Current jargon on antibiotic resistance fails to stick or scare, study finds

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In a recently published study, Dr Communication Medicine, Researchers evaluated the effectiveness of current antimicrobial resistance (AMR) in public health communications based on their memorability, risk correlates, and linguistic characteristics.

Study: Existing terminology related to antimicrobial resistance fails to evoke risk perception and recall. Image credit: Five Images /


AMR is a growing health care crisis, as it caused nearly 5 million deaths in 2019, surpassing the number of deaths from coronavirus disease 2019 (COVID-19) in 2020. AMR occurs when certain microorganisms such as bacteria and viruses evolve to resist treatments such as antibiotics.

Overuse of antibiotics, influenced by factors such as risk aversion in healthcare and growth objectives in agriculture, exacerbates AMR. Despite the severity of AMR, public awareness remains low, with media coverage often overshadowing AMR with more relevant health threats or events such as the COVID-19 pandemic.

Although there is a need for more effective AMR communication, terms such as “antimicrobial resistance” are considered abstract and challenging, while in the media, “antibiotic resistance” and “superbugs” are the most used and “AMR” the least. Although scholars suggest, consistently using terms such as “drug-resistant infections” for clarity.

Further research is needed, as current AMR-related terminology has shown inconsistency and ineffectiveness in public health communication. This has led to insufficient awareness and understanding among the general public despite the significant public health impact of AMR.

About the study

The University of Leicester School of Psychology and Vision Sciences Ethics Committee conducted the two studies, ensured ethical approval and informed consent of all participants. In Study 1, conducted in May 2020, 305 US participants were recruited from Amazon Mechanical Turk (MTurk).

Although MTurk has historically been a rich source of diverse, quality data, recent problems have arisen with inattentive participants and “bots”. Despite the increase in its participant pool in the early stages of the COVID-19 pandemic, concerns about data quality remain.

To address this, the researchers applied rigorous data screening and launched subsequent surveys through Prolific, a platform known for superior data quality. In November 2021, Study 2 enrolled 998 UK participants from Prolific who matched the national population profile.

Both studies explored word effectiveness and considered factors such as risk associations and recall across 40 health terms, including six terms related to AMR. Predictive factors for word performance included linguistic measures such as familiarity, processing fluency, and pronounceability.

Other controls, such as demographic details and medical history, were also examined. The Wechsler Adult Intelligence Scale (WAIS) was used to assess cognitive ability, as previous research indicated its relevance to word memory.

All participants engaged in an online questionnaire. In Study 1, the health terms were presented in different orders, while in Study 2, the order was randomized for each participant.

The list includes globally recognized health threats, including terms such as “COVID-19,” “acquired immunodeficiency syndrome (AIDS),” and “superbugs.” Participants rated two non-health-related terms, included as an attention test, on several criteria and completed a vocabulary test from the WAIS.

A final memory test presented 40 new as well as original terms, in which participants were asked to recall which terms they had previously seen. On average, the survey took 10–20 minutes, versus one hour for Study 2.

Data were carefully checked for authenticity and consistency. Statistical analysis involves various techniques suited to the nature of the data, thereby ensuring the reliability and validity of the results.

Study results

In two studies comparing risk association ratings and memory scores for 40 health risk and disease terms, six AMR-related terms ranked lower in both global risk perception and memorability. More specifically, high-risk perception scores were attributed to terms such as “cancer,” “ebola,” and “heart disease,” with “cancer” achieving a significant mean score of 6.65 out of seven in the second study.

In comparison, terms like “chicken pox,” “AMR,” and “diarrhea” received the lowest risk ratings. In particular, three AMR-related terms, including “antimicrobial resistance,” “bacterial resistance,” and “AMR” were least associated with risk.

Statistical analysis revealed significant differences in risk association ratings for AMR terms in both studies. Importantly, “drug-resistant infection” received a higher risk association score than other AMR-related terms.

Regarding recall, conditions such as “diarrhea,” “human immunodeficiency virus (HIV)” and “AIDS” were the most remembered, with 96% of participants in the second study recalling them correctly. In stark contrast, AMR-related terms such as “AMR,” “antimicrobial resistance,” and “drug-resistant infection” scored very low in terms of recall.

The researchers also wanted to determine factors that predict the effectiveness of more AMR-related health conditions. “Antibiotic resistance” was selected due to relevance in the existing literature and high-risk association ratings in the study. “Drug-resistant infection” was also selected, as it performed best in terms of sound efficacy metrics.

Preliminary tests were conducted to determine correlations between word performance metrics, including risk factors and memorability, various linguistic components, and participant factors including demographics and medical history. For the term “drug-resistant infection,” multiple regression analysis showed that demographic variables, memory scores, and linguistic dimensions significantly influenced risk association scores in both studies. In contrast, for “antibiotic resistance”, only the linguistic dimension plays a significant role in influencing the risk association score.

When examining recall, demographic factors and linguistic dimension were primary predictors. Notably, men were nearly three times more likely than women to recall the term “drug-resistant infection” in the first study. For “antibiotic resistance,” a broader vocabulary and familiarity with the term increased participants’ chances of remembering it.

Journal Reference:

  • Krockow, EM, Cheng, KO, Maltby, J., & McElroy, E. (2023). Existing terminology related to antimicrobial resistance fails to evoke risk perception and recall. Communication Medicine. doi:10.1038/s43856-023-00379-6

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