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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.

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT06356285
Enrollment
4296
Registered
2024-04-10
Start date
2024-04-10
Completion date
2024-05-01
Last updated
2025-01-14

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Antimicrobial Resistance, Attitude to Health

Keywords

Antimicrobial Resistance, Behaviour Change

Brief summary

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.

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.

Interventions

BEHAVIORALPresentation 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.

Sponsors

The Behavioural Insights Team
CollaboratorOTHER
Imperial College London
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)

Masking description

Participants will be blinded to the study arm that they have been assigned to.

Intervention model description

This study has been designed as a four-armed online randomised control trial (RCT). This will be conducted using Predictiv, an online platform for running behavioural experiments built by the Behavioural Insights Team The 4,000 participants will be randomised in a 1:1:1:1 ratio to one of four trial arms.

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes

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.

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Correct Answers by Participants on Questions Designed to Evaluate Attitudes Towards Antimicrobial Resistance (Sentiment)6 weeksEvaluation 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.

Secondary

MeasureTime frameDescription
Percentage of Correct Answers by Participants on Questions Designed to Evaluate Comprehension of Antimicrobial Resistance6 weeksComprehension 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.
Percentage of Participants Who Stated They Would Request Antibiotics6 weeksIntention 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).
Percentage of Participants Who Correctly Recalled the Terminology Related to Antimicrobial Resistance6 weeksRecall 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).

Countries

United Kingdom

Participant flow

Participants by arm

ArmCount
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.
1,055
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. 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.
1,113
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. 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.
1,092
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. 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.
1,036
Total4,296

Baseline characteristics

CharacteristicTotalControl Arm - Antimicrobial ResistanceIntervention Arm 1 - SuperbugsIntervention Arm 2 - Antibiotic ResistanceIntervention Arm 3 - Antibiotic Crisis
Age, Customized
18-24
487 Participants121 Participants129 Participants114 Participants123 Participants
Age, Customized
25-39
1090 Participants279 Participants281 Participants272 Participants258 Participants
Age, Customized
40-54
1178 Participants283 Participants304 Participants295 Participants296 Participants
Age, Customized
55+
1541 Participants372 Participants399 Participants411 Participants359 Participants
Race/Ethnicity, Customized
Asian
350 Participants93 Participants98 Participants75 Participants84 Participants
Race/Ethnicity, Customized
Black
125 Participants31 Participants31 Participants39 Participants24 Participants
Race/Ethnicity, Customized
Mixed / Other
177 Participants39 Participants55 Participants38 Participants45 Participants
Race/Ethnicity, Customized
White
3644 Participants892 Participants929 Participants940 Participants883 Participants
Region of Enrollment
United Kingdom
4296 participants1055 participants1113 participants1092 participants1036 participants
Sex/Gender, Customized
Female
2050 Participants487 Participants526 Participants543 Participants494 Participants
Sex/Gender, Customized
Male
2224 Participants565 Participants580 Participants541 Participants538 Participants
Sex/Gender, Customized
Other
22 Participants3 Participants7 Participants8 Participants4 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
0 / 00 / 00 / 00 / 0
other
Total, other adverse events
0 / 00 / 00 / 00 / 0
serious
Total, serious adverse events
0 / 00 / 00 / 00 / 0

Outcome results

Primary

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.

Time frame: 6 weeks

Population: All adults (over the age of 18, representative of the UK population) who responded to the survey question.

ArmMeasureValue (NUMBER)
Control Arm - Antimicrobial ResistancePercentage of Correct Answers by Participants on Questions Designed to Evaluate Attitudes Towards Antimicrobial Resistance (Sentiment)81 percentage of correct answers
Intervention Arm 1 - SuperbugsPercentage of Correct Answers by Participants on Questions Designed to Evaluate Attitudes Towards Antimicrobial Resistance (Sentiment)83.2 percentage of correct answers
Intervention Arm 2 - Antibiotic ResistancePercentage of Correct Answers by Participants on Questions Designed to Evaluate Attitudes Towards Antimicrobial Resistance (Sentiment)86.3 percentage of correct answers
Intervention Arm 3 - Antibiotic CrisisPercentage of Correct Answers by Participants on Questions Designed to Evaluate Attitudes Towards Antimicrobial Resistance (Sentiment)85.2 percentage of correct answers
p-value: 0.017Quasibinominal regression
Secondary

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.

Time frame: 6 weeks

Population: Adults residing in the UK aged over 18, passed attention check

ArmMeasureValue (NUMBER)
Control Arm - Antimicrobial ResistancePercentage of Correct Answers by Participants on Questions Designed to Evaluate Comprehension of Antimicrobial Resistance63.3 Percentage of correct answers
Intervention Arm 1 - SuperbugsPercentage of Correct Answers by Participants on Questions Designed to Evaluate Comprehension of Antimicrobial Resistance65.1 Percentage of correct answers
Intervention Arm 2 - Antibiotic ResistancePercentage of Correct Answers by Participants on Questions Designed to Evaluate Comprehension of Antimicrobial Resistance66.0 Percentage of correct answers
Intervention Arm 3 - Antibiotic CrisisPercentage of Correct Answers by Participants on Questions Designed to Evaluate Comprehension of Antimicrobial Resistance65.4 Percentage of correct answers
Secondary

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).

Time frame: 6 weeks

Population: Adults residing in the UK aged over 18, passed attention check

ArmMeasureValue (NUMBER)
Control Arm - Antimicrobial ResistancePercentage of Participants Who Correctly Recalled the Terminology Related to Antimicrobial Resistance72 Percentage of participants
Intervention Arm 1 - SuperbugsPercentage of Participants Who Correctly Recalled the Terminology Related to Antimicrobial Resistance65.4 Percentage of participants
Intervention Arm 2 - Antibiotic ResistancePercentage of Participants Who Correctly Recalled the Terminology Related to Antimicrobial Resistance79 Percentage of participants
Intervention Arm 3 - Antibiotic CrisisPercentage of Participants Who Correctly Recalled the Terminology Related to Antimicrobial Resistance74.5 Percentage of participants
Secondary

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).

Time frame: 6 weeks

Population: Adults residing in the UK aged over 18, passed attention check

ArmMeasureValue (NUMBER)
Control Arm - Antimicrobial ResistancePercentage of Participants Who Stated They Would Request Antibiotics8.7 Percentage of participants
Intervention Arm 1 - SuperbugsPercentage of Participants Who Stated They Would Request Antibiotics8.5 Percentage of participants
Intervention Arm 2 - Antibiotic ResistancePercentage of Participants Who Stated They Would Request Antibiotics8.8 Percentage of participants
Intervention Arm 3 - Antibiotic CrisisPercentage of Participants Who Stated They Would Request Antibiotics8.4 Percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026