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Public Communication of Antimicrobial Resistance: A Decade of Scholarship (2015–2024)

Part of: Antimicrobial Resistance: Just Transitions for Shared Futures

Published online by Cambridge University Press:  03 December 2025

Marina Joubert Open the ORCID record for Marina Joubert [Opens in a new window]  and
Marietjie Botes
Marina Joubert*
Affiliation:
Centre for Research on Evaluation, Science and Technology (CREST), Stellenbosch University , Stellenbosch, South Africa
Marietjie Botes
Affiliation:
Centre for Research on Evaluation, Science and Technology (CREST), Stellenbosch University , Stellenbosch, South Africa
*
Corresponding author: Marina Joubert; Email: marinajoubert@sun.ac.za
Rights & Permissions [Opens in a new window]

Abstract

Public communication about antimicrobial resistance (AMR) is widely acknowledged as a cornerstone of global, national, and regional strategies to tackle this urgent health threat. However, much like AMR itself, efforts to communicate about it are hindered by complex and intersecting challenges. This scoping review synthesises insights from 88 scholarly manuscripts published between 2015 and 2024 to explore critical issues in AMR communication and identify potential options to address them. We distil nine overarching themes that underpin effective public communication and engagement, with particular significance for engaging with disadvantaged and vulnerable communities. These themes encompass (1) social science theoretical frameworks, (2) varied sociocultural contexts, (3) public engagement and dialogue, (4) linguistic considerations, (5) messaging strategies, (6) media use and its impacts, (7) large-scale public campaigns, (8) creative communication approaches, and (9) evaluation. We discuss each theme and outline related recommendations, collectively advocating a re-imagining of AMR communication as a civic, cultural, and reflexive practice that is attuned to the complexities of diverse contexts and cultures, and designed to enhance societal relevance and impact.

Keywords

antimicrobial resistanceglobal healthhealth inequalitiesparticipatory communicationpublic engagementsocial justice

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Public Humanities , Volume 1 , 2025 , e172
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
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© The Author(s), 2025. Published by Cambridge University Press

With a forecast of 10 million deaths per year globally by 2050, antimicrobial resistance (AMR) is one of the most pressing health challenges of the current era.Footnote 1 As harmful microbes become progressively resistant to antimicrobials, they no longer respond to previously effective treatments. Consequently, it becomes increasingly costly and challenging to prevent and treat infections, adding to morbidity, mortality, and socioeconomic burdens. In the face of this escalating threat, public communication and engagement are recognised as essential tools to combat AMR, and the topic is attracting attention from policymakers, health organisations, and communication scholars.Footnote 2 Communicating about AMR, ranging from raising awareness to behaviour change interventions and monitoring for accountability, is now recognised as a cornerstone of the Global Action Plan on AMR by all Tripartite agencies, partners, stakeholders, and National Action Plans on AMR.Footnote 3

The nature of antimicrobial resistance (AMR) aligns closely with two science-related philosophical ideas, namely that of a “super-wicked problem” and the related concept of “post-normal” science. Super-wicked problems are complex and urgent, but also uncertain and lacking clear solutions.Footnote 4 Post-normal scientific challenges are described as situations or issues where facts are uncertain, values are disputed, stakes are high, and decisions are urgent.Footnote 5 Notably, for this kind of problem, there is a pressing need for solutions, but people may be reluctant to act in the interest of solving what is perceived to be a distant or future problem.Footnote 6 The challenge of achieving effective and impactful public communication and engagement around AMR is an integral part of this wicked and post-normal scientific challenge, similarly facing considerable uncertainty and lacking clear and practical solutions. AMR communication has been described as a “Goldilocks” problem, where effective messaging is a balancing act between alerting and alarming audiences, and messages must be carefully crafted to be “just right” if they are to be successful.Footnote 7 Over the past decade, natural and social scientists, along with scholars from the humanities, have studied and reflected on AMR communication and public engagement. Therefore, the aim of this scoping review was to explore academic literature to identify and synthesise the documented challenges that hinder effective communication about AMR, as well as the proposed solutions to address these issues. Specifically, we asked:

  • • RQ1: What are the key challenges related to public communication of AMR that are documented in recent academic literature?

  • • RQ2: What solutions or remedies are scholars suggesting for improving or enhancing the effectiveness and impact of public communication of AMR?

Arguably, the efficacy and impact of AMR communication are cross-cutting issues that concern us all. However, given that low- and middle-income countries (LMICs) are disproportionately affected by AMR, our reflections highlight societal considerations that further complicate public communication in poor and vulnerable communities.Footnote 8

With this review, we bring together a decade of scholarship, highlighting how these challenges and solutions are connected and interdependent. With this mapping of the challenges and solutions associated with public communication of AMR, our goal is to assist policymakers, AMR experts, and science communicators with their collaborative efforts to help them improve their work towards a more strategic and evidence-informed approach to public communication and engagement around AMR.Footnote 9

1. Challenges and solutions associated with public communication of AMR

The challenges and solutions related to AMR communication, as documented in the scientific literature, focus on communication theory, strategy, and content. We identified nine key themes from our dataset of 88 articles (see the Supplementary Material for details). Each theme is discussed below.

  1. 1. Theoretical insights to move on from raising awareness towards achieving behaviour change;

  2. 2. Tailor-made communication for diverse contexts, cultures, and audiences;

  3. 3. A commitment to public engagement and participation;

  4. 4. Considerations around renaming and reframing AMR;

  5. 5. The need for compelling and actionable AMR messages;

  6. 6. Media use and effects;

  7. 7. Rethinking large AMR campaigns;

  8. 8. Getting creative with AMR communication;

  9. 9. The need for more robust evaluations.

1. Theoretical insights to move on from raising awareness towards achieving behaviour change

Possibly the most fundamental question regarding public communication about AMR is: To what end? In other words: What is the purpose, and precisely what are we trying to achieve? Raising awareness is a common default objective for public health campaigns and has historically been the focus of public communication around AMR. For example, to “improve awareness and understanding of AMR through effective communication, education, and training” is listed as the first strategic objective of the Global Action Plan on AMR.Footnote 10 This is a common theme across various AMR national action plans and public campaigns, and experts in the field often emphasise the need for increased public awareness.Footnote 11

Organisations and individual scientists focus on raising awareness (or “educating” the public) in the hope that increased knowledge (or health literacy) will lead to behaviour change. This assumption has been challenged by science communication literature.Footnote 12 In addition, despite ongoing public campaigns and widespread educational efforts, surveys assessing public understanding of AMR continue to identify knowledge gaps about how resistance develops and how antimicrobials work, along with various misconceptions concerning the nature and risks of AMR.Footnote 13

Current insights from science communication research help us to understand that the connection between knowledge and behaviour is weak and, therefore, the awareness of an issue seldom motivates individuals to change their actions.Footnote 14 The way people process information, form opinions, and make decisions is based on how they feel, rather than what they know, and their responses are shaped by their beliefs, values, worldviews, identities, and lived experiences.Footnote 15 That is why providing facts is often ineffective.Footnote 16 While knowledge (or awareness) matters, it is only the first step in achieving behaviour change. Thus, to bridge the critical gap between knowledge and action, AMR communication efforts should be informed by the current insights from communication and behavioural sciences and should be strategically designed for achieving measurable changes in desired behaviours.Footnote 17 Currently, many AMR communication interventions lack a theoretical underpinning and do not apply behavioural change theories or outcomes in their design.Footnote 18 Instead, they rely on simplistic assumptions about message transmission and reception that fail to consider the complexity of how health messages are produced, circulated, and interpreted by diverse publics in real-world contexts.Footnote 19 At the same time, it should be acknowledged that publicly accessible and credible information about AMR remains a vital foundational step in long-term AMR communication strategies. For example, understanding the causes, likelihood, and consequences of a health threat will influence how the public perceives that risk, and people will be more likely to engage in protective or preventive behaviour if they perceive a risk as relevant to themselves, especially if the knowledge is paired with motivational and contextual factors that encourage action.Footnote 20

Social scientists from disciplines such as health psychology, behavioural sciences, and risk communication can provide much-needed insight into relevant communication theory and evidence-based engagement practices to ensure more effective (and more cost-effective) communication strategies that can bridge the intention–behaviour gap.Footnote 21 It involves recognising that effective communication goes beyond raising awareness or transmitting facts towards engaging with different stakeholders’ values and priorities, and connecting with audiences on an emotional level.Footnote 22 Therefore, AMR experts should collaborate beyond disciplinary silos and collaborate with social scientists, artists, and a wide range of other forms of expertise to design and deliver interventions with maximum impact, as well as to avoid ineffective communication or even public disengagement in specific communities.Footnote 23 Training of AMR communicators should also be informed by the latest theoretical insights to ensure communication efforts that are context-appropriate, responsive to evolving public concerns, and effective at building trust and achieving desired outcomes.Footnote 24 Redesigning and re-aligning global and regional AMR communication efforts strategically towards theoretically informed approaches that aim for behaviour change will require significant multidisciplinary expertise. However, this shift in strategy is widely regarded as a vital step in effectively addressing the complexities and interconnections of AMR communication challenges.

2. Tailor-made communication for diverse contexts, cultures, and audiences

Public interpretation of and response to AMR threats are influenced by subtle and overt sociocultural determinants, inequities, norms, and personal histories, meaning that it is particularly challenging to communicate about the topic across diverse cultural contexts.Footnote 25 As a result, global campaigns and generic messaging frequently lack contextual relevance and often fail to consider the sociocultural factors, economic constraints, and moral dimensions that shape how people respond to AMR messaging.Footnote 26 AMR messaging may not resonate with local health beliefs and practices, reminding us that generic messages intended to address everyone may end up addressing no one in particular and therefore fail to achieve desired effects.Footnote 27

It is increasingly recognised that meaningful public engagement requires moving away from broad, generic rhetoric and approaches towards targeted and deliberate engagement with well-defined stakeholder groups, rooted in specific issues and recognising diverse knowledge systems.Footnote 28 This requires moving beyond the notion of a single “general public” towards approaches based on an understanding of how different segments of the public (defined by values, demographics, health experiences, cultural backgrounds, media use patterns, and information needs) access, interpret, and respond to AMR information.Footnote 29 Messages and materials should be tailored to specific audience segments (e.g., youth, health workers, teachers, and parents of young children), rather than assuming audience homogeneity.

When designing tailor-made AMR communication strategies, it is essential to consider social justice perspectives, keeping in mind that the burden of AMR falls excessively on LMICs and vulnerable groups in society in general.Footnote 30 Extra care should be taken to ensure cultural sensitivity and resonance when engaging with vulnerable or marginalised communities, such as young children and elderly people, those who lack access to healthcare, and those living in the margins of societies, such as migrant and refugee populations. It must also be kept in mind that the existing challenges of effective public communication and engagement are multiplied in LMICs due to the high cost of interventions in resource-poor healthcare settings, as well as language barriers and inequitable access.Footnote 31 Since the bulk of current literature about AMR originates from the Global North, the scarcity of country-specific information on AMR for LMICs further complicates the task of tailoring messages that are relevant and impactful within different cultural and societal contexts.Footnote 32

When engaging with communities in the Global South, AMR communicators should be aware of and responsive to cultural differences. They must be willing to challenge entrenched hierarchies of knowledge and foreground local perspectives and beliefs.Footnote 33 The validity and value of local (or indigenous) knowledge must be acknowledged through opportunities for these knowledge systems to contribute to locally appropriate solutions. An essential step towards embracing diversity and equity in AMR communication is dialogue and deliberate in-depth engagement to include views and voices from local communities in the development of locally relevant and culturally appropriate messages and solutions.Footnote 34 Trusted local leaders and community health workers who understand how to engage their communities can be key allies to ensure local relevance and facilitate access.Footnote 35

While recognising that there is no one-size-fits-all solution for communicating about AMR across national and regional boundaries, it should also be acknowledged that designing, implementing, and evaluating stratified and targeted communication campaigns is complex and costly.Footnote 36

3. A commitment to public engagement and participation

The social and behavioural dimensions of AMR make effective public engagement and participation a critical component of any meaningful response.Footnote 37 For example, the WHO’s Global Action Plan on AMR explicitly calls for “whole-of-society engagement.”Footnote 38 Yet, in practice, AMR communication remains dominated by top-down, expert-to-public approaches. These often assume that experts hold superior knowledge while discounting the perspectives and lived experiences of “ordinary” people. This framing casts citizens as passive recipients awaiting scientific solutions and fails to recognise the existence of multiple, active publics—each interpreting information through the lens of their social positions, identities, and prior experiences.Footnote 39 The result is communication that risks being disconnected from public reasoning, undermining relevance, and missing opportunities to incorporate valuable societal insights.

Deliberate, democratic, and participatory approaches, combined with genuine, two-way dialogue that acknowledges local realities and structural constraints, offer meaningful alternatives.Footnote 40 By involving communities in defining problems, co-producing knowledge, and sharing in decision-making, these approaches can strengthen both the resonance and legitimacy of AMR communication.Footnote 41 Reflexive engagement recognises publics as agents with collective responsibility that are capable of interpreting, appropriating, or even resisting expert knowledge; this implies that scientists need to listen, learn, and act on public input as part of a mutually beneficial dialogue.Footnote 42

Effective engagement also means moving beyond tokenistic consultation with community representatives, who often reflect more educated or elite perspectives and risk reinforcing existing hierarchies.Footnote 43 Communities are heterogeneous, and factors such as gender, class, age, disability, and geography shape how people encounter and respond to health messaging. Genuine co-production must acknowledge and mitigate systemic inequalities in participation by proactively reaching those most affected but least heard, for example, informal workers, young people, caregivers, migrants, and others typically excluded from top-down campaigns.

Despite growing calls for participative and dialogic approaches, sustained engagement remains rare, constrained by the cost, time, and specialist skills required.Footnote 44 Additional barriers include difficulty recruiting researchers and students to invest in engagement work, and the undervaluation of public engagement in academic reward systems, and limited evidence of effectiveness, particularly in LMIC contexts.Footnote 45 Without sustained support, promising initiatives may fade, fail to scale, or leave communities feeling exploited when participation does not lead to meaningful change.

These patterns echo findings from wider science communication scholarship, where the “scientist-to-public” model remains deeply entrenched despite rhetorical commitments to engagement.Footnote 46 Many scientists continue to prioritise public education, misinformation correction, and visibility over dialogic goals such as trust-building, mutual learning, and co-creation.Footnote 47 Engagement is often instrumentalised as a means to secure funding or policy support, while institutional incentives and time pressures further reinforce reliance on one-way dissemination.Footnote 48

A genuine commitment to public engagement requires a rebalancing of the relationship between science and society. This means recognising that public perspectives can provide valid and necessary knowledge while maintaining respect for scientific expertise.Footnote 49 Plural epistemologies—where different knowledge systems work together—enable the co-production of context-sensitive solutions. Examples such as co-designed antibiotic stewardship campaigns in South Africa or participatory action research in community TB interventions illustrate both the potential and the pitfalls of co-producing knowledge between experts and communities.Footnote 50 Poorly executed models risk limiting community input to early idea generation, without feedback loops or continued influence, or fair acknowledgement of public input.

Finally, it must be recognised that public engagement routinely occurs within power-laden institutional settings. If scientists, health professionals, or funders dominate decision-making, participation may legitimise existing authority rather than redistribute it.Footnote 51 Engagement conducted as a “tick-box” exercise to meet institutional or funder requirements without a genuine commitment to dialogue or shared decision-making not only fails to empower communities but can also actively erode trust.Footnote 52

4. Considerations around renaming and reframing AMR

The “language problem” associated with AMR communication relates to the technical nature of terminology, as well as AMR-related frames, narratives, and metaphors used in the public domain.Footnote 53 The language used to describe and discuss AMR significantly influences public understanding and willingness to act.Footnote 54

The complexity and abstract nature of AMR mean that policymakers, scientists, and other communicators habitually use technical terms (or jargon) and complex explanations when they talk or write about AMR in the public domain. However, people find it difficult to pronounce or remember a long, vague, ambiguous, and abstract term such as “antimicrobial resistance.” In addition, the term lacks intuitive meaning, making it seem less familiar, less important, and even less truthful.Footnote 55 As a result, the term fails to capture attention and engage people, contributing to low public knowledge and media interest, as well as a general underestimation of the associated threat and risks. Moreover, jargon hinders people’s ability to process information fluently and diminishes their interest and engagement.Footnote 56 Multiple variations in terms used to describe AMR (such as “antibiotic resistance,” “bacterial resistance,” and “drug-resistant infections”) further add to public confusion about the topic. Related terms used in the AMR space (e.g., “antimicrobial stewardship”) are similarly fragmented and technical to the extent that they have become significant obstacles in public understanding and collective global action, undermining efforts to address the issue.

To bring about the necessary change in the global discussion and response around AMR, a review and coordination of all terminology used in AMR communication is suggested.Footnote 57 An important starting point may be to invent and consistently use clear and neutral terminology that resonates with the public, avoiding jargon and potentially alienating value-laden terms and acronyms.Footnote 58 It may even be necessary to rename “antimicrobial resistance” and replace it with a single, pronounceable, meaningful, and specific term that is memorable and effective in evoking risk perceptions proportionate to the threat and to avoid referring to AMR as a “silent pandemic.”Footnote 59 It has been found that people are more familiar with the term “antibiotic resistance” than “antimicrobial resistance,” but it is problematic since antibiotic resistance pertains to bacteria and does not encompass resistance in other micro-organisms, such as viruses, fungi, or parasites.Footnote 60 This distinction is crucial because it can lead to a narrowed public understanding of the broader issue of AMR, which includes resistance across various types of pathogens.

However, renaming AMR is far from a straightforward solution. The term “antimicrobial resistance” (including the acronym AMR) is deeply embedded in national action plans, science policy, and regulatory frameworks. Renaming it comes with the risk of further fragmentation, disruption, and dilution of communication efforts. Moreover, despite calls to rename AMR, no apparent and feasible alternatives have been suggested that can capture the complexity and scope of the topic.

Related to AMR terminology, concerns have also been raised about the potentially counterproductive and misleading nature of dominant AMR narratives, metaphors, and frames in the public domain that mostly relate to war, heroes and villains, apocalypse, and catastrophe.Footnote 61 On the one hand, this type of sensationalist language may be effective in attracting the attention of policymakers and funders, but people may perceive these negative frames as manipulative or judgemental, resulting in public anxiety, resentment, defiance, or disengagement.Footnote 62 Consequently, scholars call for an urgent exploration of novel ways to frame AMR that are theoretically informed to engage and motivate behaviour change, possibly grounded in shared community values such as intergenerational equity, solidarity, and collective responsibility.Footnote 63

Notably, circumventing technical jargon and using relatable metaphors and analogies are also crucial social justice considerations to avoid excluding specific audiences.Footnote 64 Any efforts to rename or reframe AMR will also be needed in other languages beyond English and should to be informed by public dialogue.Footnote 65

5. The need for compelling and actionable AMR messages

Current public messaging on AMR often fails to provide clear, specific, and actionable advice, portraying the public as passive victims rather than active agents of change.Footnote 66 Without guidance on what individuals can realistically do, people may experience anxiety, fatalism, and disengagement, which can exacerbate health inequalities.Footnote 67

However, reaching consensus on the content and framing of AMR messages, including adapting messaging to diverse audiences and contexts, is one of the most significant communication challenges facing the global health community. Science communication scholarship stresses the need for normative clarity and explicitly stating what is being asked of citizens, why it matters for them and their communities, and how their actions contribute to solutions.Footnote 68 Therefore, messages should position citizens as empowered participants rather than spectators awaiting scientific fixes.Footnote 69 To be motivating, they need to connect with real-life contexts, offer personally relevant examples, and provide concrete, feasible actions suited to the audience’s circumstances.Footnote 70

The inherently slow-moving and invisible nature of AMR makes urgency difficult to convey, meaning that many people perceive it as a distant or foreign threat.Footnote 71 Effective messages should therefore emphasise current impacts and severity, clearly outline the benefits of appropriate antimicrobial use, and address common misconceptions.Footnote 72

AMR information should be factual and trustworthy, while also resonating with people’s values and evoking an emotional connection.Footnote 73 Drawing on Aristotle’s classic rhetorical appeals can enhance persuasiveness: logos (reason), ethos (credibility), and pathos (emotion).Footnote 74 Trusted messengers, such as healthcare professionals, veterinarians, patient advocacy groups, and community leaders, can play a pivotal role in lending credibility and reach to AMR campaigns.Footnote 75 Ultimately, compelling AMR messages combine clarity, credibility, emotional resonance, and concrete action steps, delivered by trusted voices and adapted over time to meet audiences where they are in their understanding and capacity to act.

While there is broad agreement that AMR messaging should aim for desired behavioural outcomes and be guided by ethics, fairness, and inclusion, developing messages that are relevant, accessible, and equitable—without adding burdens to vulnerable groups—remains difficult. Co-development with diverse stakeholders, including public audiences, can help ensure that messages are iteratively tested, refined, and adapted over time.

6. Media use and effects

Recognising that the mass media have a powerful and widespread influence on public and policy responses to AMR, stakeholders in the field are encouraged to collaborate more strategically and proactively with media outlets to enhance the quality, scope, and impact of media AMR coverage. Simultaneously, media use and effects present several challenges that complicate public communication about AMR, and it is acknowledged that harnessing mass and social media as tools for improving public understanding can be a double-edged sword.Footnote 76 A major part of this intricate challenge involves minimising potential unintended consequences of media exposure, such as misunderstandings and misconceptions, as well as the reinforcement of social inequalities and the erosion of public trust.

Considering the frequency of AMR media coverage, we have some evidence that media attention to AMR is generally low and infrequent compared to more acute health events, leading to a perception that the topic has low news value and is viewed as less urgent or relevant compared to issues such as cancer or air pollution.Footnote 77 In terms of quality, media representation of AMR has been found to be oversimplified, inaccurate, incomplete, and fragmented.Footnote 78 Moreover, we generally lack evidence about media effects on public AMR-related behaviour.Footnote 79

Another perceived challenge is that journalists mostly frame AMR as a story of scientific discovery and therefore a problem that can only be solved by scientists, positioning the public as passive observers, with relatively few stories giving a voice to the public and their lived experiences of AMR, thereby marginalising the role and agency of civil society.Footnote 80 Therefore, scholars advocate for a “solutions journalism” approach, which includes reporting on potential solutions alongside the problems.Footnote 81 In a similar vein, AMR media coverage can be enriched by narratives that reflect the societal dimensions of AMR, as opposed to solely focusing on scientific heroes and microbial villains, which could be instrumental in achieving more impactful coverage, and diversifying the sources featured as AMR experts to enrich the public discourse and make media representations more inclusive.Footnote 82

In digitally connected contexts, social media platforms offer powerful tools for tailoring and targeting AMR communication. Their algorithmic design enables segmentation by geography, age, language, and health interest, allowing for nuanced messaging that can resonate with specific communities. Health campaigns have used platforms such as WhatsApp, Facebook, Instagram, and TikTok to disseminate regionally adapted content, collaborate with trusted local influencers, and engage publics in dialogue. These affordances align well with the theme of contextual sensitivity and inclusiveness. However, social media use must also be approached with care, since unequal digital access, misinformation, and algorithmic amplification of polarisation pose real risks. As such, the potential of social media should be strategically harnessed alongside offline efforts, with particular attention to trust-building and co-produced narratives. This aligns with recommendations from digital health communication literature, which advocate integrating online platforms within broader, ethically grounded public health strategies.Footnote 83

Overall, theory-informed science communication expertise is needed to construct effective interventions and facilitate productive interactions with mass media, considering that complex mediation is required in media ecosystems characterised by fragmented channels, platforms, and audiences.Footnote 84

7. Rethinking large AMR campaigns

Large public campaigns, for example, World AMR Awareness Week (WAAW), are widely used as strategies to address AMR, but there are concerns about their value and a lack of evidence about their impact.Footnote 85 Scholars highlight several key concerns. First, large campaigns are typically short-lived and expensive, primarily reaching people already engaged within the health sector, rather than broader public audiences. Even with well-designed and long-term campaigns, it is hard to maintain public interest and engagement, and campaign fatigue may set in, where the public becomes inattentive to messaging, potentially reducing long-term effectiveness. Second, an over-reliance on top-down approaches aimed at educating the public and the passive nature of campaign materials (e.g., the use of posters and brochures) has little to no impact on public knowledge, attitudes, and behaviour. And, finally, these large campaigns are often underfunded and insufficiently tailored to diverse cultural and linguistic contexts, frequently failing to address the complex social, cultural, and economic factors that contribute to AMR and constrain individual choices and agency in varied contexts.

Suggestions for improving the outcomes of large AMR campaigns include learning from other health campaigns and investing more in strategic planning, including clarifying communication goals and outcomes.Footnote 86 Moreover, campaigns should be tailored to the needs of specific groups while simultaneously adopting coordinated, multimodal approaches across diverse communication channels.Footnote 87 Implementing these solutions will require high-level collaboration, coordination, and synergy between global and regional role-players in AMR. Another insight from our review is the importance of fostering creativity, experimentation, and localised efforts. Unlike the formal nature of many top-down institutional campaigns, such as WAAW or national stewardship initiatives that depend heavily on mass media channels like television, radio, and print advertising, innovative communication strategies often emerge from grassroots, localised, or artistic spaces. These include community theatre, participatory art exhibitions, comic books, and youth-led social media movements that embed AMR into the everyday language of the public. Instead of aiming for perfection or control, these approaches focus on local relevance, emotional connection, and creative strategies, resulting from community input and participation.

8. Getting creative with AMR communication

The abstract and invisible nature of AMR makes it hard to create clear, compelling, and emotionally resonant imagery that resonates with public audiences. Despite this challenge, arts-based approaches offer potential to enhance public comprehension and motivation, as well as to bridge language and literacy barriers, especially when embedded in participatory and culturally sensitive communication strategies. Furthermore, creative approaches facilitate connecting with audiences on an emotional level, triggering curiosity and navigating social conversations about AMR, thereby making the topic more meaningful, relatable, memorable, and engaging. Examples include videos, emojis, infographics, games, animations, storytelling, quizzes, role play, citizen science, podcasting, card games, and events at science festivals such as public debates.Footnote 88

Among these, storytelling is heralded as a potent tool for public engagement, advocacy, and policy influence since science-based stories are memorable, engaging, and intrinsically persuasive.Footnote 89 AMR-related stories can make information relevant and meaningful, achieving emotional connections with audiences and helping individuals make sense of their experiences, which in turn allows new understanding to emerge.Footnote 90 Personal and patient-centred stories help to humanise AMR and emphasise its immediacy, and can help to encourage discussion.Footnote 91

While creative communication methods hold promise for enhancing public interest and engagement, their use in AMR communication outreach faces several theoretical and practical concerns related to their quality, relevance, and the ideologies they endorse.Footnote 92 Notably, translating scientific complexity into engaging narratives or visuals can lead to distorted messages with unintended negative impacts. Therefore, creative formats must strike a careful balance between popular appeal and emotional engagement on the one hand, and scientific accuracy and cultural appropriateness on the other. Innovative approaches need to be grounded in social science theory and insights, developed collaboratively by multidisciplinary research teams and science communication practitioners. This includes that they must be designed with care and sensitivity, preferably co-developed with target audiences to ensure their impact and appropriateness, and pilot-tested before public roll-out and scaling.

9. The need for more robust evaluations

There is a general lack of rigorous and coordinated evaluation of AMR communication campaigns and interventions, resulting in limited evidence about their cost-effectiveness and societal impact.Footnote 93 When evaluations are done, they often rely on inappropriate evaluation methodologies and simple metrics (likes, shares, and views), or respondents’ self-reported knowledge or attitudes, which do not necessarily equate to understanding or behaviour change, with a general focus on outputs, rather than outcomes.Footnote 94 Yet, robust evaluations are key to building an evidence base for improving AMR communication and sharing best practices that can refine future efforts, as well as to help researchers gain a more nuanced understanding of an intervention’s impact and to identify any unintended consequences.Footnote 95

Quality evaluation should include formative, process, and summative measures; pilot studies to verify the effectiveness of different communication approaches and identify areas for improvement before wider scaling; and follow-up assessments and longitudinal analysis.Footnote 96 In the case of large campaigns, systematic evaluation processes must be considered and embedded within the initial design of campaigns, with pre-determined outcome measures collected pre- and post-campaign to measure reach, understanding, and impact on attitudes and behaviours.Footnote 97 Evaluations should combine quantitative metrics with qualitative insights into user experience and understanding.Footnote 98 Evaluators should use logic models to help articulate how and why an intervention is expected to work.Footnote 99 Information and insights about the successes and failures of AMR communication strategies should be shared to build a collective evidence base.Footnote 100 Current evaluations of AMR interventions are varied and inconsistent, but without standardised survey instruments, directive and actionable information will remain elusive.Footnote 101

Scholars admit that evaluations can be complex, since it is inherently difficult to demonstrate a direct causal link between communication interventions and changes in public understanding or behaviour.Footnote 102 It is furthermore hard to evaluate the outcomes of large or global campaigns, since they are influenced by local contexts and the mix of strategies used, and the inclusion of adequate controls and randomisation is difficult.Footnote 103

2. Recommendations

Building on the nine thematic areas identified in this review (as discussed above), we propose the following recommendations to guide more inclusive, effective, and context-sensitive public communication and engagement around AMR. While each recommendation is grounded in evidence, we recognise that implementation is neither straightforward nor easy. Like the AMR challenge itself, these recommendations are shaped by complexity and demand reflexivity, cross-sector collaboration, and a sustained commitment to equity and justice. From a policy and practice perspective, realising these recommendations will require long-term investment, coordinated multi-stakeholder engagement, and the mobilisation of interdisciplinary expertise and resources.

1. Base communication efforts on behavioural and social science theory

Earlier research confirms the underuse of theoretical grounding in the design of AMR communication interventions and stresses the need for theoretically informed, multifaceted, and innovative intervention design.Footnote 104 In particular, public communication and engagement around AMR should go beyond raising awareness towards adopting evidence-based frameworks that reflect how people form attitudes and make decisions. While awareness is a crucial first step to action, science communication research indicates that people’s responses to information are influenced by their values, worldviews, identities, and emotions.Footnote 105 Relying solely on information provision, which is a common approach in AMR campaigns, overlooks these determinants and has been shown to have a limited impact on behaviour change.Footnote 106 By integrating behavioural science, risk communication, and social science insights, we can bridge the gap between knowledge and action, allowing AMR interventions to be strategically designed for measurable behavioural outcomes, culturally relevant, and responsive to diverse public contexts.

2. Tailor communication to diverse social and cultural contexts

Since one-size-fits-all messaging does not resonate well with diverse audiences, AMR communication should be co-designed with communities, especially in LMICs, to ensure that they are locally relevant and culturally sensitive. Communication theory highlights that public understanding and response to health risks are influenced by sociocultural norms, lived experiences, and inequalities, meaning that generic, global messaging often lacks contextual relevance and fails to connect with local health beliefs and practices.Footnote 107 Audience segmentation, informed by factors such as values, demographics, media use, and health experiences, can help target messages to distinct public groups rather than assuming a homogenous “general public.”Footnote 108 From a social justice perspective, this approach is crucial as AMR disproportionately affects LMICs and vulnerable populations.Footnote 109 Participatory models that involve communities in co-identifying risks, priorities, and barriers not only improve cultural resonance but also recognise and incorporate local knowledge systems, resulting in more ethical, equitable, and effective interventions.Footnote 110

3. Embed meaningful public engagement and co-creation

Transition from top-down, expert-led strategies to participatory models that engage communities in defining problems, shaping narratives, and co-producing solutions. Public engagement theory and science communication scholarship show that one-way, expert-to-public approaches tend to cast communities as passive recipients of knowledge, overlooking the diversity of publics and the validity of their lived experiences.Footnote 111 Participatory and dialogic models that are rooted in concepts of co-production, diverse epistemologies, and mutual learning recognise citizens as active agents capable of interpreting, adapting, and even resisting expert knowledge.Footnote 112 Such approaches enhance the legitimacy, relevance, and trustworthiness of AMR communication, while also addressing systemic inequalities that often marginalise certain voices. Theory-informed engagement necessitates power-sharing, ongoing dialogue, and genuine inclusion to ensure interventions align with community priorities, respect multiple knowledge systems, and produce contextually sensitive and culturally resonant solutions.Footnote 113 Without this shift, AMR communication risks remaining disconnected from public reasoning, thereby limiting both its reach and its impact.

4. Simplify and clarify language

Use clear, consistent, and accessible terminology in AMR communication. Communication research shows that technical jargon, inconsistent terminology, and fragmented frames hinder public comprehension, reduce perceived relevance, and can alienate audiences.Footnote 114 Consistency, clarity, and the co-development of terminology and framing with publics across languages and cultural contexts can enhance resonance, build trust, and support more accurate and actionable public understanding.Footnote 115 Exploring options for renaming AMR should be undertaken collaboratively to ensure scientific accuracy, cultural appropriateness, and public acceptance.

5. Design messages that are actionable, empowering, and emotionally resonant

Messages should offer clear, specific, and achievable actions that individuals can take, be rooted in real-life relevance, and connect with audiences through logic (logos), credibility (ethos), and emotion (pathos).Footnote 116 Health communication theory emphasises that actionable messages increase self-efficacy and motivation, particularly when they address key misconceptions, highlight immediate benefits of appropriate antimicrobial use, and are tailored to the audience context.Footnote 117 Positioning publics as active participants aligns with participatory communication principles and can strengthen both personal and collective agency in tackling AMR.Footnote 118

6. Engage more proactively and strategically with news and social media

Communicators should collaborate with journalists, social media experts, and influencers to produce accurate, engaging, and socially relevant AMR narratives that reflect lived experiences and public agency. Building relationships with journalists, providing accessible resources, and offering training can increase both capacity and interest in reporting on AMR beyond scientific discovery, while collaborations with trusted digital influencers can help extend reach, diversify narratives, and strengthen public engagement.Footnote 119

7. Strengthen the planning, targeting, and coordination of large campaigns

Large public AMR campaigns should establish clear communication goals, segment audiences, and employ multimodal strategies, moving beyond passive tools like posters towards interactive, dialogic, and culturally resonant activities. Tailored, multimodal strategies that integrate mass media with targeted community engagement are more likely to resonate across diverse cultural and linguistic settings and to tackle the complex social and structural factors influencing antimicrobial use.Footnote 120 Lessons from grassroots and arts-based initiatives demonstrate that locally relevant, creative, and participatory formats can foster emotional connection, community ownership, and sustained engagement, making campaigns more inclusive and effective.Footnote 121

8. Harness creative and arts-based methods responsibly

Use storytelling, theatre, visuals, and other creative tools to make AMR relatable, emotionally engaging, and memorable, while ensuring they are co-created, culturally appropriate, and theoretically grounded. Creative and arts-based approaches can overcome language and literacy barriers, spark curiosity, and embed AMR in everyday social conversations, helping audiences connect with the issue on a personal level.Footnote 122 Storytelling (particularly patient-centred narratives) has proven to humanise AMR, enhance relevance, and stimulate discussion, while theatre, games, and participatory art can foster community dialogue and ownership.Footnote 123 Co-creation with target audiences, pilot testing, and multidisciplinary collaboration are vital to ensure accuracy, cultural resonance, and positive behavioural change.

9. Embed rigorous and inclusive evaluation into AMR communication efforts

Evaluation of AMR communication should go beyond simply measuring outputs to assess understanding, engagement, and behavioural outcomes. Communication and public health evaluation theory emphasises the importance of using mixed methods, standardised tools, and clear outcome measures that are integrated from the beginning of a campaign.Footnote 124 Participatory evaluation frameworks are able to capture local perspectives, identify unintended consequences, and ensure that interventions are relevant and equitable.Footnote 125 Combining quantitative indicators with qualitative insights allows for a deeper understanding of what works, for whom, and in which contexts, building an evidence base to refine and enhance future AMR communication strategies.

3. Summary and conclusions

This scoping review highlights the prominent and persistent challenges and emerging solutions associated with the public communication of AMR. Despite growing recognition of the importance of communication and engagement in addressing AMR, dominant approaches remain overly reliant on awareness-raising and expert-driven narratives. These strategies often overlook the social, cultural, and political complexities that shape public understanding and action, particularly in low-resource or marginalised settings.

Our synthesis reveals a pressing need to move beyond one-way information dissemination towards more participatory, context-sensitive, and justice-oriented communication practices. This includes recognising public audiences as active participants with diverse lived experiences, values, and capacities to contribute meaningfully to AMR solutions. Such a shift requires interdisciplinary collaboration across biomedical, social, and humanities fields, as well as institutional commitment to power-sharing, inclusion, and responsiveness. Furthermore, the societal, ethical, and policy challenge of AMR demands transdisciplinary collaboration, integrating expertise from health research, social sciences, public policy, and communication. This aligns well with the post-normal science approach, which emphasises stakeholder engagement, extended peer communities, and reflexive decision-making. In line with the call for “just transitions in AMR,” we argue that communication should not merely support technical interventions but should itself be reimagined as a site of ethical engagement and cultural negotiation. Reframing AMR communication through a public humanities lens invites us to critically examine who speaks, who is heard, and whose knowledge is legitimised in global health discourse. By embracing this complexity, public communication and engagement have the potential to become a transformative force in combating AMR.

Returning to our framing of AMR as a super-wicked problem, it becomes clear that traditional models of communication, linear, expert-led, and decontextualised, are not equipped to meet the demands of such a crisis. Super-wicked problems require responses that are as dynamic and plural as the systems they emerge from. In this light, communication cannot be reduced to the transfer of correct information. Still, it must become a mode of adaptive governance, supporting reflexive learning, distributed agency, and long-term transformation. Our review suggests that embracing participatory, justice-oriented, and culturally attuned approaches to communication is not just a normative ideal but a strategic necessity. To engage publics in navigating the uncertainty, urgency, and moral complexity of AMR, we must treat communication not as an afterthought, but as a core site of collective problem-solving in the face of the super-wicked nature of the AMR communication challenge.

Efforts to implement these recommendations should be cognizant of the need to address structural gaps in AMR communications infrastructure. Our review highlights a fragmented and under-resourced AMR communication network, especially in LMICs, where responsibility often falls between overstretched public health departments, underfunded NGOs, and fragmented global initiatives. Health communication literature emphasises that structural capacity, clear mandates, and institutional support are prerequisites for effective, consistent, and locally adapted messaging.Footnote 126 Mapping institutional roles, funding flows, and message sources—while enabling intersectoral coordination through mechanisms such as One Health networks, Ministries of Health, education systems, and public broadcasters—is an essential first step. Without clear responsibility and sufficient resources, AMR communication strategies risk remaining aspirational rather than actionable.

Supplementary material

The supplementary material for this article can be found at http://doi.org/10.1017/pub.2025.10063.

Study limitations

The formal search strategy of this scoping review was limited to three databases (Scopus, Web of Science, and PubMed). Only English-language publications were included, which may have excluded insights from non-English-speaking countries, particularly in the Global South, where AMR is a pressing concern. Finally, as with all thematic reviews, the identification and interpretation of themes involve a degree of researcher subjectivity.

Author contribution

Data curation: M.B.; Conceptualization: M.J.

Acknowledgements

We used ChatGPT 4.0 to create the charts in this manuscript based on data that we collected and provided (Supplementary Figures 1–3).

Financial support

We acknowledge funding from The British Academy, which supports the first author (M.J.) as a member of the global convening for “A Just Transitions Framework for Equitable and Sustainable Mitigation of Antimicrobial Resistance” (2024–2026).

Footnotes

1 Just Transitions for AMR Working Group 2024; Tang, Millar, and Moore Reference Tang, Millar and Moore2023.

2 North Reference North, Anderson, Cecchini and Mossialos2020; Thornber and Pitchforth, Reference Thornber, Huso, Rahman, Biswas, Rahman, Brum and Tyler2021.

3 The Tripartite agencies refer to the collaborative partnership between three key international organisations working together on global health, particularly in the context of One Health and antimicrobial resistance, namely the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations, and the World Organisation for Animal Health. WHO 2018.

4 Littmann, Viens, and Silva Reference Littmann, Viens, Silva, Jamrozik and Selgelid2020; Rickard et al. Reference Rickard, Watkin, Baldwin, De Souza, Ciric and Cloutman-Green2023; Scott et al. Reference Scott, Acuff, Bergeron, Bourassa, Simjee and Singer2019.

5 Funtowicz and Ravetz Reference Funtowicz and Ravetz1993.

6 Rørtveit and Simonsen Reference Rørtveit2022.

7 A “Goldilocks” problem in health communication refers to the challenge of delivering messages that are neither too alarming nor too reassuring, but “just right” to effectively inform and motivate the public without causing panic or complacency. Davis and Lohm Reference Davis, Lohm, Flowers and Whittaker2020; Rickard et al. Reference Rickard, Watkin, Baldwin, De Souza, Ciric and Cloutman-Green2023.

8 Just Transitions for AMR Working Group 2024.

9 The Methods section of this study is provided as the Supplementary Material. The main text (below) focuses on our findings and recommendations.

10 WHO 2015.

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46 Besley, Anthony, and Yuan Reference Besley, Dudo and Yuan2018; Jensen and Holliman Reference Jensen and Holliman2016.

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51 Bucchi and Trench Reference Bucchi and Trench2021.

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53 Framing refers to the way information is selectively presented, structured, and contextualised to promote particular interpretations, meanings, or responses from an audience. Frames highlight certain aspects of an issue while omitting or downplaying others, thus shaping how people understand and react to scientific topics. In science communication, frames influence how scientific information is interpreted by defining problems, diagnosing causes, making moral judgements, and suggesting remedies (Nisbet and Scheufele Reference Nisbet and Scheufele2009). Notably, Guenter et al. (2021) point out that health framing studies typically focus on a limited set of topics (cancer, nutrition, and vaccination), signalling that AMR communication research is lacking in this context and that there is space for innovation and adaptation of framing research on this topic.

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88 Lotfinejad et al. Reference McCall, Shallcross, Wilson and Hayward2020; Parveen et al. Reference Parveen, Garzon-Orjuela, Amin, McHugh and Vellinga2022; Redfern et al. Reference Redfern, Bowater, Coulthwaite and Verran2020; Tarin-Pelló et al. Reference Tarin-Pelló, Marco-Crespo, Suay-Garcia, Galiana-Roselló, Bueso-Bordils and Pérez-Gracia2022; Trehan et al. Reference Trehan, Goujet, Sharma, Vats, Patel and Bhardwaj2024; Walker Reference Walker2019; Waruingi et al. Reference Waruingi, Hafees and Babuya2023; Young et al. Reference Young, Berry, Verlander, Ridgway and Cliodna2019.

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97 Gilham et al. Reference Gilham, Pearce-Smith, Carter and Ashiru-Oredope2024; Godinho et al. Reference Godinho, Bezbaruah, Nayyar, Gautam, Sachdeva, Behara and Vong2017.

98 Parveen et al. Reference Parveen, Garzon-Orjuela, Amin, McHugh and Vellinga2022; Redfern et al. Reference Redfern, Bowater, Coulthwaite and Verran2020.

99 Virhia et al. Reference Virhia, Laurie, Lembo, Seni, Pollack, Davis, Mapunjo, Mshana, Mmbaga and Hilton2024.

100 Othieno et al. Reference Othieno, Njagi and Azegele2020; Redfern et al. Reference Redfern, Bowater, Coulthwaite and Verran2020.

101 Hawkins et al. Reference Hawkins, Scott, Montgomery, Nicholas, Mullan, van Oijen and Degeling2022.

102 Gilham et al. Reference Gilham, Pearce-Smith, Carter and Ashiru-Oredope2024; Redfern et al. Reference Redfern, Bowater, Coulthwaite and Verran2020.

103 Barchitta et al. Reference Barchitta, Quattrocchi, Maugeri, La Rosa, La Mastra, Basile, Giuffrida, Rinaldi, Murolo and Agodi2020; Price et al. Reference Price, Gozdzielewska, Young, Smith, MacDonald, McParland, Williams, Langdridge, Davis and Flowers2018.

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105 Cormick Reference Cormick2019a; Kahan et al. Reference Kahan, Peters, Wittlin, Slovic, Ouellette, Braman and Mandel2012.

106 Bubela et al. Reference Bubela, Nisbet, Borchelt, Brunger, Critchley, Einsiedel and Geller2009; Nisbet and Scheufele Reference Nisbet and Scheufele2009.

107 Davis et al. 2021; Price et al. Reference Price, Gozdzielewska, Young, Smith, MacDonald, McParland, Williams, Langdridge, Davis and Flowers2018.

108 Cai et al. Reference Cai, Tran, Nguyen, Vu, Tran, Bui and Nguyen2022; Fuller et al. Reference Fuller, Kapona, Aboderin, Adeyemo, Olatunbosun, Gahimbare and Ahmed2023.

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112 Charoenboon et al. Reference Charoenboon, Haenssgen, Warapikuptanun, Xayavong and Zaw2019; Rajkhowa and Thursky Reference Rajkhowa and Thursky2020.

113 Appiah et al. Reference Appiah, Asamoah-Akuoko, Samman, Koduah, Kretchy, Ludu, Odonkor, Nam and Gyansa-Luterrodt2022; Mitchell et al. Reference Mitchell, Cooke, Ahorlu, Arjyal, Baral, Carter and Dasgupta2022a.

114 Krockow Reference Krockow2020; Mendelson et al. Reference Mendelson, Balasegaram, Jinks, Pulcini and Sharland2017; Shulman et al. Reference Shulman, Dixon, Bullock and Amill2020; Grailey et al. Reference Grailey, Finlayson, Stuijfzand, McCrudden, Jones, Brickwedde, Brown, Huf, Behrendt and Darzi2025.

115 King et al. Reference King, Wald, Coberley, Dahlstrom and Plummer2022; Virhia et al. Reference Virhia, Laurie, Lembo, Seni, Pollack, Davis, Mapunjo, Mshana, Mmbaga and Hilton2024.

116 Rapp Reference Rapp and Zalta2010.

117 Karvanen and Cars Reference Karvanen and Cars2024; Price et al. Reference Price, Gozdzielewska, Young, Smith, MacDonald, McParland, Williams, Langdridge, Davis and Flowers2018.

118 Djerf-Pierre and Lindgren Reference Djerf-Pierre and Lindgren2021.

119 Pan American Health Organization 2021; Wagner et al. Reference Wagner, Gurr and Siemon2019.

120 Appiah et al. Reference Appiah, Asamoah-Akuoko, Samman, Koduah, Kretchy, Ludu, Odonkor, Nam and Gyansa-Luterrodt2022; Virhia et al. Reference Virhia, Laurie, Lembo, Seni, Pollack, Davis, Mapunjo, Mshana, Mmbaga and Hilton2024.

121 Redfern et al. Reference Redfern, Bowater, Coulthwaite and Verran2020; Waruingi et al. Reference Waruingi, Hafees and Babuya2023.

122 Cormick Reference Cormick2019b; Dahlstrom Reference Dahlstrom2014; Tyrrell et al. Reference Tyrrell, Ayanikkad, Nalleppillil-Gopakumar, Oyebode, Blessing, Hatch and Eberl2024b.

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