Using Social Influencers for Public Health Education on Antibiotic Use and Antimicrobial Resistance

Different Strokes for Different Folks - Leveraging on Social Networks for Public Health Education on Antibiotic Use and Antimicrobial Resistance

This study aims to compare the effectiveness of health education facilitated by neighborhood food and beauty establishments with that facilitated by clinics in increasing the public's knowledge of antibiotic use and antimicrobial resistance (AMR) and improving antibiotic behaviors.

The quasi-experimental study will involve a total of 3300 patrons of the 10 most popular consenting clinics, food and beauty establishments respectively, in two neighborhoods in Singapore.

Recruitment Process

1. Participants will scan the QR code on the posters in the participating clinics/establishments
2. Read the study information sheet
3. Consent will be implied on submission of survey
4. Total recruitment period: One year
5. Target: 3300 patrons of the 30 establishments (10 each of clinics, food, and beauty establishments)

Intervention Structure

1. Participants will complete a pre-intervention/baseline survey (#1)
2. Intervention includes an animated educational video with key messages on appropriate antibiotic use and AMR
3. Followed by immediate post-intervention survey (#2)
4. Provide contact details (mobile phone number) for reimbursement & future follow-up online surveys
5. Complete follow-up online surveys: at 1 month post-intervention (#3), 3 months post-intervention (#4) and 6 months post-intervention (#5)

Expected Outcomes Increase in public knowledge of antibiotic use and AMR, and antibiotic behaviors through health education facilitated by neighborhood food and beauty establishments, in addition to that facilitated by clinics

According to the World Health Organisation (WHO), antimicrobial resistance (AMR) is one of top 10 global public health threats facing humanity [1,2] and is primarily driven by overuse and misuse of antibiotics [3]. Majority of the population-based national AMR educational campaigns focused on raising public awareness of appropriate antibiotic use and promoting action against antimicrobial resistance have shown mixed results largely due to its "one-size-fits-all" approach [4,5,6].

While healthcare providers are key players in health communication and considered most trusted sources of health information across all age groups [7], there is a need to identify and harness non-healthcare related establishments which can serve as trusted sources of health information especially for younger age groups who are less likely to have healthcare encounters [8-10]. The present study aims to engage non-healthcare establishments (food and beauty) with high degree centrality in the community identified through social network analysis, and evaluate the effectiveness of sharing health information about antibiotic use facilitated by non-healthcare establishments (food and beauty) as compared to traditional healthcare sources (clinics).

The Investigators conducted an exploratory sequential mixed methods study to identify both healthcare and non-healthcare (food and beauty) establishments which were highly frequented by the residents in the community. Findings from the above study were used to select the top 10 highly frequented healthcare and non-healthcare (food and beauty) establishments.

A quasi-experimental study will be conducted to compare the effectiveness of sharing health information about antibiotic use and AMR facilitated through healthcare clinics, and beauty and food establishments in 2 neighborhoods. Participants (patients/patrons) who visit the participating establishments (clinics/food establishments/beauty establishments) will be invited to take part in the study by scanning the QR code on the recruitment posters placed inside the premises. Upon scanning the QR code, participants will proceed to complete a pre-intervention questionnaire survey (#1) on an online platform after going through the study information sheet. Upon completion of the survey #1, participants will be guided through embedded instructions to click on a link to access the health educational intervention. The educational intervention includes a short 2-minute animated video (developed based on the preferences of the community as identified from the results of the quantitative survey) will be hosted on a multimedia online platform providing key information on appropriate antibiotic use and AMR. After viewing the video, the participants will be subsequently led to the post-intervention survey #2 via a link. Before submitting survey #2, contact details (mobile number) and the preferred payment method will be collected for reimbursement purposes and future follow-up surveys. The enrolled participants will be re-contacted by the study team via a mobile messaging service (such as WhatsApp), and will be guided through embedded instructions to complete three more surveys (#3, #4 & #5) at 1-, 3-, and 6-month post-intervention to assess knowledge on antibiotic use and AMR and behaviors on antibiotic use. Participants will be recruited from all 30 participating establishments (10 clinics, 10 F&B shops, 10 beauty salons) for the entire study duration of one year and will be followed up for 6 months after the intervention.

Inclusion Criteria:

• Adults aged 21 years and above
• Patrons of the 30 participating healthcare clinics, food and beauty establishments

Exclusion Criteria:

• Patrons who are already enrolled in the study at one of the 30 participating establishments