How Social-Health Nudges Can Help Combat Antibiotic Resistance

A new study by researchers including APARC's Asia Health Policy Postdoctoral Fellow Dr. Jianan Yang reveals that text messages providing information on the harmful social impacts of antibiotic resistance help reduce antibiotics purchase, identifying a cost-effective means of addressing the risks of antibiotics misuse and overuse.
Pouring multi-colored capsule pills from plastic drug bottle. Antibiotic drug overuse concept.

The rise of antibiotic resistance is a global public health issue that poses a severe threat to the effectiveness of modern medicine. Antibiotic resistance can lead to prolonged hospital stays, increased mortality rates, and higher medical costs. The World Health Organization warns that there are not enough new antibacterial treatments in development to keep up with the growing resistance. The need to regulate the use of antibiotics is, therefore, critical. But Patients' lack of information intensifies the problem: misconceptions about antibiotics are prevalent and exacerbate unnecessary drug use.

In response to this challenge, a team of researchers, including Dr. Jianan Yang, a 2022-23 Asia Health Policy Postdoctoral Fellow at APARC, conducted a study to test the efficacy of informing patients directly of the risks of antibiotics overuse. In partnership with a community healthcare center in China, which is among the countries with the highest per capita usage of antibiotics, the researchers designed a randomized controlled trial to evaluate whether the provision of information on the impacts of antibiotic resistance via text messages could induce behavioral changes and reduce the unnecessary use of antibiotics. The results of the study, published in the Journal of Development Economics, suggest that social-health messaging could be a powerful tool in addressing antibiotics overuse as well as a variety of public health challenges with externalities.


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The researchers’ findings show that patients who received text messages highlighting the threat of antibiotic resistance to society reduced their antibiotics purchases by 17% relative to the control group. The reduction did not come at the cost of a decline in other observed dimensions of healthcare utilization, including the number of visits, examination and service spending, and the purchase of other medicines.

The study also reveals that messages with information on the social impacts of antibiotic resistance had a more pronounced effect than those with information on the harmful consequences for individual patients: text messages that emphasized the threats of antibiotics overuse to recipients’ own health showed negligible effects on antibiotics purchases.

The results provide evidence that prosocial messaging can have a substantial impact on health-related behavior and identify a cost-effective, low-touch intervention means of addressing concerns over antibiotics misuse and overuse. The rapid increase in mobile phone penetration makes text messaging easily scalable, highly inclusive, and inexpensive to implement public health interventions. While the study focused on antibiotic use in China, the findings may have broader implications for public health interventions across different countries and cultures.

The study results also suggest that social-health messaging could be an effective tool to address public health challenges with externalities beyond antibiotic resistance, such as low vaccination rates. For example, many governments have been attempting to increase COVID-19 vaccination rates among their populations. People might be more willing to act if they receive relevant information on the social impacts of their behavior from an institution that they trust.

Future studies that evaluate the effectiveness of this approach in different institutional contexts and their welfare implications with richer clinical data would be valuable.

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