An interventional study of metaphorical messages and conventional messages in Antimicrobial Resistance, sponsored by Bo Yan. Completed at 1 site in China. Open to participants aged 18 Years to 80 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-09-04.
Sponsored by Bo Yan · Not applicable, Interventional, and Prevention
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.
To assess the influence of metaphorical and conventional health education messages on the AMR-related knowledge and behavioural intentions of rural and urban residents, the investigators conducted a survey experimental study across two provinces in China. Prior to receiving any health education message, the respondents completed questions on AMR-related knowledge, behaviours, and behavioural intentions. Subsequently, participants were randomly assigned to read either metaphorical or conventional health education messages. Following the reading of assigned message, the respondents once again completed the questions on AMR-related knowledge and behavioural intentions.
Bo Yan is the lead sponsor of 3 studies on the registry; 2 are open to participants now.
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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
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
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.
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).
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?
Time frame: 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".
Time frame: 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.
Time frame: Immediately after the 30-second message exposure.
Plan to share: Undecided — Available on request.
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This study is completed, as verified in Sep 2026. You cannot join it, but the record below documents what was studied.
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