School of Psychology and Vision Sciences



A key driver of antibiotic resistance is antibiotic overuse due to misinformation. Patients are often unaware of antibiotic resistance or falsely conceptualise antibiotics as ‘wonder drugs’. This may lead them to pressure doctors to prescribe antibiotics, hoard antibiotics or use other patients’ drugs. Some may even purchase antibiotics illegally. Patient behaviour differs globally and is affected by beliefs, healthcare systems and drug regulations. This project will address inappropriate patient behaviour by raising health risk literacy in the UK and South Africa, which has particularly high levels of infectious diseases and antibiotic resistance.

Current antibiotic resistance risk communication is abstract, and health organisations have called for more effective language. This project responds to user needs by developing new risk communication materials that address public misunderstandings about antibiotic use. Psychological knowledge on how to communicate risks efficiently is the foundation of our research. Specifically, we focus on successful health risk terminology and the communication tool of metaphors, i.e., figures of speech that compare abstract concepts such as antibiotic resistance to other topics that are better known and understood. Metaphors have been successful in communicating other health risks. For example, recent UK National Health Service (NHS) campaigns likened COVID-19 to smoke, thus providing a rationale for opening windows. Yet, metaphors remain unexplored in the context of antibiotic resistance. Working closely with doctors, patients, healthcare experts and creative writing facilitators from the UK, South Africa and internationally, we aim to develop a set of new metaphors that communicate information about antibiotics to audiences with little medical knowledge.


Initial ideas for terminology and metaphors will be generated in qualitative focus groups with doctors and patients that have lived experiences of drug-resistant infections. The focus groups will be face-to-face workshops that explore participants’ conceptualisations of AMR and their perceptions of current AMR-related risk communication and terminology. Facilitated by creative agencies, workshops will also include creative brainstorming elements to generate a list of metaphors and alternative terminology to be further developed and tested in follow-up studies. The initial list of metaphors and AMR-related terminology will be assessed and rated using an international panel of expert stakeholders in a Delphi research study. Using a snowball sampling approach, approximately 50 international experts with backgrounds in antibiotic resistance, infectious diseases, health communication, decision making and psycholinguistics will be invited to participate in a virtual Delphi exercise that involves several rounds of opinion consolidation and consensus-building to identify a shortlist of the most useful metaphors and terminology. Finally, this expert-approved shortlist will be tested in a 2-part online experiment with nationally representative samples in the UK and South Africa. Controlling for existing participant knowledge, different metaphors and language pertaining to antibiotic resistance will be tested with regard to memorability, risk ratings and their ability to communicate accurate information. The second part of the experiment will be a follow-up study to test information retention of participants over time.


The main project outcome will be a carefully designed, tried and tested set of metaphors and terminology related to antibiotic resistance that can be used by governments, health organisations, charities, media and doctors internationally to raise awareness about antibiotic resistance, inform patients how antibiotics work, and change the way we use antibiotics. The project will also provide an example of bottom-up, stakeholder-driven research methodology for developing future variations of health risk messages related to antibiotic resistance to respond to local needs and challenges (e.g., in the context of different languages).

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