In a recent study published in Communications Medicine, researchers evaluate the effectiveness of current antimicrobial resistance (AMR)-related terms in public health communication based on their memorability, risk association, and linguistic attributes.
Background
AMR is a growing healthcare crisis, as it caused nearly five million deaths in 2019, which surpassed the fatalities from the coronavirus disease 2019 (COVID-19) in 2020. AMR occurs when certain microorganisms like bacteria and viruses evolve to resist treatments like antibiotics.
The overuse of antibiotics, influenced by factors like risk aversion in healthcare and growth motives in agriculture, aggravates AMR. Despite the severity of AMR, public awareness remains low, with media coverage often overshadowing AMR with more relatable health threats or events like the COVID-19 pandemic.
Although there is a need for more effective AMR communication, terms like "antimicrobial resistance" are perceived as abstract and challenging, while in media, "antibiotic resistance" and "superbugs" are most commonly used, and "AMR" is least used. Scholars, however, propose consistently using terms like "drug-resistant infections" for clarity.
Further research is needed, as current AMR-related terminology has shown inconsistency and inefficacy in public health communication. This has led to insufficient awareness and understanding among the general public despite the significant public health effects of AMR.
About the study
The University of Leicester School of Psychology and Vision Sciences Ethics Committee conducted two studies, ensuring ethical compliance and informed consent from all participants. In Study 1, conducted in May 2020, 305 United States participants were sourced from Amazon Mechanical Turk (MTurk).
Although MTurk has historically been a rich source of diverse, quality data, recent issues arose with inattentive participants and "bots." Despite the growth in its participant pool during the initial phase of the COVID-19 pandemic, concerns over data quality remained.
To address this, the researchers enforced rigorous data screening and initiated a subsequent survey through Prolific, a platform known for superior data quality. In November 2021, Study 2 enlisted 998 United Kingdom participants from Prolific who resembled the national demographic profile.
Both studies explored word effectiveness and considered factors such as risk association and memorability across 40 health terms, including six terms related to AMR. Predictive factors for word effectiveness included linguistic measures like familiarity, processing fluency, and pronounceability.
Other controls, like demographic details and medical history, were also examined. The Wechsler Adult Intelligence Scale (WAIS) was used to assess cognitive abilities, as prior research indicated its relevance in word memory.
All participants engaged with an online questionnaire. In Study 1, health terms were presented in varied sequences, while in Study 2, the order was randomized for each participant.
The list included globally recognized health threats, with terms like "COVID-19," "acquired immunodeficiency syndrome (AIDS)," and "superbugs." Participants rated two non-health-related terms, inserted as attention checks, based on several criteria and completed a vocabulary test from the WAIS.
A final memory test presented the original terms alongside 40 new ones, in which participants were asked to recall which terms they had seen before. On average, the survey took 10-20 minutes, with a one-hour time limit for Study 2.
Data were meticulously scrutinized for authenticity and consistency. Statistical analyses involved various techniques tailored to the nature of the data, thereby ensuring reliability and validity in the results.
Study findings
In two studies comparing the risk association ratings and memory scores for 40 health risk and disease terms, six terms related to AMR consistently ranked low in both risk perception and memorability. More specifically, high-risk perception scores were attributed to terms like "cancer," "Ebola," and "heart disease," with "cancer" achieving a notable mean score of 6.65 out of seven in the second study.
Comparatively, terms such as "chicken pox," "AMR," and "diarrhea" received the lowest risk ratings. In particular, three AMR-related terms, including "antimicrobial resistance," "bacterial resistance," and "AMR," ranked among the least associated with risk.
Statistical analyses revealed significant disparities in risk association ratings for AMR terms in both studies. Interestingly, "drug-resistant infections" received higher risk association scores as compared to other AMR-related terms.
Regarding memorability, conditions like "diarrhea," "human immunodeficiency virus (HIV)," and "AIDS" were most remembered, with an impressive 96% of participants in the second study recalling them correctly. In stark contrast, AMR-related terms such as "AMR," "antimicrobial resistance," and "drug-resistant infections" scored poorly in memorability.
The researchers further sought to determine factors predicting the effectiveness of AMR-related health terms. "Antibiotic resistance" was selected due to its relevance in the existing literature and high-risk association ratings in the studies. "Drug-resistant infections" was also selected, as it performed best in terms of word effectiveness metrics.
Preliminary tests were conducted to determine correlations between word effectiveness metrics, including risk association and memorability, various linguistic elements, and participant factors, including demographics and medical history. For the term "drug-resistant infections," multiple regression analyses showed that demographic variables, memory scores, and linguistic dimensions significantly impacted risk association scores in both studies. In contrast, for "antibiotic resistance," only linguistic dimensions played a significant role in influencing risk association scores.
When examining memorability, demographic factors and linguistic dimensions were the primary predictors. Notably, men were almost three times more likely than women to recall the term "drug-resistant infections" in the first study. For "antibiotic resistance," having a broader vocabulary and familiarity with the term increased the likelihood of participants remembering it.
Journal reference:
Krockow, E. M., Cheng, K. O., Maltby, J., & McElroy, E. (2023). Existing terminology related to antimicrobial resistance fails to evoke risk perceptions and be remembered. Communications Medicine. doi:10.1038/s43856-023-00379-6
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