Knowledge, Beliefs, and Non-Prescription Antibiotic Acquisition in Indonesia: Evidence from a National Health Survey

Purpose Antimicrobial Resistance (AMR) is a critical global crisis projected to cause 10 million annual deaths by 2050. Self-medication with antibiotics (SMA) is a primary accelerant of this crisis, as it bypasses medical safeguards. This study aims to quantify the "Know-Do Gap" by analyzing how specific dimensions of antibiotic knowledge and permissive beliefs influence the likelihood of acquiring antibiotics without a prescription among the Indonesian public. Methods This quantitative cross-sectional study utilized secondary micro-data from the 2023 Indonesia Health Survey (N = 101,482) involving residents aged ≥ 15 years. Binomial logistic regression was employed to estimate Adjusted Odds Ratios (AOR) for prescription-based acquisition, controlling for age, sex, education, and occupation as potential confounders. Results Non-prescription acquisition was 30.5%. While general awareness was low, only 34.3% understood that improper use leads to resistance. Respondents who believed antibiotics must be finished (AOR: 0,365) or taken on schedule (AOR: 0,477) were significantly less likely to obtain antibiotics without prescription. Conversely, permissive beliefs, such as the acceptability of purchasing without a prescription (AOR: 2,267) or reusing leftovers (AOR: 1,366), significantly increased the likelihood of non-prescription acquisition. Conclusion Non-prescription antibiotics acquisition remains a substantial issue in Indonesia, driven by critical gaps in translating awareness into practice. Procedural, actionable knowledge exerts a stronger influence on behavior than abstract awareness. Stewardship interventions should prioritize dismantling permissive social norms and reinforcing practical dosing skills to mitigate the accelerating threat of AMR.