Who or what has agency in the discussion of antimicrobial resistance in UK news media (2010-2015)? A transivity analysis

Abstract

This article combines transitivity analysis with a social representations framework to examine the ways in which the issue of antimicrobial resistance (AMR) is discussed in UK news publications (2010–2015). A more specific aim of the article is to determine which social actors are presented as having agency in tackling this global issue. The concept of agency construction brings together the analysis of discourse through transi- tivity, with social representations theory (SRT; Moscovici, 1988) as a framework for understanding how a community comes to comprehend, discuss and behave in relation to a social object (in this case, the issue of AMR). In 2015, the issue of ‘antibiotic resistance’ (resistance that bacteria develop to drugs used to treat bacterial infections) or, more generally, AMR (resistance that bacteria and other microbes develop to antibiotics and antimicrobials) was widely discussed in the media. The year 2015 ended with reports that antibiotic-resistant gonorrhoea is becom- ing untreatable (Blakemore, 2015) and that scientists in China discovered a gene in Escherichia coli that makes it resistant to a class of ‘last-resort’ antibiotics and transfers resistance to other epidemic pathogens (Food Safety News, 2015). It has become increasingly evident that ‘if we fail to find effective antibiotics and manufacture them at the scale needed, ten million people a year across the world will die by 2050’ (Dhaliwal, 2016). Both Desilva et al. (2004) and Bohlin and Höst (2014) found that the most commonly reported cause of increasing antibiotic resistance was the unnecessary prescription of antibiotics. Patient expectation is one of the several factors that underlie primary care physicians’ decision-making regarding the prescription of antibiotics (Coenen et al., 2000). In their survey of patients with upper respiratory tract infections, Linder and Singer (2003) found that physicians prescribed antibiotics to 46 per cent of patients who requested them. Their multiple regression model demonstrated that patients asking for antibiotics was a significant independent predictor of physicians prescribing them. Nisbet and Markowitz (2016) have pointed out in a recent report for the American Association for the Advancement of Science that

Despite the pervasive use of antibiotics and growing problems, research on public awareness, knowledge, and attitudes about antibiotic resistance is limited, as is research on communication and engagement strategies. (p. 56)

McCulloch et al.’s (2016) systematic review of public knowledge and beliefs about antibiotic resistance found that people believed that (1) others were largely responsible for the development of antibiotic resistance, (2) they had a low personal risk from resist- ance, (3) their risk increased if they were hospitalised or used prolonged courses of antibiotics and (4) causes of resistance included antibiotic use and overuse and not

Collins et al. 3 completing an antibiotic course. Most importantly, McCulloch et al. (2016) found that people believed that minimising antibiotic resistance was outside their control and, therefore, that strategies should be aimed at clinicians. This is consistent with Brooks et al.’s (2008) work, which found that patients generally viewed antibiotic resistance as a societal problem rather than as one that would affect them individually. Similarly, Wood (2016) found that ‘most people do not feel they have a personal role in either the problem of AMR or its solution’ (p. 2). Nisbet and Markowitz (2016) found that mem- bers of the public put trust in science to find new antibiotics, thus distancing their own actions and responsibilities from this issue. They concluded that this ‘disconnect between science, knowledge, and patient expectations has led some scientists to argue that public health campaigns need to focus on bolstering public understanding of antibiotics’ (Nisbet and Markowitz, 2016: 57). Gill et al. (2006) show that both patients and medical professionals have high levels of knowledge concerning methicillin-resistant Staphylococcus aureus (MRSA), a par- ticular hospital infection resistant to antibiotics. For both patients and visitors, general media constituted the most common source of information concerning MRSA, which is consistent with other studies of public understanding of science and medicine (Bucchi, 1998). It has been recognised that ‘[a]s a forum for the discourses of others and a speaker in their own right, the media have a key part in the production and transformation of meanings’ (Carvalho, 2007: 224). Although forms of social and digital media offer alter- native sources and means through which such information is accessed by members of the public, research has shown that social media users rely just as much on local and national newspaper websites for information (Hermida et al., 2012).