# Effects of educational animations using message framing on the appropriate antibiotic use by parents: a randomised, three-armed intervention study

## TL;DR

This study tested how different types of educational animations affect parents' intentions to use antibiotics appropriately, finding that loss-framed messages were most effective.

## Contribution

The study introduces a novel approach using message framing in animations to influence appropriate antibiotic use among parents.

## Key findings

- Loss-framing animations significantly increased parents' intention to use antibiotics appropriately.
- Gain-framing animations had minimal impact on changing antibiotic use intentions.
- Animations with loss-framing improved awareness of the severity of antimicrobial resistance risks.

## Abstract

Appropriate antimicrobial use should be encouraged among parents to prevent the increase in antimicrobial resistance. In Japan, antibiotics are widely used in paediatrics. This study aimed to create educational animations to educate parents on the appropriate use of antibiotics and to examine the effects of different animation scenarios using message framing on the intention to use antibiotics appropriately (hereinafter referred to as ‘intention’).

In this intervention study, three educational animations were created: Animation A with a general message for Group A, Animation B with a gain-framing message for Group B, and Animation C with a loss-framing message for Group C. A questionnaire survey was conducted for parents of children who visited a medical facility before and after watching one of the animations. The primary questions focused on the intention to use antimicrobials appropriately and the assessment items based on the PMT that influence this intention (severity, vulnerability, response efficacy, self-efficacy, intrinsic rewards, and response costs).

Responses were obtained from 27, 29, and 31 participants in groups A, B, and C, respectively. Intention scores increased significantly in groups A (p = 0.001) and C (p < 0.001), whereas no significant difference was observed in group B (p = 0.237). Effect sizes were large in groups A (r = 0.62) and C (r = 0.64) and small in group B (r = 0.22). Regarding the PMT assessment items, severity significantly increased in groups A (p < 0.001) and C (p = 0.001), whereas no significant difference was observed in group B (p = 0.589). Effect sizes were large in groups A (r = 0.76) and C (r = 0.60).

The addition of loss-framing messages to general knowledge was found to be more effective than that of gain-framing messages in improving intention. Positive expressions might reduce awareness of the severity of the risk of antimicrobial resistance and not improve intention. The use of loss-framing animation may be an effective tool for educating parents on the appropriate use of antibiotics.

Japan Registry of Clinical Trials (Registration number: jRCT1030210605; Registration date: 10 February 2022).

The online version contains supplementary material available at 10.1186/s12889-025-23577-4.