Reducing expectations for antibiotics in primary care: a randomised experiment to test the response to fear-based messag
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RESEARCH ARTICLE
Open Access
Reducing expectations for antibiotics in primary care: a randomised experiment to test the response to fear-based messages about antimicrobial resistance Laurence S. J. Roope1,2,3, Sarah Tonkin-Crine2,4, Natalie Herd5, Susan Michie5, Koen B. Pouwels1,2, Enrique Castro-Sanchez6, Anna Sallis7, Susan Hopkins2,8,9, Julie V. Robotham2,10, Derrick W. Crook2,3,11,12, Tim Peto2,3,11,12, Michele Peters13, Christopher C. Butler2,4, A. Sarah Walker2,3,11† and Sarah Wordsworth1,2,3*†
Abstract Background: To reduce inappropriate antibiotic use, public health campaigns often provide fear-based information about antimicrobial resistance (AMR). Meta-analyses have found that fear-based campaigns in other contexts are likely to be ineffective unless respondents feel confident they can carry out the recommended behaviour (‘selfefficacy’). This study aimed to test the likely impact of fear-based messages, with and without empowering selfefficacy elements, on patient consultations/antibiotic requests for influenza-like illnesses, using a randomised design. Methods: We hypothesised that fear-based messages containing empowering information about self-management without antibiotics would be more effective than fear alone, particularly in a pre-specified subgroup with low AMR awareness. Four thousand respondents from an online panel, representative of UK adults, were randomised to receive three different messages about antibiotic use and AMR, designed to induce fear about AMR to varying degrees. Two messages (one ‘strong-fear’, one ‘mild-fear’) also contained empowering information regarding influenza-like symptoms being easily self-managed without antibiotics. The main outcome measures were selfreported effect of information on likelihood of visiting a doctor and requesting antibiotics, for influenza-like illness, analysed separately according to whether or not the AMR information was ‘very/somewhat new’ to respondents, pre-specified based on a previous (non-randomised) survey. (Continued on next page)
* Correspondence: [email protected] A. Sarah Walker and Sarah Wordsworth are joint last authors. 1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK 2 The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated
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