively tackling the complex issue of antibiotic resistance in food animals and ensuring consumer trust and safety. The review underscores the critical role of consumers in driving change and the need for a collaborative effort from all stakeholders to address this important public health issue.