Despite its importance, the term ‘AMR’ fails to resonate with the public, limiting its power to drive behaviour change. New research is revealing how language itself may be one of the biggest barriers in the fight against AMR.
Lost in translation
Antimicrobial resistance (AMR) is one of the most urgent health challenges of our time, yet the term itself is ineffective at gaining public understanding or capturing attention, which are both critical to inspire change.
Despite global campaigns and policy statements, public awareness remains low, and comprehension is even lower. UK-based Dr Eva Krockow and Dr Kate Grailey are investigating how the public perceives AMR terminology. Their research is shaping the global conversation around how best to communicate this growing threat.
This article explores why the term ‘AMR’ doesn’t resonate with the public, what alternative terms may be more effective and how inconsistent terminology complicates the public’s understanding of AMR, preventing necessary behavioural change.
Our everyday choices fuel antimicrobial resistance
AMR is often driven by everyday human behaviour, sometimes without us realising it. When people misuse antimicrobials – by not following the prescription, asking for antibiotics for infections when they’re not needed (like viruses) or overusing them – they contribute to fuelling AMR.
Encouraging behaviour change is essential to preserve the effectiveness of antibiotics. But first, the public requires an improved understanding of AMR. People need a clear, relatable understanding of what AMR is – and why it matters.
Why AMR feels irrelevant
Dr Kate Grailey, Academic Research Lead for the Centre for Health Policy at the Institute of Global Health Innovation, The Fleming Initiative, Imperial College London, highlights a deeper issue than lack of knowledge or awareness: the lack of perceived relevance.
“People know what HIV is, what cancer is. They’ve heard these terms for decades, and they relate to them personally. But AMR? It feels far away, like it only affects people who are already critically ill.”
The reality is that AMR is not a distant threat in the future. It is already here.
A recently published Australian study demonstrates that 1,031 Australian deaths were directly attributable to AMR in 2020 alone[i], and this number is likely to be under-reported. Microorganisms exist today that we lack effective antimicrobial treatments for.
Globally, the 2024 Global Burden of Disease report estimated that 1.14 million deaths were directly caused by bacterial resistance and another 4.71 million deaths were associated with bacterial resistance in 2021[ii]. The takeaway: AMR is here now and it affects everyone.
Language matters: why ‘AMR’ does not resonate
The term ‘antimicrobial resistance’ is long, technical and unfamiliar. These are barriers that weaken its public health impact.
Almost everyone finds the term “antimicrobial resistance” difficult to pronounce, let alone understand. Dr Eva Krockow, Associate Professor of Psychology at the College of Life Sciences, University of Leicester, says that even an academic colleague confessed, ‘I simply cannot pronounce antimicrobial resistance. It’s a real mouthful.’
Dr Krockow is looking to understand why AMR awareness campaigns have not been very successful in changing behaviour by investigating the language used to communicate about AMR.
In her experimental Nature Communications Medicine-published study[iii], Krockow tested the public’s recall of and threat perception response to AMR-associated terms. She found that both ‘AMR’ and ‘antimicrobial resistance’ performed poorly, failing to trigger concern or recognition, unlike terms such as ‘cancer’.
Participants neither remembered AMR terms well nor associated them with a significant health risk, which they did for terms such as cancer and Ebola. Her findings suggested that existing AMR-related health terms – particularly “AMR” and “Antimicrobial resistance” – are unsuitable for public health communication because they score consistently low on both memorability and risk association.
Results showed that out of the AMR terms, ‘Antibiotic resistance’ and ‘Drug-resistant infections’ performed best. This suggests that linguistic attributes (e.g., familiarity, processing fluency and pronounceability) are predictors of the terms’ risk association.
Terms like ‘antibiotic resistance’ performed somewhat better, likely because the word ‘antibiotics’ is already familiar to the public. However, even this term was considered lengthy and abstract.
Clearer language can inspire better choices
Dr Grailey’s research echoes Krockow’s findings.
Grailey is looking for alternative ways to provide effective information about AMR to the general public. Changing people’s behaviour can help reduce the risk of AMR if it enables people to take antibiotics exactly as prescribed, also known as ‘appropriately’. But to do this, the public needs an understanding of AMR.
Her study, published by Nature Communications Medicine, co-designed with the public and conducted in collaboration with the UK Behavioural Insights Team, tested several alternative terms for AMR in an online experiment with 4,000 participants[iv].
The results were consistent: ‘AMR’ performed worst across all measures (in areas of comprehension, recall and perceived seriousness). “Antibiotic resistance” and “the antibiotic crisis” outperformed it and were found to be more effective in understanding the importance of AMR and inspiring people to use antibiotics appropriately.
This work highlights that using terms already familiar to the public, such as ‘antibiotics’ could make AMR public health campaigns more memorable and effective.
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We need for public-centric language that builds on what people already know.
What language works best – and what doesn’t
Both Krockow and Grailey agree: we need for public-centric language that builds on what people already know.
Their research shows that terms with the word ‘antibiotic’ generally perform better because they build on existing knowledge and understanding.
Grailey noted that ‘superbugs,’ despite being popular with some study participants and a media favourite, can be ineffective and showed the least recall of all terms tested.
Interestingly, Krockow pointed to a recent UK Health and Security Agency campaign that completely avoided the term ‘antibiotic resistance.’ Instead, it focused on actionable advice: ‘Don’t share antibiotics’ and ‘Complete the course as instructed.’ She found this approach clever and effective, as it bypassed terminology issues entirely.
Krockow’s research considered the term ‘drug-resistant infections.’ While not highly memorable, it was perceived as serious, likely due to the word ‘infection.’
The lesson: even seemingly clear terms can be misunderstood without audience testing.
Krockow says, ‘With each of those terms, you have to really think about how people from different contexts and backgrounds will interpret them. There’s a lot of room sometimes for bringing in people from different backgrounds to avoid misunderstandings in messaging.’
How the studies were designed
Krockow designed two studies: one theoretical, focusing on linguistic properties of AMR-related terms and one empirical, measuring public risk perception and recall.
Participants were asked to rate how scary, memorable, and understandable they found each term. She also assessed linguistic properties like syllable count, pronounceability, and familiarity.
Her conclusion: linguistic features significantly affect public perception. Terms that are easier to pronounce and rooted in familiar vocabulary performed better.
Grailey’s research followed a co-design methodology. Members of the public participated in workshops to brainstorm new terms, which were then shortlisted and tested in an online survey.
Four names made the final cut: ‘AMR’, ‘antibiotic resistance,’ ‘antibiotic crisis,’ and ‘superbugs.’ Participants were randomised to see a poster using one of these terms and then asked questions about recall, comprehension, emotional response and their behavioural intent.
Terms containing ‘antibiotic’ scored best, primarily due to the public’s existing familiarity with the concept. These terms had a significant impact on people’s intent towards antimicrobial stewardship, highlighting the importance of language in inspiring behaviour change.
Inconsistent language hinders research and policy
Beyond public engagement, inconsistent AMR terminology creates major challenges in monitoring and funding AMR-related research. Funders and policymakers, especially those outside medical circles, may struggle to interpret AMR terminology. This inconsistency can obscure grant applications or lead to misalignment in research priorities.
Grailey notes that there’s no consensus for AMR terminology. This lack of consensus affects the ability to convey a complex topic to the public in a consistent and meaningful manner.
Krockow also highlights the impact on interdisciplinary funding bodies like the Economic and Social Research Council. ‘Reviewers unfamiliar with AMR might not understand how behavioural studies fit into the landscape. Even for me, explaining how ‘antibiotic resistance’ connects to AMR can be difficult in a proposal.’
One initiative aiming to address this complexity is an AMR data dashboard that provides an overview of AMR technologies and solutions in Australia. It is a collaboration between The Lens and CSIRO. Still in its early stages, it attempts to build understanding of Australia’s AMR research capabilities and develop collaborations.
Where we go from here: four strategic takeaways
- Tailor language to the audience: For scientists, specificity matters; for the public, simplicity and relevance are key. AMR is ineffective as a public-facing term. Use familiar, emotionally resonant language like ‘antibiotic resistance’ or ‘infections we can’t treat.’
- Use research to guide communications: Both qualitative (e.g., focus groups) and quantitative (e.g., large-scale surveys) approaches are necessary to understand how terms are perceived across populations.
- Push for unified global terminology: Endorsement from WHO or another global body could help standardise terminology, supporting better oversight and communication.
- Focus on actionable messages: Concrete advice e.g. ‘Don’t share antibiotics’ and ‘Take antibiotics as prescribed’, resonate more than abstract warnings.
AMR is a crisis of language
AMR is a crisis of language as much as it is of public health. As Krockow says, “We’ve got big words nobody remembers.”
If we hope to drive behavioural change, we must rethink the way we talk about AMR. This includes simplifying language, using terms with built-in familiarity and ensuring consistency across research, policy and public discourse.
Public health history shows us that language matters. Terms like ‘HIV’ and ‘COVID’ became household terms because they were consistently used and deeply personal. AMR must follow suit to resonate and drive action by the general public.
Melissa Waine swapped Petri dishes for prose, transforming her love of science into compelling health and medical writing. She is passionate about antimicrobial resistance (AMR) and communicating the looming threat it will pose if we exhaust our supply of effective treatments.
[i] Disease burden, associated mortality and economic impact of antimicrobial resistant infections in Australia. Wozniak, Teresa M. et al. The Lancet Regional Health – Western Pacific, Volume 27, 100521
[ii] Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. Naghavi, Mohsen et al. The Lancet, Volume 404, Issue 10459, 1199 – 1226
[iii] Krockow, E.M., Cheng, K.O., Maltby, J. et al. Existing terminology related to antimicrobial resistance fails to evoke risk perceptions and be remembered. Commun Med 3, 149 (2023). https://doi.org/10.1038/s43856-023-00379-6
[iv] Grailey, K., Finlayson, A., Stuijfzand, B. et al. Differing terminology used to describe antimicrobial resistance can influence comprehension and subsequent behavioural intent. Commun Med 5, 146 (2025). https://doi.org/10.1038/s43856-025-00849-z
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