A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public

Objectives: In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. Design: A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k=20). Methods: A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. Results: Whilst all studies examined tacitly rely on affect only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs and superheroes; (2) responsibility, threat, and the mis-use/abuse of antibiotics; (3) the figure of the child. Conclusions: The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorised or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of AMR interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalise upon the use of affect to effect behaviour change concerning antimicrobial stewardship.