A "SMART" Toolkit Uses Metaphors to Explain Antimicrobial Resistance

Imagine a world where doctors are unable to treat infections or safely perform routine procedures such as surgeries or even root canals. As microbes increasingly become resistant to the drugs meant to stop them, antimicrobial resistance (AMR) threatens to unravel some of medicine’s greatest achievements.

One of the drivers of AMR is inappropriate use of antimicrobials like antibiotics. When people do not complete antibiotic courses or use them for minor infections, bacteria can evolve to become resistant to the drug. In part due to this, scientists estimate that AMR could cause up to 8.2 million deaths globally by 2050. Yet, awareness about antibiotic misuse and AMR remains low among people.¹

“It is an intrinsically complex scientific topic to communicate and understand,” Eva Krockow, a researcher studying health decision making at the University of Leicester, wrote to The Scientist. So, she and her team joined forces with patients, doctors, and communicators to find effective ways to communicate about AMR.

Their project—called Strategic Metaphors for Antibiotic Resistance Toolkit (SMART)—offers a practical, free-of-cost, research-backed resource to support communication about AMR. The toolkit includes tested metaphors, ready-to-use posters for communication, and templates to adjust existing material to guide more informed decisions about using antibiotics.

SMART Toolkit Uses Relatable Metaphors to Communicate About AMR

Krockow and her team turned to metaphors for their toolkit because they can help people make sense of complex issues. “Through simple comparisons of an abstract medical topic with familiar and relatable concepts, they can build immediate understanding without lengthy explanations,” said Krockow. “For example, by comparing antibiotic use for viruses to using diesel in a petrol car, it becomes immediately obvious that using the wrong tool, even if it looks similar, is futile at best and may only result in harm,” said Krockow. The SMART Toolkit has another poster that compares using antibiotics for minor infections to blowing out a candle using a fire extinguisher, giving a vivid and relatable description of the futility of antibiotic overuse.

Psychology researchers have previously shown that metaphorical framing could potentially shift people’s perspectives, change attitudes, and motivate behavioral changes.² Communication initiatives explaining cancer, vaccines, and COVID-19 commonly employ metaphors, but such framing around AMR messaging remains limited.^3-5

So, the team approached members of the public, doctors, and international expert communicators in the field of AMR to come up with a pool of candidate metaphors. This led them to develop nearly 180 metaphors.⁶

The team then refined the toolkit, being mindful of a few things, including conveying AMR’s threat without branding bacteria as villains, or avoiding messages that could touch sensitive topics like comparing bacteria to rebellious teenagers. They eventually narrowed down their toolkit to 38 metaphors.

A Flexible Tool for Global Impact

Consulting various stakeholders to improve AMR communication was “great fun,” said Krockow, who added that this was the first time she ventured beyond academic impact to develop material for non-academic audiences. “We loved translating insights from social science theory into something practical and hopefully useful for antibiotic resistance communications.”

She hopes that people will use the toolkit widely and adapt it to fit cultural or geographical contexts. While designing the material, the team made provisions for flexibility, so that people in different parts of the world could alter the posters depending on what the target audience prefers.

According to Krockow, this is particularly important, since the success of health messages depends on the context. “We hope that our materials therefore have the potential to make a difference across many different communities by increasing awareness, knowledge and shifting behaviors related to antibiotics and antibiotic resistance,” she said.