“WHY NOT TAKE A RISK?” EXPLAINS SUBJECTS' EXPECTATIONS FOR ANTIBIOTICS AND PRIOR PRESCRIBING IN A LARGE ONLINE SAMPLE

Purpose: Patient expectations greatly influence physician prescribing with regard to antibiotics, potentially leading to over prescription and antibiotic resistance. Fuzzy-trace theory predicts that patients make decisions based on categorical gist mental representations that emphasize simple bottom-line meanings such as “Why Not Take a Risk?” – a categorical bottom line of how the option to take antibiotics stacks up against the option not to do –  and “Germs are Germs” – the hypothesis that patients do not know the difference between viruses and bacteria; yet, the relationship between patients’ mental representations and their expectations for antibiotics has been understudied.

 Method: We surveyed 519 subjects recruited from Amazon’s Mechanical Turk service using 46 Likert scale questions measuring patients’ mental representations, 2 yes/no questions measuring patients’ expectations for antibiotics, and 2 free response questions measuring patients’ knowledge regarding antibiotic prescribing. Results were analyzed using exploratory factor analysis (EFA).

Results: Subjects’ expectations, and prescriptions for antibiotics were significantly associated with all gists covered by survey items with the exception of those corresponding to knowledge of antibiotic use (e.g., “antibiotics should be taken for strep throat”). Thirty four percent of the variance in our data is explained by the “Why Not Take a Risk” gist. Separate factors capture gists associated with the possibility of harm from side effects (18% of variance), concerns about antibiotic efficacy (14% of variance), and factors associated with patients’ knowledge about conditions necessitating antibiotic use.

Conclusion: “Why Not Take a Risk?” is a widespread strategy that, although individually-rational, can lead to socially-suboptimal results including antibiotic resistance. As predicted by fuzzy-trace theory, “Why Not Take a Risk?” is associated with categorical risk perceptions rather than verbatim calculation. Furthermore, these perceptions are associated with subjects’ expectations for antibiotics which can affect physician prescribing, suggesting opportunities for public health communication interventions.