Advancing health risk Literacy about Antimicrobial Resistance through the use of Metaphors (ALARM): An international comparative study

Research context
There is an urgent need for social science methods to improve risk communication materials and raise awareness about global health threats. An important context for risk communication is the 'silent pandemic' of antimicrobial resistance. This refers to germs such as bacteria, which have developed stronger genes that mean they no longer respond to existing drugs such as antibiotics. Antimicrobial resistance can result in drug-resistant infections, which are illnesses that cannot be cured with current medication. The rise of drug-resistant infections is a problem with a scope similar to climate change. It is predicted to cause 10 million annual deaths by 2050-more than all types of cancer combined. All use of antibiotics contributes to the development of antimicrobial resistance. In other words, each time we use antibiotics, they lose some of their effectiveness for treating future infections. To conserve existing antibiotics and ensure they keep working for longer, a united public effort is needed. We must reduce the use of antibiotics when they are not necessary. Unfortunately, many members of the public know little about the way antibiotics work. They are also often unaware of the risks associated with antibiotic overuse. This lack of knowledge may lead them to disregard doctors' advice or engage in inappropriate behaviours such as hoarding of antibiotics.

Aims and objectives
This project aims to develop new scientific methods for effective risk communication. It will test these methods in the context of antimicrobial resistance and address public misunderstandings about antibiotic use. The project spans two different healthcare contexts-the UK and South Africa-to gain international insights and compare countries with different disease burdens. The goal is to develop new, global information materials that radically change the way the public think about antimicrobial resistance. Psychological knowledge on how to communicate risks efficiently is the foundation of our research. Specifically, we focus on the communication tool of metaphors, i.e. figures of speech that compare abstract concepts such as antimicrobial resistance to other topics that are better known and understood. 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. We will test these metaphors in large, cross-cultural experiments, which will involve presenting participants from the UK and South Africa with the new metaphors and checking if they improve people's knowledge about antimicrobial resistance.

Potential applications and benefits
The main project outcome will be a carefully designed, tried and tested set of metaphors that can be used by governments, health organisations, charities, media and doctors internationally to raise awareness about antimicrobial resistance, inform patients how antibiotics work, and change the way we use antibiotics. A large range of stakeholders will benefit from the project. Health communicators will receive improved contents for their public health messages. Doctors will benefit from more efficient communication tools in their consultations with patients. The public will increase its health knowledge and make better choices relating to medication. All of this will help to reduce overuse of antibiotics, conserve effective drugs, and fight antimicrobial resistance. The project is therefore likely to benefit overall society and future generations of patients. Finally, even though this project focuses on communication about antimicrobial resistance, the newly developed insights and methods for metaphor design will be applicable to many other areas of risk communication and could help to transform other information campaigns about pandemics or climate change.