Should we stop referring to the pandemic of antimicrobial resistance as silent?

Background: Referring to the ongoing antimicrobial resistance crisis as a 'silent' pandemic has gained popularity, but there are mixed views on whether such a phrase should be used in public health communication. Some researchers have argued that using the term 'silent pandemic' may lower the perceived threat and hinder mobilization efforts to tackle the problem. Objectives: I investigated the impact of the phrase 'silent pandemic' on perceived threat levels and mobilization intentions. Methods: In three experiments (n = 1677), participants from the UK's general adult population were randomly allocated to either a 'pandemic' or 'silent pandemic' condition, where the different terms were embedded in statements (Experiment 1) or brief information materials (Experiments 2 and 3). The term 'silent pandemic' was also presented with a brief description of its intended meaning (Experiment 3). The participants expressed their perception of the threat and their mobilization intentions. Results: In Experiments 1 and 2, referring to the pandemic as silent did not significantly affect the perceived threat (Cohen's d = -0.06; Cohen's d = 0.08, respectively) or mobilization intentions (Cohen's d = -0.07; Cohen's d = 0.11, respectively). However, in Experiment 3, the term 'silent pandemic' decreased the perceived threat and mobilization intentions (Cohen's d = 0.27; Cohen's d = 0.35, respectively). Conclusions: Describing the pandemic as 'silent' yielded no measurable effects on perceived threat and mobilization intentions but it showed depreciating effects when accompanied by its intended meaning. Taken together, it is advisable to avoid the term.

When intuitive Bayesians need to be good readers: The problem-wording effect on Bayesian reasoning.

Are humans intuitive Bayesians? It depends. People seem to be Bayesians when updating probabilities from experience but not when acquiring probabilities from descriptions (i.e., Bayesian textbook problems). Decades of research on textbook problems have focused on how the format of the statistical information (e.g., the natural frequency effect) affects such reasoning. However, it pays much less attention to the wording of these problems. Mathematical problem-solving literature indicates that wording is critical for performance. Wording effects (the wording varied across the problems and manipulations) can also have far-reaching consequences. These may have confounded between-format comparisons and moderated within-format variability in prior research. Therefore, across seven experiments (N = 4909), we investigated the impact of the wording of medical screening problems and statistical formats on Bayesian reasoning in a general adult population. Participants generated more Bayesian answers with natural frequencies than with single-event probabilities, but only with the improved wording. The improved wording of the natural frequencies consistently led to more Bayesian answers than the natural frequencies with standard wording. The improved wording effect occurred mainly due to a more efficient description of the statistical information-cueing required mathematical operations, an unambiguous association of numbers with their reference class and verbal simplification. The wording effect extends the current theoretical explanations of Bayesian reasoning and bears methodological and practical implications. Ultimately, even intuitive Bayesians must be good readers when solving Bayesian textbook problems.

Science Communication as a Collective Intelligence Endeavor: A Manifesto and Examples for Implementation.

Effective science communication is challenging when scientific messages are informed by a continually updating evidence base and must often compete against misinformation. We argue that we need a new program of science communication as collective intelligence-a collaborative approach, supported by technology. This would have four key advantages over the typical model where scientists communicate as individuals: scientific messages would be informed by (a) a wider base of aggregated knowledge, (b) contributions from a diverse scientific community, (c) participatory input from stakeholders, and (d) better responsiveness to ongoing changes in the state of knowledge.

How Should Doctors Frame the Risk of a Vaccine's Adverse Side Effects? It Depends on How Trustworthy They Are.

BACKGROUND: How health workers frame their communication about vaccines' probability of adverse side effects could play an important role in people's intentions to be vaccinated (e.g., positive frame: side effects are unlikely v. negative frame: there is a chance of side effects). Based on the pragmatic account of framing as implicit advice, we expected that participants would report greater vaccination intentions when a trustworthy physician framed the risks positively (v. negatively), but we expected this effect would be reduced or reversed when the physician was untrustworthy. DESIGN: In 4 online experiments (n = 191, snowball sampling and n = 453, 451, and 464 UK residents via Prolific; Mage≈ 34 y, 70% women, 84% White British), we manipulated the trustworthiness of a physician and how they framed the risk of adverse side effects in a scenario (i.e., a chance v. unlikely adverse side effects). Participants reported their vaccination intention, their level of distrust in health care systems, and COVID-19 conspiracy beliefs. RESULTS: Physicians who were trustworthy (v. untrustworthy) consistently led to an increase in vaccination intention, but the way they described adverse side effects mattered too. A positive framing of the risks given by a trustworthy physician consistently led to increased vaccination intention relative to a negative framing, but framing had no effect or the opposite effect when given by an untrustworthy physician. The exception to this trend occurred in unvaccinated individuals in experiment 3, following serious concerns about one of the COVID vaccines. In that study, unvaccinated participants responded more favorably to the negative framing of the trustworthy physician. CONCLUSIONS: Trusted sources should use positive framing to foster vaccination acceptance. However, in a situation of heightened fears, a negative framing-attracting more attention to the risks-might be more effective. HIGHLIGHTS: How health workers frame their communication about a vaccine's probability of adverse side effects plays an important role in people's intentions to be vaccinated.In 4 experiments, we manipulated the trustworthiness of a physician and how the physician framed the risk of adverse side effects of a COVID vaccine.Positive framing given by a trustworthy physician promoted vaccination intention but had null effect or did backfire when given by an untrustworthy physician.The effect occurred over and above participants' attitude toward the health care system, risk perceptions, and beliefs in COVID misinformation.

When a thinker does not want to think: Adding meta-control into the working model.

De Neys proposes an elegant solution to several theoretical problems of the dual-process theories but underspecifies the role of motivation in initiating, intensifying, and ceasing deliberation. Therefore, I suggest including a meta-cognitive control component in the working model that can moderate deliberation, for instance by affecting the deliberation threshold.

Tell Us What You Really Think: A Think Aloud Protocol Analysis of the Verbal Cognitive Reflection Test.

The standard interpretation of cognitive reflection tests assumes that correct responses are reflective and lured responses are unreflective. However, prior process-tracing of mathematical reflection tests has cast doubt on this interpretation. In two studies (N = 201), we deployed a validated think-aloud protocol in-person and online to test how this assumption is satisfied by the new, validated, less familiar, and non-mathematical verbal Cognitive Reflection Test (vCRT). Verbalized thoughts in both studies revealed that most (but not all) correct responses involved reflection and that most (but not all) lured responses lacked reflection. The think-aloud protocols seemed to reflect business-as-usual performance: thinking aloud did not disrupt test performance compared to a control group. These data suggest that the vCRT usually satisfies the standard interpretation of the reflection tests (albeit not without exceptions) and that the vCRT can be a good measure of the construct theorized by the two-factor explication of 'reflection' (as deliberate and conscious).

Rationally irrational: When people do not correct their reasoning errors even if they could.

Why is it that sometimes people do not correct their reasoning errors? The dominating dual-process theories of reasoning detail how people (fail to) detect their reasoning errors but underspecify how people decide to correct these errors once they are detected. We have unpacked the motivational aspects of the correction process here, leveraging the research on cognitive control. Specifically, we argue that when people detect an error, they decide whether or not to correct it based on the overall expected value associated with the correction-combining perceived efficacy and the reward associated with the correction while considering the cost of effort. Using a modified two-response paradigm, participants solved cognitive reflection problems twice while we manipulated the factors defining the expected value associated with correction at the second stage. In five experiments (N = 5,908), we found that answer feedback and reward increased the probability of correction while cost decreased it, relative to the control groups. These cognitive control critical factors affected the decisions to correct reasoning errors (Experiments 2 and 3) and the corrective reasoning itself (Experiments 1, 4 and 5) across a range of problems, feedbacks, types of errors (reflective or intuitive), and cost and reward manipulations pre-tested and checked in five separate studies (N = 951). Thus, some people did not correct their epistemically irrational reasoning errors because they followed the instrumentally rational principle of the expected value maximization: They were rationally irrational. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

People prefer to predict middle, most likely quantitative outcomes (not extreme ones), but they still over-estimate their likelihood.

Past work showed a tendency to associate verbal probabilities (e.g., possible, unlikely) with extreme quantitative outcomes, and to over-estimate the outcomes' probability of occurrence. In the first four experiments (Experiment 1, Experiments 2a-c), we tested whether this "extremity effect" reflects a general preference for extreme (vs central or less extreme) values of a distribution. Participants made predictions based on a frequency distribution in two scenarios. We did not find a preference for extreme outcomes. Instead, most of the participants made a prediction about the middle, most frequent outcome of the distribution (i.e., the modal outcome), but still over-estimated the outcomes' probabilities. In Experiment 3, we tested whether the over-estimation could be better explained by an "at least"/"at most" reading of the predictions. We found that only a minority of participants interpreted predictions as the lower/upper bounds of an open interval and that these interpretations were not associated with heightened probability estimates. In the final three experiments (Experiments 4a-c), we tested whether participants perceived extreme outcome predictions as more correct, useful and interesting than modal outcome predictions. We found that extreme and modal predictions were considered equally correct, but modal predictions were judged most useful, whereas extreme predictions were judged to be more interesting. Overall, our results indicate that the preference for extreme outcomes is limited to specific verbal probability expressions, whereas the over-estimation of the probability of quantitative outcomes may be more general than anticipated and applies to non-extreme values as well.

Framing Effects, Social Norm Perception, and Tolerance of Lesbian and Gay Individuals: Experimental Evidence From Slovakia.

Perceptions of social norms can have downstream consequences for attitudes and behaviors, especially when it comes to the acceptance of marginalized groups. While interventions focusing on social norms may boost tolerance, few studies test whether variations in norm communication affect individuals' perceptions. Thus, in this paper, we test the effectiveness of three communicative aspects-valence framing (Experiments 1-3), point of view (Experiment 1), and group centrism (Experiment 3)-in shifting perceptions of social norms. Specifically, we investigate whether manipulating these aspects affects perceptions of tolerance of lesbian and gay individuals in Slovakia, where LGBTQ+ acceptance is among the lowest in Europe. We found that while positively valenced messages shifted perceptions toward tolerance, manipulating point of view and group-centrism did not. We believe that these findings can inform interventions intended to shift perceptions of social norms in hostile contexts, an important first step in changing prejudiced attitudes and behaviors.

Ambiguity and unintended inferences about risk messages for COVID-19.

The World Health Organization established that the risk of suffering severe symptoms from coronavirus disease (COVID-19) is higher for some groups, but this does not mean their chances of infection are higher. However, public health messages often highlight the "increased risk" for these groups such that the risk could be interpreted as being about contracting an infection rather than suffering severe symptoms from the illness (as intended). Stressing the risk for vulnerable groups may also prompt inferences that individuals not highlighted in the message have lower risk than previously believed. In five studies, we investigated how U.K. residents interpreted such risk messages about COVID-19 (n = 396, n = 399, n = 432, n = 474) and a hypothetical new virus (n = 454). Participants recognized that the risk was about experiencing severe symptoms, but over half also believed that the risk was about infection, and had a corresponding heightened perception that vulnerable people were more likely to be infected. Risk messages that clarified the risk event reduced misinterpretations for a hypothetical new virus, but existing misinterpretations of coronavirus risks were resistant to correction. We discuss the need for greater clarity in public health messaging by distinguishing between the two risk events. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Age differences in COVID-19 risk-taking, and the relationship with risk attitude and numerical ability.

This study aimed to investigate age differences in risk-taking concerning the coronavirus pandemic, while disentangling the contribution of risk attitude, objective risk and numeracy. We tested (i) whether older and younger adults differed in taking coronavirus-related health risks, (ii) whether there are age differences in coronavirus risk, risk attitude and numerical ability and (iii) whether these age differences in coronavirus risk, attitude and numerical ability are related to coronavirus risk-taking. The study was observational, with measures presented to all participants in random order. A sample of 469 participants reported their coronavirus-related risk-taking behaviour, objective risk, risk attitude towards health and safety risks, numerical ability and risk perception. Our findings show that age was significantly related to coronavirus risk-taking, with younger adults taking more risk, and that this was partially mediated by higher numeracy, but not objective risk or risk attitude. Exploratory analyses suggest that risk perception for self and others partially mediated age differences in coronavirus risk-taking. The findings of this study may better our understanding of why age groups differ in their adoption of protective behaviours during a pandemic and contribute to the debate whether age differences in risk-taking occur due to decline in abilities or changes in risk attitude.

Are COVID-19 conspiracies a threat to public health? Psychological characteristics and health protective behaviours of believers.

We tested the link between COVID-19 conspiracy theories and health protective behaviours in three studies: one at the onset of the pandemic in the United Kingdom (UK), a second just before the first national lockdown, and a third during that lockdown (N = 302, 404 and 399). We focused on conspiracy theories that did not deny the existence of COVID-19 and evaluated the extent to which they predicted a range of health protective behaviours, before and after controlling for psychological and sociodemographic characteristics associated with conspiracy theory belief. COVID-19 conspiracy beliefs were positively correlated with beliefs in other unrelated conspiracies and a general conspiracy mind-set, and negatively correlated with trust in government and a tendency towards analytical thinking (vs. intuitive thinking). Unexpectedly, COVID-19 conspiracy believers adhered to basic health guidelines and advanced health protective measures as strictly as non-believers. Conspiracy believers were, however, less willing to install the contact-tracing app, get tested for and vaccinated against COVID-19, and were more likely to share COVID-19 misinformation-all of which might undermine public health initiatives. Study 3 showed conspiracy theory believers were less willing to undertake health protective behaviours that were outside of their personal control, perceiving these as having a negative balance of risks and benefits. We discuss models explaining conspiracy beliefs and health protective behaviours, and suggest practical recommendations for public health initiatives.

Offset-related brain activity in the left ventrolateral prefrontal cortex promotes long-term memory formation of verbal events.

BACKGROUND: Recent evidence suggests that brain activity following the offset of a stimulus during encoding contributes to long-term memory formation, however the exact mechanisms underlying offset-related encoding are still unclear. OBJECTIVES: Here, in three repetitive transcranial magnetic stimulation studies (rTMS) we investigated offset-related activity in the left ventrolateral prefrontal cortex (VLPFC). rTMS was administered at different points in time around stimulus offset while participants encoded visually-presented words or pairs of words. The analyses focused on the effects of the stimulation on subsequent memory performance. RESULTS: rTMS administered at the offset of the stimuli, but not during online encoding, disrupted subsequent memory performance. In Experiment 1 we found that rTMS specifically disrupted encoding mechanisms initiated by the offset of the stimuli rather than general, post-stimulus processes. Experiment 2 showed that this effect was not dependent upon rTMS-induced somatosensory effects. In a third rTMS experiment we further demonstrated a robust decline in associative memory performance when the stimulation was delivered at the offset of the word pairs, suggesting that offset-related encoding may contribute to the binding of information into an episodic memory trace. CONCLUSIONS: The offset of the stimulus may represent an event boundary that promotes the reinstatement of the previously experienced event and episodic binding.

Effect of information on reducing inappropriate expectations and requests for antibiotics.

People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians' decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples (n1  = 402; n2  = 190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.

Focus to an attribute with verbal or numerical quantifiers affects the attribute framing effect.

People find positive attribute frames (e.g., 75% lean) more persuasive than negative ones (e.g., 25% fat). In three pre-registered experiments, we tested whether this effect would be magnified by using verbal quantifiers instead of numerical ones (e.g., 'high % lean' vs. '75% lean'). This moderating effect of quantifier format was predicted based on previous empirical work and two non-exclusive accounts of framing effects. First, verbal quantifiers are presumed to be a more intuitive format than numerical quantifiers, so might predispose people more to judgement biases such as the framing effect. Second, verbal quantifiers draw a greater focus to the attributes they describe. This could provide a linguistic signal that the positive frame is better than the negative one. In three experiments, we manipulated the attribute frame (positive or negative) and the quantifier format (verbal or numerical) between-subjects, and quantity pairs (e.g., 5% fat and 95% lean or 25% fat and 75% lean) within-subjects. We also tested if participants focused more on the attributes in the frame, by measuring whether participants selected causal sentence completions about the beef that focused on why it had fat meat or lean meat. Results showed a robust framing effect, which was partially mediated by the focus of the sentence completions. However, the verbal format did not increase the magnitude of the framing effect. These results suggest that a focus on the attribute contributes to the framing effect, but contrary to past work, this focus is not different between verbal and numerical quantifiers.

Action bias in the public's clinically inappropriate expectations for antibiotics.

Clinical guidelines recommend that physicians educate patients about illnesses and antibiotics to eliminate inappropriate preferences for antibiotics. We expected that information provision about illnesses and antibiotics would reduce but not eliminate inappropriate preferences for antibiotics and that cognitive biases could explain why some people resist the effect of information provision. In 2 experiments, participants (n1 = 424; n2 = 434) either received incomplete information (about the viral etiology of their infection) or complete information (about viral etiology and the ineffectiveness and harms of taking antibiotics), before deciding to rest or take antibiotics. Those in the complete information conditions responded to items on 4 biases: action bias, social norm, source discrediting, and information neglect. In 2 follow-up experiments (n1 = 150; n2 = 732), we aimed to counteract the action bias by reframing the perception of the resting option as an action. Complete information provision reduced but did not eliminate inappropriate preferences for antibiotics. Around 10% of people wanted antibiotics even when informed they are harmful and offer no benefit and even when the alternative option (i.e., rest) was framed as an active treatment option. Results suggest an action bias underpins this preference but appears challenging to counteract. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

'Always take your doctor's advice': Does trust moderate the effect of information on inappropriate antibiotic prescribing expectations?

Objectives To reduce overprescribing, health campaigns urge physicians to provide people with information regarding appropriate antibiotic use and encourage the public to trust their physicians' prescribing decisions. We test (1) whether providing individuals with complete information about the viral aetiology of an illness and the ineffectiveness of antibiotics will reduce inappropriate antibiotic expectations, (2) whether individuals with greater trust in their physician will have lower expectations, and (3) whether individuals with greater trust in their physician will benefit more from the complete information provision and have lower expectations. Design Experiment 1 features a between-subjects design (information provision: baseline vs. complete information) with a general measure of participants' trust in their physician. Experiment 2 features a 2 (physician trustworthiness: low vs. high) × 2 (information provision: baseline vs. complete information) between-subjects design. Methods In Experiment 1, participants (n = 366) reported their trust in their physician, read a vignette describing a hypothetical consultation with a physician for a viral cold and then expressed their expectations for antibiotics. In Experiment 2, participants (n = 380) read a vignette of a consultation with a physician for a viral ear infection then expressed their expectations for antibiotics. Results In both experiments, the provision of complete information significantly reduced inappropriate expectations for antibiotics. Greater trust in physicians was associated with higher antibiotic expectations in Experiment 1, but lower expectations in Experiment 2. In both experiments, trust in physicians appeared to facilitate the effect of information provision, but this effect was weak and inconsistent. Conclusion Providing information about viral aetiology and the ineffectiveness and side effects of antibiotics reduces inappropriate antibiotic expectations. Further research into the effect of trust in physicians as a moderator of the effect information provision is required, particularly given the recent increase in trust-based antibiotic campaigns. Statement of contribution What is already known Inappropriate expectations for antibiotics encourage overprescribing in primary care. To reduce inappropriate expectations, interventions often aim to educate people about antibiotics and encourage them to trust their physician. What does this study add Causal evidence that clinical information provision reduces but does not eliminate inappropriate antibiotic expectations. We find that increased trust in physicians is not always associated with lower expectations for antibiotics. Although increased trust seemed to boost the effect of information provision, this effect was weak and inconsistent.

The intuitive use of contextual information in decisions made with verbal and numerical quantifiers.

Verbal and numerical formats (e.g., verbal: "low fat," or numerical: "20% fat") are used interchangeably to communicate nutritional information. However, prior research implies that verbal quantifiers are processed more intuitively than numerical ones. We tested this hypothesis in two pre-registered experiments measuring four indicators of processing style: (a) response time, (b) decision performance, (c) reliance on irrelevant contextual information, which we inferred from participants' decision patterns, and (d) the level of interference from a concurrent memory task. Participants imagined they had consumed a given amount of a nutrient (represented in a pie chart) and decided whether a new quantity (either verbal or numerical) could be eaten within their guideline daily amount (GDA). The experiments used a mixed design varying format (verbal or numerical), concurrent memory load (no load, easy, and hard load in Experiment 1; no load and hard load in Experiment 2), nutrient (fat and minerals), quantity (low, medium, and high in Experiment 1; low and high in Experiment 2), and the assigned correct response for a trial (within and exceeding limits). Participants were faster and made fewer correct decisions with verbal quantifiers, and they relied more on contextual information (i.e., the identity of the nutrient involved). However, memory load did not impair decisions with verbal or numerical quantifiers. Altogether, these results suggest that verbal quantifiers are processed intuitively, slightly more so than numerical quantifiers, but that numerical quantifiers do not require much analytical processing to reach simple decisions.

Do people really prefer verbal probabilities?

When people communicate uncertainty, do they prefer to use words (e.g., "a chance", "possible") or numbers (e.g., "20%", "a 1 in 2 chance")? To answer this question, past research drew from a range of methodologies, yet failed to provide a clear-cut answer. Building on a review of existing methodologies, theoretical accounts and empirical findings, we tested the hypothesis that the preference for a particular format is driven by the variant of uncertainty that people experience. We expected that epistemic uncertainty would be more often communicated in words, whereas distributional uncertainty would be more often communicated in numbers; for the dispositional uncertainty, we expected that an individual's disposition would be more often communicated in words, whereas dispositions from the world would be more often communicated numerically. In three experiments (one oral, two written), participants communicated their uncertainty regarding two outcomes per variants of uncertainty: epistemic, dispositional and distributional. Overall, participants communicated their uncertainty more often in words, but this preference depended on the variants of uncertainty. Participants conveyed their epistemic and dispositional uncertainties more often in words and their distributional uncertainty in numbers (Experiments 1 and 2) but this effect was greatly reduced when the precision of uncertainty was held constant (Experiment 3), pointing out the key role of uncertainty vagueness. We have reviewed the implications of our findings for the existing accounts of format preferences.