Making microbes matter: evidence for the use digital storytelling in antimicrobial resistance public engagement

Making microbes matter: evidence for the use digital storytelling in antimicrobial resistance public engagement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Making microbes matter: evidence for the use digital storytelling in antimicrobial resistance public engagement Becky McCall, Andrew Hayward, Michael Lang, Michael Wilson, Kate Grailey, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9532775/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Antimicrobial resistance (AMR) is a major global health threat, yet public engagement remains limited as it is often perceived by the general public as distant and abstract. Digital storytelling (DST) may offer a more accessible approach by situating AMR within lived experience. In this exploratory qualitative study, members of the general public attended a facilitated screening and discussion of five digital stories depicting resistant infection, antibiotic use, and antibiotic-related harm. Discussion data were analysed using reflexive thematic analysis. Three themes were identified. First, DST made AMR visible, personal, and emotionally grounded through lived experience rather than information alone. Second, engagement was shaped by storytelling devices including metaphor, imagery, voice, and framing. Third, interpretations were embedded within viewers’ pre-existing beliefs, social norms, and values, as captured in the discussion. Taken together, these findings suggest that DST may complement conventional AMR communication by reducing psychological distance and making AMR more personally meaningful. Health sciences/Health care Biological sciences/Microbiology Biological sciences/Psychology Social science/Psychology Figures Figure 1 Introduction Antimicrobial resistance (AMR) is largely driven by inappropriate antimicrobial use in human and animal health, with resistant infections undermining the foundations of modern medicine and contributing to millions of deaths worldwide each year. 1 – 4 However, despite the scale and urgency of the issue, public engagement with AMR, and its relevance to both individuals and society, remains relatively poor. 5 – 7 Unlike acute public health crises such as the COVID-19 pandemic, which rapidly mobilised public attention and behaviour, AMR is often perceived as distant and abstract, which contributes to this sense of public disconnection from the issue. 8 – 10 This highlights the need for more meaningful public engagement interventions that shape understanding and behaviour in everyday decision-making around the prevention and management of non-serious infections, ultimately supporting appropriate behaviours such as using antibiotics only when clinically indicated. 11 , 12 To date, most public health AMR communication and stewardship efforts have relied heavily on informational and biomedical framings, emphasising knowledge transmission, guidelines, and risk statistics, for example, ‘Keep Antibiotics Working’, or European Antibiotic Awareness Day campaign material. 13 – 15 Even for those interventions that improve knowledge and attitudes, there remains little robust evidence that these gains translate into sustained change in beliefs and behaviour related to reduced antibiotic use for non-serious infections. 14 , 16 Human behaviour is recognised as an important contributor to the AMR crisis, including poor compliance with antimicrobial prescriptions, and requests, use or provision of antibiotics when not clinically indicated. 17 Existing public AMR communication has also shown limited ability to address emotional and experiential dimensions of antibiotic use, such as fear, uncertainty, and prior illness experiences, or to overcome the perceived irrelevance of AMR in everyday life. There is increasing recognition of the need for more affective and relatable approaches that engage the public with the human impact of AMR and antibiotic use. 7 , 18 In response to this gap in research – the need for more affective and relatable approaches to public engagement with AMR that may encourage behaviour to mitigate its development - the StoryBug study examined Digital Storytelling (DST) as an innovative and under-explored approach. Building on prior conceptual work proposing storytelling as a means to “make microbes matter” in public engagement with AMR, this study examines the impact of digital stories that were created through a facilitated process in which individuals create short, first-person videos combining images, and a voiced script representing their lived experience. 19 In addition, as an exploratory outcome, this study also considered the extent to which public engagement with digital stories could be situated on the causal pathway to behaviour change. 20 The digital story creation process in this study followed the ‘Four Phases’ method, designed for health and wellness contexts and taught by Common Language Digital Storytelling (CLDST). In brief, each participant worked virtually one-to-one with a trained facilitator (BM) to develop a 3–5-minute video based on lived experience of antibiotic-resistant infection or antibiotic-related harm. Events and associated emotions were iteratively explored (Finding Phase), then scripted and recorded as a voiceover (Telling Phase). This was subsequently integrated with authentic images and video using a range of editing techniques (Crafting Phase), before being screened to a small group of lay participants with no specialist knowledge of AMR or DST beyond that of the general public. 21 Using this process, DST was hypothesised to situate antibiotic use and AMR within everyday lives and as such, challenge assumptions and misunderstandings about AMR through highly contextualised and personal lived experiences. For example, the misunderstanding that AMR that it only affects people who use antibiotics frequently or who have underlying disease can be challenged through a digital story from a relatively healthy storyteller whose life was impacted by AMR. In this way digital stories may shift perceptions of AMR from a distant threat to a real health concern and encourage more informed and responsible antibiotic use. The study was guided by the following overall research question: What is the value of DST in enriching public engagement with concepts of AMR? Specifically, this analysis addresses Part 2 of the two-part StoryBug study, asking: how do digital stories enrich public engagement with the significance and implications of antibiotic use and AMR as a threat to health and well-being, and as an exploratory outcome, how might such engagement sit on the causal pathway to behaviour change? Part 1 explored the DST process from the storytellers’ perspective and will be reported separately. To our knowledge, the StoryBug study represents the first application of DST in the context of AMR. Results Six participants (out of eight) completed the screening and discussion, and were included in the analysis. Participants ranged in age from 18 to 70 years and represented diverse educational and occupational backgrounds (Table 1). Table 2 provides a summary of the five digital stories, including links to the videos created for this study. Closely following Braun and Clarke’s reflexive thematic analysis (RTA), a total of 25 initial codes were generated by BM alone and refined into nine initial themes, which were subsequently consolidated into three final themes reflecting how viewers engaged with, and interpreted, the digital stories (Figure 1). Table 3 presents verbatim, and in addition, illustrates the stepwise process of mapping verbatim - categorised by final themes and initial themes - to the Capability, Opportunity, Motivation–Behaviour (COM-B) model including DST mechanisms of action (MoA) and suggested Behavioural Change Techniques (BCTs) and Theoretical Domain Frameworks (TDFs). Theme 1: Viewers of digital stories recognise and realise the personal and often unacknowledged impacts and associated knowledge of lived experiences of AMR and antibiotic adversity. Across the discussion, participants consistently described how the digital stories transformed AMR from a distant or abstract concept into a more humanised and personally meaningful health issue. Rather than reporting acquisition of new factual knowledge, viewers described moments of realisation in which the consequences of antibiotic use and AMR became more tangible and personally meaningful when embedded in everyday life contexts. “I thought it was the cancer that would kill me, but now I think the resistant infection is the more imminent threat. That for me was the dramatic twist.” (BO, False Peak ) Participants acknowledged that the stories did not deliver a comprehensive education but instead fostered shifts in perception by presenting AMR as situated, human, and unpredictable. ‘I really think that these videos tell us about the human impact of AMR rather than the science or medicine behind AMR and antibiotics.’ (BO) Emotional responses, including empathy for fear, vulnerability, and uncertainty portrayed in the stories, were central to this shift. Participants described moving from perceiving AMR as a problem affecting ‘other people’ to recognising its relevance within familiar circumstances, suggesting a reduction in psychological distance. 22 “ It could happen to anyone…he was a healthy man and it is very relatable. ” (LK, Stiletto ) Importantly, participants emphasised that this resonance arose not from explicit messaging about AMR, but from witnessing ordinary lives disrupted by illness, treatment failure, or adverse drug effects. “I really think these videos tell us about the human impact of AMR rather than the science or medicine behind it.” (BO, general) One participant highlighted how Fight to Breathe , narrated from a mother’s perspective, reframed a complex clinical situation as an everyday family experience, intensifying its emotional impact: “I thought it was really good, especially having it from the mother’s perspective…the relationship between the mother and the child is so important. ” (JH, Fight to Breathe ) Taken together, these responses indicate that DST grounded understanding of AMR in lived experience, combining emotional engagement with contextualised sense‑making rather than didactic information delivery. Theme 2: Viewers relate by DST devices that nurture immersion and connectedness with the AMR story This theme captures how engagement can be shaped not only by story content, but by DST devices and techniques such as setting, story structure, metaphor, imagery, and voice. Viewers reflected on how these elements nurtured immersion in the story and shaped perceived relevance of the subject matter, while also recognising that the same techniques could resonate differently across viewers. Responses were contingent on individual experience and interpretation, reflecting a transactional interpretative process between storyteller and viewer. Stories depicting ordinary people in recognisable situations were widely described as accessible and relevant. Reflecting on Toxic Turn , one participant noted: ‘This is a regular guy, he has kids, went skiing, and had an accident.’ (JN, Toxic Turn ) At the same time, others questioned the universality of this framing, noting that the same setting could limit engagement. “Skiing is known to be a risky sport so it’s not an everyday activity for most people, so skiing does not resonate with me.” (BO, Toxic Turn ) The use of familiar hospital imagery, for example a chair in a hospital waiting area, was perceived as effective in evoking shared experiences and emotions associated with being in hospital. ‘…everybody, patient or not, has been in hospital and experienced the feelings that go with that’ (LK, on Fight to Breathe) Extremes of experience also shaped engagement. Stories that framed the illness experience towards mundane versus traumatic were found to be more relatable , particularly for this largely healthy group of viewers. ‘I thought it was more balanced… not as extreme as cancer or cystic fibrosis, so more relatable.’ (JH, Toxic Turn – story of a healthy man who had a ski accident and experienced serious antibiotic side effects ) Metaphor and imagery were widely recognised as providing a bridge to understanding of the often unfamiliar experiences of AMR as portrayed by the stories. ‘Metaphors are really important… I can imagine what it’s like to hike up a mountain.’ (JN, False Peak ) Hidden Embers was frequently cited for its aesthetic and emotional intensity, using the visual metaphor of wildfire to convey pain and resistance. ‘…the burning trees were a great way to show the pain and discomfort without being graphic…’ (LK, Hidden Embers ) Authenticity was consistently prioritised over production polish. Personal photographs and first‑hand footage, often from mobile phones, enhanced credibility and emotional connection , making stories feel real rather than constructed. ‘ You wanted to see pictures of the family, and they were good because they were authentic. ’ (JN, Fight to Breathe ) Overall, this theme highlights that engagement with AMR - often considered distant and irrelevant to most people’s lives - through DST is shaped by an interaction between multiple storytelling devices and techniques that help drive viewer interpretation, producing varied but routes to meaningful connection. Theme 3 : Psychosocial concepts, and wider societal values underpin viewer/public engagement with antibiotic use and AMR as a threat to health This theme reflects the transactional nature of participants interpreting the stories through broader psychosocial, cultural, and personal frames of reference, rather than responding as passive recipients of information. It extends some of the formative ideas expressed in Theme 2, with Theme 3 representing the viewer’s experiential input. Meaning was co‑constructed through viewers own life experience, social roles, and beliefs about illness, medicine, and risk, resulting in diverse and sometimes contrasting interpretations. Participants situated antibiotic use within wider expectations of modern medicine as a source of rapid control and recovery. ‘Illness intrudes like an interruption… we expect the health service and pills to manage it.’ (ST, general) This framing was linked to assumptions about health as the default state of modern life, and discomfort with vulnerability and uncertainty. ‘Modernity teaches us that it’s normal to be healthy and live a long life.’ (ST, general) Exposure to the stories prompted some viewers to question antibiotics as a benign ‘quick fix’ and to reflect on tolerance of uncertainty. ‘Learning to be comfortable with being uncomfortable… everything is instant gratification.’ (JN, general) Participants also discussed entrenched beliefs about bacteria as inherently harmful, contrasting these with emerging lay narratives of human-bacteria coexistence within human microbiomes. ‘It’s always been a modern fantasy that bacteria are bad, rather than something we live alongside.’ (ST, general) This theme illustrates how DST surfaced underlying norms and values – both individual and societal - that shape public engagement with antibiotic use and AMR, situating resistance within a broader social and cultural landscape rather than as a purely biomedical issue. Mapping themes to COM-B Mapping of the thematic findings to the COM-B model showed that four domains were most clearly reflected in the data: Reflective Motivation, Automatic Motivation, Psychological Capability, and Social Opportunity. Across these domains, DST appeared to operate through a mix of educational, persuasive, and modelling functions. Key mechanisms included emotion, social influence, beliefs about consequences, knowledge, and self-identity, which together capture how participants engaged with, and made sense of the stories. These mechanisms aligned with a range of Behaviour Change Techniques (BCTs), particularly those relating to information about emotional and health consequences, social comparison, framing and reframing, prompts and cues, and credible source. Theoretical DomainsFramework (TDF) domains such as emotion, beliefs about consequences, knowledge, and social influences were consistently evident across the findings. Overall, this suggests that engagement with DST is shaped by a combination of cognitive, emotional, and social processes, rather than simply through the transfer of information. Importantly, the findings suggest that DST may help reduce psychological distance by making AMR feel more immediate and relevant to people’s own lives. Through relatable narratives, first-person perspectives, and the use of metaphor, abstract concepts about AMR were translated into something more tangible and easier to connect with. In this sense, DST appears to work as an upstream, sense-making intervention that supports reflection, challenges assumptions, and reframes how antibiotic use is understood, rather than directly changing behaviour. Discussion Digital storytelling (DST) offered a distinctive mode of engagement by making AMR more visible, personal, and emotionally grounded through authentic first-person accounts of lived experience. Rather than learning new facts, participants described moments of recognition and realisation, in which AMR became tangible and meaningful when embedded in stories of ordinary lives disrupted by antibiotic-resistant infection, treatment failure, or antibiotic-related harm. As one of the first empirical examinations of DST as a public engagement approach to AMR – here focusing on viewers rather than storytellers - the findings highlight how engagement emerges through interpretation rather than information transmission. Taken together, the findings suggest DST can reposition AMR from a distant biomedical issue to an immediate, humanised health concern. The findings emphasise the transactional and immersive nature of DST engagement, in which meaning is co-constructed through interaction between story and viewer rather than transmitted one-way. 23 , 24 Responses were shaped not only by story content, including metaphor, imagery, voice, and framing, but also by viewers’ own identities, experiences, and beliefs. This helps explain why the same stories resonated differently across individuals, supporting DST as a dialogic and interpretive process grounded in personal frames of reference. In doing so, these findings extend beyond conventional evaluations focused on message recall or attitude change, suggesting instead that DST may activate affective, relational, and social pathways often under-recognised in antibiotic stewardship communications. Toxic Turn illustrates this: some viewers related to the skiing context, while others found it socio-culturally distant. Engagement therefore emerges through this dynamic relationship, fostering a sense of individual ownership and highlighting the value of developing diverse stories on a single topic to broaden resonance across audiences. In contrast to conventional campaigns that present knowledge as isolated facts, DST embeds biomedical information within storytelling, for example, conveying the seriousness of infection for cancer survival in False Peak . This addresses a gap in AMR communication research, which has largely prioritised information provision over interpretive, two-way engagement. A scoping review by Park et al. found DST to be a well-received, engaging approach to knowledge translation for patients, caregivers, and professionals. 25 Through this process, audiences do not simply receive information but interpret and internalise it in personally meaningful ways. Rather than tightly controlling interpretation, DST invites multiple readings and stimulates conversation, representing a departure from information-deficit, transmission-based public health messaging. In addition, the DST approach here prioritised an open-ended, storyteller-led process over predetermined messaging, consistent with psychologist, Arthur Frank’s account of storytelling in illness. 26 This preserved the meaning-making character of DST for both storytellers and viewers and aligned with the study’s interpretivist paradigm. Storyteller agency is evident in Fight to Breathe , where the mother shaped the story to emphasise reflection on what mattered most to her family, informing treatment decisions beyond a purely clinical framing. This interplay between storyteller agency and viewer interpretation helps explain the diversity of responses observed and sheds light on how DST operates as an engagement mechanism. These findings are supported by broader theories of narrative communication. Storytelling can induce narrative transportation (Green and Brock), where attention, emotion, and imagination are absorbed in the story world, reducing counter-arguing and enabling experiential engagement. 23 , 27 – 29 Participants’ accounts of being ‘drawn in’, emotionally connected, and prompted to reflect on their own experiences indicate that DST operates through similar mechanisms, supporting personally meaningful interpretation and reducing perceived distance from AMR. 26 Narrative devices such as tone, pacing, imagery, and voice further support this immersion. 30 For example, Hidden Embers and False Peak use metaphor to convey emotional and clinical risk. Similar effects are reported elsewhere; Difulvio et al. found that shared storytelling elicited empathy and solidarity through shared experience. 31 In the context of AMR, DST reduces psychological distance by immersing viewers cognitively and emotionally in lived experience, reframing AMR as an immediate, shared vulnerability rather than a distant threat. Vulnerability is depicted across a spectrum, from healthy individuals to those living with serious illness, challenging assumptions that AMR affects only high-risk groups. The stories also show that AMR-related vulnerability extends beyond physical illness to psychosocial impacts, including stigma, uncertainty, and isolation, as reflected in prior DST research. 32 , 33 These dimensions are illustrated in Fight to Breathe , where a child describes feeling ‘under attack’ and unsure ‘who was now the enemy’, or in Hidden Embers the storyteller describes feeling trapped psychosocially as well as physically by her urinary tract infection. Through these portrayals, DST fosters emotional resonance and personal relevance, addressing a key limitation of AMR communication, which often struggles when risks are framed in abstract or population-level terms. 7 , 11 , 34 Participant viewers were largely drawn from the general public and did not necessarily share lived experience of AMR, in contrast to much of the existing DST literature, where audiences often have shared illness, community, or cultural ties with storytellers, and as such are already personally invested; for example, DST work with Inuit women on HIV and sexually transmitted infection (STI) prevention draws on shared social and cultural experience to support engagement. 35 , 36 This distinction is important, as it highlights how DST functions in more targeted settings, and conversely, how engagement may differ when addressing a broader, less invested public audience, as in StoryBug. In these cases, additional outreach may be needed to attract initial attention and bring viewers to the stories. The evidence base linking DST to behaviour change is limited and mixed, particularly in relation to sustained effects. A systematic review of narrative interventions found mixed results, with moderate short-term effects on intentions but less consistent evidence of sustained behaviour change. 37 As such, to situate the thematic findings from the StoryBug study within a behaviour change context, an exploratory mapping to the COM-B model suggested that DST may influence psychological capability, motivation (reflective and automatic), and social opportunity. Social opportunity, for example, was evident through processes of role, identity, and social comparison, as evidenced by a participant-mother identifying strongly with the parent in Fight to Breathe . This aligns with wider narrative communication literature, which emphasises the importance of relatable characters and audience characteristics in shaping engagement and interpretation. 29 This mapping was conceptual rather than evaluative and does not constitute evidence of behaviour change; however, DST appeared to operate through mechanisms aligned with behaviour change techniques (BCTs), including identification, emotional resonance, and self-identity, alongside delivery features such as source credibility, first-person narration, and authentic imagery, which correspond to BCTs such as credible source and prompts/cues. 38 However, the relationship between DST and behaviour change is likely indirect. StoryBug was designed to prompt reflection rather than prescribe behaviour, and existing evidence suggests only modest and short-term effects on behavioural intentions. In practice, antibiotic stewardship messages and intentions may also be limited by structural and clinical constraints, highlighting the complexity of AMR behavioural change. This study has several strengths and limitations. A key strength lies in its interpretivist design, which enabled exploration of collective meaning-making through open-ended discussion. The use of reflexive thematic analysis (RTA) supported identification of patterns of engagement while acknowledging the researcher’s role. 39 A diverse participant viewer sample enriched the range of perspectives. However, limitations include a small, self-selected sample, a single screening session, and the potential influence of negative (as well as positive) group dynamics. Analysis by a single researcher may also limit interpretive breadth, and the exploratory nature of COM-B mapping constrained the depth of behavioural inference. Future research should build on these findings by examining how DST can contribute to antimicrobial stewardship in real-world settings and at scale. Prospective studies incorporating behavioural or clinical endpoints are needed, alongside pragmatic trials in healthcare and public campaign contexts. Methodological development will also be important, including mixed-methods evaluation, comparative studies of narrative framing, and exploration of different complementary and/or comparative formats such as podcasts or short-form media. Further work could explore targeted approaches for specific populations and strategies for wider digital dissemination, while preserving the authenticity central to the fundamental fabric of DST. Future work may also further explore and validate the connections between DST and behaviour change. In conclusion, this study provides insight into how DST can support public engagement with complex health issues such as AMR. Rather than transmitting information didactically, DST fosters engagement through a transactional, interpretive, and emotional process that makes abstract threats more visible and personally meaningful. By situating AMR within lived experience, it enables reflection on vulnerability, responsibility, and the consequences of antibiotic resistance in ways conventional messaging may not achieve. These findings extend prior conceptual work on storytelling as a means to ‘make microbes matter’ and suggest that DST can play a valuable complementary role in antimicrobial stewardship by reducing psychological distance and enabling personal meaning-making around antibiotic use and AMR. Methods Design and overview Part 2 of the StoryBug study that is reported in this analysis comprised the screening and facilitated discussion of the five stories created in Part 1 of the study. Participants comprised members of the general public drawn from across London for reasons of cost and convenience, as well as demographic diversity. The screening discussion was recorded to capture how viewers engaged with, interpreted and responded to the digital stories as an engagement intervention that aimed to enrich meaning-making around AMR and antibiotic adversity. Viewers were members of the general public who were unknown to the storytellers (who did not attend the screenings to minimise potential bias in viewer responses). Viewers were encouraged to reflect on their interpretations, emotional responses and understanding of concepts and issues around AMR and antibiotic use raised by the stories. Table 4 shows the questionnaire used. Recruitment and methods for the screening and discussion Participants for the digital story screening and discussion were recruited via social media (StoryBug Project and Institute of Health Informatics Twitter/X accounts) and local community groups in London, alongside snowball sampling to support demographic diversity across age, education, ethnicity and occupation. The StoryBug stories aimed to address members of the general population with respect to understanding AMR and antibiotic use, and as such, the study sample aimed to represent this as far as reasonably possible in a small qualitative study that had to balance representation with costs. Individuals with medical backgrounds were excluded to preserve a lay public perspective on AMR. Participants received an information sheet and provided written informed consent. Eight participants attended the five-hour screening held at the Institute of Health Informatics (IHI), University College London (UCL), London on 8 April 2024, and received £100 to cover time and travel. Inclusion criteria were age ≥16 years, adequate English proficiency, and willingness to be recorded. The digital stories were screened and discussed both immediately following the viewing of each story individually as well as after viewing all the stories as a collection. Stiletto was read aloud by the facilitator because the storyteller withdrew from the study for personal reasons before completion of story creation. Questions asked at the end of each video viewing were deliberately open in approach to avoid bias through leading participants towards researcher views, and the same initial question about what resonated with the viewers was asked for each video to ensure consistency. This was followed by two specific questions tailored to each video but again, these aimed for openness in response. Participants were also asked a small set of open, reflective questions after viewing the story collection to explore how perceptions were formed over a series rather than the restriction of one story. The questions elicited expectations, comparisons with traditional health communication, and any shifts in perception of antibiotic use and AMR, without directing responses. Analysis The recorded discussion was analysed using Braun and Clarke’s RTA, an inductive, interpretivist, and reflexive approach that prioritises participant-led meaning through open coding and theme generation grounded in the data. BM followed the six-part RTA process comprised of initial familiarisation with the transcript, detailed line-by-line coding, the development of initial themes, which were iteratively refined (merged, revised, or discarded) in alignment with the research aims, resulting in final themes .39 Patterns were generated in how viewers engaged with AMR through DST across the collection, while drawing on specific examples from different stories, rather than treating individual stories as discrete analytic units. As a secondary and exploratory synthesis, the three themes were mapped to the COM-B model of behaviour change (Capability, Opportunity, and Motivation) to examine how viewer engagement through DST aligned with the COM-B behaviour change model. This involved conducting a COM-B (behaviour) diagnosis to relate a wide range of concepts of AMR to COM-B via storytelling generally, largely based on literature including Brooks et al Storytelling Framework study (see COM-B diagnosis table in supplementary data). 40 The three themes empirically generated by the RTA were then mapped against this COM-B diagnosis to identify the behavioural domains most strongly reflected in the data (psychological capability, social and physical opportunity, and reflective and automatic motivation). Next, to further explicate the potential behaviour change techniques (BCTs; the smallest identifiable components of an intervention that may change behaviour) the BCT Theory and Techniques Tool was used to link DST mechanisms of action (DST MoA) to BCTs and Theoretical Domains Framework (TDF) domains (Table 3). 41 The thematic findings were subsequently mapped onto this integrated COM-B–DST MoA–BCT framework to identify corresponding and BCTs and Theoretical Domains Framework (TDF) domains implicated in the empirical findings of the StoryBug study, and to examine whether the findings suggested that DST may operate along a plausible causal pathway to behaviour change. This approach aimed to translate thematic insights into hypothesised behavioural mechanisms, rather than to assess behavioural outcomes directly. Theoretical orientation Both the creation of the digital stories and the subsequent screening and discussion were theoretically guided by philosophical hermeneutics, which aligns with the interpretivist paradigm by positioning understanding as an interpretive process through which human experience is made meaningful. Beyond interpretivism, philosophical hermeneutics emphasises that understanding is always historically and linguistically mediated, shaped by the social, cultural and experiential backgrounds of those involved and understanding is arrived at through negotiation of meaning. 42 Ethical issues pertaining to human subjects Health Research Authority approval for the StoryBug study granted 9 May 2023. REC reference: 23/WS/0059. Sponsor UCL. Participants provided written informed consent for both the Story creation process and the screening-and-discussion event (refers to this analysis). Participants had the right to withdraw at any time without repercussions. Data security measures included anonymisation and storage on password-protected systems compliant with NHS data protection requirements. Declarations Data availability The qualitative data (audio recordings and transcripts of participant discussions) generated during this study are not publicly available due to the potential risk of participant identification and the conditions of ethical approval. Anonymised data may be made available from the corresponding author upon reasonable request, subject to appropriate data sharing agreements and institutional approval. Acknowledgements This work was supported by the Medical Research Foundation (grant number MRF-145-0004-TPG-AVISO). Thanks to the storyteller and the story viewers for their time and effort. Author contributions BM conceived and led the study, conducted the analysis, and drafted the manuscript. LS, AH, and MW supervised the research and provided methodological and conceptual guidance throughout. ML contributed expertise in digital storytelling and supported interpretation of the findings. KG provided expertise in behaviour change theory. All authors reviewed, revised, and approved the final manuscript. Competing Interests: None to declare References Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399(10325):629–55. doi:10.1016/S0140-6736(21)02724-0 PubMed PMID: 35065702. Barber S, Sutherland N. O’Neill Review into Antibiotic Resistance. House of Commons Library [Internet]. 2017;(March):2–4. Available from: https://researchbriefings.files.parliament.uk/documents/CDP-2017-0074/CDP-2017-0074.pdf HM Government. Confronting antimicrobial resistance 2024 to 2029; The UK’s Five-Year National Action Plan. HM Government [Internet]. 2024;1–84. 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Implement Sci Commun. 2022;3(1):1–13. doi:10.1186/s43058-022-00282-6 Zhang L, Schenk PM, Santilli M, Wright AJ, Marques MM, Johnston M, et al. Linking behaviour change techniques to mechanisms of action: Using the Theory and Techniques Tool alongside the Behaviour Change Intervention Ontology. Wellcome Open Res. 2025;10(May):192. doi:10.12688/wellcomeopenres.23879.1 Davey N. Unfinished worlds: Hermeneutics, aesthetics, and Gadamer. Edinburgh University Press.; 2013. Fabiana L. UCL Centre for Behaviour Change [Internet]. Applying behavioural science to combating antimicrobial resistance. Available from: https://www.ucl.ac.uk/behaviour-change/sites/behaviour_change/files/applying_a_behavioural_science_approach_to_amr_-_dr_fabiana_lorencatto.pdf?utm_source=chatgpt.com Brooks SP, Zimmermann GL, Lang M, Scott SD, Thomson D, Wilkes G, et al. A framework to guide storytelling as a knowledge translation intervention for health-promoting behaviour change. Implement Sci Commun. 2022;3(1):1–13. doi:10.1186/s43058-022-00282-6 Tables Table 1. Participant Characteristics (N = 8) Characteristic Category n (%) Age (years) 18–24 3 (37.5) 25–44 2 (25.0) 45–64 2 (25.0) ≥65 1 (12.5) Ethnicity White British 4 (50.0) White and Asian 1 (12.5) Black British – African 1 (12.5) Asian (Japanese) 1 (12.5) White – Other 1 (12.5) Location London 8 (100) Highest educational qualification GCSEs 1 (12.5) A Levels 1 (12.5) Bachelor’s degree (BA/BSc) 3 (37.5) Master’s degree (MA) 2 (25.0) PGCE 1 (12.5) Occupation Student 3 (37.5) Computer programmer/technical 2 (25.0) Photographer 1 (12.5) Teacher 1 (12.5) Chef 1 (12.5) Table 2. Summary of StoryBug Digital Stories Digital story (title and link) Synopsis Hidden Embers https://www.storybug.org.uk/hidden-embers Hidden Embers tells the story of a 38-year-old London woman whose recurrent, antibiotic-resistant UTI disrupted her life. Told in her own words (voiced by an actor), it captures the pain, stigma, and emotional strain of a condition often minimised. Through metaphor and imagery, it shows how a routine infection became chronic and isolating, highlighting the hidden impacts of antimicrobial resistance beyond the clinic. False Peak https://www.storybug.org.uk/false-peak False Peak recounts Laila, a 31-year-old undergoing chemotherapy, who developed drug-resistant sepsis. Told in her own voice, it traces how the infection, not the cancer, became the immediate threat. Using a mountain-climbing metaphor, the story captures uncertainty and loss of control, humanising the intersection of cancer treatment and antimicrobial resistance. Stiletto https://www.storybug.org.uk/stiletto Stiletto tells the story of a 25-year-old PhD student who developed an antibiotic-resistant infection after a minor injury from a stiletto heel. Read by an actor, it uses vivid language to convey escalating pain and disruption, challenging assumptions that AMR is confined to severe illness and highlighting its unpredictability in everyday life. Fight to Breathe https://www.storybug.org.uk/fight-to-breathe Fight to Breathe tells the story of Luke, a 9-year-old with cystic fibrosis who battled an antibiotic-resistant infection for nearly three years. Voiced by his mother, it captures the emotional strain of repeated treatment failure, using child-centred metaphors to convey the relentlessness of AMR in long-term illness. Toxic Turn (not publicly available due to storyteller request) Toxic Turn follows a healthy 41-year-old man who developed a post-surgical infection after a skiing accident and experienced severe side effects from intravenous antibiotics. Using a mountain storm metaphor, it shows how treatment intended to heal instead caused harm, challenging assumptions that antibiotics are benign. Table 3. Examples of verbatim (by theme and initial theme from the thematic analysis) and the mapping of a path via DST mechanisms of action to the COM-B behavioural framework Theme & sub-theme; verbatim examples (and rationale) COM-B domain Intervention Function DST MoA; BCTs/TDF Theme 1. Viewers of digital stories recognise and realise the personal and often unacknowledged impacts and associated knowledge of lived experiences of AMR and antibiotic adversity. Initial theme 1. Informs of impacts beyond medical – human, lived impacts, and relates via empathic connection ‘… of we understood more about her life and the effect of her UTI and her relationships then that started to resonate with me because relationships are such a big part of our life…’ (BO, Hidden Embers ) ‘the human impact of AMR rather than the science or medicine behind AMR and antibiotics’ …’ I think only if it is relevant to the story.’ (BO, general ) ‘… relationship between the mother and the child is so important, especially when a child is sick… (JH, Fight to Breathe ) ( Rationale: importance of relationships, human connections, emotional resonance and empathy; value of relational support during illness, shift in understanding/knowledge from science AMR to human impact). Reflective Motivation Psychological Capability Automatic Motivation IFs: Emotion; Modelling; Persuasion MoAs : Social/Professional Role and Identity and Self-Image; Emotion; Social influence (together create empathic connections) how viewers relate parts of the story to their own lives; immersive mechanisms identifying with characters, mirroring, emotional resonance, sociocultural homophily, and self-identity) BCTs Social Comparison, Information about emotional consequences; Salience of consequences; TDFs: Social Influences; Social Role and Identity; Initial theme 3. Imparts ‘novel’ knowledge woven into DST - mechanistic and human impacts (initial theme 2 was not mapped to) ‘Hearing about the antibiotic side effects was really interesting… you would never have thought the antibiotics could break down bone marrow or damage the liver . (JN, Toxic Turn ) ‘I had never before thought that antibiotics could attack the body and have such severe side-effects .’ (LK, Toxic Turn ) ‘ I didn’t realise the impact this could have if you have cancer , I never thought that AMR could be such a threat… [it] really shocked me.’ (LK, False Peak ) ‘ I thought it was the cancer that would kill me but now I think the resistant infection is more imminent threat. That for me was the dramatic twist because it was telling me something. ’ (BO) ‘… the simplest and clearest message and I really like it because it is a message about taking out antibiotics can be negative as well as positive’ (LK, Toxic Turn ) ( Rationale: Shifts in understanding and perception of risk; gaining new factual understanding; new information changes perceived severity of AMR/antibiotics’ side effects; emotional reaction of shock) Psychological capability Social Opportunity (norms of antibiotics as harmless drugs) Automatic Motivation (LK, False Peak ) IFs: Emotion; Modelling; Persuasion; Education; Training MoA Social Influences; Subjective Norms (inc. Social Norms); Knowledge; Beliefs about consequences BCTs: Social Comparison; Information about Others' Approval; Education; Information about health consequences; Information about antecedents TDFs: Knowledge; Beliefs about consequences; Emotion (LK, False Peak ); THEME 2: Viewers relate by DST devices that nurture immersion and connectedness with the AMR story Initial theme 4. Relatability via ST devices and choices including metaphor, imagery, voice & script stimulates empathy & emotional connection ‘…the Stiletto story would appeal .. a subject that’s not too extreme , a small accident that actually changed their life forever – people are less likely say ‘well I don’t have an underlying disease so it doesn’t apply to me. ’ (JN, general) ‘Skiing is known to be a risky sport so it’s not an everyday activity for most people so skiing does not resonate me’ (BO, Toxic Turn ) ‘I don’t actually think that the choice of a ski accident impacts the ability to relate to this at all.’ (LK, Toxic Turn) ‘…this story was so easy to relate to because how many of us have had someone step on our toes in a bar?” (JN, Stiletto) ‘… a regular guy … skiing accident…” (JN, Toxic Turn) ‘a bit more of a balanced film . It wasn’t on the extreme end of illness as with cystic fibrosis or cancer. So it is more relatable to more people’ (JH, Toxic Turn) ‘ CF is something not many people know about… is less relatable … cancer it is more common so more easily relatable because we can envisage that relate to someone we might know who has all had cancer.’ (JN, Fight to Breathe ) ( Rationale: social context shaping engagement; relatability of story’s context, characters, and events help engagement with AMR messages, perceived applicability to own situation; tap into pre-existing emotional familiarity and norms; emotional and cognitive cues to shift beliefs) Reflective Motivation Psychological Capability Automatic Motivation (… someone step on our toes in a bar?’ (JN, Stiletto) and So it is more relatable to more people’ (JH, Toxic Turn ) IFs: Emotion; Modelling; Persuasion; Education; MoAs: Knowledge; Social influence (identification with others); Beliefs about consequences; Emotion BCTs: Social comparison; Information about others’ approval; Salience of consequences; TDFs: Beliefs about consequences; Social influences; Emotion Initial theme 5: Strength of written, verbal, visual and metaphorical format in DST Metaphors are really important in film… calming images and concept of climbing a mountain and then cut to somebody covered in lots of tubes.” (JN, False Peak) “…works very well because the way it is written evokes such strong images in the mind of the listener. If that popped up on my phone, I would probably be more attentive to that than some of the visual films.” (JN, Stiletto) Visual vocabulary and how being too prescriptive with visuals can trigger as many positive responses as negative… ambivalence and even dichotomy…” (ST, general) ‘I don’t think you need any audio officially because I created all the imagery in my own head. ‘(LK, Stiletto) …one line of ‘why don’t you just stop taking the antibiotics?’ said the Dr … was really, very impactful… emphasises the role of the doctor in that part of the story.” (JN, Fight to Breathe) I thought the opening was really brilliant. It really gave me that feeling of oh what is coming next?” (LK, Stiletto) ( Rationale: emotional and imaginative pull of vivid imagery; DST’s aesthetic and other narrative devices activate responses in viewers on the causal pathway to behaviour change by making abstract risks tangible, enhancing emotional connection, and sustaining attention.) Automatic Motivation Reflective Motivation (JN, False Peak; JN, Fight to Breathe; JN, Stiletto) Social Opportunity (JN, Fight to Breathe) IFs: Persuasion; Education MoA: Emotion; Knowledge; Beliefs about consequences BCTs: Information about emotional consequences; Salience of consequences; Prompts/cues; Framing/reframing; Credible source TDFs: Emotion; Knowledge; Beliefs about consequences; Attention (strong images); Social influences; Memory, attention & decision processes Initial theme 6. DST may influence beliefs and attitudes alongside other interventions ‘I don’t think they would change behaviour that requires something much more drastic but they might change attitudes. (BO, general) ‘..difficult to change the attitude of adults... Until something really shocking happens…with children, if you teach them from the beginning in the forward of years then that becomes normal to them. (MY, general) ( Rationale: conscious and reflective evaluation of likelihood to change and perceived relevance; Reflective Motivation Automatic Motivation (habit e.g. becomes normal to them.) Psychological Capability IFs: Education; Persuasion; Modelling MoAs: Beliefs about consequences; Attitude toward the behaviour; Habit (as Behavioural regulation - establishing and maintaining routines, and Reinforcement) BCTs: Information about consequences; Framing/reframing; Habit formation; Social comparison TDFs : Beliefs about consequences; Attitude towards the behaviour; Beliefs about capabilities; Social influences; THEME 3. Psychosocial concepts, and wider societal values underpin viewer/public engagement with antibiotic use and AMR as a threat to health Initial theme 7. Social norms & societal values influence interpretations e.g. human-bacteria/ABs relationship, modernity, vulnerability ‘It’s always been a modern fantasy that bacteria are bad… rather than we live together alongside.’ (ST, general) ‘… we need to live with bacteria… [trend] for probiotics’ (JN, generally) ‘…raises the hygiene hypothesis… when I was younger, it is good to play dirt to develop an effective immune system.’ (BO, general) **** ‘…take time and space and pull back and let things self-heal [self-limit] and take stock was an important point here…’ (ST, Stiletto ) ‘…learning to be comfortable with being uncomfortable. Everything is instant gratification; social media primes us for this. …need to except that life doesn’t always go to plan,’ (JN, general) ‘Illness intrudes like an unwelcome interruption… expect the health service and pills to manage… accepting things that are out of the ordinary as part of our ecosystem (ST, general) ‘concept of vulnerability gets head-to-head with modernity. Modernity teaches us that it’s normal to be healthy and it’s normal to live a good long life’ (ST, general). ‘the mother seems to refer to this when she says she needs breathing space even if it is taking a [calculated] risk so her son and the family indeed can live something approaching normal.’ (JN, Fight to Breathe) ( Rationale: public attitudes toward co-existing with bacteria-interpretations challenge dominant ‘bacteria as enemy’ narrative, promotes co-existence with microbes, and reframe illness as part of life.) Reflective Motivation and Psychological Capability (ST general; JN, generally; BO, general) **** Reflective Motivation Automatic Motivation Plus Social Opportunity (JN, Fight to Breathe) Education; Persuasion; Modelling (‘…family indeed can live something approaching normal.’) MoA: Knowledge; Beliefs about consequences; Reframing (via formal MoA Beliefs about consequences, Attitude toward the behaviour, or Knowledge); Emotion (related to domain Automatic Motivation); Identity (it’s normal to live a good long life’) BCTs: Information about health consequences; Framing/reframing; Salience of consequences; Information about emotional consequences TDFs: Knowledge; Beliefs about consequences; Social/professional role & identity; Emotion; Optimism/Pessimism Initial theme 8. Psychological distance - temporal, spatial, social similarity; hypotheticality (& vulnerability) ‘.. She showed the mountain she showed not being able to find the path which expressed her feelings… feeling lost and not knowing what was going on etc… nobody answered her when she said ‘will I die?’. There was a real connection with understanding how she felt. It’s a really good film.’(LK, False Peak ) ‘I was in her step, I could empathise with her. The pictures were great and clear to understand.’ (LK, False Peak) ‘This film is really evocative because especially for people from minority backgrounds there is a lot of concern around intimacy before marriage.’ (BO, Hidden Embers) ‘… as we got nearer to the end, we understood more about her life and the effect of her UTI and her relationships then that started to resonate with me because [physical] relationships are such a big part of our life… this video certainly appears to me but in a different way to the appeal of the first video (Laila).’ (BO, Hidden Embers ) Automatic Motivation (all); Reflective Motivation ( “She showed the mountain…’; ‘…we understood more about her life’; Social Opportunity ( BO, Hidden Embers) Persuasion; Education; Modelling MoA: Emotion; Beliefs about consequences (Make abstract more understandable); Reframing (via formal MoA Beliefs about consequences, Attitude toward the behaviour, or Knowledge); Social influence; Social comparison (via Social influence or Norms). BCTs: Information about emotional consequences; Framing/reframing; Social comparison TDFs: Emotion; Beliefs about consequences; Social influences; Initial theme 9. Interpretation according to viewer’s own frame/s of reference informed by world/life views; clarity of information imparted by digital stories ‘It’s all about how you personally see the situation of your life - if it was me, I’d think about climbing the table to get promoted in the football leagues’ (SS, False Peak ) ‘a good story does not reduce to a moral but they stay with you because you draw upon your own interpretation. This is compelling as it is.’ (ST, general) ‘[I like this. It could happen to anyone he was a healthy man and it is very relatable. It reminds me of a situation where my cousin had a cat scratch and he ended up with sepsis.’ (LK, Stiletto ) ‘…making sure the drugs are preserved and available for those who really need them is a little bit like the weight loss drug scenario where people who really need them with type two diabetes cannot get their drugs now because everybody’s buying them for weight loss’ (BO False Peak) ‘…it felt as if I was watching a short film rather than being involved in someone’s story . I felt like I was on the outside looking in and not really understanding how it could relate to anyone who is not in that exact situation…’ (CF story, Fight to Breathe ) (JN) ‘I really didn’t like this film [ Hidden Embers ] because I came really thinking that it’s only pe ople who have intimacy before marriage that are affected , and this isn’t the case’ (LK). ‘I don’t know why they didn’t start without antibiotics in this patient.’ (MY, Fight to Breathe ) ( Rationale: analogy enables understanding and this shifts perspectives e.g. football leagues; viewers draw on personal connections e.g. cousin and this way arrive at empathy; perceived exclusion or misrepresentation e.g.’… only people who have intimacy before marriage that are affected; correct misconceptions and improve relevance through IF Education) Reflective Motivation (all) Social Opportunity (reminds me of a situation where my cousin had a cat scratch) Persuasion; Education; Modelling MoA: Beliefs about consequences; Attitude toward the behaviour; Social influence; Knowledge BCTs: Framing/reframing; Social comparison and Information about health consequences (LK, Stiletto and BO False Peak) TDFs: Beliefs about consequences; Social/professional role and identity (LK, Stiletto) Table 4. Table showing example questions to guide the screening discussion Examples of questions by digital story title Questions False Peak 1. Does anything in particular resonate with you about Laila’s story? a) AMR b) story production 2. Does Laila’s digital story, tell you anything about how antibiotics work/how we use ABs, or how AMR can arise? 3. Does any part of Laila’s story relate – even tentatively - to you and your life at all? Hidden Embers 1. Does anything, in particular, resonate with you about this digital story? a) AMR b) story production 2. What does this digital story tell you about the impact & consequences of antibiotic use for health and other aspects of a person’s life? 3. Does this story make you think differently about seeking/using antibiotics, and considering alternatives? General questions 1. Were these digital stories as expected, or did they differ in some way? 2. Is there a place for digital stories above and beyond or alongside posters and radio adverts and TV advert etc…? How do they compare? 3. Do you feel any differently about antibiotic use and the threat of AMR? Additional Declarations No competing interests reported. Supplementary Files Supplementaryinformation.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 May, 2026 Reviews received at journal 15 May, 2026 Reviewers agreed at journal 12 May, 2026 Reviews received at journal 11 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 07 May, 2026 Editor assigned by journal 07 May, 2026 Submission checks completed at journal 02 May, 2026 First submitted to journal 26 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9532775","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":641483898,"identity":"6482e589-d222-4feb-a753-dfd14e7f6be7","order_by":0,"name":"Becky 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London","correspondingAuthor":false,"prefix":"","firstName":"Kate","middleName":"","lastName":"Grailey","suffix":""},{"id":641483903,"identity":"d5ebe0dd-ba33-44e9-a707-0d333ee82426","order_by":5,"name":"Laura Shallcross","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Shallcross","suffix":""}],"badges":[],"createdAt":"2026-04-26 14:39:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9532775/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9532775/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109431342,"identity":"89ed827f-20cc-48fb-8ca8-c4935fbd2d14","added_by":"auto","created_at":"2026-05-18 05:05:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":190595,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThematic map of initial themes (light blue) and final themes (peach) from the DST screening discussion data\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9532775/v1/a5463cae423a83d42109b89a.png"},{"id":109759509,"identity":"2b8f73db-1801-4f47-8045-997dfd4980d4","added_by":"auto","created_at":"2026-05-22 07:27:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":562919,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9532775/v1/7e93ad87-8a17-42e3-8999-121dc51ec3d0.pdf"},{"id":109431343,"identity":"e1cbad2e-869e-4b9a-ab9a-a9af4ddbadb0","added_by":"auto","created_at":"2026-05-18 05:05:19","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39828,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryinformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-9532775/v1/43e7c4d8e7db5cca69a68631.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Making microbes matter: evidence for the use digital storytelling in antimicrobial resistance public engagement","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntimicrobial resistance (AMR) is largely driven by inappropriate antimicrobial use in human and animal health, with resistant infections undermining the foundations of modern medicine and contributing to millions of deaths worldwide each year.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e However, despite the scale and urgency of the issue, public engagement with AMR, and its relevance to both individuals and society, remains relatively poor.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Unlike acute public health crises such as the COVID-19 pandemic, which rapidly mobilised public attention and behaviour, AMR is often perceived as distant and abstract, which contributes to this sense of public disconnection from the issue.\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This highlights the need for more meaningful public engagement interventions that shape understanding and behaviour in everyday decision-making around the prevention and management of non-serious infections, ultimately supporting appropriate behaviours such as using antibiotics only when clinically indicated.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo date, most public health AMR communication and stewardship efforts have relied heavily on informational and biomedical framings, emphasising knowledge transmission, guidelines, and risk statistics, for example, \u0026lsquo;Keep Antibiotics Working\u0026rsquo;, or European Antibiotic Awareness Day campaign material.\u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Even for those interventions that improve knowledge and attitudes, there remains little robust evidence that these gains translate into sustained change in beliefs and behaviour related to reduced antibiotic use for non-serious infections.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Human behaviour is recognised as an important contributor to the AMR crisis, including poor compliance with antimicrobial prescriptions, and requests, use or provision of antibiotics when not clinically indicated.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Existing public AMR communication has also shown limited ability to address emotional and experiential dimensions of antibiotic use, such as fear, uncertainty, and prior illness experiences, or to overcome the perceived irrelevance of AMR in everyday life. There is increasing recognition of the need for more affective and relatable approaches that engage the public with the human impact of AMR and antibiotic use.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn response to this gap in research \u0026ndash; the need for more affective and relatable approaches to public engagement with AMR that may encourage behaviour to mitigate its development - the StoryBug study examined Digital Storytelling (DST) as an innovative and under-explored approach. Building on prior conceptual work proposing storytelling as a means to \u0026ldquo;make microbes matter\u0026rdquo; in public engagement with AMR, this study examines the impact of digital stories that were created through a facilitated process in which individuals create short, first-person videos combining images, and a voiced script representing their lived experience.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In addition, as an exploratory outcome, this study also considered the extent to which public engagement with digital stories could be situated on the causal pathway to behaviour change.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe digital story creation process in this study followed the \u0026lsquo;Four Phases\u0026rsquo; method, designed for health and wellness contexts and taught by Common Language Digital Storytelling (CLDST). In brief, each participant worked virtually one-to-one with a trained facilitator (BM) to develop a 3\u0026ndash;5-minute video based on lived experience of antibiotic-resistant infection or antibiotic-related harm. Events and associated emotions were iteratively explored (Finding Phase), then scripted and recorded as a voiceover (Telling Phase). This was subsequently integrated with authentic images and video using a range of editing techniques (Crafting Phase), before being screened to a small group of lay participants with no specialist knowledge of AMR or DST beyond that of the general public.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUsing this process, DST was hypothesised to situate antibiotic use and AMR within everyday lives and as such, challenge assumptions and misunderstandings about AMR through highly contextualised and personal lived experiences. For example, the misunderstanding that AMR that it only affects people who use antibiotics frequently or who have underlying disease can be challenged through a digital story from a relatively healthy storyteller whose life was impacted by AMR. In this way digital stories may shift perceptions of AMR from a distant threat to a real health concern and encourage more informed and responsible antibiotic use.\u003c/p\u003e \u003cp\u003eThe study was guided by the following overall research question: What is the value of DST in enriching public engagement with concepts of AMR? Specifically, this analysis addresses Part 2 of the two-part StoryBug study, asking: how do digital stories enrich public engagement with the significance and implications of antibiotic use and AMR as a threat to health and well-being, and as an exploratory outcome, how might such engagement sit on the causal pathway to behaviour change? Part 1 explored the DST process from the storytellers\u0026rsquo; perspective and will be reported separately. To our knowledge, the StoryBug study represents the first application of DST in the context of AMR.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSix participants (out of eight) completed the screening and discussion, and were included in the analysis. Participants ranged in age from 18 to 70 years and represented diverse educational and occupational backgrounds (Table 1). Table 2 provides a summary of the five digital stories, including links to the videos created for this study.\u003c/p\u003e\n\u003cp\u003eClosely following Braun and Clarke\u0026rsquo;s reflexive thematic analysis (RTA), a total of 25 initial codes were generated by BM alone and refined into nine initial themes, which were subsequently consolidated into \u003cstrong\u003ethree final themes\u003c/strong\u003e reflecting how viewers engaged with, and interpreted, the digital stories (Figure 1).\u003c/p\u003e\n\u003cp\u003eTable 3 presents verbatim, and in addition, illustrates the stepwise process of mapping verbatim - categorised by final themes and initial themes - to the Capability, Opportunity, Motivation\u0026ndash;Behaviour (COM-B) model including DST mechanisms of action (MoA) and suggested Behavioural Change Techniques (BCTs) and Theoretical Domain Frameworks (TDFs).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Viewers of digital stories recognise and realise the personal and often unacknowledged impacts and associated knowledge of lived experiences of AMR and antibiotic adversity.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross the discussion, participants consistently described how the digital stories transformed AMR from a distant or abstract concept into a more humanised and personally meaningful health issue. \u003cstrong\u003eRather than reporting acquisition of new factual knowledge, viewers described moments of realisation in which the consequences of antibiotic use and AMR became\u0026nbsp;\u003c/strong\u003emore tangible and personally meaningful \u003cstrong\u003ewhen embedded in everyday life contexts.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I thought it was the cancer that would kill me, but now I think the resistant infection is the more imminent threat. That for me was the dramatic twist.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(BO, \u003cem\u003eFalse Peak\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003eParticipants acknowledged that the stories did not deliver a comprehensive education but instead fostered shifts in perception by presenting AMR as situated, human, and unpredictable.\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;I really think that these videos tell us about the human impact of AMR rather than the science or medicine behind AMR and antibiotics.\u0026rsquo; (BO)\u003c/p\u003e\n\u003cp\u003eEmotional responses, including empathy for fear, vulnerability, and uncertainty portrayed in the stories, were central to this shift. \u003cstrong\u003eParticipants described moving from perceiving AMR as a problem affecting \u0026lsquo;other people\u0026rsquo; to recognising its relevance within familiar circumstances, suggesting a reduction in psychological distance.\u003csup\u003e22\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cstrong\u003e\u003cem\u003eIt could happen to anyone\u0026hellip;he was a healthy man and it is very relatable.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e (LK, \u003cem\u003eStiletto\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003eImportantly, participants emphasised that this resonance arose not from explicit messaging about AMR, but from witnessing ordinary lives disrupted by illness, treatment failure, or adverse drug effects.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I really think these videos tell us about the human impact of AMR rather than the science or medicine behind it.\u0026rdquo;\u003c/em\u003e (BO, general)\u003c/p\u003e\n\u003cp\u003eOne participant highlighted how \u003cem\u003eFight to Breathe\u003c/em\u003e, narrated from a mother\u0026rsquo;s perspective, reframed a complex clinical situation as an everyday family experience, intensifying its emotional impact:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I thought it was really good, especially having it from the mother\u0026rsquo;s perspective\u0026hellip;the relationship between the mother and the child is so important.\u003c/em\u003e\u0026rdquo; (JH, \u003cem\u003eFight to Breathe\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTaken together, these responses indicate that DST grounded understanding of AMR in lived experience, combining emotional engagement with contextualised sense‑making rather than didactic information delivery.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Viewers relate by DST devices that nurture immersion and connectedness with the AMR story\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme captures how engagement can be shaped not only by story content, but by DST devices and techniques such as setting, story structure, metaphor, imagery, and voice. \u003cstrong\u003eViewers reflected on how these elements nurtured immersion in the story and shaped perceived relevance of the subject matter, while also\u0026nbsp;\u003c/strong\u003erecognising that the same techniques could resonate differently across viewers. Responses\u003cstrong\u003e\u0026nbsp;were contingent on individual experience and interpretation,\u0026nbsp;\u003c/strong\u003ereflecting a transactional interpretative process between storyteller and viewer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStories depicting ordinary people in recognisable situations were widely described as accessible and relevant. Reflecting on \u003cem\u003eToxic Turn\u003c/em\u003e, one participant noted:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;This is a regular guy, he has kids, went skiing, and had an accident.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(JN, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003eAt the same time, others questioned the universality of this framing, noting that the same setting could limit engagement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Skiing is known to be a risky sport so it\u0026rsquo;s not an everyday activity for most people, so skiing does not resonate with me.\u0026rdquo;\u003c/em\u003e(BO, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003eThe use of familiar hospital imagery, for example a chair in a hospital waiting area, was perceived as effective in evoking shared experiences and emotions associated with being in hospital.\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;\u0026hellip;everybody, patient or not, has been in hospital and experienced the feelings that go with that\u0026rsquo; (LK, on Fight to Breathe)\u003c/p\u003e\n\u003cp\u003eExtremes of experience also shaped engagement. \u003cstrong\u003eStories that framed the illness experience towards\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003emundane versus traumatic were found to be more relatable\u003c/strong\u003e, particularly for this largely healthy group of viewers. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I thought it was more balanced\u0026hellip; not as extreme as cancer or cystic fibrosis, so more relatable.\u0026rsquo;\u003c/em\u003e (JH, \u003cem\u003eToxic Turn\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026ndash; story of a healthy man who had a ski accident and experienced serious antibiotic side effects\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003eMetaphor and imagery were widely recognised as providing a bridge to understanding of the often unfamiliar experiences of AMR as portrayed by the stories.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Metaphors are really important\u0026hellip; I can imagine what it\u0026rsquo;s like to hike up a mountain.\u0026rsquo;\u003c/em\u003e (JN, \u003cem\u003eFalse Peak\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHidden Embers\u003c/em\u003e was frequently cited for its aesthetic and emotional intensity, using the visual metaphor of wildfire to convey pain and resistance.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026hellip;the burning trees were a great way to show the pain and discomfort without being graphic\u0026hellip;\u0026rsquo;\u003c/em\u003e (LK, \u003cem\u003eHidden Embers\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003eAuthenticity was consistently prioritised over production polish. \u003cstrong\u003ePersonal photographs and first‑hand footage, often from mobile phones, enhanced credibility and emotional connection\u003c/strong\u003e, making stories feel real rather than constructed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u003c/em\u003e\u003cstrong\u003e\u003cem\u003eYou wanted to see pictures of the family, and they were good because they were authentic.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026rsquo;\u0026nbsp;\u003c/em\u003e(JN, \u003cem\u003eFight to Breathe\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverall, this theme highlights that engagement with AMR - often considered distant and irrelevant to most people\u0026rsquo;s lives - through DST is shaped by an interaction between multiple storytelling devices and techniques that help drive viewer interpretation, producing varied but routes to meaningful connection.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3\u003c/strong\u003e\u003cstrong\u003e: Psychosocial concepts, and wider societal values underpin viewer/public engagement with antibiotic use and AMR as a threat to health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme reflects the transactional nature of participants interpreting the stories through broader psychosocial, cultural, and personal frames of reference, rather than responding as\u0026nbsp;passive recipients of information.\u0026nbsp;It extends some of the formative ideas expressed in Theme 2, with Theme 3 representing the viewer\u0026rsquo;s experiential input. \u003cstrong\u003eMeaning was co‑constructed through viewers own life experience, social roles, and beliefs about illness, medicine, and risk, resulting in diverse and sometimes contrasting interpretations.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants situated antibiotic use within wider expectations of modern medicine as a source of rapid control and recovery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Illness intrudes like an interruption\u0026hellip; we expect the health service and pills to manage it.\u0026rsquo;\u003c/em\u003e (ST, general)\u003c/p\u003e\n\u003cp\u003eThis framing was linked to assumptions about health as the default state of modern life, and discomfort with vulnerability and uncertainty.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Modernity teaches us that it\u0026rsquo;s normal to be healthy and live a long life.\u0026rsquo;\u003c/em\u003e (ST, general)\u003c/p\u003e\n\u003cp\u003eExposure to the stories prompted some viewers to question antibiotics as a benign \u0026lsquo;quick fix\u0026rsquo; and to reflect on tolerance of uncertainty.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Learning to be comfortable with being uncomfortable\u0026hellip; everything is instant gratification.\u0026rsquo;\u003c/em\u003e (JN, general)\u003c/p\u003e\n\u003cp\u003eParticipants also discussed entrenched beliefs about bacteria as inherently harmful, contrasting these with emerging lay narratives of human-bacteria coexistence within human microbiomes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;It\u0026rsquo;s always been a modern fantasy that bacteria are bad, rather than something we live alongside.\u0026rsquo;\u003c/em\u003e (ST, general)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis theme illustrates how DST surfaced underlying norms and values \u0026ndash; both individual and societal - that shape public engagement with antibiotic use and AMR, situating resistance within a broader social and cultural landscape rather than as a purely biomedical issue.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMapping themes to COM-B\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMapping of the thematic findings to the COM-B model showed that four domains were most clearly reflected in the data: Reflective Motivation, Automatic Motivation, Psychological Capability, and Social Opportunity. Across these domains, DST appeared to operate through a mix of educational, persuasive, and modelling functions. Key mechanisms included emotion, social influence, beliefs about consequences, knowledge, and self-identity, which together capture how participants engaged with, and made sense of the stories.\u003c/p\u003e\n\u003cp\u003eThese mechanisms aligned with a range of Behaviour Change Techniques (BCTs), particularly those relating to information about emotional and health consequences, social comparison, framing and reframing, prompts and cues, and credible source. Theoretical DomainsFramework (TDF) domains such as emotion, beliefs about consequences, knowledge, and social influences were consistently evident across the findings. Overall, this suggests that engagement with DST is shaped by a combination of cognitive, emotional, and social processes, rather than simply through the transfer of information.\u003c/p\u003e\n\u003cp\u003eImportantly, the findings suggest that DST may help reduce psychological distance by making AMR feel more immediate and relevant to people\u0026rsquo;s own lives. Through relatable narratives, first-person perspectives, and the use of metaphor, abstract concepts about AMR were translated into something more tangible and easier to connect with. In this sense, DST appears to work as an upstream, sense-making intervention that supports reflection, challenges assumptions, and reframes how antibiotic use is understood, rather than directly changing behaviour.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDigital storytelling (DST) offered a distinctive mode of engagement by making AMR more visible, personal, and emotionally grounded through authentic first-person accounts of lived experience. Rather than learning new facts, participants described moments of recognition and realisation, in which AMR became tangible and meaningful when embedded in stories of ordinary lives disrupted by antibiotic-resistant infection, treatment failure, or antibiotic-related harm. As one of the first empirical examinations of DST as a public engagement approach to AMR \u0026ndash; here focusing on viewers rather than storytellers - the findings highlight how engagement emerges through interpretation rather than information transmission. Taken together, the findings suggest DST can reposition AMR from a distant biomedical issue to an immediate, humanised health concern.\u003c/p\u003e \u003cp\u003eThe findings emphasise the transactional and immersive nature of DST engagement, in which meaning is co-constructed through interaction between story and viewer rather than transmitted one-way.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Responses were shaped not only by story content, including metaphor, imagery, voice, and framing, but also by viewers\u0026rsquo; own identities, experiences, and beliefs. This helps explain why the same stories resonated differently across individuals, supporting DST as a dialogic and interpretive process grounded in personal frames of reference. In doing so, these findings extend beyond conventional evaluations focused on message recall or attitude change, suggesting instead that DST may activate affective, relational, and social pathways often under-recognised in antibiotic stewardship communications. \u003cem\u003eToxic Turn\u003c/em\u003e illustrates this: some viewers related to the skiing context, while others found it socio-culturally distant. Engagement therefore emerges through this dynamic relationship, fostering a sense of individual ownership and highlighting the value of developing diverse stories on a single topic to broaden resonance across audiences.\u003c/p\u003e \u003cp\u003eIn contrast to conventional campaigns that present knowledge as isolated facts, DST embeds biomedical information within storytelling, for example, conveying the seriousness of infection for cancer survival in \u003cem\u003eFalse Peak\u003c/em\u003e. This addresses a gap in AMR communication research, which has largely prioritised information provision over interpretive, two-way engagement. A scoping review by Park \u003cem\u003eet al.\u003c/em\u003e found DST to be a well-received, engaging approach to knowledge translation for patients, caregivers, and professionals.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Through this process, audiences do not simply receive information but interpret and internalise it in personally meaningful ways. Rather than tightly controlling interpretation, DST invites multiple readings and stimulates conversation, representing a departure from information-deficit, transmission-based public health messaging.\u003c/p\u003e \u003cp\u003eIn addition, the DST approach here prioritised an open-ended, storyteller-led process over predetermined messaging, consistent with psychologist, Arthur Frank\u0026rsquo;s account of storytelling in illness.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e This preserved the meaning-making character of DST for both storytellers and viewers and aligned with the study\u0026rsquo;s interpretivist paradigm. Storyteller agency is evident in \u003cem\u003eFight to Breathe\u003c/em\u003e, where the mother shaped the story to emphasise reflection on what mattered most to her family, informing treatment decisions beyond a purely clinical framing. This interplay between storyteller agency and viewer interpretation helps explain the diversity of responses observed and sheds light on how DST operates as an engagement mechanism.\u003c/p\u003e \u003cp\u003eThese findings are supported by broader theories of narrative communication. Storytelling can induce narrative transportation (Green and Brock), where attention, emotion, and imagination are absorbed in the story world, reducing counter-arguing and enabling experiential engagement.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Participants\u0026rsquo; accounts of being \u0026lsquo;drawn in\u0026rsquo;, emotionally connected, and prompted to reflect on their own experiences indicate that DST operates through similar mechanisms, supporting personally meaningful interpretation and reducing perceived distance from AMR.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Narrative devices such as tone, pacing, imagery, and voice further support this immersion.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e For example, \u003cem\u003eHidden Embers\u003c/em\u003e and \u003cem\u003eFalse Peak\u003c/em\u003e use metaphor to convey emotional and clinical risk. Similar effects are reported elsewhere; Difulvio \u003cem\u003eet al.\u003c/em\u003e found that shared storytelling elicited empathy and solidarity through shared experience.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the context of AMR, DST reduces psychological distance by immersing viewers cognitively and emotionally in lived experience, reframing AMR as an immediate, shared vulnerability rather than a distant threat. Vulnerability is depicted across a spectrum, from healthy individuals to those living with serious illness, challenging assumptions that AMR affects only high-risk groups. The stories also show that AMR-related vulnerability extends beyond physical illness to psychosocial impacts, including stigma, uncertainty, and isolation, as reflected in prior DST research.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e These dimensions are illustrated in \u003cem\u003eFight to Breathe\u003c/em\u003e, where a child describes feeling \u0026lsquo;under attack\u0026rsquo; and unsure \u0026lsquo;who was now the enemy\u0026rsquo;, or in \u003cem\u003eHidden Embers\u003c/em\u003e the storyteller describes feeling trapped psychosocially as well as physically by her urinary tract infection. Through these portrayals, DST fosters emotional resonance and personal relevance, addressing a key limitation of AMR communication, which often struggles when risks are framed in abstract or population-level terms.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eParticipant viewers were largely drawn from the general public and did not necessarily share lived experience of AMR, in contrast to much of the existing DST literature, where audiences often have shared illness, community, or cultural ties with storytellers, and as such are already personally invested; for example, DST work with Inuit women on HIV and sexually transmitted infection (STI) prevention draws on shared social and cultural experience to support engagement.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e This distinction is important, as it highlights how DST functions in more targeted settings, and conversely, how engagement may differ when addressing a broader, less invested public audience, as in StoryBug. In these cases, additional outreach may be needed to attract initial attention and bring viewers to the stories.\u003c/p\u003e \u003cp\u003eThe evidence base linking DST to behaviour change is limited and mixed, particularly in relation to sustained effects. A systematic review of narrative interventions found mixed results, with moderate short-term effects on intentions but less consistent evidence of sustained behaviour change.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e As such, to situate the thematic findings from the StoryBug study within a behaviour change context, an exploratory mapping to the COM-B model suggested that DST may influence psychological capability, motivation (reflective and automatic), and social opportunity. Social opportunity, for example, was evident through processes of role, identity, and social comparison, as evidenced by a participant-mother identifying strongly with the parent in \u003cem\u003eFight to Breathe\u003c/em\u003e. This aligns with wider narrative communication literature, which emphasises the importance of relatable characters and audience characteristics in shaping engagement and interpretation.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis mapping was conceptual rather than evaluative and does not constitute evidence of behaviour change; however, DST appeared to operate through mechanisms aligned with behaviour change techniques (BCTs), including identification, emotional resonance, and self-identity, alongside delivery features such as source credibility, first-person narration, and authentic imagery, which correspond to BCTs such as credible source and prompts/cues.\u003csup\u003e38\u003c/sup\u003e However, the relationship between DST and behaviour change is likely indirect. StoryBug was designed to prompt reflection rather than prescribe behaviour, and existing evidence suggests only modest and short-term effects on behavioural intentions. In practice, antibiotic stewardship messages and intentions may also be limited by structural and clinical constraints, highlighting the complexity of AMR behavioural change.\u003c/p\u003e \u003cp\u003eThis study has several strengths and limitations. A key strength lies in its interpretivist design, which enabled exploration of collective meaning-making through open-ended discussion. The use of reflexive thematic analysis (RTA) supported identification of patterns of engagement while acknowledging the researcher\u0026rsquo;s role.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e A diverse participant viewer sample enriched the range of perspectives. However, limitations include a small, self-selected sample, a single screening session, and the potential influence of negative (as well as positive) group dynamics. Analysis by a single researcher may also limit interpretive breadth, and the exploratory nature of COM-B mapping constrained the depth of behavioural inference.\u003c/p\u003e \u003cp\u003eFuture research should build on these findings by examining how DST can contribute to antimicrobial stewardship in real-world settings and at scale. Prospective studies incorporating behavioural or clinical endpoints are needed, alongside pragmatic trials in healthcare and public campaign contexts. Methodological development will also be important, including mixed-methods evaluation, comparative studies of narrative framing, and exploration of different complementary and/or comparative formats such as podcasts or short-form media. Further work could explore targeted approaches for specific populations and strategies for wider digital dissemination, while preserving the authenticity central to the fundamental fabric of DST. Future work may also further explore and validate the connections between DST and behaviour change.\u003c/p\u003e \u003cp\u003eIn conclusion, this study provides insight into how DST can support public engagement with complex health issues such as AMR. Rather than transmitting information didactically, DST fosters engagement through a transactional, interpretive, and emotional process that makes abstract threats more visible and personally meaningful. By situating AMR within lived experience, it enables reflection on vulnerability, responsibility, and the consequences of antibiotic resistance in ways conventional messaging may not achieve. These findings extend prior conceptual work on storytelling as a means to \u0026lsquo;make microbes matter\u0026rsquo; and suggest that DST can play a valuable complementary role in antimicrobial stewardship by reducing psychological distance and enabling personal meaning-making around antibiotic use and AMR.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003e\u003cstrong\u003eDesign and overview\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003ePart 2 of the StoryBug study that is reported in this analysis comprised the screening and facilitated discussion of the five stories created in Part 1 of the study. Participants comprised members of the general public drawn from across London for reasons of cost and convenience, as well as demographic diversity. The screening discussion was recorded to capture how viewers engaged with, interpreted and responded to the digital stories as an engagement intervention that aimed to enrich meaning-making around AMR and antibiotic adversity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eViewers were members of the general public who were unknown to the storytellers (who did not attend the screenings to minimise potential bias in viewer responses). Viewers were encouraged to reflect on their interpretations, emotional responses and understanding of concepts and issues around AMR and antibiotic use raised by the stories. Table 4 shows the questionnaire used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment and methods for the screening and discussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants for the digital story screening and discussion were recruited via social media (StoryBug Project and Institute of Health Informatics Twitter/X accounts) and local community groups in London, alongside snowball sampling to support demographic diversity across age, education, ethnicity and occupation. The StoryBug stories aimed to address members of the general population with respect to understanding AMR and antibiotic use, and as such, the study sample aimed to represent this as far as reasonably possible in a small qualitative study that had to balance representation with costs. Individuals with medical backgrounds were excluded to preserve a lay public perspective on AMR. Participants received an information sheet and provided written informed consent. Eight participants attended the five-hour screening held at the Institute of Health Informatics (IHI), University College London (UCL), London on 8 April 2024, and received \u0026pound;100 to cover time and travel. Inclusion criteria were age \u0026ge;16 years, adequate English proficiency, and willingness to be recorded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe digital stories were screened and discussed both immediately following the viewing of each story individually as well as after viewing all the stories as a collection. \u0026nbsp;\u003cem\u003eStiletto\u0026nbsp;\u003c/em\u003ewas read aloud by the facilitator because the storyteller withdrew from the study for personal reasons before completion of story creation. Questions asked at the end of each video viewing were deliberately open in approach to avoid bias through leading participants towards researcher views, and the same initial question about what resonated with the viewers was asked for each video to ensure consistency. This was followed by two specific questions tailored to each video but again, these aimed for openness in response. Participants were also asked a small set of open, reflective questions after viewing the story collection to explore how perceptions were formed over a series rather than the restriction of one story. The questions elicited expectations, comparisons with traditional health communication, and any shifts in perception of antibiotic use and AMR, without directing responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe recorded discussion was analysed using Braun and Clarke\u0026rsquo;s RTA, an inductive, interpretivist, and reflexive approach that prioritises participant-led meaning through open coding and theme generation grounded in the data. BM followed the six-part RTA process comprised of initial familiarisation with the transcript, detailed line-by-line coding, the development of initial themes, which were iteratively refined (merged, revised, or discarded) in alignment with the research aims, resulting in final themes\u003csup\u003e.39\u003c/sup\u003e \u003cstrong\u003ePatterns were generated in how viewers engaged with AMR through DST across the collection, while drawing on specific examples from different stories, rather than treating individual stories as discrete analytic units.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs a secondary and exploratory synthesis, the three themes were mapped to the COM-B model of behaviour change (Capability, Opportunity, and Motivation) to examine how viewer engagement through DST aligned with the COM-B behaviour change model. This involved conducting a COM-B (behaviour) diagnosis to relate a wide range of concepts of AMR to COM-B via storytelling generally, largely based on literature including Brooks \u003cem\u003eet al\u003c/em\u003e Storytelling Framework study (see COM-B diagnosis table in supplementary data).\u003csup\u003e40\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe three themes empirically generated by the RTA were then mapped against this COM-B diagnosis to identify the behavioural domains most strongly reflected in the data (psychological capability, social and physical opportunity, and reflective and automatic motivation). Next, to further explicate the potential behaviour change techniques (BCTs; the smallest identifiable components of an intervention that may change behaviour) the BCT Theory and Techniques Tool was used to link DST mechanisms of action (DST MoA) to BCTs and Theoretical Domains Framework (TDF) domains (Table 3).\u003csup\u003e41\u003c/sup\u003e The thematic findings were subsequently mapped onto this integrated COM-B\u0026ndash;DST MoA\u0026ndash;BCT framework to identify corresponding and BCTs and Theoretical Domains Framework (TDF) domains implicated in the empirical findings of the StoryBug study, and to examine whether the findings suggested that DST may operate along a plausible causal pathway to behaviour change. This approach aimed to translate thematic insights into hypothesised behavioural mechanisms, rather than to assess behavioural outcomes directly.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTheoretical orientation\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eBoth the creation of the digital stories and the subsequent screening and discussion were theoretically guided by philosophical hermeneutics, which aligns with the interpretivist paradigm by positioning understanding as an interpretive process through which human experience is made meaningful. Beyond interpretivism, philosophical hermeneutics emphasises that understanding is always historically and linguistically mediated, shaped by the social, cultural and experiential backgrounds of those involved and understanding is arrived at through negotiation of meaning.\u003csup\u003e42\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical issues pertaining to human subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth Research Authority approval for the StoryBug study granted 9 May 2023. REC reference: 23/WS/0059. Sponsor UCL. Participants provided written informed consent for both the Story creation process and the screening-and-discussion event (refers to this analysis). Participants had the right to withdraw at any time without repercussions. Data security measures included anonymisation and storage on password-protected systems compliant with NHS data protection requirements.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative data (audio recordings and transcripts of participant discussions) generated during this study are not publicly available due to the potential risk of participant identification and the conditions of ethical approval. Anonymised data may be made available from the corresponding author upon reasonable request, subject to appropriate data sharing agreements and institutional approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Medical Research Foundation (grant number MRF-145-0004-TPG-AVISO). Thanks to the storyteller and the story viewers for their time and effort.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBM conceived and led the study, conducted the analysis, and drafted the manuscript. LS, AH, and MW supervised the research and provided methodological and conceptual guidance throughout. ML contributed expertise in digital storytelling and supported interpretation of the findings. KG provided expertise in behaviour change theory. All authors reviewed, revised, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eNone to declare\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMurray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. 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In: Advances in foundational mass communication theories. 1st ed. London: Routledge; 2018. 19\u0026ndash;38 p.\u003c/li\u003e\n \u003cli\u003eKreuter MW, Green MC, Cappella JN, Slater MD, Wise ME, Storey D, et al. Narrative communication in cancer prevention and control: A framework to guide research and application. Annals of Behavioral Medicine. 2007 Sep;33(3):221\u0026ndash;35. doi:10.1007/BF02879904\u003c/li\u003e\n \u003cli\u003eMichael Lang. Emerging Horizons: Crafting Meaning and Cultivating Understanding Through Digital Storytelling. U of Calgary thesis. 2021.\u003c/li\u003e\n \u003cli\u003eDiFulvio GT, Gubrium AC, Fiddian-Green A, Lowe SE, Del Toro-Mejias LM. Digital storytelling as a narrative health promotion process: Evaluation of a pilot study. Int Q Community Health Educ. 2016;36(3). doi:10.1177/0272684X16647359\u003c/li\u003e\n \u003cli\u003eHamilton RA, Lond B, Wilde L, Williamson I. Understanding the lived-experience and support-needs of people living with antimicrobial resistance in the UK through interpretative phenomenological analysis. Sci Rep. 2024;14(1):1\u0026ndash;10. doi:10.1038/s41598-024-53814-6 PubMed PMID: 38337017.\u003c/li\u003e\n \u003cli\u003eAlRawashdeh MM, Ishak A, Al-Bunnia A, Agouridis AP, Lytras T, Spernovasilis N, et al. Patient Experiences and Perceptions with Infections Due to Multidrug-Resistant Organisms: A Systematic Review. Pathogens. 2024;13(9):1\u0026ndash;14. doi:10.3390/pathogens13090817\u003c/li\u003e\n \u003cli\u003eKrockow EM, Jenkins DR, Mkumbuzi S, Flusberg SJ, Tarrant C. Why antimicrobial resistance messaging fails: qualitative insights interpreted through the elaboration likelihood model. JAC Antimicrob Resist. 2025 Aug 1;7(4). doi:10.1093/jacamr/dlaf148\u003c/li\u003e\n \u003cli\u003ePark E, Forhan M, Jones CA. The use of digital storytelling of patients\u0026rsquo; stories as an approach to translating knowledge: a scoping review. Res Involv Engagem. 2021 Dec 1;7(1). doi:10.1186/s40900-021-00305-x\u003c/li\u003e\n \u003cli\u003eRand JR. Inuit women\u0026rsquo;s stories of strength: Informing inuit community-based HIV and STI prevention and sexual health promotion programming. Int J Circumpolar Health. 2016;75. doi:10.3402/ijch.v75.32135 PubMed PMID: 27938640.\u003c/li\u003e\n \u003cli\u003ePerrier MJ, Martin Ginis KA. Changing health-promoting behaviours through narrative interventions: A systematic review. J Health Psychol. 2018;23(11):1499\u0026ndash;517. doi:10.1177/1359105316656243 PubMed PMID: 27387514.\u003c/li\u003e\n \u003cli\u003eShen F, Sheer VC, Li R. Impact of narratives on persuasion in health communication: A meta-analysis. J Advert. 2015;44(2):105\u0026ndash;13. doi:10.1080/00913367.2015.1018467\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101. doi:10.1191/1478088706qp063oa\u003c/li\u003e\n \u003cli\u003eBrooks SP, Zimmermann GL, Lang M, Scott SD, Thomson D, Wilkes G, et al. A framework to guide storytelling as a knowledge translation intervention for health-promoting behaviour change. Implement Sci Commun. 2022;3(1):1\u0026ndash;13. doi:10.1186/s43058-022-00282-6\u003c/li\u003e\n \u003cli\u003eZhang L, Schenk PM, Santilli M, Wright AJ, Marques MM, Johnston M, et al. Linking behaviour change techniques to mechanisms of action: Using the Theory and Techniques Tool alongside the Behaviour Change Intervention Ontology. Wellcome Open Res. 2025;10(May):192. doi:10.12688/wellcomeopenres.23879.1\u003c/li\u003e\n \u003cli\u003eDavey N. Unfinished worlds: Hermeneutics, aesthetics, and Gadamer. Edinburgh University Press.; 2013.\u003c/li\u003e\n \u003cli\u003eFabiana L. UCL Centre for Behaviour Change [Internet]. Applying behavioural science to combating antimicrobial resistance. Available from: https://www.ucl.ac.uk/behaviour-change/sites/behaviour_change/files/applying_a_behavioural_science_approach_to_amr_-_dr_fabiana_lorencatto.pdf?utm_source=chatgpt.com\u003c/li\u003e\n \u003cli\u003eBrooks SP, Zimmermann GL, Lang M, Scott SD, Thomson D, Wilkes G, et al. A framework to guide storytelling as a knowledge translation intervention for health-promoting behaviour change. Implement Sci Commun. 2022;3(1):1\u0026ndash;13. doi:10.1186/s43058-022-00282-6\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Participant Characteristics (N = 8)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e3 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e45\u0026ndash;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u0026ge;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eWhite British\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eWhite and Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eBlack British \u0026ndash; African\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAsian (Japanese)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eWhite \u0026ndash; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eLondon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest educational qualification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eGCSEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eA Levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree (BA/BSc)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e3 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree (MA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePGCE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e3 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eComputer programmer/technical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePhotographer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTeacher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eChef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Summary of StoryBug Digital Stories\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.6424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDigital story (title and link)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.3576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSynopsis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.6424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHidden Embers\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;https://www.storybug.org.uk/hidden-embers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.3576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHidden Embers\u003c/strong\u003e tells the story of a 38-year-old London woman whose recurrent, antibiotic-resistant UTI disrupted her life. Told in her own words (voiced by an actor), it captures the pain, stigma, and emotional strain of a condition often minimised. Through metaphor and imagery, it shows how a routine infection became chronic and isolating, highlighting the hidden impacts of antimicrobial resistance beyond the clinic.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.6424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalse Peak\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;https://www.storybug.org.uk/false-peak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.3576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalse Peak\u003c/strong\u003e recounts Laila, a 31-year-old undergoing chemotherapy, who developed drug-resistant sepsis. Told in her own voice, it traces how the infection, not the cancer, became the immediate threat. Using a mountain-climbing metaphor, the story captures uncertainty and loss of control, humanising the intersection of cancer treatment and antimicrobial resistance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.6424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStiletto\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;https://www.storybug.org.uk/stiletto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.3576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStiletto\u003c/strong\u003e tells the story of a 25-year-old PhD student who developed an antibiotic-resistant infection after a minor injury from a stiletto heel. Read by an actor, it uses vivid language to convey escalating pain and disruption, challenging assumptions that AMR is confined to severe illness and highlighting its unpredictability in everyday life.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.6424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFight to Breathe\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;https://www.storybug.org.uk/fight-to-breathe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.3576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFight to Breathe\u003c/strong\u003e tells the story of Luke, a 9-year-old with cystic fibrosis who battled an antibiotic-resistant infection for nearly three years. Voiced by his mother, it captures the emotional strain of repeated treatment failure, using child-centred metaphors to convey the relentlessness of AMR in long-term illness.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.6424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToxic Turn\u003c/strong\u003e (not publicly available due to storyteller request)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70.3576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToxic Turn\u003c/strong\u003e follows a healthy 41-year-old man who developed a post-surgical infection after a skiing accident and experienced severe side effects from intravenous antibiotics. Using a mountain storm metaphor, it shows how treatment intended to heal instead caused harm, challenging assumptions that antibiotics are benign.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Examples of verbatim (by theme and initial theme from the thematic analysis) and the mapping of a path via DST mechanisms of action to the COM-B behavioural framework\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme \u0026amp; sub-theme; verbatim examples\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e(and rationale) \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOM-B domain \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDST MoA;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eBCTs/TDF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme 1. Viewers of digital stories recognise and realise the personal and often unacknowledged impacts and associated knowledge of lived experiences of AMR and antibiotic adversity.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 1. Informs of impacts beyond medical \u0026ndash; human, lived impacts, and relates via empathic connection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;\u0026hellip;\u003c/strong\u003eof \u003cstrong\u003ewe understood more about her life and the effect of her UTI and her relationships\u003c/strong\u003e then that started to resonate with me because relationships are such a big part of our life\u0026hellip;\u0026rsquo; (BO, \u003cem\u003eHidden Embers\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;the \u003cstrong\u003ehuman impact of AMR rather than the science\u003c/strong\u003e or medicine behind AMR and antibiotics\u0026rsquo; \u0026hellip;\u0026rsquo; I think only if it is relevant to the story.\u0026rsquo; (BO, \u003cem\u003egeneral\u003c/em\u003e)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;\u003cstrong\u003erelationship between the mother and the child\u003c/strong\u003e is so important, especially when a child is sick\u0026hellip; (JH, \u003cem\u003eFight to Breathe\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(\u003c/em\u003e\u003cstrong\u003eRationale:\u003c/strong\u003e \u003cem\u003eimportance of relationships, human connections, emotional resonance and empathy; value of relational support during illness, shift in understanding/knowledge from science AMR to human impact).\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReflective Motivation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePsychological Capability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAutomatic Motivation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIFs:\u003c/strong\u003e Emotion; Modelling; Persuasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoAs\u003c/strong\u003e: Social/Professional Role and Identity and Self-Image;\u0026nbsp;Emotion; Social influence (together create empathic connections)\u003c/p\u003e\n \u003cp\u003ehow viewers relate parts of the story to their own lives; immersive mechanisms identifying with characters, mirroring, emotional resonance, sociocultural homophily, and self-identity)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs\u0026nbsp;\u003c/strong\u003eSocial Comparison,\u0026nbsp;Information about emotional consequences; Salience of consequences;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u003c/strong\u003e Social Influences; Social Role and Identity;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 3. Imparts \u0026lsquo;novel\u0026rsquo; knowledge woven into DST - mechanistic and human impacts (initial theme 2 was not mapped to)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lsquo;Hearing about the antibiotic side effects was really interesting\u0026hellip; \u003cstrong\u003eyou would never have thought the antibiotics could break down bone marrow or damage the liver\u003c/strong\u003e. (JN, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;I had \u003cstrong\u003enever before thought that antibiotics could attack the body and have such severe side-effects\u003c/strong\u003e.\u0026rsquo; (LK, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u003cstrong\u003eI\u0026nbsp;didn\u0026rsquo;t realise the\u0026nbsp;impact this could have\u0026nbsp;if\u0026nbsp;you have cancer\u003c/strong\u003e, I never thought that AMR could be such a threat\u0026hellip; [it] really shocked me.\u0026rsquo; (LK, \u003cem\u003eFalse Peak\u003c/em\u003e)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;\u003c/strong\u003e\u003cstrong\u003eI thought it was the cancer that would kill me but now I think the resistant infection\u003c/strong\u003e is more imminent threat. That for me was the \u003cstrong\u003edramatic twist because it was telling me something.\u003c/strong\u003e\u0026rsquo; (BO)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026hellip;\u003c/em\u003ethe \u003cstrong\u003esimplest and clearest message\u003c/strong\u003e and I really like it because it is a message about taking out antibiotics can be negative as well as positive\u0026rsquo; (LK, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(\u003c/em\u003e\u003cstrong\u003eRationale:\u003c/strong\u003e \u003cem\u003eShifts in understanding and perception of risk; gaining new factual understanding; new information changes perceived severity of AMR/antibiotics\u0026rsquo; side effects; emotional reaction of shock)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological capability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Opportunity\u003c/strong\u003e (norms of antibiotics as harmless drugs)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAutomatic Motivation\u0026nbsp;\u003c/strong\u003e(LK, \u003cem\u003eFalse Peak\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIFs:\u003c/strong\u003e Emotion; Modelling; Persuasion; Education; Training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoA\u0026nbsp;\u003c/strong\u003eSocial Influences; Subjective Norms (inc. Social Norms); Knowledge; Beliefs about consequences\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u003c/strong\u003e Social Comparison; Information about Others\u0026apos; Approval; Education; Information about health consequences; Information about antecedents\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u003c/strong\u003e Knowledge; Beliefs about consequences; Emotion (LK, \u003cem\u003eFalse Peak\u003c/em\u003e);\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEME 2: Viewers relate by DST devices that nurture immersion and connectedness with the AMR story\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 4. Relatability via ST devices and choices including metaphor, imagery, voice \u0026amp; script stimulates empathy \u0026amp; emotional connection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;the\u003cem\u003e\u0026nbsp;Stiletto\u003c/em\u003e story would appeal\u003cstrong\u003e.. a subject that\u0026rsquo;s not too extreme\u003c/strong\u003e, a small accident that actually changed their life forever \u0026ndash; people are \u003cstrong\u003eless likely say \u0026lsquo;well I don\u0026rsquo;t have an underlying disease so it doesn\u0026rsquo;t apply to me.\u003c/strong\u003e\u0026rsquo; (JN, general)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;Skiing is known to be a risky sport so it\u0026rsquo;s\u003cstrong\u003e\u0026nbsp;not an everyday activity\u0026nbsp;\u003c/strong\u003efor most people so skiing does not resonate me\u0026rsquo; (BO, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;I don\u0026rsquo;t actually think that the \u003cstrong\u003echoice of a ski accident impacts the ability to relate\u003c/strong\u003e to this at all.\u0026rsquo; (LK, Toxic Turn)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;this story was so easy to relate to because \u003cstrong\u003ehow many of us have had someone step on our toes in a bar?\u0026rdquo;\u003c/strong\u003e (JN, Stiletto)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip; a \u003cstrong\u003eregular guy\u003c/strong\u003e\u0026hellip; skiing accident\u0026hellip;\u0026rdquo; (JN, Toxic Turn)\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;a bit \u003cstrong\u003emore of a balanced film\u003c/strong\u003e. It wasn\u0026rsquo;t on the extreme end of illness as with cystic fibrosis or cancer. So it is more \u003cstrong\u003erelatable to more people\u0026rsquo;\u003c/strong\u003e (JH, Toxic Turn)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u003cstrong\u003eCF is something not many people know about\u0026hellip;\u003c/strong\u003e is less relatable \u0026hellip; \u003cstrong\u003ecancer it is more common\u003c/strong\u003e so more easily relatable because we can envisage that relate to someone we might know who has all had cancer.\u0026rsquo; (JN, \u003cem\u003eFight to Breathe\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(\u003c/em\u003e\u003cstrong\u003eRationale:\u003c/strong\u003e \u003cem\u003esocial context shaping engagement; relatability of story\u0026rsquo;s context, characters, and events help engagement with AMR messages, perceived applicability to own situation;\u0026nbsp;\u003c/em\u003etap into pre-existing emotional familiarity and norms; \u003cem\u003eemotional and cognitive cues to shift beliefs)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReflective Motivation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePsychological Capability\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAutomatic Motivation\u003c/strong\u003e (\u0026hellip;\u003cem\u003esomeone step on our toes in a bar?\u0026rsquo;\u0026nbsp;\u003c/em\u003e (JN, Stiletto) and So it is more relatable to more people\u0026rsquo; (JH, \u003cem\u003eToxic Turn\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIFs:\u003c/strong\u003e Emotion; Modelling; Persuasion; Education;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoAs:\u0026nbsp;\u003c/strong\u003eKnowledge; Social influence (identification with others); Beliefs about consequences; Emotion\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u0026nbsp;\u003c/strong\u003eSocial comparison; Information about others\u0026rsquo; approval; Salience of consequences;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u003c/strong\u003e Beliefs about consequences; Social influences; Emotion\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 5:\u0026nbsp;Strength of written, verbal, visual and metaphorical format in DST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetaphors\u003c/strong\u003e are really important in film\u0026hellip; \u003cstrong\u003ecalming images and concept of climbing a mountain\u003c/strong\u003e and then cut to somebody covered in lots of tubes.\u0026rdquo; (JN, False Peak)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;works very well because the way it is \u003cstrong\u003ewritten evokes such strong images in the mind\u0026nbsp;\u003c/strong\u003eof the listener. If that popped up on my phone, I would probably be more attentive to that than some of the visual films.\u0026rdquo; (JN, Stiletto)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVisual vocabulary\u003c/strong\u003e and how being too prescriptive with visuals can trigger as many positive responses as negative\u0026hellip; ambivalence and even dichotomy\u0026hellip;\u0026rdquo; (ST, general)\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;I don\u0026rsquo;t think you need any audio officially because I \u003cstrong\u003ecreated all the imagery in my own head.\u003c/strong\u003e \u0026lsquo;(LK, Stiletto)\u003c/p\u003e\n \u003cp\u003e\u0026hellip;one line of \u003cstrong\u003e\u0026lsquo;why don\u0026rsquo;t you just stop taking the antibiotics?\u0026rsquo; said the Dr\u003c/strong\u003e\u0026hellip; was really, very impactful\u0026hellip; emphasises the role of the doctor in that part of the story.\u0026rdquo; (JN, Fight to Breathe)\u003c/p\u003e\n \u003cp\u003eI thought the opening was really brilliant. It really gave me that \u003cstrong\u003efeeling of oh what is coming next?\u0026rdquo;\u003c/strong\u003e (LK, Stiletto)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(\u003c/em\u003e\u003cstrong\u003eRationale:\u003c/strong\u003e \u003cem\u003eemotional and imaginative pull of vivid imagery; DST\u0026rsquo;s aesthetic and other narrative devices activate responses in viewers on the causal pathway to behaviour change by making abstract risks tangible, enhancing emotional connection, and sustaining attention.)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAutomatic Motivation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eReflective Motivation (JN, False Peak; JN, Fight to Breathe; JN, Stiletto)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Opportunity\u003c/strong\u003e (JN, Fight to Breathe)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIFs:\u003c/strong\u003e Persuasion; Education\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoA:\u0026nbsp;\u003c/strong\u003eEmotion; Knowledge;\u0026nbsp;Beliefs about consequences\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u003c/strong\u003e Information about emotional consequences; Salience of consequences; Prompts/cues; Framing/reframing; Credible source\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u003c/strong\u003e Emotion; Knowledge; Beliefs about consequences; Attention (strong images); Social influences; Memory, attention \u0026amp; decision processes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 6. DST may influence beliefs and attitudes\u003c/strong\u003e \u003cstrong\u003ealongside other interventions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lsquo;I don\u0026rsquo;t think they would change behaviour that \u003cstrong\u003erequires something much more drastic\u0026nbsp;\u003c/strong\u003ebut they might change attitudes. (BO, general)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;..difficult to change the attitude of adults... Until something really shocking happens\u0026hellip;with children, if you teach them from the beginning\u003c/strong\u003e in the forward of years then that \u003cstrong\u003ebecomes normal\u003c/strong\u003e to them. (MY, general)\u003c/p\u003e\n \u003cp\u003e(\u003cstrong\u003eRationale:\u003c/strong\u003e conscious and reflective evaluation of likelihood to change and perceived relevance;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReflective Motivation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAutomatic Motivation (habit e.g. becomes normal to them.)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Capability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIFs:\u003c/strong\u003e Education; Persuasion; Modelling\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoAs:\u0026nbsp;\u003c/strong\u003eBeliefs about consequences; Attitude toward the behaviour; Habit (as Behavioural regulation - establishing and maintaining routines, and Reinforcement)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u003c/strong\u003e Information about consequences; Framing/reframing; Habit formation; Social comparison\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs\u003c/strong\u003e: Beliefs about consequences; Attitude towards the behaviour; Beliefs about capabilities; Social influences;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEME 3. Psychosocial concepts, and wider societal values underpin viewer/public engagement with antibiotic use and AMR as a threat to health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 7. Social norms \u0026amp; societal values influence interpretations e.g. human-bacteria/ABs relationship, modernity, vulnerability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lsquo;It\u0026rsquo;s always been a modern fantasy that \u003cstrong\u003ebacteria are bad\u0026hellip; rather than we live together\u003c/strong\u003e alongside.\u0026rsquo; (ST, general)\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip; we \u003cstrong\u003eneed to live with bacteria\u0026hellip;\u003c/strong\u003e [trend] for probiotics\u0026rsquo; (JN, generally)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;raises the \u003cstrong\u003ehygiene hypothesis\u0026hellip;\u003c/strong\u003ewhen I was younger, it is good to play dirt to develop an effective immune system.\u0026rsquo; (BO, general)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e****\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;take time and space and \u003cstrong\u003epull back and let things self-heal [self-limit]\u003c/strong\u003e and take stock was an important point here\u0026hellip;\u0026rsquo; (ST, \u003cem\u003eStiletto\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;learning to \u003cstrong\u003ebe comfortable with being uncomfortable.\u003c/strong\u003e Everything is instant gratification; social media primes us for this. \u0026hellip;need to except that life doesn\u0026rsquo;t always go to plan,\u0026rsquo; (JN, general)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;Illness intrudes like an unwelcome interruption\u0026hellip;\u003cstrong\u003eexpect the health service and pills to manage\u0026hellip;\u003c/strong\u003e accepting things that are out of the ordinary as part of our ecosystem (ST, general)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;concept of\u003cstrong\u003e\u0026nbsp;vulnerability gets head-to-head with modernity.\u0026nbsp;\u003c/strong\u003eModernity teaches us that it\u0026rsquo;s normal to be healthy and it\u0026rsquo;s normal to live a good long life\u0026rsquo; (ST, general).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;the mother seems to refer to this when she says she \u003cstrong\u003eneeds breathing space\u003c/strong\u003e even if it is taking a [calculated] risk so her son and the family indeed can live something approaching normal.\u0026rsquo; (JN, \u003cem\u003eFight to Breathe)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e(\u003cstrong\u003eRationale:\u003c/strong\u003e public attitudes toward co-existing with bacteria-interpretations challenge dominant \u0026lsquo;bacteria as enemy\u0026rsquo; narrative, promotes co-existence with microbes, and reframe illness as part of life.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReflective Motivation\u003c/strong\u003e and Psychological Capability (ST general; JN, generally; BO, general)\u003c/p\u003e\n \u003cp\u003e****\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eReflective Motivation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAutomatic Motivation\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePlus \u003cstrong\u003eSocial Opportunity\u003c/strong\u003e (JN, \u003cem\u003eFight to Breathe)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eEducation; Persuasion; Modelling (\u0026lsquo;\u0026hellip;family indeed can live something approaching normal.\u0026rsquo;)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoA:\u003c/strong\u003e Knowledge; Beliefs about consequences; Reframing (via formal MoA Beliefs about consequences, Attitude toward the behaviour, or Knowledge); Emotion (related to domain Automatic Motivation); Identity (it\u0026rsquo;s normal to live a good long life\u0026rsquo;)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u0026nbsp;\u003c/strong\u003eInformation about health consequences; Framing/reframing; Salience of consequences; Information about emotional consequences\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u003c/strong\u003e Knowledge; Beliefs about consequences; Social/professional role \u0026amp; identity; Emotion; Optimism/Pessimism\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 8.\u0026nbsp;Psychological distance - temporal, spatial, social similarity; hypotheticality (\u0026amp; vulnerability)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;..\u003c/strong\u003e She showed the mountain she showed not being able to find the path which expressed her feelings\u0026hellip; feeling lost and not knowing what was going on etc\u0026hellip;\u003cstrong\u003e\u0026nbsp;nobody answered her when she said \u0026lsquo;will I die?\u0026rsquo;. \u0026nbsp;\u003c/strong\u003eThere was a real connection with understanding how she felt. It\u0026rsquo;s a really good film.\u0026rsquo;(LK, \u003cem\u003eFalse Peak\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;I\u0026nbsp;was\u0026nbsp;in her step,\u0026nbsp;I\u0026nbsp;could empathise\u003c/strong\u003e with her. The pictures were great and clear to understand.\u0026rsquo; \u0026nbsp;(LK, \u003cem\u003eFalse Peak)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;This film is really \u003cstrong\u003eevocative because especially for people from minority backgrounds\u003c/strong\u003e there is a lot of concern around intimacy before marriage.\u0026rsquo; (BO, \u003cem\u003eHidden Embers)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;\u0026hellip;\u003c/strong\u003eas we got nearer to the end, we understood more about her life and the \u003cstrong\u003eeffect of her UTI and her relationships then that started to resonate\u003c/strong\u003e with me because \u003cstrong\u003e[physical] relationships are such a big part of our life\u0026hellip;\u003c/strong\u003ethis video certainly appears to me but in a different way to the appeal of the first video (Laila).\u0026rsquo; (BO, \u003cem\u003eHidden Embers\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAutomatic Motivation\u003c/strong\u003e (all);\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eReflective Motivation (\u003cem\u003e\u0026ldquo;She showed the mountain\u0026hellip;\u0026rsquo;; \u0026lsquo;\u0026hellip;we understood more about her life\u0026rsquo;;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Opportunity\u003c/strong\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003eBO, Hidden Embers)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003ePersuasion; Education; Modelling\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoA:\u0026nbsp;\u003c/strong\u003eEmotion; Beliefs about consequences (Make abstract more understandable); Reframing (via formal MoA Beliefs about consequences, Attitude toward the behaviour, or Knowledge); Social influence; Social comparison (via Social influence or Norms).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u003c/strong\u003e Information about emotional consequences; Framing/reframing; Social comparison\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u0026nbsp;\u003c/strong\u003eEmotion; Beliefs about consequences; Social influences;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial theme 9. Interpretation according to viewer\u0026rsquo;s own frame/s of reference informed by world/life views; clarity of information imparted by digital stories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026lsquo;It\u0026rsquo;s all about how you personally see the situation of your life - \u003cstrong\u003eif it was me, I\u0026rsquo;d think about climbing the table to get promoted in the football leagues\u0026rsquo;\u003c/strong\u003e (SS, \u003cem\u003eFalse Peak\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lsquo;a good story does not reduce to a moral but they stay with you because you draw upon your own interpretation.\u003c/strong\u003e This is compelling as it is.\u0026rsquo; (ST, general)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;[I like this. \u003cstrong\u003eIt could happen to anyone he was a healthy man\u003c/strong\u003e and it is very relatable. It \u003cstrong\u003ereminds me of a situation where my cousin had a cat scratch\u003c/strong\u003e and he ended up with sepsis.\u0026rsquo; (LK, \u003cem\u003eStiletto\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;making sure \u003cstrong\u003ethe drugs are preserved and available for those who really need them\u003c/strong\u003e is a little bit like the weight loss drug scenario where people who really need them with type two diabetes cannot get their drugs now because everybody\u0026rsquo;s buying them for weight loss\u0026rsquo; (BO \u003cem\u003eFalse Peak)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;\u0026hellip;it felt as if I was \u003cstrong\u003ewatching a short film rather than being involved in someone\u0026rsquo;s story\u003c/strong\u003e. I felt like I was on the \u003cstrong\u003eoutside looking in and not really understanding\u003c/strong\u003e how it could relate to anyone who is not in that exact situation\u0026hellip;\u0026rsquo; (CF story, \u003cem\u003eFight to Breathe\u003c/em\u003e) (JN)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;I really didn\u0026rsquo;t like this film [\u003cem\u003eHidden Embers\u003c/em\u003e] because I came really \u003cstrong\u003ethinking that it\u0026rsquo;s only pe\u003c/strong\u003e\u003cstrong\u003eople who have intimacy before marriage that are affected\u003c/strong\u003e, and this isn\u0026rsquo;t the case\u0026rsquo; (LK).\u003c/p\u003e\n \u003cp\u003e\u0026lsquo;I don\u0026rsquo;t know why they didn\u0026rsquo;t start without antibiotics in this patient.\u0026rsquo; (MY, \u003cem\u003eFight to Breathe\u003c/em\u003e)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u003cstrong\u003eRationale:\u003c/strong\u003e analogy enables understanding and this shifts perspectives e.g. football leagues; viewers draw on personal connections e.g. cousin and this way arrive at empathy; perceived exclusion or misrepresentation e.g.\u0026rsquo;\u0026hellip; only people who have intimacy before marriage that are affected; correct misconceptions and improve relevance through IF Education)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReflective Motivation\u003c/strong\u003e (all)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Opportunity\u003c/strong\u003e (reminds me of a situation where my cousin had a cat scratch)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003ePersuasion; Education; Modelling\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoA:\u0026nbsp;\u003c/strong\u003eBeliefs about consequences; Attitude toward the behaviour; Social influence; Knowledge\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBCTs:\u0026nbsp;\u003c/strong\u003eFraming/reframing; Social comparison and Information about health consequences (LK, \u003cem\u003eStiletto and\u0026nbsp;\u003c/em\u003eBO \u003cem\u003eFalse Peak)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTDFs:\u003c/strong\u003e Beliefs about consequences; Social/professional role and identity (LK, Stiletto)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Table showing example questions to guide the screening discussion\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExamples of questions by digital story title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eFalse Peak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. \u0026nbsp; \u0026nbsp; Does anything in particular resonate with you about Laila\u0026rsquo;s story?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; a)\u0026nbsp;\u0026nbsp;AMR\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; b) \u0026nbsp;story production\u003c/p\u003e\n \u003cp\u003e2.\u0026nbsp;\u0026nbsp;Does Laila\u0026rsquo;s digital story, tell you anything about how antibiotics work/how we use ABs, or how AMR can arise?\u003c/p\u003e\n \u003cp\u003e3.\u0026nbsp;\u0026nbsp;Does any part of Laila\u0026rsquo;s story relate \u0026ndash; even tentatively - to you and your life at all?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eHidden Embers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. \u0026nbsp; \u0026nbsp; \u0026nbsp;Does anything, in particular, resonate with you about this digital story?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; a) AMR\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; b) story production\u003c/p\u003e\n \u003cp\u003e2. \u0026nbsp;What does this digital story tell you about the impact \u0026amp; consequences of antibiotic use for health and other aspects of a person\u0026rsquo;s life?\u003c/p\u003e\n \u003cp\u003e3. \u0026nbsp;Does this story make you think differently about seeking/using antibiotics, and considering alternatives?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eGeneral questions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1. \u0026nbsp;Were these digital stories as expected, or did they differ in some way?\u003c/p\u003e\n \u003cp\u003e2. \u0026nbsp;Is there a place for digital stories above and beyond or alongside posters and radio adverts and TV advert etc\u0026hellip;? How do they compare?\u003c/p\u003e\n \u003cp\u003e3. \u0026nbsp;Do you feel any differently about antibiotic use and the threat of AMR?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-antimicrobials-and-resistance","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjamar","sideBox":"Learn more about [npj Antimicrobials and Resistance](http://www.nature.com/npjamar/)","snPcode":"44259","submissionUrl":"https://submission.springernature.com/new-submission/44259/3","title":"npj Antimicrobials and Resistance","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9532775/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9532775/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAntimicrobial resistance (AMR) is a major global health threat, yet public engagement remains limited as it is often perceived by the general public as distant and abstract. Digital storytelling (DST) may offer a more accessible approach by situating AMR within lived experience. In this exploratory qualitative study, members of the general public attended a facilitated screening and discussion of five digital stories depicting resistant infection, antibiotic use, and antibiotic-related harm. Discussion data were analysed using reflexive thematic analysis. Three themes were identified. First, DST made AMR visible, personal, and emotionally grounded through lived experience rather than information alone. Second, engagement was shaped by storytelling devices including metaphor, imagery, voice, and framing. Third, interpretations were embedded within viewers\u0026rsquo; pre-existing beliefs, social norms, and values, as captured in the discussion. Taken together, these findings suggest that DST may complement conventional AMR communication by reducing psychological distance and making AMR more personally meaningful.\u003c/p\u003e","manuscriptTitle":"Making microbes matter: evidence for the use digital storytelling in antimicrobial resistance public engagement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-18 05:05:15","doi":"10.21203/rs.3.rs-9532775/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T18:25:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T18:49:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76015468349957000138079478553793075218","date":"2026-05-12T17:04:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T06:29:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295186311765436910833179348012694094202","date":"2026-05-07T11:04:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-07T09:49:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-07T09:47:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-02T06:56:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Antimicrobials and Resistance","date":"2026-04-26T14:21:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-antimicrobials-and-resistance","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjamar","sideBox":"Learn more about [npj Antimicrobials and Resistance](http://www.nature.com/npjamar/)","snPcode":"44259","submissionUrl":"https://submission.springernature.com/new-submission/44259/3","title":"npj Antimicrobials and Resistance","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ecb61bb3-2ca3-4c99-b019-2eff49a96898","owner":[],"postedDate":"May 18th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T18:25:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T18:49:34+00:00","index":19,"fulltext":""},{"type":"reviewerAgreed","content":"76015468349957000138079478553793075218","date":"2026-05-12T17:04:30+00:00","index":17,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T06:29:12+00:00","index":15,"fulltext":""},{"type":"reviewerAgreed","content":"295186311765436910833179348012694094202","date":"2026-05-07T11:04:00+00:00","index":13,"fulltext":""},{"type":"reviewersInvited","content":"6","date":"2026-05-07T09:49:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-07T09:47:21+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":68236094,"name":"Health sciences/Health care"},{"id":68236095,"name":"Biological sciences/Microbiology"},{"id":68236096,"name":"Biological sciences/Psychology"},{"id":68236097,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-18T18:38:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-18 05:05:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9532775","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9532775","identity":"rs-9532775","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}