This study aims to investigate the public's views on antibiotics and the impact of different ways to name the potential consequences of antibiotics not working in the future. It is known that current ways to name this don't resonate well with the public, and the study team have worked with members of the public through focus groups and community workshops to develop new ways of describing this in a process of co-design. This study aims to test four different ways of presenting this potential crisis to the public, some of which are new communication strategies designed by the public themselves, to evaluate which are the most memorable and investigate the impact on behaviour change.

Adults aged over 18, living in the United Kingdom, who have already signed up to a market panel research company will be eligible to participate in this study.

Participants will be invited to complete a short online survey (this should take around five minutes), advertised to them by the market research panel they have already signed up to. This survey is completely anonymous, and contains some multiple-choice questions, and some that require a short free text response. At the start of the survey one of the four ways to name AMR will be presented to participants in the form of a poster.

This study aims to result in an improved understanding regarding the general public's understanding of antibiotic use and investigate the impact of communication on behaviour change. The data from this study may be used to inform future public health campaigns on this topic and improve the use of antibiotics.

This study will be conducted online using the Predictiv platform, an online platform built by the Behavioural Insights Team. The study is being run in collaboration between the Behavioural Insights Team and the Institute of Global Health Innovation at Imperial College London.

Is it anticipated that the survey will open in April 2024 and be open until recruitment of 4000 participants is complete. This is expected to take 4-6 weeks.

Antimicrobial resistance (AMR) refers to the process by which bacteria become resistant to antibiotics, rendering them ineffective in treating infections. Public behaviour change is needed to use antibiotics more sparingly and wisely (for example, only taking them when needed and finishing the course). However, studies and public engagement work have shown that the current language around the crisis of AMR is not well known or understood by the general public. It is felt to be too scientific, not memorable, and doesn't convey sufficient meaning to inspire behaviour change.

Building on previous studies, this project aims to identify whether different ways to present or frame Antimicrobial Resistance (AMR) can lead to improved comprehension and change attitudes towards the crisis. Through extensive public engagement and involvement work three different ways to frame AMR to the public have been developed. One of these ways is a novel name developed through co-design with public members, and the other two were existing terms that the public believed were better than AMR during our engagement activities.

An online randomised controlled trial (RCT) has been designed to test these three names against the control of AMR/Antimicrobial resistance, to see if they can improve comprehension, attitudes towards and recall of the subject.

This online RCT will be delivered in collaboration with the Behavioural Insights Team using their well established online platform, called Predictiv. 4,000 participants will be recruited (to be representative of the UK population). They will see one of our four names (this will be presented in the typical community setting of seeing a poster at a bus stop), and be asked to complete a short five minute survey, answering a series of questions to explore their understanding of the topic and their future attitudes to antibiotic use.

Statistical analysis will be conducted to see which of the four communication strategies were most effective across the different outcomes, helping us to understand which communication strategies for AMR are most useful at inspiring behaviour change. Data will additionally be analysed to explore whether different messaging strategies are more effective in certain population subgroups - for example by age or previous antibiotic use.

Inclusion Criteria:

• Adults aged over 18
• Resident in the United Kingdom (UK)
• Have passed the attention check at the start of the online survey.

Exclusion Criteria:

• Individuals not signed up a market research panel, and will therefore not have access to the online survey
• Those resident outside the UK
• Those who fail the attention check at the start of the online survey.
• Individuals aged under 18.

No personal IPD will be collected in this study. Aggregate participant data will be shared between the Behavioural Insights Team and Imperial College London

Adults residing in the United Kingdom who accessed the online survey and passed the attention check.

Serious and other [non-serious] adverse events were not collected or assessed as part of the study: No adverse event data were collected. Given this is an online survey, with no personal identifying information gathered the risk of serious adverse events or all-cause mortality is zero.

Given this is an online survey, with no personal identifying information gathered the risk of serious adverse events or all-cause mortality is zero

Participants will be blinded to the study arm that they have been assigned to.