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

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.

• 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.
• 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).

Primary outcomes

• knowledge [Immediately after the 30-second message exposure.]: 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?
• Willingness to pay for antibiotic-free animal food [Immediately after the 30-second message exposure.]: 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".
• antibiotic disposal intention [Immediately after the 30-second message exposure.]: 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.

Sex: All, ages: 18 Years to 80 Years, accepts healthy volunteers

Inclusion Criteria:

* adult child parent, willing to participate

Exclusion Criteria:

* declining to participate