Background: The Q-method is a research approach that combines quantitative and qualitative techniques to study people's subjectivity on a given theme. In Madagascar, antibiotic usage practices remain largely unstudied, particularly among pregnant and breastfeeding women. This study aims to use the Q-method to document the opinions of pregnant and breastfeeding women on antibiotic use practices in the Northwest region of Madagascar.

Methods: The Q-method was applied to 115 pregnant and breastfeeding women from two districts, one urban and one rural, in Northwest Madagascar. The participants ranked 36 statements about antibiotic use on a 7-point scale ranging from - 3 (strong disagreement) to + 3 (strong agreement). Principal component analysis (PCA) was used to analyze the rankings and identify groups of women with differing or similar viewpoints. The Wilcoxon and Kruskal-Wallis rank sum tests were employed to assess significant differences among participants in each group and to evaluate the differences between these groups. Additionally, semistructured interviews were conducted to explore the participants' reasoning behind their rankings and to complement the quantitative findings.

Results: Among the 115 women, 51% (59/115) resided in urban areas, while 49% (56/115) lived in rural regions. PCA identified two main groups of women with distinct viewpoints on antibiotic use. Group 1 comprised 55.6% (64/115) of the women and consisted of women who only complied with medical indications and instructions by being vigilant. Group 2 represented 35.6% (41/115) of the respondents and included women who believed in antibiotic usage based on receiving information first from multiple sources (medical staff or personal experience or other nonmedical relatives). 10 women (8.8%) could not be classified under either of the two groups. Differences in opinions were observed in Group 1 based on age (p = 0.004), marital status (p = 0.013), educational level (p = 0.007), gravidity (p = 0.062), and area of residence (p = 0.125), and in Group 2 based on educational level (p = 0.065) and gravidity (p = 0.127). Insights from the semistructured interviews enriched the interpretation of these groups' classification.

Conclusions: Pregnant and breastfeeding women surveyed in Northwest Madagascar believe that the best approach to antibiotic use is to follow the recommendations of health care professionals. However, some rely on advice from others, whether medical or nonmedical. To improve adherence to antibiotic treatments based solely on medical prescriptions and ensure their proper use in Madagascar, the communication between health care providers and patients must be strengthened.

Keywords: Antibiotics; Madagascar; Perceptions; Pregnant and breastfeeding women; Q-method.

© 2025. The Author(s).

背景：Q方法是一种结合了定量和定性技术的研究方法，用于研究人们对特定主题的主观看法。在马达加斯加，抗生素使用实践仍然缺乏研究，尤其是在怀孕和哺乳期妇女中。本研究旨在利用Q方法记录马达加斯加西北部地区怀孕和哺乳期妇女对抗生素使用实践的看法。

方法：该Q方法应用于来自马达加斯加西北部两个地区的115名怀孕和哺乳期妇女，其中一个为城市地区，另一个为农村地区。参与者根据从-3（强烈不同意）到+3（强烈同意）的7分量表对关于抗生素使用的36项陈述进行排序。主成分分析（PCA）用于分析排序结果，并识别具有不同或相似观点的女性群体。使用Wilcoxon秩和检验和Kruskal-Wallis秩和检验来评估各组参与者之间的显著差异以及这些群体之间的差异。此外，还进行了半结构化访谈以探讨参与者对排名的理由，并补充定量研究发现。

结果：在115名妇女中，51%（59/115）居住在城市地区，而49%（56/115）居住在农村地区。PCA识别出两个主要具有不同观点的女性群体。第一组包括了55.6%（64/115）的妇女，她们只遵守医疗指示并通过保持警惕来遵从医学建议。第二组占35.6%（41/115）的受访者，这些妇女认为在获得来自多个来源的信息后使用抗生素是合理的（如医疗人员或个人经验或其他非医务人员）。有10名妇女（8.8%）无法归类到这两个群体中的任何一个。基于年龄（p=0.004）、婚姻状况（p=0.013）、教育水平（p=0.007）、妊娠次数（p=0.062）和居住地区（p=0.125），第一组的意见存在差异，第二组则基于教育水平（p=0.065）和妊娠次数（p=0.127）。半结构化访谈提供的见解丰富了这些群体分类的解释。

结论：在马达加斯加西北部地区调查怀孕和哺乳期妇女发现，她们认为使用抗生素的最佳方法是遵循医疗专业人员的建议。然而，有些妇女则依赖来自其他人的建议（无论是医学还是非医学）。为了改善基于仅凭医嘱使用的抗生素治疗依从性，并确保其正确使用，必须加强医疗服务提供者与患者之间的沟通。

关键词：抗生素；马达加斯加；认知；怀孕和哺乳期妇女；Q方法。

© 2025. The Author(s).