Metaphors to Enhance Antibiotic Appropriate Use Knowledge and Behaviours to Reduce Educational Disparities

NCT07352371 | Completed

• 2 other identifiers: ZGL202403-372004194
• Study Type: interventional
• Target: 866
• Locations: 1 country
• Sites: 1

Brief Summary

A randomized controlled survey experiment was conducted from October to November 2024 to assess the effectiveness of metaphor-based health education in improving Chinese parents' knowledge and behavioural intentions regarding appropriate antibiotic use. A total of 866 parents from two Chinese provinces were randomly assigned to either a metaphorical message group (n = 432) or a conventional message group (n = 434). Metaphors included comparing antimicrobial resistance (AMR) to insect resistance to pesticides, improper antibiotic disposal to mercury battery pollution, and antibiotic-free foods to organic foods. Outcomes measured were AMR knowledge, willingness to pay (WTP) for antibiotic-free foods, and proper antibiotic disposal intention.

Conditions

Antimicrobial Resistance

Keywords

metaphor; antimicrobial resistance; antibiotic use behaviour; equity

Outcome Measures

Primary Outcomes (3)

• knowledge

  Three items were summed to form the AMR-related knowledge scale. This scale was assessed by asking respondents to judge the correctness of the following statements before and after their first exposure to health education message: (1) Does antimicrobial resistance imply that bacteria are becoming increasingly difficult to kill with antibiotics? (2) Dose overuse of antibiotics lead to antimicrobial resistance? (3) Can antimicrobial resistant be transmitted between people?

  Immediately after the 30-second message exposure.

• Willingness to pay for antibiotic-free animal food

  Respondents were asked whether they were willing to pay a higher price for antibiotic-free animal foods compared to regular animal- foods. Their answers were dichotomized into "Yes" and "No/Not Sure".

  Immediately after the 30-second message exposure.

• antibiotic disposal intention

  To evaluate antibiotic disposal practices, participants were asked to recall how they had handled expired or unused antibiotic prior to receiving a third exposure to health education message.

  Immediately after the 30-second message exposure.

Study Arms (2)

metaphorical messages group

EXPERIMENTAL

The metaphorical messages, by contrast, were crafted to be more accessible, drawing on familiar daily-life analogies derived from our prior qualitative research. We created three specific pairs: the first explained mechanisms of AMR, comparing resistant bacteria to pesticide-resistant insects. The second addressed environmental contamination by likening antibiotics to mercury batteries. The third used the analogy of "organic" food to convey the concept of antibiotic-free animal foods.

Behavioral: metaphorical messages

conventional messages group

PLACEBO COMPARATOR

The conventional messages were adapted from formal health communication sources, such as the World Health Organization and the Chinese National Health Commission, and retained the technical tone typical of official health education materials (China NHC, 2010; He, 2018; WHO, 2022).

Behavioral: conventional messages

Interventions

metaphorical messages BEHAVIORAL

We created three specific pairs: the first explained mechanisms of AMR, comparing resistant bacteria to pesticide-resistant insects. The second addressed environmental contamination by likening antibiotics to mercury batteries. The third used the analogy of "organic" food to convey the concept of antibiotic-free animal foods. All metaphorical messages were reviewed by a panel of experts in public health, clinical microbiology, health communication, and health education to ensure factual consistency and clarity.

metaphorical messages group

conventional messages BEHAVIORAL

The conventional messages were adapted from formal health communication sources, such as the World Health Organization and the Chinese National Health Commission, and retained the technical tone typical of official health education materials (China NHC, 2010; He, 2018; WHO, 2022).

conventional messages group

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• adult child parent, willing to participate

You may not qualify if:

• declining to participate

Sponsors & Collaborators

• Bo Yan: lead
• Hangzhou Normal University: collaborator

Study Sites (1)

Zhejiang University

Hangzhou, Zhejiang, 311121, China

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Masking Details: The study is double-blinded, meaning that both the subjects and the researchers are unaware of the group assignments. The randomization of groups is conducted using Wenjuanxing (a survey tool). However, blinding is not implemented during data analysis.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Dr.

Study Record Dates

• First Submitted: January 11, 2026
• First Posted: January 20, 2026
• Study Start: October 16, 2024
• Primary Completion: November 10, 2024
• Study Completion: November 10, 2024
• Last Updated: January 22, 2026

Record last verified: 2026-01

Locations

CN (1)