Evidence map›Paper›PMID 41708978›Full record

ArticleScientific reports2026

Developing public health risk messages about antibiotic resistance using metaphors: an international co-design and e-Delphi consensus study.

Eva M Krockow, Meghann Jones, Samkele Mkumbuzi, Marc Mendelson, Carolyn Tarrant, Robert Froud, Anastasia Koch, Stephen J Flusberg, Emma Pitchforth

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In one paragraph

Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Eva M KrockowSchool of Psychology and Vision Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK. emk12@le.ac.uk.
Meghann JonesSchool of Psychology and Vision Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
Samkele MkumbuziDivision of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Marc MendelsonDivision of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Carolyn TarrantSchool of Medical Sciences, University of Leicester, Leicester, UK.
Robert FroudSchool of Health Sciences, Kristiania University of Applied Sciences, Oslo, Norway.
Anastasia KochEh!woza, Khayelitsha, South Africa.
Stephen J FlusbergDepartment of Cognitive Science, Vassar College, Poughkeepsie, NY, USA.
Emma PitchforthFaculty of Health and Life Sciences, University of Exeter, Exeter, UK.

Funding

Economic and Social Research Council ES/X001652/1
6 · The paper itself

Abstract

Antimicrobial resistance (AMR) is a global health threat, yet public awareness of its causes and risks remains low, limiting behaviour change. Metaphors—linking abstract ideas to familiar concepts—are promising but underused tools in AMR communication. We conducted the first systematic mixed-methods study to develop novel metaphors addressing key misunderstandings and behaviours. Co-design workshops with the public and doctors in the UK (n = 29) and public in South Africa (n = 22) generated 89 initial metaphors. These were extended through 101 additional suggestions, and evaluated via a 3-round e-Delphi study with 37 AMR communication experts from 27 countries, using the UCLA/RAND appropriateness method. 38 metaphors were endorsed for global use. Invoking domains like nature, tools, and fire fighting, they offer relatable, culturally resonant alternatives to alarmist war and doomsday imagery. This study pioneers participatory methods in behavioural science and provides a blueprint for co-creating health messages, such as tailoring AMR metaphors to specific needs.

Indexed as

Drug Resistance, MicrobialMetaphorPublic HealthConsensusDelphi TechniqueHumansSouth AfricaAnalogyAntibiotic resistanceAntimicrobial resistanceDrug-resistant infectionsMetaphorPublic healthRisk communication

Identifiers

PMID41708978
PMCPMC13013596

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.