Messages of fear and empowerment are best for reducing inappropriate antibiotic use

Référence

Roope LS, Tonkin-Crine S, Herd N, et al. Reducing expectations for antibiotics in primary care: a randomised experiment to test the response to fear-based messages about antimicrobial resistance. BMC Med 2020;18(1):110.https://doi.org/10.1186/s12916-020-01553-6

Sommaire

A previous study found that a fear-based message regarding AMR had the effect of increasing the likelihood that patients with a low knowledge of AMR would seek an antibiotic for their next acute respiratory tract infection (ARTI). In this follow-up, these UK researchers compared a fear-based message with empowering information regarding the typical prognosis and benign course of most ARTIs, and explained that antibiotics do not help most ARTIs. They invited randomly selected adults to receive 1 of 3 online messages: (1) fear message only (n = 1000), (2) mild fear message plus empowerment information (n = 1500), and (3) strong fear message plus empowerment information (n = 1500). Participants were first given an illness description resembling an influenza-like illness, and then presented with the message. A total of 8000 people responded to the invitations. The mean age of respondents was 47 years. Overall, 27.8% of respondents believed antibiotics would probably or definitely help with the episode of ARTI, and 25.2% thought the information was somewhat or very new to them. The latter was a bit more likely to be reported by those in the fear-only group (28.5% for fear-only vs 22.4% to 25.9% for fear plus empowerment). Those given one of the fear plus empowerment messages were significantly more likely to report that they would be less likely to visit a doctor for their next ARTI (45.1% - 46.1% vs 29.2%; P < .001) and were also more likely to report that they would be less or much less likely to request an antibiotic (52.5% - 54.7% vs 42.3%; P < .001). There were small and paradoxical increases in the likelihood of seeking medical care and requesting an antibiotic for those in the fear-only message group, as was found previously. Unfortunately, the messaging had less impact on those for whom the information was new and those who believed that antibiotics were helpful for ARTI. Results were similar when adults were asked about requesting an antibiotic for their children.