Chinese Parents’ Medical Decisions for Children: Why do they Choose Self-Medication with Antibiotics?

Di Pei

Major Professor: Xiaoquan Zhao, PhD, Department of Communication

Committee Members: Timothy A. Gibson, Gary L. Kreps

Merten Hall (formerly University Hall), #1203
April 01, 2020, 12:00 PM to 02:00 PM


Parental Self-medication with antibiotics (SMA) has been a popular health practice in China for many years. It refers to the use of antibiotics on parents’ own initiatives or advice of others, without consulting health professionals. Misuse of antibiotics is a problematic behavior that may cause fatal side effects, and children are particularly vulnerable to the potential risks. It is therefore important to better understand the social, cultural, and personal determinants of this behavior. Guided by Bandura’s (1986) social cognitive theory, this dissertation used a mixed-method study design to examine the issue. The first study took a qualitative approach to explore Chinese parents’ medical decision-making process and to identify the influential social/cultural and individual factors that might have contributed to the phenomenon of parental SMA in China. A conceptual model was built based on existing literature and findings from the first study, followed by a quantitative survey study to test the factors and relationships hypothesized in the model.

The first study interviewed 19 parents of 6-12 years old children in China. Findings suggested that Chinese cultural belief systems have a significant impact on parents’ cognitive and emotional reactions to children’s illness. The culturally-based beliefs about parents’ role in children’s illness also influenced parents’ efficacy beliefs in taking proper actions to treat children’s illness, their perceived outcomes of the treatments, and the experienced uncertainty in illness, which eventually impacted their medical decision-making. A conceptual model was developed illustrating the relationships among these variables.

            A total of 931 survey questionnaire were collected from the Shandong, Gansu, and Shaanxi provinces of China. A majority of the respondents (76.5%) self-medicated their children in their lifetime. Most respondents (66.5%) used antibiotic medicines at least one time in the year prior to the survey, while 22.6 % used at least twice. Amoxicillin was found to be the most frequently used antibiotic drug among the Chinese parents. Results of the path analysis showed that orientation to traditional cultural values significantly impacted parents’ parenting styles, cognitive understanding and emotional reactions to children’s illness, and beliefs and perceptions about medication. These factors affected the decision to perform parental self-medication with antibiotics through parents’ expected outcomes about antibiotic treatments and the level of uncertainty experienced during the process.

            Collectively, these two studies provided a comprehensive understanding of the how culturally based cognitive factors would influence parental SMA in China through uncertainty and outcome expectations. Results from the quantitative analysis also showed that the personal factors that focused more on evaluations of the situation (e.g., uncertainty) and evaluation of the treatments (e.g., outcome expectations) matters more than self-evaluative factors (e.g., self-efficacy). In addition, the important roles uncertainty and outcome expectations played in explaining parental SMA decisions also highlighted the importance of promoting cognitive appraisal of uncertain situations and correcting misperceptions about antibiotics among the Chinese public.