Understanding individuals’ preferences for antibiotics can help mitigate the acceleration of antibiotic resistance. Similar to the climate crisis, individuals “today” need to appropriately use antibiotics to reduce the negative consequences of antibiotic resistance for individuals “tomorrow.” We use an established—yet novel in this research field—behavioral game approach to investigate individuals’ preferences for antibiotics in the face of a between-generations conflict. In an online study, we investigated whether a between-generations (vs within-generations) conflict in antibiotic intake leads to larger overuse and how to promote appropriate use of antibiotics. Results indicate that overuse in the face of a between-generations (vs within-generations) conflict increased. Eliciting empathy toward future generations in the case of a between-generations conflict decreased overuse. Findings suggest that different representations of this social dilemma can influence people’s preferences for antibiotics, and that empathy-based interventions might promote appropriate antibiotic use.
AncillottiMErikssonSAnderssonDI, et al. (2020) Preferences regarding antibiotic treatment and the role of antibiotic resistance: A discrete choice experiment. International Journal of Antimicrobial Agents56(6): 106198.
2.
AncillottiMErikssonSVeldwijkJ, et al. (2018) Public awareness and individual responsibility needed for judicious use of antibiotics: A qualitative study of public beliefs and perceptions 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Public Health18(1): 1–9.
3.
AshtonMCLeeK (2009) The HEXACO-60: A short measure of the major dimensions of personality. Journal of Personality Assessment91(4): 340–345.
BöhmRBetschC (2022) Prosocial vaccination. Current Opinion in Psychology43: 307–311.
6.
BöhmRBetschCKornL (2016) Selfish-rational non-vaccination: Experimental evidence from an interactive vaccination game. Journal of Economic Behavior and Organization131(B): 183–195.
7.
BöhmRHoltmann-KlennerCKornL, et al. (2022) Behavioral determinants of antibiotic resistance: The role of social information. Applied Psychology: Health and Well-Being14: 757–775.
8.
BrownKAdgerWNDevine-WrightP, et al. (2019) Empathy, place and identity interactions for sustainability. Global Environmental Change56: 11–17.
9.
Centers for Disease Control and Prevention (2019) Antibiotic resistance threats in the United States. Atlanta, GA: Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/drugresistance/biggest_threats.html (accessed 14 December 2022).
10.
ChaintarliKIngleSMBhattacharyaA, et al. (2016) Impact of a United Kingdom-wide campaign to tackle antimicrobial resistance on self-reported knowledge and behaviour change. BMC Public Health16(1): 1–9.
11.
ChapmanGBLiMVietriJ, et al. (2012) Using game theory to examine incentives in influenza vaccination behavior. Psychological Science23(9): 1008–1015.
12.
DawesRM (1980) Social dilemmas. Annual Reviews31(1): 169–193.
13.
DiamantMBaruchSKassemE, et al. (2021) A game theoretic approach reveals that discretizing clinical information can reduce antibiotic misuse. Nature Communications12(1): 1148.
14.
ErdfelderEFAulFBuchnerA, et al. (2009) Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods41(4): 1149–1160.
15.
FreedmanGFlanaganM (2017) From dictators to avatars: Furthering social and personality psychology through game methods. Social and Personality Psychology Compass11(12): 1–20.
16.
HardinG (1968) The tragedy of the commons. Science162(3859): 1243–1248.
17.
HarringNKrockowEM (2021) The social dilemmas of climate change and antibiotic resistance: An analytic comparison and discussion of policy implications. Humanities and Social Sciences Communications8(1): 1–9.
18.
HauserDJEllsworthPCGonzalezR (2018) Are manipulation checks necessary?Frontiers in Psychology9: 1–10.
19.
HollisAMaybardukP (2015) Antibiotic resistance is a tragedy of the commons that necessitates global cooperation. Journal of Law, Medicine and Ethics43(S3): 33–37.
20.
IbukaYLiMVietriJ, et al. (2014) Free-riding behavior in vaccination decisions: An experimental study. PLoS One9(1): 1–9.
21.
JacquetJHagelKHauertC, et al. (2013) Intra- and intergenerational discounting in the climate game. Nature Climate Change3(12): 1025–1028.
22.
KianmehrHSabounchiNSSeyedzadeh SabounchiS, et al. (2019) Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta-regression analysis. International Journal of Clinical Practice73(7): e13360.
23.
KohutMRKellerSCLinderJA, et al. (2020) The inconvincible patient: How clinicians perceive demand for antibiotics in the outpatient setting. Family practice37(2): 276–282.
24.
KotwaniAWattalCKatewaS, et al. (2010) Factors influencing primary care physicians to prescribe antibiotics in Delhi India. Family Practice27(6): 684–690.
25.
KrockowEMTarrantCColmanAM (2021) Prosociality in the social dilemma of antibiotic prescribing. Current Opinion in Psychology44: 164–169.
26.
LaxminarayanRHeymannDL (2012) Challenges of drug resistance in the developing world. BMJ (Clinical research ed.)344: e1567.
27.
MurnighanJKWangL (2016) The social world as an experimental game. Organizational Behavior and Human Decision Processes136: 80–94.
28.
MurphyLDockrayS (2018) The consideration of future consequences and health behaviour: A meta-analysis. Health Psychology Review12(4): 357–381.
O’NeillJ (2016) Tackling drug-resistant infections globally: Final report and recommendations. Archives of Pharmacy Practice7(3): 110–111.
31.
OstromE (2000) Collective action and the evolution of social norms. The Journal of Economic Perspectives14: 137–158.
32.
PalanSSchitterC (2018) Prolific.ac: A subject pool for online experiments. Journal of Behavioral and Experimental Finance17: 22–27.
33.
PfattheicherSPetersenMBBöhmR (2022). Information about herd immunity through vaccination and empathy promote COVID-19 vaccination intentions. Health Psychology41(2): 85–93.
34.
Qualtrics [Computer software] (2020) Make every interaction an experience that matters. Available at: http://www.qualtrics.com (accessed 14 December 2022).
35.
RoopeLSJSmithRDPouwelsKB, et al. (2019) The challenge of antimicrobial resistance: What economics can contribute. Science364(6435): eaau4679.
36.
ScaioliGGualanoMRGiliR, et al. (2015) Antibiotic use: A cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PLoS One10(4): 1–12.
37.
ShahenMEMasayaWKotaniK, et al. (2020) Motivational factors in intergenerational sustainability dilemma: A post-interview analysis. Sustainability12: 7078.
38.
ShenFSheerVCLiR (2015) Impact of narratives on persuasion in health communication: A meta-analysis. Journal of Advertising44(2): 105–113.
39.
SirotaMRoundTSamaranayakaS, et al. (2017) Expectations for antibiotics increase their prescribing: Causal evidence about localized impact. Health Psychology36(4): 402–409.
40.
StrathmanAGleicherFBoningerDS, et al. (1994) The consideration of future consequences: Weighing immediate and distant outcomes of behavior. Journal of Personality and Social Psychology66: 742–752.
41.
SunBZChaitoffAHuB, et al. (2017) Empathy, burnout, and antibiotic prescribing for acute respiratory infections: A cross-sectional primary care study in the US. The British Journal of General Practice67(661): e565–e571.
42.
TarrantCKrockowEMNakkawitaWMID, et al. (2020) Moral and contextual dimensions of “inappropriate” antibiotic prescribing in secondary care: A three-country interview study. Frontiers in Sociology5: 1–9.
43.
Teixeira RodriguesARoqueFFalcãoA, et al. (2013) Understanding physician antibiotic prescribing behaviour: A systematic review of qualitative studies. International Journal of Antimicrobial Agents41(3): 203–212.
44.
ThielmannIBöhmROttM, et al. (2021) Economic games: An introduction and guide for research. Collabra: Psychology7(1): 19004.
45.
ThorpeASirotaMJuanchichM, et al. (2020) Action bias in the public’s clinically inappropriate expectations for antibiotics. Journal of Experimental Psychology: Applied26(3): 422–431.
46.
ThorpeASirotaMOrbellS, et al. (2021) Effect of information on reducing inappropriate expectations and requests for antibiotics. British Journal of Psychology112(3): 804–827.
47.
Van BeekJAntonidesGHandgraafMJJ (2013) Eat now, exercise later: The relation between consideration of immediate and future consequences and healthy behavior. Personality and Individual Differences54(6): 785–791.
48.
Van DijkEDe DreuCKW (2021) Experimental games and social decision making. Annual Review of Psychology72: 415–438.
49.
VandeweerdtCLuongTAtchaperoM, et al. (2022) Virtual reality reduces COVID-19 vaccine hesitancy in the wild: A randomized trial. Scientific Reports12(1): 1–7.
50.
WaltzTJPowellBJFernándezME, et al. (2019) Choosing implementation strategies to address contextual barriers: Diversity in recommendations and future directions. Implementation Science14(1): 1–15.
51.
World Health Organization (2021) The TAP Quick Guide: A Practical Handbook for Implementing Tailoring Antimicrobial Resistance Programmes. Copenhagen, Denmark: WHO.
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