Framing superbugs - testing whether advocacy frames change attitudes, intention or behaviour using an online randomised control experiment

Background: Antimicrobial resistance (AMR) presents a significant threat to global health, requiring multifaceted action by individuals and policymakers. Advocates must persuade others to act. Making communication about AMR more effective could plausibly increase support for action. The Wellcome Trust-funded ‘Reframing Resistance’ project used communications research to develop framing recommendations for the language practitioners use to describe AMR. The aim of this study was to explore how this language influenced attitudes and behaviours towards AMR. Methods: This study was a randomised trial to evaluate the effects of different styles of AMR framing language upon attitudinal and behavioural measures. Participants (n=1,934) were recruited in October 2019 using an on-line tool called “Prolific” and randomly assigned to review five variations of AMR narratives: four experimental frames which incorporated different combinations of language recommended by the framing guidelines, or a control frame without these features, taken from UN AMR communications. Participants were then asked a series of attitudinal and behavioural questions in relation to the AMR narrative they reviewed. Attitudes were measured using five-point Likert-type scales and behaviours were measured using binary variables. Descriptive analysis was used to explore respondents’ characteristics and multivariable logistic regression models were used to establish independent associations between AMR frames and respondents’ attitudes and behaviours. Results: Participants who reviewed narratives that followed framing language guidelines were more likely to donate money or sign a petition, and rated narratives as more usable and important than participants who reviewed the control framing. Conclusions: While larger trials with more diverse participants are needed to confirm generalisability, these results suggest that applying framing to communications could help advocates of AMR to drive action. Furthermore, the study reinforces the value of randomised studies to empirically test the impact of frames upon behaviour and indicates the potential for a more extensive programme of research.