Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance Among Users of an Indian Digital Healthcare Platform: A Cross-sectional Online Survey
- 1Tata 1mg Technologies Private Limited, Gurugram, Haryana, India
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.
MethodsA 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.
ResultsMean 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.
ConclusionIn 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.
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BibTeX
@misc{agarwal2026knowledge,
title = {{Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance Among Users of an Indian Digital Healthcare Platform: A Cross-sectional Online Survey}},
author = {Z. Agarwal and S. Mishra and J. Kaur and R. Sharma and T. Sethi},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.14.26365518},
url = {https://www.medrxiv.org/content/10.64898/2026.10.14.26365518v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance Among Users of an Indian Digital Healthcare Platform: A Cross-sectional Online Survey
AU - Z. Agarwal
AU - S. Mishra
AU - J. Kaur
AU - R. Sharma
AU - T. Sethi
PY - 2026
DA - 2026/10/14
PB - medRxiv
DO - 10.64898/2026.10.14.26365518
UR - https://www.medrxiv.org/content/10.64898/2026.10.14.26365518v1
AB - 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. MethodsA 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. ResultsMean 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. ConclusionIn 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.
ER -