By conducting a series of interviews and focus groups in London, Manchester and Birmingham, researchers found that most people, if they had heard of antibiotic resistance at all, thought that it was their body which becomes resistant to antibiotics, rather than the bacteria that cause drug-resistant infections.
This misconception often makes people feel like antibiotic resistance is someone else’s problem. Few of those interviewed think they overuse or misuse antibiotics so therefore they mistakenly think resistance will not be a problem for them. One person interviewed during the research said: "The more you take, the more your body becomes resistant to it. They stop working, but I don’t take them very often."
The research, conducted by the consultancy firm Good Business, suggested that people understand the concept more readily when doctors, the media and other communicators talk about "drug-resistant infections" or "antibiotic-resistant germs", rather than "antibiotic resistance". This makes it easier to understand that it is bacteria that acquire resistance, not people’s bodies.
The misconception could help to explain why many people who are prescribed antibiotics fail to complete the course, believing that this will prevent their bodies from becoming resistant. In fact, failure to complete a course of antibiotics can be a major factor in the development of drug-resistant infections, as it exposes germs to enough of the drug to promote resistance, but not enough to kill them.
The research also revealed that the language that is currently used by the media and scientists to describe the problem of antibiotic resistance is meaningless or puts people off. For example, reports that estimate antibiotic resistance could cost the economy trillions of dollars, or lead to millions of extra deaths a year, were found by participants to be difficult to grasp, leaving them feeling distanced from the problem.
In comparison, people were much more receptive when they were presented with real examples of how antibiotic resistance could affect them or their families, or with reference to specific bacterial infections that they might have had.
The scale of the problem was best explained when researchers showed people pictures of six common resistant bacteria which are becoming harder to treat. Understanding that the issue was about infections like strep throat, urinary tract infections (UTIs) or E-coli made the problem seem common, as most interviewees had had at least one of these illnesses and been treated with antibiotics. Explaining that antibiotic resistance could make routine operations like hip replacements or caesareans deadly was also effective.
Another consistent finding was that people have a positive relationship with antibiotics. Interviewees felt that getting them was validation that they were ill, both for themselves and others, and that they hadn’t "wasted the doctor’s time or my own". This means that in many cases people want to be prescribed antibiotics, whatever the nature of the illness they have, and will deploy a series of tactics to ensure they do, which may contribute to antibiotic overuse.
The research was carried out in two main phases. In the first, researchers sought to gain a good base of knowledge about people’s understanding of antibiotics and antibiotic resistance. To do this, they conducted two-hour in-depth interviews with eight pairs of friends in Manchester and London. Interviewing friends together provides a secure environment for the interview and also tends to keep the answers honest, as friends will remind each other of past events – for example when they were ill or went to see their GP.
The second phase of the research sought to widen the number of people whose perspective on the issue was included. Researchers convened ten focus groups of six to eight people in London and Birmingham.
In each phase, all the participants had taken antibiotics in the past 12 months. The friendship pair interviews and the focus groups were also split by life stage (adults who were not yet parents, parents, and people over 70 years old) and education level, and recruited to ensure a good spread of gender, socio-economic grade and ethnic group.
Mark Henderson, Head of Communications at the Wellcome Trust, said: "Wider awareness of the problem of drug-resistant infections could be an important part of the solution, as people who appreciate the issue should be more likely to accept medical advice when antibiotics aren’t the right option for them. It was encouraging to see that a small shift in language, from ‘antibiotic resistance’ to ‘drug-resistant infections’, could do so much to build this understanding. We’ll be using this at the Wellcome Trust, and would encourage doctors, other health professionals and the media to use it as well."
Larissa Persons, Director of Strategy at Good Business, the company that conducted the research, said: "We were struck by how hard it is to make antibiotic resistant infections feel like something that ‘matters to me.’ It’s only when people think about an infection they might get, which they would expect to take antibiotics for, and then imagine not being able to treat it in this way that it starts to become personally relevant and real. Otherwise it just feels like someone else’s problem."
Chief Medical Officer, Dame Sally Davies said: "I welcome this work from The Wellcome Trust. The public are an essential part of the fight against drug-resistance infections, and we need to understand how to best communicate with them so that they understand why antibiotic-resistance germs develop, the impact that this could have on individuals and their families and the actions that people can take to help the fight.
"People are already dying from drug resistant infections in the UK and we all need to act if we are going to tackle the problem."