Antimicrobial resistance awareness and associated factors among family physicians in Turkey: a national cross-sectional study.

Abstract

Background: Antimicrobial resistance (AMR) is a major global public health threat requiring effective antimicrobial stewardship across healthcare systems. Primary care physicians are responsible for a substantial proportion of antibiotic prescribing; however, evidence on awareness of antimicrobial stewardship policies in primary care remains limited, particularly in middle-income settings. This study aimed to assess antimicrobial resistance awareness among family physicians and to examine its association with exposure to national policy initiatives.

Methods: A nationwide cross-sectional survey was conducted between October 2025 and January 2026 among 351 family physicians across Turkey using a stratified quota-based convenience sampling approach. AMR awareness was measured using the Turkish-adapted 23-item Antibiotic Resistance Awareness Scale, originally developed using Rasch Measurement Theory. Internal consistency was assessed using Cronbach's alpha. Associations between AMR awareness scores and sociodemographic, educational, and contextual factors-including specialist status, sources of AMR-related information, perceived adequacy of AMR knowledge for daily practice, and awareness of national rational drug use policies-were examined using multivariable linear regression analysis.

Results: The mean standardized AMR awareness score was 76.55 ± 14.95 (Cronbach's α = 0.934). AMR awareness scores were not significantly associated with age, gender, or years of professional experience (p > 0.05). Higher AMR awareness scores were independently associated with perceived adequacy of AMR-related knowledge for daily clinical practice (p < 0.001) and awareness of national rational drug use policies (B = 4.28, p = 0.010). Demographic characteristics were not independently associated with AMR awareness scores.

Conclusions: Antimicrobial stewardship-related competencies in primary care were more strongly associated with policy exposure and knowledge, training, and institutional awareness reinforced through routine clinical practice than with demographic factors. Strengthening policy-linked and practice-oriented educational strategies may support AMR awareness initiatives in primary care settings. These findings may contribute to future research and policy discussions regarding antimicrobial stewardship awareness and related educational initiatives in primary care settings.