Antimicrobial resistance: still widely misunderstood
The rise of antimicrobial resistance is one of the biggest challenges of modern times, yet there are still large gaps in public understanding of the issue. To help us focus our approach to communicating the subject, we commissioned a study to find out people's attitudes to antibiotics and their understanding of resistance.
Headlines stating that antibiotic resistance could cost the economy trillions of dollars, or lead to millions of extra deaths a year, may influence governments and policy makers, but are they helping the public get the message about the scale of the problem we face?
Not according to research that looks at how the public engage with the issue of antimicrobial resistance.
The Wellcome Trust commissioned Good Business Ltd to conduct a number of focus groups and pair interviews with members of the public, and conversations with GPs, to explore their relationship with antibiotics. The results have highlighted a need to rethink the way we communicate the issue to the public.
While scientists and policy makers are happy using terms such as 'antimicrobial resistance', 'AMR' and 'antibiotic resistance', we perhaps take it for granted that everyone understands what these means as well as we do.
Perhaps unsurprisingly, no-one in the focus groups was familiar with the initialisation 'AMR', which often gets used as shorthand. More importantly, 'antimicrobial resistance' also drew blank faces from the participants, who came from a range of social, educational and age groups. "I need a dictionary for that" commented one participant.
Even 'antibiotic resistance' left the vast majority of participants confused, with many believing it is patients who build up a resistance to antibiotics prescribed, rather than the bacteria they treat.
Does it really matter?
Why should we care if people don’t accurately understand these terms? The reason is that a large part of the problem – other than the lack of new drugs being developed – is linked to people's behaviour. It's vital that antibiotics aren't over-used, and when they are used it's important that people finish the treatment course.
The research highlighted that many people feel validated when they are prescribed antibiotics, commenting, "It confirms I'm ill" and "I don’t feel like I've wasted the doctor's time". Others think of antibiotics as "a magic pill" to help them get better, without understanding that they are only effective against bacterial infections.
The result of these beliefs and attitudes is that many patients put pressure on GPs to prescribe antibiotics, even when they are not needed. This was reflected in the GP interviews that were conducted, with some admitting that it can be "hard to say no" when patients are set on getting antibiotics.
What can be done?
By understanding people's attitudes to antibiotics, and what has led them to these beliefs, we are in a better position to address misunderstandings and tackle the issues they lead to.
For example, if people think that they will develop a resistance to antibiotics, they may be less likely to finish the full course, when in fact not finishing the course could increase the rate at which resistance develops.
This study indicated that understanding that it is the microbes that develop resistance (not humans) did have an impact, but as individuals many still felt powerless to change things.
One of the most interesting outcomes was that using big numbers to show the size of the problem didn't engage people with the issue - "You still don’t think it'll happen to you," said one. "The numbers are so big it just seems ridiculous," commented another.
People were much more likely to take notice when they felt the issue might affect them, their family or friends, directly.
Know your audience
It's important that we know our audiences and tailor communication styles to suit different people in order to best engage with them.
The language we use at work, in labs, and at academic conferences is quite different to that we use with our friends on a night out. It makes sense that what works best when communicating with health experts, economists, and politicians may well be different to what works with the general public. If we want people to fully engage with important scientific issues, such as drug resistant infections, we need to ensure that they understand them enough to be able to – and that requires us to explain things better.
We will be using the insights from this work to inform the way that we communicate and engage with the public – moving away from terms such as 'antimicrobial resistance' towards 'drug resistant infections' – to help clarify that it is bugs, not people, that develop resistance to drugs.
Too big to ignore
Drug resistance is too big an issue to ignore. There are several approaches to tackling it – from developing new drugs to cracking down on counterfeits – but it is important that individuals understand that they have a part to play too. Tackling misunderstandings and empowering people to make informed choices about their use of antibiotics is an essential piece of the puzzle.
Cultural change can be a slow process, but ensuring people clearly understand the problem we face is a good place to start. We hope these insights into people's attitudes to drug resistance will enable us – and the wider community – to communicate more effectively.