Rethinking how we talk about antimicrobial resistance and who we’re talking to
By Archana Balamohan, MPH Candidate Lakehead University
Spend some time reading the research on antimicrobial resistance (AMR) communication, and one question keeps surfacing: Why aren’t awareness levels improving? In Canada, the numbers tell a humbling story.
A 2022 survey by the Public Health Agency of Canada found that only 57% of Canadians expressed concern about antibiotic resistance—a figure that hasn’t meaningfully changed since 2008.
The tempting conclusion is that people just aren’t paying attention. But the research tells a more interesting story: the way we’ve been communicating may itself be part of the challenge. And it may be reaching some Canadians far less than others.
When you look more closely at who holds the most misinformation about antibiotics and AMR, a clear pattern emerges. The same PHAC survey found that younger adults between 18 and 34, people with lower incomes, and those with less formal education were significantly more likely to hold inaccurate beliefs; for example, that antibiotics can treat viral infections like colds and flu, or that stopping a course early is harmless. In some cases, nearly half of respondents in these groups held misconceptions that standard campaigns have been trying to address.
This may reflect, in part, the communication channels many awareness campaigns have traditionally relied on, including written resources, institutional websites, and awareness weeks. Though these efforts are valuable, particularly when well-designed, they may be more likely to reach people who are already engaged and actively seeking out health information. Some of the people who could benefit most from AMR education may be the least likely to be ‘in the room’—or online—where that education is happening.
This is the gap at the heart of what I’ve been exploring during my practicum at the National Collaborating Centre for Infectious Diseases (NCCID), which is focused on identifying opportunities for the AMR Aware Canada campaign. There’s a meaningful difference between telling people about AMR and inviting them into the conversation. Patients and communities, including those who may not be well represented in current campaigns, can be more than an audience for expert messaging. They can be co-designers, helping to shape how AMR messages are developed. When they are, research on patient engagement and health communication suggests the results are more trusted and more likely to resonate with the intended audience.
There’s a meaningful difference between telling people about AMR and inviting them into the conversation.
One idea from the literature on AMR communication stood out to me.
Even well-designed campaigns run into a real obstacle: by the time accurate information reaches someone, a competing story is often already there. “Antibiotics always helped me before.” “I stopped the course early and I was fine.” This isn’t a reflection of indifference. It is a reflection of people doing what humans do: making sense of their experience using the stories available to them. And when formal health information is inaccessible, distant, or simply not showing up in your social media feed, those informal stories fill the gap.
This is where a body of communication research known as inoculation theory may be useful. The idea is: if people are gently introduced to the kinds of misleading claims they might encounter and shown why those claims are not true, they’re better equipped to evaluate them in the wild. It’s a shift from reacting to misinformation after the fact, to building the kind of informed confidence that makes people less susceptible to it in the first place. Researchers call it “prebunking”. Now picture it delivered through channels people commonly use—formats like short videos in social media feeds or peer-voiced content formats that meet people where they are. This is one example of an approach that researchers are exploring as a way to reach audiences who may not engage with more traditional forms of AMR communication.
Through this practicum with NCCID and collaborators on the AMR Aware Canada campaign, I have been exploring how ideas like these might inform future awareness efforts. In the coming months, collaborators and others will be convened to help us consider what it means to reach people meaningfully, how we might co-create resources with them, and approaches to communicating in language that resonates with individuals’ lived experiences and meets them where they are.
It’s an approach that invites us to think differently about campaign audiences and public engagement. It starts from the assumption that people are capable of engaging meaningfully with complex health information, particularly when it’s made accessible and relevant. When addressing the gap in AMR understanding, the question worth asking is not why people aren’t listening, but whether we’ve been speaking in a way that meaningfully invites them in.
Reference:
Crago AL, et al. Understanding Canadians’ knowledge, attitudes and practices related to antimicrobial resistance and antibiotic use: results from public opinion research. Canada Communicable Disease Report. 2022;48(11/12):550–8. https://doi.org/10.14745/ccdr.v48i1112a08