1. Consumers’ motivation in responding to prescription drug advertising Consumers’ motivation in responding to prescription drug advertising by Nithima Sumpradit, PhD 1 Frank J. Ascione, PharmD PhD 2 Richard P. Bagozzi, PhD 3 1 Thai Food and Drug Administration 2 University of Michigan 3 Rice University

2. Overview of direct-to-consumer advertising of prescription drugs (DTCA) –Evolution and Trends of DTCA –Effects of DTCA on consumers Research about DTCA –Research 1: Content analysis of DTCA –Research 2: Impact of DTCA on consumers Conclusions Talk outline Motivation & DTCA -Slide 2- 04.01.04

3. Evolution & Trends of DTCA Motivation & DTCA -Slide 3- 04.01.04 - Philosophy in public policy regarding consumer protection - Self-care movement - Competition in drug market - Emergence: - Introduced in the USA, 1981 - USFDA requested the 2-year moratorium, 1983-1985 - USFDA issued the fair balance regulation for DTCA, 1985 - Trends: - Adopted in New Zealand - Debated in Canada and EU - Placed concerns in developing countries

4. Types & Regulations of DTCA Motivation & DTC advertising -Slide 4- 04.01.04 Types of DTCAMajor componentsRegulation Product-specificBrand name + Indication“Fair-balance” regulation Print ad - Risk information - Brief summary (e.g., summary of a leaflet) TV or broadcast ad - Major (risk) statement - More information available at: - Health professionals - Toll-free number - Internet website - Print ad Help-seekingIndication onlyNo specific regulation (Physicians or health professionals as gatekeepers for Rx drugs) ReminderBrand name only

5. Effects of DTCA Motivation & DTC advertising -Slide 5- 04.01.04 Positive effectsNegative effects Create informed consumersCreate consumers’ demand Educate consumers about disease and treatment Improve MD-Pt relationship Lead to shared-decisions in healthcare Improve consumer health Misinform or mislead consumers about disease and treatment Create tension on MD-Pt relationship Lead to inappropriate decisions in healthcare Jeopardize consumer health

6. Research Motivation & DTC advertising -Slide 6- 04.01.04 Research 1: Content analysis of DTCA characteristics –Sumpradit N, Ascione FJ, Bagozzi RP. A cross-media content analysis of motivational themes in direct-to-consumer prescription drug advertising. Clinical Therapeutics. 2004; 26(1): 135-154. Research 2: Impact of DTCA on consumer behavior –Sumpradit N, Ascione FJ, Bagozzi RP. “Give me happiness versus take away our pain”: Consumers’ motivation in responding to prescription drug advertising. (working manuscript)

7. Research 1: Content Analysis of DTCA Motivation & DTC advertising -Slide 7- 04.01.04 Goal: To examine motivational strategies used in DTCA Method: –Analyses of ads presented in 10 consumer magazines and 4 TV channel networks during Sep–Dec 2001 –Two drug classes Cox-2 inhibitors (Celebrex® vs. Vioxx®) Statin drugs (Lipitor®, Pravachol®, vs. Zocor®) –Three independent trained judges

8. Research 1(Results) Motivation & DTC advertising -Slide 8- 04.01.04 Cultural orientation –Use motivational themes that are consistent with cultural values. Ex. US ads rely on individualistic (as opposed to collectivistic) orientation. Goal orientation –Maximize the promise of obtaining positive outcomes –Minimized the chance that negative outcomes would occur Presentation style  Cognition –Maximize association between product and positive attributes Ex. Direct match of visual-verbal presentation in the benefit information announcement –Minimize association between product and negative attributes. Ex. No visual-verbal match in the risk information announcement

9. Research 2 Motivation & DTC advertising -Slide 9- 04.01.04 Cultural orientation –Use motivational themes that are consistent with cultural values. Ex. US ads rely on individualistic (as opposed to collectivistic) orientation. Goal orientation –Maximize the promise of obtaining positive outcomes –Minimized the chance that negative outcomes would occur Presentation style  Cognition –Maximize association between product and positive attributes Ex. Direct match of visual-verbal presentation in the benefit information announcement –Minimize association between product and negative attributes. Ex. No visual-verbal match in the risk information announcement Objective 1: How can the motivational themes persuade consumers to take actions? Objective 2: How can the motivational themes affect consumers’ ability to recall of risk information?

10. Goal compatibility Motivation & DTC advertising -Slide 8- 08.15.03 Motivation & DTC advertising -Slide 10- 04.01.04 TheoriesGoal Compatibility Self- regulatory focus theory Promotion focus Goal is to achieve positive outcomes Sensitive to presence/absence of positive outcome Focus on accomplishment Prevention focus Goal is to avoid negative outcomes Sensitive to presence/absence of negative outcome Focus on safety & obligation Self-construal orientation Independent self Goal is to achieve personal benefits (personal goals) Focus on uniqueness, self- reliance, self-fulfillment Interdependent self Goal is to achieve group benefits (collective goals) Focus on relationship, comply to duties, avoid conflicts Goal compatibility occurs when the ad combines:  Promotion focus with Independent self  Prevention focus with Interdependent self

11. Research 2 (Methodology) Motivation & DTC advertising -Slide 11- 04.01.04 Methods: –Design: Experiment based on a 2 (promotion vs. prevention) x 2 (independence vs. interdependence) factorial design –Sample: 220 females aged 40 years old or older –Data collection procedures: They were randomly assigned to view one of the four mock ads for cholesterol-lowering drug (Travacor) and completed a questionnaire. –Data analyses: Two-way ANOVA/ANCOVA

12. Intention to talk about high cholesterol with doctor (1 = definitely not to talk to 5 = definitely yes to talk with MD) Positive/Neutral DTCA attitudeNegative DTCA attitude Motivation & DTC advertising -Slide 13- 04.01.04 A D C B A D C B Research 2 (Persuasive effects of DTCA)

13. Research 2 (Effects on risk info recall) Exploratory AnalysisMain A. Positive/neutral DTCA attitude N=95 Neg. DTCA attitude N=102 Total N = 220 Promotion ads elicits risk information recall better than prevention ads 4.2 vs. 3.1, p = 0.002 4.6 vs. 3.9, p = 0.045 4.3 vs. 3.5, p = 0.001 Motivation & DTC advertising -Slide 21- 08.15.03 Motivation & DTC advertising -Slide 14- 03.27.04 Motivation & DTC advertising -Slide 14- 04.01.04

14. Conclusions Motivation & DTC advertising -Slide 15- 04.01.04 Failure of the drug distribution system (i.e., Rx drugs are accessible just like OTC drugs) remains unresolved. In Thailand, we prohibit prescription drugs to be advertised directly to consumers. So, why worry? DTCA is already here whether we are ready or not! Technology makes the world smaller.

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