Disconnects between knowledge and practice in antimicrobial resistance stewardship: findings from Vietnam's National...

Antimicrobial resistance (AMR) poses a critical public health challenge, particularly in low- and middle-income countries such as Vietnam. Assessing healthcare professionals' knowledge, attitudes, and practices (KAP) is vital to track progress and optimize national AMR interventions. This study aimed to assess KAP toward AMR and identify influencing factors among healthcare professionals, generating baseline evidence to strengthen stewardship and guide the implementation of Vietnam's 2023-2030 Action Plan. A cross-sectional study was conducted in six cities and provinces in Vietnam during 2023-2024, involving 3051 healthcare professionals across health system levels. Data were analyzed using multilevel linear regression, structural equation modeling (SEM), and multigroup SEM (MG-SEM) to examine KAP patterns and associated determinants. Respondents demonstrated moderate knowledge and attitude about AMR, but reported suboptimal practices. While 75.7% totally agreed that self-medication without prescription is a key cause of AMR and 66.4% rated AMR as an important community issue, only 34.2% frequently participated in AMR-related training. Moreover, only 41.1% were fully confident in educating patients on antimicrobial use. Regression analyses identified physician status, higher education, and working in provincial hospitals as key factors associated with better KAP outcomes. Notably, SEM revealed a negative association between knowledge of AMR causes and practice, and MG-SEM highlighted significant provincial variations in KAP relationships. While Vietnamese healthcare professionals show foundational awareness and support for AMR control, gaps in confidence and practice remain. These findings underscore the need for context-specific training and decentralized stewardship strategies tailored to professional roles and regional healthcare contexts.