When it comes to inappropriate antibiotic use, ‘social norm’ framing alone doesn’t shift intentions
Chris Dall, MA50 minutes ago.
Antimicrobial Stewardship
Newly published survey results suggest that just using “social norm” framing to dissuade people from inappropriate antibiotic use won’t get the job done. But explaining why certain behaviors should be avoided can move the needle in some cases.
The survey, published this week in Open Forum Infectious Diseases, found that 43% of respondents overall said they probably or definitely would want to get antibiotics for cold or flu symptoms. That’s not recommended, because cold and flu symptoms are primarily caused by viral infections. Not only do antibiotics not work for cold and flu, but using them unnecessarily can promote antibiotic resistance.
Thirty-nine percent of respondents said they would probably or definitely keep leftover antibiotics so they could use them again in the future—another behavior that is not advised.
But the point of the survey, which was created by researchers with the Spencer Fox Eccles School of Medicine at the University of Utah, was not just to gauge people’s willingness to engage in these behaviors. It was also to determine the type of messages that may influence their intentions.
“We are a team of communicators, clinicians, and stewards, and one of our main overarching aims is not just to provide quality clinical information to patients and the public, but we also really want to figure out ways that we can help people understand the information they need to make the best decisions,” lead study author Alistair Thorpe, PhD, told CIDRAP News.
Social norm messages alone didn’t resonate
The survey randomly assigned participants to receive one of four messages.All of the message included social norms framing: Half said “Research shows that 38% of people want antibiotics for cold or flu symptoms;” the other half said 62% of people don’t. Those percentages were based on previous research showing that 38% of adults seeking care for respiratory infections want antibiotics. The same percentages were used for the leftover antibiotics question for consistency.
Half of the all the messages provided no additional information. The other half included information explaining why these behaviors aren’t recommended by experts. Thorpe and his colleagues wanted to fill an evidence gap on whether social norms messages can boost efforts to encourage people to follow recommended antibiotic behaviors.
“There’s a lot of literature showing that providing information about appropriate antibiotic use is necessary and can be effective,” Thorpe said. “But it doesn’t work for everyone.”
After seeing the messages, roughly half the 972 respondents (mean age, 42; 58% female) were then given a question about wanting antibiotics for cold and flu symptoms and asked to respond using a four-point scale. The other half were asked about their willingness to keep leftover antibiotics, using a five-point scale.
When respondents were given contextual information about why antibiotics should not be taken for cold or flu symptoms, they were significantly less likely to want antibiotics for such symptoms than those who didn’t receive that information—36% compared with 50%.
But among the participants who were presented with only the social norms messages and no contextual information, there was no impact. Forty-nine percent of those who saw the “38% do” message still wanted antibiotics for cold and flu symptoms, while 51% of those who saw the “62% don’t” message wanted antibiotics.
In the leftover antibiotics arm, social norms messages alone were no more successful at swaying participants in this group. But contextual information about why it’s important to dispose of antibiotics properly did not affect people’s willingness to keep leftover antibiotics either.
Thorpe said social norms messages about the percentage of people who engage in inappropriate antibiotic use may not resonate with people when not presented along with additional information explaining why it’s inappropriate. “A lot of people may just be like ‘I don’t care… this doesn’t mean anything to me,’” he said.
But he and his coauthors also suggest that a more pronounced majority-versus-minority comparison—95% vs 5%—or being exposed to the message multiple times might make a difference.
“Over time, seeing that message more and more could have a cumulative effect, potentially,” he said. Future research may test those hypotheses.
Thorpe says that, ultimately, he and his colleagues really want to be thoughtful about how they design patient- and public-facing messages about antibiotics.
“Effective stewardship messaging really requires an evidence base on what does and does not resonate with people, and that’s really the gap we’re trying to fill,” he said.