Antibiotic UseNCT07111754
Testing Interventions Designed to Improve How Members of the General Public Follow Instructions to Take Antibiotics
A study testing Behavioural Message, Behavioural message + positive framing and Behavioural message + negative framing in people with Antibiotic Use, run by Imperial College London.
Trial summary
Antimicrobial resistance (AMR) is a global public health challenge. Due to overuse of antibiotics, bacteria are becoming resistant to antibiotics, which creates infections that can't be treated by modern medicine. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Antibiotic Use
- What is being tested?
- Behavioural Message, Behavioural message + positive framing and Behavioural message + negative framing
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 7,000 participants
- Where
- No sites listed yet
- Study dates
- 31 Aug 2025to 1 Mar 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Adults aged 18 and over
- United Kingdom residents
- Have passed the attention check at the start of the online survey.
Who cannot join
- Individuals who are not signed up a market research panel and therefore will not have access to the online survey.
- Those resident outside the UK.
- Those who fail the attention check at the start of the online survey. Individuals aged under 18.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: How Can Behavioural Intent to Take Antibiotics "Exactly as Prescribed" be Increased? An Online Randomised Behavioural Experiment
Antimicrobial resistance (AMR) is a global public health challenge. Due to overuse of antibiotics, bacteria are becoming resistant to antibiotics, which creates infections that can't be treated by modern medicine. To combat AMR, the public need to both know that AMR is an issue and know what actions they can take to address AMR.
When patients are prescribed antibiotics, the information provided (and how this is provided) is likely to be influential on whether they are taken correctly, or if behaviours that contribute to antimicrobial resistance (such as not finishing the course) predominate.
Read more
This study, a large online experiment involving 7,000 people across the UK, aims explore the influence of what information and how it is provided. The study looks at different ways of presenting information on antibiotic packets-from clear instructions to warnings and even scannable QR codes with extra details.
The main goals are to see if these changes can help participants understand how to take antibiotics exactly as prescribed. The investigators also want to see if it helps participants understand what antibiotic resistance is and their role in preventing it.
By understanding what works best, the investigators hope to find simple, effective ways to help everyone use antibiotics wisely, protecting these vital medicines for the future.
Read the detailed description
Antimicrobial resistance (AMR), or antibiotic resistance, is a serious global health problem. It happens when bacteria evolve and become strong enough to resist the very antibiotics designed to kill them. This makes common infections much harder, or even impossible, to treat. A major reason for this growing threat is the overuse and misuse of antibiotics.
To fight AMR, it's crucial that the public not only understand that antibiotic resistance is a problem, but also know what steps can be taken to help. A key action is to take antibiotics exactly as prescribed. However, the investigators know that many people aren't entirely sure what "exactly as prescribed" really means. This can involve things like remembering to take the full course, taking it at the right times, and simply taking the medication at all.
To better understand these challenges, the Fleming Initiative conducted focus groups with the UK public in spring 2025. These discussions helped identify the main reasons people might not take antibiotics as directed, such as not understanding what "exactly as prescribed" means, or not knowing about AMR and how individual actions might contribute to it.
Using these insights, the Fleming Initiative then held co-design workshops with public participants. Together, several new ways to make it easier for individuals to take antibiotics correctly were developed.
This study is a seven-armed online behavioral experiment conducted in collaboration between the Fleming Initiative at Imperial College London, and the Behavioural Insights Team. It aims to understand how different presentations of information on antibiotic packaging about desired target behaviors and antimicrobial resistance (AMR) influence the public's correct antibiotic use, attitudes towards AMR, and future behavioral intent.
Primary Objective:
To measure the change in behavioral intent to "take antibiotics exactly as prescribed," using a composite measure of four individual behaviors related to antimicrobial stewardship (AMS).
Secondary Objectives:
To assess comprehension of how to take antibiotics. To assess comprehension of AMR.
Exploratory Objectives:
To evaluate changes in behavioral intent for individual behaviors related to "taking antibiotics exactly as prescribed" (e.g., finishing the course, number per day).
To understand if participants recognise that not taking antibiotics exactly as prescribed contributes to AMR.
To examine the impact of message framing and the mechanism of intervention delivery on behavioral intent to take antibiotics exactly as prescribed.
To assess the impact on perceived personal responsibility regarding AMR.
To determine the proportion of individuals who interacted with a QR code (in relevant arms).
To gauge the impact of interventions on sentiment towards information on the package itself.
To evaluate participants' opinions on whether text message reminders would help participants take antibiotics exactly as prescribed.
Study Design and Participant Recruitment:
The study will recruit 7,000 UK participants, aged 18 and over, through market research panels via the Predictiv online platform, an online survey platform created by the Behavioural Insights Team.
Participants will be randomised 1:1:1:1:1:1:1 into one of seven trial arms: a control arm with a standard antibiotic packet, and six intervention arms. Interventions include QR codes linking to additional information (Arms 2-4) and warning messages on the packaging (Arms 5-7).
Recruitment will use quotas for age, gender, region, and ethnicity to ensure a nationally representative sample.
The participant journey involves accessing the survey, an introduction slide, an attention check, randomisation, baseline measures of AMR understanding, a standardized medical scenario, exposure to their assigned antibiotic packet image (intervention), a series of survey questions, and finally, demographic questions.
Participants will be anonymous, with no personally identifying data transferred to the research team. Participants will receive a small financial incentive (£0.70) managed by the market research panels. The total study duration is anticipated to be around 3 weeks.
Sub-group Analysis:
The primary analysis will be repeated for subgroups based on age, health confidence, and baseline comprehension of AMR to identify differential impacts of the intervention.
- Conditions
- Antibiotic Use
- Being tested
- Behavioural Message, Behavioural message + positive framing, Behavioural message + negative framing
- Keywords
- Antibiotics, Behaviour Change, Randomised controlled trial, Antibiotic Resistance, Antimicrobial Resistance
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Behavioural MessageBehavioural
Participants are presented with an image of an antibiotic packet, that contains information about the behaviour "take antibiotics exactly as prescribed". This can be delivered to participants via a QR code, or a warning message on the packet.
Behavioural message + positive framingBehavioural
Participants are presented with an image of an antibiotic packet, that contains information about the behaviour "take antibiotics exactly as prescribed" and information about AMR, framed in a positive manner. This can be delivered to participants via a QR code, or a warning message on the packet.
Behavioural message + negative framingBehavioural
Participants are presented with an image of an antibiotic packet, that contains information about the behaviour "take antibiotics exactly as prescribed" and information about AMR, framed in a negative manner. This can be delivered to participants via a QR code, or a warning message on the packet.
| Study group | Role | What they receive |
|---|---|---|
| Control | No intervention | Control arm, with a picture of a typical antibiotic packet shown to participants |
| Behavioural Message - QR code | Experimental | Antibiotic packet with a QR code as the mechanism of delivery of the intervention, the intervention only contains information about the desired behaviour Receives: Behavioral: Behavioural Message |
| Behavioural Message - Warning | Experimental | Antibiotic packet with a warning message on it as the mechanism of delivery of the intervention, the intervention only contains information about the desired behaviour Receives: Behavioral: Behavioural Message |
| Behavioural message + positive framing - QR code | Experimental | Antibiotic packet with a QR code as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a positive manner) Receives: Behavioral: Behavioural message + positive framing |
| Behavioural message + positive framing - Warning | Experimental | Antibiotic packet with a warning message on it as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a positive manner) Receives: Behavioral: Behavioural message + positive framing |
| Behavioural message + negative framing - QR Code | Experimental | Antibiotic packet with a QR code as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a negative manner) Receives: Behavioral: Behavioural message + negative framing |
| Behavioural message + negative framing - Warning | Experimental | Antibiotic packet with a warning message on it as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a negative manner) Receives: Behavioral: Behavioural message + negative framing |
What is being measured
The primary outcome is the main question the study is designed to answer.
Overall intent to take antibiotics as prescribed
The proportion of Moderately, Very likely, or 'Yes' responses across the 4 measures of intent (taking one dose at a time, taking the full course, spacing the doses throughout the day, stopping when feeling better).
Measured: During the intervention
Secondary outcomes (1)
Proportion of correct responses on comprehension questions about antibiotic use
Responses to six questions relating to taking antibiotics exactly as prescribed, including how many per day, how many days for, when should tablets be taken, duration of course, how many tablets at a time and how to space across day
Measured: During the intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Aug 2025
- Study start31 Aug 2025 (estimated)
- Primary completion24 Oct 2025 (estimated)
- Study completion1 Mar 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Antibiotic UseStudies of the same condition, open and under way.
- More trials run by Imperial College LondonThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- The study intervention aims to change behavioural intent regarding the use of antibiotics. It is a 7 armed parallel randomised controlled trial
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 7,000 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Imperial College London
- Sponsor type
- University, hospital or other
- Collaborators
- The Behavioural Insights Team
- Responsible party
- Sponsor
- Investigators
- Kate Grailey, Principal investigator, Imperial College London
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07111754
- Sponsor's protocol ID
- 7836387
- Status last verified
- Aug 2025
- First submitted
- 17 Jul 2025
- Last updated
- 8 Aug 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Anonymised participant data will be shared at the time of study publication on an openly available database
Study at a glance
From the registry record, last updated by the sponsor on 8 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- How Can Behavioural Intent to Take Antibiotics "Exactly as Prescribed" be Increased? An Online Randomised Behavioural Experiment
- ClinicalTrials.gov ID
- NCT07111754
- Acronym / sponsor ID
- 7836387
- Conditions
- Antibiotic Use
- Keywords
- Antibiotics, Behaviour Change, Randomised controlled trial, Antibiotic Resistance, Antimicrobial Resistance
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 7,000 participants (estimated)
- Lead sponsor
- Imperial College LondonUniversity, hospital or other
- Collaborators
- The Behavioural Insights Team
- Study start
- 31 Aug 2025 (estimated)
- Primary completion
- 24 Oct 2025 (estimated)
- Study completion
- 1 Mar 2026 (estimated)
- First posted
- 8 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Antimicrobial resistance (AMR) is a global public health challenge. Due to overuse of antibiotics, bacteria are becoming resistant to antibiotics, which creates infections that can't be treated by modern medicine. To combat AMR, the public need to both know that AMR is an issue and know what actions they can take to address AMR.
When patients are prescribed antibiotics, the information provided (and how this is provided) is likely to be influential on whether they are taken correctly, or if behaviours that contribute to antimicrobial resistance (such as not finishing the course) predominate.
This study, a large online experiment involving 7,000 people across the UK, aims explore the influence of what information and how it is provided. The study looks at different ways of presenting information on antibiotic packets-from clear instructions to warnings and even scannable QR codes with extra details.
The main goals are to see if these changes can help participants understand how to take antibiotics exactly as prescribed. The investigators also want to see if it helps participants understand what antibiotic resistance is and their role in preventing it.
By understanding what works best, the investigators hope to find simple, effective ways to help everyone use antibiotics wisely, protecting these vital medicines for the future.
Detailed description
Antimicrobial resistance (AMR), or antibiotic resistance, is a serious global health problem. It happens when bacteria evolve and become strong enough to resist the very antibiotics designed to kill them. This makes common infections much harder, or even impossible, to treat. A major reason for this growing threat is the overuse and misuse of antibiotics.
To fight AMR, it's crucial that the public not only understand that antibiotic resistance is a problem, but also know what steps can be taken to help. A key action is to take antibiotics exactly as prescribed. However, the investigators know that many people aren't entirely sure what "exactly as prescribed" really means. This can involve things like remembering to take the full course, taking it at the right times, and simply taking the medication at all.
To better understand these challenges, the Fleming Initiative conducted focus groups with the UK public in spring 2025. These discussions helped identify the main reasons people might not take antibiotics as directed, such as not understanding what "exactly as prescribed" means, or not knowing about AMR and how individual actions might contribute to it.
Using these insights, the Fleming Initiative then held co-design workshops with public participants. Together, several new ways to make it easier for individuals to take antibiotics correctly were developed.
This study is a seven-armed online behavioral experiment conducted in collaboration between the Fleming Initiative at Imperial College London, and the Behavioural Insights Team. It aims to understand how different presentations of information on antibiotic packaging about desired target behaviors and antimicrobial resistance (AMR) influence the public's correct antibiotic use, attitudes towards AMR, and future behavioral intent.
Primary Objective:
To measure the change in behavioral intent to "take antibiotics exactly as prescribed," using a composite measure of four individual behaviors related to antimicrobial stewardship (AMS).
Secondary Objectives:
To assess comprehension of how to take antibiotics. To assess comprehension of AMR.
Exploratory Objectives:
To evaluate changes in behavioral intent for individual behaviors related to "taking antibiotics exactly as prescribed" (e.g., finishing the course, number per day).
To understand if participants recognise that not taking antibiotics exactly as prescribed contributes to AMR.
To examine the impact of message framing and the mechanism of intervention delivery on behavioral intent to take antibiotics exactly as prescribed.
To assess the impact on perceived personal responsibility regarding AMR.
To determine the proportion of individuals who interacted with a QR code (in relevant arms).
To gauge the impact of interventions on sentiment towards information on the package itself.
To evaluate participants' opinions on whether text message reminders would help participants take antibiotics exactly as prescribed.
Study Design and Participant Recruitment:
The study will recruit 7,000 UK participants, aged 18 and over, through market research panels via the Predictiv online platform, an online survey platform created by the Behavioural Insights Team.
Participants will be randomised 1:1:1:1:1:1:1 into one of seven trial arms: a control arm with a standard antibiotic packet, and six intervention arms. Interventions include QR codes linking to additional information (Arms 2-4) and warning messages on the packaging (Arms 5-7).
Recruitment will use quotas for age, gender, region, and ethnicity to ensure a nationally representative sample.
The participant journey involves accessing the survey, an introduction slide, an attention check, randomisation, baseline measures of AMR understanding, a standardized medical scenario, exposure to their assigned antibiotic packet image (intervention), a series of survey questions, and finally, demographic questions.
Participants will be anonymous, with no personally identifying data transferred to the research team. Participants will receive a small financial incentive (£0.70) managed by the market research panels. The total study duration is anticipated to be around 3 weeks.
Sub-group Analysis:
The primary analysis will be repeated for subgroups based on age, health confidence, and baseline comprehension of AMR to identify differential impacts of the intervention.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 7
- Model description
- The study intervention aims to change behavioural intent regarding the use of antibiotics. It is a 7 armed parallel randomised controlled trial
| Arm | Type | Receives |
|---|---|---|
| Control | No intervention | –Control arm, with a picture of a typical antibiotic packet shown to participants |
| Behavioural Message - QR code | Experimental | Behavioral: Behavioural MessageAntibiotic packet with a QR code as the mechanism of delivery of the intervention, the intervention only contains information about the desired behaviour |
| Behavioural Message - Warning | Experimental | Behavioral: Behavioural MessageAntibiotic packet with a warning message on it as the mechanism of delivery of the intervention, the intervention only contains information about the desired behaviour |
| Behavioural message + positive framing - QR code | Experimental | Behavioral: Behavioural message + positive framingAntibiotic packet with a QR code as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a positive manner) |
| Behavioural message + positive framing - Warning | Experimental | Behavioral: Behavioural message + positive framingAntibiotic packet with a warning message on it as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a positive manner) |
| Behavioural message + negative framing - QR Code | Experimental | Behavioral: Behavioural message + negative framingAntibiotic packet with a QR code as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a negative manner) |
| Behavioural message + negative framing - Warning | Experimental | Behavioral: Behavioural message + negative framingAntibiotic packet with a warning message on it as the mechanism of delivery of the intervention, the intervention contains information about the desired behaviour and antimicrobial resistance (framed in a negative manner) |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Adults aged 18 and over
- United Kingdom residents
- Have passed the attention check at the start of the online survey.
Key exclusion criteria (3 listed)
- Individuals who are not signed up a market research panel and therefore will not have access to the online survey.
- Those resident outside the UK.
- Those who fail the attention check at the start of the online survey. Individuals aged under 18.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Behavioural MessageParticipants are presented with an image of an antibiotic packet, that contains information about the behaviour "take antibiotics exactly as prescribed". This can be delivered to participants via a QR code, or a warning message on the packet. | Behavioural | Behavioural Message - QR code, Behavioural Message - Warning |
| Behavioural message + positive framingParticipants are presented with an image of an antibiotic packet, that contains information about the behaviour "take antibiotics exactly as prescribed" and information about AMR, framed in a positive manner. This can be delivered to participants via a QR code, or a warning message on the packet. | Behavioural | Behavioural message + positive framing - QR code, Behavioural message + positive framing - Warning |
| Behavioural message + negative framingParticipants are presented with an image of an antibiotic packet, that contains information about the behaviour "take antibiotics exactly as prescribed" and information about AMR, framed in a negative manner. This can be delivered to participants via a QR code, or a warning message on the packet. | Behavioural | Behavioural message + negative framing - QR Code, Behavioural message + negative framing - Warning |
Primary outcome
Overall intent to take antibiotics as prescribed
Time frame: During the intervention
The proportion of Moderately, Very likely, or 'Yes' responses across the 4 measures of intent (taking one dose at a time, taking the full course, spacing the doses throughout the day, stopping when feeling better).
1 secondary outcome
Proportion of correct responses on comprehension questions about antibiotic use
Time frame: During the intervention
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Aug 2025.
- Individual participant dataSharing planned: Yes. Anonymised participant data will be shared at the time of study publication on an openly available database
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Kate Grailey principal investigator
Imperial College London
Questions about this trial
What is this clinical trial studying?
A study testing Behavioural Message, Behavioural message + positive framing and Behavioural message + negative framing in people with Antibiotic Use, run by Imperial College London.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 8 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Kate Grailey, PhD (07912563290, k.grailey18@imperial.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Overall intent to take antibiotics as prescribed (time frame: During the intervention). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Aug 2025.