## 3 Discussion
### Personal Knowledge and Attitude towards Antimicrobial Resistance and Consumption  
Current results indicated that there was a significant variation in KAP levels between participants from LMICs and HICs. While the LMIC participants displayed poor attitude and practice, they demonstrated better knowledge on AMR than the HIC participants. This difference in knowledge might be due to a sampling bias that occurred as the proportion of non-government stakeholders was higher in the LMIC (55.7%) subset compared to the HIC subset (2.1%). As an example, LMIC individuals self-reported to consume antimicrobials more regularly (38.3%) than HIC participants (8.8%). The poor attitude toward antimicrobial use among LMIC participants might be explained by the higher incidence of infections in these regions and easier access to antimicrobials since the regulations are less restricted on antimicrobial use (AMU) in LMICs compared to HICs. The Eurobarometer survey in 2018, covering over 27,000 citizens, described that almost all Europeans (93%) obtained antimicrobials via a healthcare professional [18]. Observational studies from LMICs generally show that most antimicrobials are sold without prescription [19; 20]. Taken together, our study suggests that a country's regulation of antimicrobial use is the main determinant for appropriate use, and the role of knowledge and awareness of AMR is limited when there is a lack of a regulatory framework on antimicrobial sales. However, awareness campaigns might be fruitful in LMICs when they directly target antimicrobial suppliers, as previously concluded by a study in Saudi Arabia [21].  
Given how AMR was perceived differently in LMICs and HICs, multivariate analyses were performed to further explore explanatory factors for these differences. Notably, a scientific field of expertise and master/doctoral levels of education were the main determinants for good knowledge of AMR. These findings were similar to other studies among the general public in Sweden and Japan that showed that higher education levels yielded higher knowledge scores on antimicrobial use and AMR [22; 23]. Another study from Poland furthermore showed that low levels of education were associated with poor knowledge, behavior, and attitudes toward antimicrobial use [24]. In line with these previous findings, our results highlighted that level of education was a strong predictor for personal knowledge on AMR and AMU, regardless of age, gender, or country of origin. In the case of attitude and perception, the country of origin, education, and field expertise were significant factors. Even after adjusting for other factors, including education and field of expertise, country of origin (i.e., HIC vs. LMIC) remained significantly associated with good perception and behavior. Combined, our results suggest that a background in science and having a university degree lead to the attitudes and perceptions towards antimicrobial resistance and use. However, the country's wealth status might also play an important role, and the underlying mechanisms of how policy-makers and stakeholders perceive antimicrobial resistance remain complex. Our finding is in line with the hypothesis that a country's regulations on antimicrobials may be one of the main determinants for the prudent use of antimicrobials on an individual level, regardless of knowledge, education, and field of expertise.