Testing New Ways to Name Antimicrobial Resistance

How Can we Frame Antimicrobial Resistance in the Best Way to Inspire Behaviour Change? An Online Randomised Controlled Trial.

This study aims to investigate the public's views on antibiotics and the impact of different ways to name the potential consequences of antibiotics not working in the future. It is known that current ways to name this don't resonate well with the public, and the study team have worked with members of the public through focus groups and community workshops to develop new ways of describing this in a process of co-design. This study aims to test four different ways of presenting this potential crisis to the public, some of which are new communication strategies designed by the public themselves, to evaluate which are the most memorable and investigate the impact on behaviour change.

Adults aged over 18, living in the United Kingdom, who have already signed up to a market panel research company will be eligible to participate in this study.

Participants will be invited to complete a short online survey (this should take around five minutes), advertised to them by the market research panel they have already signed up to. This survey is completely anonymous, and contains some multiple-choice questions, and some that require a short free text response. At the start of the survey one of the four ways to name AMR will be presented to participants in the form of a poster.

This study aims to result in an improved understanding regarding the general public's understanding of antibiotic use and investigate the impact of communication on behaviour change. The data from this study may be used to inform future public health campaigns on this topic and improve the use of antibiotics.

This study will be conducted online using the Predictiv platform, an online platform built by the Behavioural Insights Team. The study is being run in collaboration between the Behavioural Insights Team and the Institute of Global Health Innovation at Imperial College London.

Is it anticipated that the survey will open in April 2024 and be open until recruitment of 4000 participants is complete. This is expected to take 4-6 weeks.

Study Overview

• Status: Completed
• Conditions: Antimicrobial Resistance; Attitude to Health
• Intervention / Treatment: Behavioral: Presentation of Antimicrobial Resistance

Detailed Description

Antimicrobial resistance (AMR) refers to the process by which bacteria become resistant to antibiotics, rendering them ineffective in treating infections. Public behaviour change is needed to use antibiotics more sparingly and wisely (for example, only taking them when needed and finishing the course). However, studies and public engagement work have shown that the current language around the crisis of AMR is not well known or understood by the general public. It is felt to be too scientific, not memorable, and doesn't convey sufficient meaning to inspire behaviour change.

Building on previous studies, this project aims to identify whether different ways to present or frame Antimicrobial Resistance (AMR) can lead to improved comprehension and change attitudes towards the crisis. Through extensive public engagement and involvement work three different ways to frame AMR to the public have been developed. One of these ways is a novel name developed through co-design with public members, and the other two were existing terms that the public believed were better than AMR during our engagement activities.

An online randomised controlled trial (RCT) has been designed to test these three names against the control of AMR/Antimicrobial resistance, to see if they can improve comprehension, attitudes towards and recall of the subject.

This online RCT will be delivered in collaboration with the Behavioural Insights Team using their well established online platform, called Predictiv. 4,000 participants will be recruited (to be representative of the UK population). They will see one of our four names (this will be presented in the typical community setting of seeing a poster at a bus stop), and be asked to complete a short five minute survey, answering a series of questions to explore their understanding of the topic and their future attitudes to antibiotic use.

Statistical analysis will be conducted to see which of the four communication strategies were most effective across the different outcomes, helping us to understand which communication strategies for AMR are most useful at inspiring behaviour change. Data will additionally be analysed to explore whether different messaging strategies are more effective in certain population subgroups - for example by age or previous antibiotic use.

• Study Type: Interventional
• Enrollment (Actual): 4296
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, W2 1NY
    • Imperial College London

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adults aged over 18
• Resident in the United Kingdom (UK)
• Have passed the attention check at the start of the online survey.

Exclusion Criteria:

• Individuals not signed up a market research panel, and will therefore not have access to the online survey
• Those resident outside the UK
• Those who fail the attention check at the start of the online survey.
• Individuals aged under 18.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Arm - Antimicrobial Resistance; Participants will be shown an image of a poster at a bus stop. This will contain information about antibiotics, and will have the words "Antimicrobial Resistance" at the top.
Experimental: Intervention Arm 1 - Superbugs; Participants will be shown an image of a poster at a bus stop. This will contain information about antibiotics, and will have the word "Superbugs" at the top.	Behavioral: Presentation of Antimicrobial Resistance; Participants will be presented with a poster containing information about antibiotics, each intervention poster will have a different name at the top, representing a new way to frame antimicrobial resistance.
Experimental: Intervention Arm 2 - Antibiotic Resistance; Participants will be shown an image of a poster at a bus stop. This will contain information about antibiotics, and will have the words "Antibiotic Resistance" at the top.	Behavioral: Presentation of Antimicrobial Resistance; Participants will be presented with a poster containing information about antibiotics, each intervention poster will have a different name at the top, representing a new way to frame antimicrobial resistance.
Experimental: Intervention Arm 3 - Antibiotic Crisis; Participants will be shown an image of a poster at a bus stop. This will contain information about antibiotics, and will have the words "The Antibiotic Crisis" at the top.	Behavioral: Presentation of Antimicrobial Resistance; Participants will be presented with a poster containing information about antibiotics, each intervention poster will have a different name at the top, representing a new way to frame antimicrobial resistance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Correct Answers by Participants on Questions Designed to Evaluate Attitudes Towards Antimicrobial Resistance (Sentiment)	Evaluation of participant's attitudes towards antimicrobial resistance, related to questions within the survey that assess sentiment (including agreement that antimicrobial resistance is an urgent issue that needs to be addressed, antimicrobial resistance poses a risk to human health and antimicrobial resistance is an issue that may impact the participants own health). This was conducted using a quasi-binominal regression model using the sum of binary ratings of sub-sentiment questions as the primary outcome analysis.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Correct Answers by Participants on Questions Designed to Evaluate Comprehension of Antimicrobial Resistance	Comprehension of the meaning of Antimicrobial Resistance, related to questions within the survey that evaluate comprehension (what has caused antimicrobial resistance, what is the solution to antimicrobial resistance, what antimicrobial resistance is). This was conducted using a quasi-binominal regression model using the number of correct answers to comprehension questions.	6 weeks
Percentage of Participants Who Stated They Would Request Antibiotics	Intention regarding antibiotic use in the context of antimicrobial resistance related to questions within the survey that evaluate intent - asking participants about whether they would request antibiotics in certain scenarios. This was conducted using a separate logistic regression for each scenario (binary - Yes or No).	6 weeks
Percentage of Participants Who Correctly Recalled the Terminology Related to Antimicrobial Resistance	Recall of the term used to describe antimicrobial resistance in the intervention. This was conducted using a separate logistic regression for each question (asking about recall of the name at the top of the poster and the content of the poster) (binary - Yes or No).	6 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Impact on population sub-groups	Explore the differing impact of different ways to present AMR on population sub-characteristics, including age, ethnicity and previous antibiotic use. This will be conducted using a subgroup analysis of the overall sentiment model, using a quasi-binomial regression model. Subgroups include: Existing familiarity (Yes; No); Taken antibiotics in past year (Yes; No); Age (18-34; 25-39; 40-54; 55+); Ethnicity (White; Non-White)	6 weeks

Collaborators and Investigators

• Sponsor: Imperial College London
• Collaborators: The Behavioural Insights Team
• Investigators: Principal Investigator: Kate Grailey, Imperial College London

Study record dates

Study Major Dates

• Study Start (Actual): April 10, 2024
• Primary Completion (Actual): April 18, 2024
• Study Completion (Actual): May 1, 2024

Study Registration Dates

• First Submitted: April 4, 2024
• First Submitted That Met QC Criteria: April 4, 2024
• First Posted (Actual): April 10, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 9, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: Behaviour Change; Antimicrobial Resistance
• Additional Relevant MeSH Terms: Anti-Bacterial Agents; Anti-Infective Agents
• Other Study ID Numbers: 6995049

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No personal IPD will be collected in this study. Aggregate participant data will be shared between the Behavioural Insights Team and Imperial College London

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No