Media and messaging

1. News media interest in the ‘superbugs’ story is regular and low key (an ‘exhausted and empty’ zombie story!).

News media interest in AMR is regular but low key. 2005 was the peak of news interest in MRSA (golden staph) both in Australia (see Figure 3), and the UK (Washer and Joffe, 2006, Crawford et al., 2008). Since that time, news items on MRSA have trailed off, but items using the term ‘superbug’, have continued to appear in a fluctuating pattern.

Our content analysis further indicates that news media have taken up a general story of ‘superbugs’ that brackets together a range of health challenges that are not specifically tied to the 2000s MRSA peak or AMR and its reduction. Importantly, ‘superbugs’ stories are less prominent than for example, ‘swine flu’ in 2009/10 and Ebola in 2014. Figure 4 (below) shows the very large media interest in COVID-19, underlining how different infectious diseases attract different levels of newsworthiness.

Figure 3. News media interest 1990-2019.

Source: Factiva

Figure 4. Covid-19 news media interest, September 2019 to August 2020

Source: Factiva

Figure 5 (below) shows the relative activity of printed, television and digital news for 2017. Notable is that digital news media are most active and that public facing campaigns, for example, Antibiotics Awareness Week (November), do to appear to attract news attention. Our analysis of the content of these items confirms this finding.

Figure 5. Television, printed and digital news media in 2017.

Source: Davis et al., 2020b

2. Digital media news sources fragment the ‘superbugs’ storyline

We found considerable source-specific diversity in AMR news. Television and printed news conveyed linear storylines, while digital news items were more akin to smorgasbord narratives. Moreover, digital media included stories that had a ghoulish, baroque quality, using images of infections or combining texts, images and video ‘clickbait’, which did not necessarily promote narrative coherence. However, digital media were able to direct readers to explainers and information videos.

Table 8. AMR news themes in 2017. Source: (Davis et al., 2020b)

3. News media narratives are dominated by scientific discovery, which supports the view that AMR is a techno-scientific problem that will be solved by experts.

Using content analysis, we identified several recurring narrative forms: discovery, which is a common story telling approach in science news and popular science (Davies et al., 2019); alert stories that contained some element of warning about the future; advice narratives that provided information and guidance on how to use antibiotics; and survivor stories of people suffering from an infection, those who had recovered, or the relatives of people who had died. Survivor narrative is another common narrative form in media and in lived experience (Brockmeier, 2011). See Table 8 (above) for examples.

Using these narrative categories, we found that discovery was the most common way of configuring the AMR story. In order of decreasing prevalence, discovery narratives were the most often featured (69%), followed by alert (22%), advice (18%), and survivor (17%). The dominance of the discovery narrative implies that AMR is a story that is seen to appeal to readers interested in science and is most often depicted as a scientific challenge that is gradually being solved by scientists. Conversely, the awareness and action of publics is less newsworthy, a perspective that coheres with the patchy awareness and understanding we found in interviews.

4. Public facing communications have been associated with some increased public awareness and changes in healthcare practices.

Numerous approaches have been used to promote public awareness and action, especially during Antibiotics Awareness Week, held annually in November. In Australia, public awareness campaigns commenced in 2000 (Wutzke et al., 2006), and have used social marketing techniques (for example, posters, internet materials, short videos), to alert publics and encourage them to comply with expert advice regarding prescription, using messages that include: ‘Antibiotics are losing their power’; ‘Don’t ask for antibiotics when you don’t need them’; ‘It’s time to take antibiotics resistance seriously’; ‘Antibiotics are a precious resource’, and; ‘Bacteria become resistant to antibiotics, not people’ (see also National Prescribing Service, 2016).

There is some evidence that public facing campaigns increase awareness and action. Increased public knowledge was associated with Antibiotics Awareness Day/Week events in Hong Kong (Ho et al., 2014) and Poland (Mazińska et al., 2017). Decrease in antibiotics consumption was associated with AAD/W in Australia (Wu et al., 2018), and Slovenia (Cizman et al., 2018). Public-facing campaigns have been shown to be effective among parents and school children (Burstein et al., 2019, Price et al., 2018), and to a lesser extent in publics in general (Cross et al., 2017, Fletcher-Miles et al., 2019, Price et al., 2018). Communications on their own (that is, without links to and practical support from prescribing and dispensing services) are unlikely to have large and enduring effects (Fletcher-Miles et al., 2019). Campaigns also show an English-speaking bias which is relayed into the evidence base (Catalan-Matamoros et al., 2019).

5. Public facing digital media audiences are mostly from the health sector.

Since 2010, approximately, digital media have become noticeable in the research literature on AMR communications. A good example is ‘eBug’, an online game that uses detective/discovery narrative to teach microbiology and hygiene to young people, which evolved from class room-based and pencil and paper activities (Young et al., 2015).

The existing research literature includes: evaluations of national and international Antibiotic Awareness Day/Week using digital media (Cizman et al., 2018, Earnshaw et al., 2014, Ho et al., 2014, Huttner et al., 2010, Huttner et al., 2019, Mazinska and Hryniewicz, 2010, Wu et al., 2018, Zowawi et al., 2015), AntibioticGuardian.com (Bhattacharya et al., 2016, Chaintarli et al., 2016, Kesten et al., 2018, Newitt et al., 2019, Newitt et al., 2018), e-bug (de Quincey et al., 2011, Gennimata et al., 2011, Young et al., 2015), the use of Twitter in social marketing campaigns (Andersen et al., 2019, Cumbraos-Sáncheza et al., 2019, Dyar et al., 2014, Plastina, 2018, Reinisch et al., 2019, Scanfeld et al., 2010), YouTube videos (Basch et al., 2018, Djerf-Pierre et al., 2019), seeking AMR information online (Anderson, 2018, Groshek et al., 2018, Kaminski et al., 2019, Zucco et al.), and assessing the impact of campaigns and news media events on health consumer behaviour (M’ikanatha et al., 2018, Smolarchuk et al., 2019).

These uses of digital media in AMR communications are marked by different levels of consumer-led action, a prominent feature of these technologies. Figure 6 provides a map of AMR digital media in two dimensions. The single-multiple axis distributes examples according to the extent to which digital media are combined with other media. The intervention-consumer axis distributes examples according to the combination of campaigns designed by public health agencies to raise awareness and change behaviour with use of digital media driven by general public consumers.

Figure 6: Map of ‘specific digital media – multiple media’ by ‘intervention – consumer led’

Evaluations of digital media effects show that they mostly reach people in the AMR health system. AntibioticGuardian.com has been the focus of a relatively large corpus of evaluations (Bhattacharya et al., 2016, Chaintarli et al., 2016, Kesten et al., 2018, Newitt et al., 2019, Newitt et al., 2018). Pledges are most often made by health care practitioners (69%) and less often by members of the general public (23%). Pledgers are also more likely to be women (61%), which may reflect the gender composition of the AMR workforce (Bhattacharya et al., 2016, Newitt et al., 2019).

Twitter shows a similar pattern as the most active AMR tweeters are health agencies, news organisations, and medical journals (Andersen et al., 2019, Cumbraos-Sáncheza et al., 2019, Dyar et al., 2014, Kendra et al., 2015, Plastina, 2018, Reinisch et al., 2019, Scanfeld et al., 2010, Djerf-Pierre et al., 2019). The most prolific tweeters were: @WHO; @UN; @WHO_Europe (Andersen et al., 2019). The top ten AMS hashtags were: #antibiotic, #eurekamag, #antibioticresistance, #amr, #health, #antibioticguardian, #msgproducts4u, #antibiotics, #news, #science. Pledging and tweeting may be important for the AMR workforce, but less so for general publics.

6. User-led, peer-to-peer online networking and support appears to address awareness and action on AMR.

Digital media can also be used by consumers to promote peer-to-peer support, awareness and education. Mumsnet.com blogs show how women chat about pregnancy, urinary tract infections and antibiotics (Ghouri et al., 2019). Research has documented how a forum for people with acne explored their experiences with antibiotics and how bloggers support one another with the physical and social impacts of the infection and its treatment (Santer et al., 2017). Djerf-Pierre et al. (2019) examined blog responses to YouTube AMR videos and found that scientific content was the most popular and produced the most blog responses, indicating the interests of a particular audience and locating AMR as a scientific problem. These articles indicate that digital media could be useful for reaching and serving specific audiences and moments in health-seeking behaviour.

7. Online pharmacies have been identified as a potential challenge for AMR.

Online purchase of antibiotics (on and off prescription) is another feature of digital media that foregrounds consumer-led action. Boyd et al. (2017), found that in the UK, 45% of online pharmacy websites did not require a prescription and that 80% let the consumer choose their antibiotics. Further research is needed to address off-prescription antibiotics use and public awareness and action on AMR.