{
  "abstract": "BackgroundAntimicrobial resistance (AMR) is a growing global health threat, and Indias high antibiotic consumption makes public knowledge, attitudes, and practices (KAP) a critical determinant of stewardship outcomes. Existing Indian KAP evidence is drawn from small, localised cohorts, leaving a gap in nationwide, digitally-sourced data. This study aimed to describe antibiotic-related knowledge, attitudes and self-reported practices among users of a digital healthcare platform in India, examine demographic and regional variation, and identify potential areas for future stewardship interventions.\n\nMethodsA cross-sectional survey was conducted among adult users of the Tata 1mg platform (December 2025-February 2026), with participants invited via an in-app banner. Knowledge and attitude were each scored on a 0-4 scale (4 items); practice was scored as a percentage of applicable items answered favourably, with scoring adjusted for branching logic based on antibiotic-access route. Of 10,726 respondents who started the survey, 4,883 completed it (45.5%). City of residence was mapped to one of six regions (Indias five statutory Zonal Council zones plus a North-Eastern region) for 4,187 respondents. Associations with demographic characteristics were assessed using multivariable linear regression, and regional differences were assessed using one-way ANOVA. A parallel survey of 256 physicians was conducted to enable patient-provider comparison.\n\nResultsMean scores were: knowledge 2.28 (SD 1.19), attitude 0.91 (SD 1.14), practice 44.9% (SD 33.4); attitude, not knowledge, was the weakest domain. Older age was associated with higher scores across all domains (practice: B=12.52, p<0.001 for age [≥]65 vs. 18-34); city tier was independently associated with lower knowledge and attitude (Tier 3 vs. Tier 1: p=0.010 and p<0.001, respectively). Regional differences were non-significant for knowledge and practice but significant for attitude (F=2.56, p=0.026, 2=0.003), driven by lower scores in the North-Eastern region. In the parallel physician survey, 55.5% of respondents estimated that more than half of their patients self-medicated before consultation.\n\nConclusionIn this platform-based sample, attitudes were the weakest domain, not knowledge, and 42.0% said their last antibiotic did not come on a doctors recommendation. The findings may inform digital stewardship touchpoints, such as point-of-purchase guidance and prescription verification, in line with Indias National Action Plan on Antimicrobial Resistance 2.0. As a cross-sectional survey of platform users, it cannot establish the relative contributions of knowledge, beliefs and access pathways to antibiotic use.",
  "abstract_shown": true,
  "affiliations": [
    "Tata 1mg Technologies Private Limited, Gurugram, Haryana, India"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "name": "Z. Agarwal"
    },
    {
      "name": "S. Mishra"
    },
    {
      "name": "J. Kaur"
    },
    {
      "affs": [
        0
      ],
      "name": "R. Sharma"
    },
    {
      "name": "T. Sethi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fqtyds3sm41w3.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.14.26365518",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365518v1.full",
  "id": "fqtyds3sm41w3",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365518v1",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "public and global health"
    ],
    [
      "openalex",
      "2402|Antibiotic Use and Resistance"
    ]
  ],
  "openalex": "W7221847362",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365518v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fqtyds3sm41w3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:57Z",
      "native_id": "10.64898/2026.10.14.26365518",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365518v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:public and global health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance Among Users of an Indian Digital Healthcare Platform: A Cross-sectional Online Survey",
  "title_text": "Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance Among Users of an Indian Digital Healthcare Platform: A Cross-sectional Online Survey",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:57Z",
  "url": "https://research.draconitic.com/paper/fqtyds3sm41w3",
  "venue": "medRxiv",
  "versions": []
}