Using social influencers for public health education on antibiotic use and antimicrobial resistance: protocol for a...

Antimicrobial resistance (AMR) is driven by the inappropriate use of antibiotics. "One-size-fits-all" campaigns have demonstrated little impact in increasing public knowledge of antibiotic use and AMR. Whilst healthcare providers are the most trusted sources of health information, only half of the adult population have a healthcare encounter annually. Their limited reach suggests inadequacies in communication channels and a need for mobilization of community-based non-healthcare influencers to increase accessibility to information on antibiotic use and AMR. Whilst the engagement of community barbershops and hair salons as health advocates has been well studied and shown to be effective for health education, there is no study to date harnessing ubiquitous neighborhood food establishments for health education and none assessing the comparative effectiveness of various types of neighborhood establishments as health advocates. This study protocol describes research which aims to compare the effectiveness of health education facilitated by neighborhood food and beauty establishments, versus neighborhood clinics, in increasing the public's knowledge of antibiotic use and AMR, and improving antibiotic behaviors.

A quasi-experimental study will be conducted in highly frequented healthcare clinics, and beauty and food establishments in two neighborhoods in Central Singapore. Clients (patients/patrons) aged ≥ 21 years visiting the chosen establishments will be invited to participate in the one-year-long study by scanning the QR code on recruitment posters placed within the establishment premises. Participants will receive educational information on antibiotic use and AMR via a two-minute animated video, developed based on the knowledge needs and media preferences of the community. Outcome measures, namely participants' knowledge of antibiotic use and AMR, and antibiotic use practices will be assessed via self-administered surveys conducted at five longitudinal time-points: pre-intervention, immediate post-intervention, 1-month post-intervention, 3-month post-intervention, and 6-month post-intervention. Additionally, the reach and implementation fidelity of the intervention at the participating study sites will be assessed.

Findings from the study will enable a more comprehensive understanding of the potential reach and effects of health education facilitated by neighborhood retail establishments in relation to neighborhood healthcare clinics, enabling better insights into selecting health message outreach options.

ClinicalTrials.gov NCT06998576; https://clinicaltrials.gov/study/NCT06998576 ; first posted on 2025-05-31, last update posted on 2025-06-05.