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Reducing expectations for antibiotics in primary care: a randomised experiment to test the response to fear-based messages about antimicrobial resistance

Authors :
Susan Hopkins
Christopher C Butler
Laurence Roope
Natalie Herd
Michele Peters
Julie V. Robotham
Derrick W. Crook
Enrique Castro-Sánchez
Sarah Wordsworth
A. Sarah Walker
Anna Sallis
Sarah Tonkin-Crine
Koen B. Pouwels
Susan Michie
Tim E. A. Peto
National Institute for Health Research
Source :
BMC Medicine, Vol 18, Iss 1, Pp 1-11 (2020), BMC Medicine
Publication Year :
2020
Publisher :
BMC, 2020.

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 (‘self-efficacy’). This study aimed to test the likely impact of fear-based messages, with and without empowering self-efficacy 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 self-reported 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. Results The ‘fear-only’ message was ‘very/somewhat new’ to 285/1000 (28.5%) respondents, ‘mild-fear-plus-empowerment’ to 336/1500 (22.4%), and ‘strong-fear-plus-empowerment’ to 388/1500 (25.9%) (p = 0.002). Of those for whom the respective information was ‘very/somewhat new’, only those given the ‘strong-fear-plus-empowerment’ message said they would be less likely to request antibiotics if they visited a doctor for an influenza-like illness (p p p Conclusions Fear could be effective in public campaigns to reduce inappropriate antibiotic use, but should be combined with messages empowering patients to self-manage symptoms effectively without antibiotics.

Details

Language :
English
ISSN :
17417015
Volume :
18
Issue :
1
Database :
OpenAIRE
Journal :
BMC Medicine
Accession number :
edsair.doi.dedup.....0608f311ad34c39bc336fb4b0590b6d2
Full Text :
https://doi.org/10.1186/s12916-020-01553-6