“Knowledge alone won’t change behaviour”

In November, the Federal Office of Public Health (FOPH) will launch a new publicity campaign. The aim is to raise public awareness of the proper use of antibiotics and of antibiotic resistance. The Psychologist Vivianne Visschers of the University of Applied Sciences and Arts Northwestern Switzerland explains in an interview what such a public campaign can achieve, where it should start and which pitfalls to avoid. On behalf of the FOPH Visschers conducted a study into the perception of antibiotics and antibiotic resistance among the Swiss population. She was not involved in designing the campaign.

The new FOPH campaign is targeted to the entire population. Do you think that such a broad-based campaign is the right way to sensitise people to the problem of antibiotic resistance?

At the moment, I believe so. In our study, we noticed that although some people realise that there is a problem, they don’t know exactly what the problem is, how it affects them or what they can do about it. It makes sense to start off in a general way to raise people’s awareness of the problem and to promote the responsible use of antibiotics.

Your study has shown that there are major gaps in the public’s understanding of this topic. For example, nearly 30% of people surveyed think that antibiotics are also effective against viruses. Roughly 75% indicated that the human body develops resistance to antibiotics. Can a campaign with simple messages correct these types of misconceptions? The underlying biological processes are quite complex, aren’t they?

I’ve asked myself that same question: Do people have to have all the information in order for behaviour to change? Actually, the important thing is that people know that antibiotic resistance is a problem, that antibiotics have to be handled responsibly and how you do that.

But doesn’t more knowledge lead to better understanding and consequently to a change in behaviour?

Knowledge alone isn’t enough to change behaviour. It is only one of many factors that play a role. Even if I know that higher antibiotic consumption leads to resistance, it might be more important to me to be healthy next week. Then I might take antibiotics, although other treatment options are available. If that is the priority, all the knowledge in the world won’t make a difference.

So such a campaign should appeal not only to reason but also to people’s emotions?

Absolutely. Even more important than knowledge is that people see the personal benefit. If, for example, an important event is coming up, and I want to be sure to be healthy, I might take antibiotics right away as a precaution. But if I understand that responsible use of antibiotics will ensure that my children can still use antibiotics in a few years’ time when they have a bad case of pneumonia, then I may decide differently.

When a campaign triggers health concerns, isn’t there a danger that they may think, “Soon there will be no antibiotics left and I may die of the next infection”, and start to panic?

Psychological health studies have shown that anxiety-based campaigns tend to have the opposite effect. People say, “That has nothing to do with me. Period.” What works better is to trigger some negative emotions, but at the same time to offer positive solutions. When an advertising agency develops such a campaign, it is more likely to be aimed at triggering positive emotions.

Your analysis also shows that the entire population cannot be lumped together, but rather that there are different subgroups that you call, for example, the “Knowledgeable Undifferentiated” and the “Young Unwilling”.

Right. For example, for some people the first step is to create awareness of the need to handle antibiotics responsibly and to increase knowledge. For others, the awareness is already there – they need to be shown what they can actually do.

Can a broad-based campaign really cover all these different needs? Or would you recommend tailoring specific messages to each group instead?

These groups could be targeted, which would ultimately be more effective. Maybe not right at the beginning, but after a year you could ask: Which groups have we already convinced? Are there channels we can use to address individual groups in a more targeted way, such as using schools to reach the “Young Unwilling”?

But isn’t the contribution that any single person can make to combating antibiotic resistance rather small compared with what doctors, veterinarians and hospital staff can achieve? Wouldn’t a campaign do better to target these professionals?

Hospitals tell us that they are already doing a lot and can hardly do more. And doctors tell us that they are very careful in prescribing antibiotics. But, naturally, as patients we consumers also shape demand for antibiotics. Here in Switzerland patients have the opportunity to actively influence their own treatment and that of their children and pets. Each individual needs to ask the question: Do I really need an antibiotic now, or is there something I can do differently?

The FOPH will be evaluating the success of the campaign. How do you measure something like that?

You can, for instance, ask a sample of the Swiss population the same questions that we did in our survey, after one or two years. That allows you to determine changes. Have attitudes towards antibiotics changed? Has knowledge about them improved?

In the context of NRP 72, you will be testing approaches to intervention in a study aimed at sensitising consumers to the safe handling of pets and food so that fewer pathogens are transmitted. That project is still in its infancy. But are there any preliminary findings?

Contact between humans and pets constitutes a transmission pathway that has been examined very little thus far. We started by interviewing different groups of people, such as pet owners. One of our objectives was to find out how close contact is to pets and how hygiene is handled when the animal becomes sick. We were also interested in finding out whether owners are aware that their pet might be able to transmit antibiotic-resistant bacteria. We also see potential for behavioural changes in the preparation of meat at home. Every year there are two peaks for gastrointestinal problems caused by food: during the barbecue season, and during the fondue season. This is a case where there is a certain degree of knowledge, but it's not sufficiently applied to everyday life.

What are the next steps?

We will check the results of the interviews against a written survey. Then we will test possible intervention approaches in small pre-tests and determine which are the most promising in order to observe the effect of a given intervention over a longer period of time in a larger study.

Do you think that the FOPH campaign and such interventions will actually lead to measurably lower antibiotic consumption in Switzerland in a few years?

That’s hard to say, because the use of antibiotics depends on many factors. In particular, during a winter where many serious colds occur, consumption of antibiotics tends to increase. But I’m sure that in the coming years many Swiss will actually be much more sensitive to responsible use of antibiotics.

• NRP 72 project “Ensuring safe food handling”
• StAR website
• Study of Perception of Antibiotics and Antibiotic Resistance (pdf, in German) (PDF)