“Give me happiness vs. Take away our pain:”
Consumers’ motivation in responding to
prescription drug advertising
Nithima Sumpradit, PhD1
Frank J. Ascione, PharmD. PhD2
Richard P. Bagozzi, PhD3
1 Thai
Food and Drug Administration
2 University of Michigan, College of Pharmacy
3 Rice University, Jesse H. Jones Graduate School of Management
Abstract
Problem Statement: Although direct-to-consumer advertising (DTCA) of prescription drugs is banned in Thailand, it recently
became a global phenomenon largely because of advances in information technology. Proponents suggest that DTCA educates
consumers about diseases and treatment. Opponents argue that DTCA misleads consumers and causes irrational drug use.
Understanding the effects of DTCA can assist policy makers in making informed, appropriate decisions on this issue.
Objective: To determine how DTCA motivates consumers, based on self-regulatory focus and self-construal orientation. Selfregulatory focus posits that behavior is regulated by two systems: promotion (emphasizing achievements) and prevention
(emphasizing safety/obligations). Self-construal orientation suggests that behavior is guided by two self-views: independent self
(emphasizing self-fulfillment/uniqueness) and interdependent self (emphasizing family/social relationships). The independent self
emphasizes self-fulfillment and therefore is compatible with a focus on promotion. The interdependent self emphasizes maintaining
relationships and avoiding mistakes, and therefore is consistent with a focus on prevention. We hypothesized that goal-compatible
ads will lead to more favorable attitudes toward the ad and the brand advertised, greater intention to act and greater likelihood of
action, and more perceived benefits and fewer perceived risks of the product. We also hypothesized that prevention ads will elicit
better recall of risk information, more negative emotions, and fewer positive emotions than promotion ads.
Design: A 2 (independence vs. interdependence) × 2 (promotion vs. prevention) factorial design was used.
Setting and Study Population: A random sample of 220 females aged 40 years or older, who work at a large university but are not
faculty members or healthcare professionals/practitioners, were randomly assigned to view one of the four mock ads for an antihyperlipidemia drug and complete a questionnaire.
Outcome Measures: Main outcome measures included attitude toward the ad and the brand advertised, intention to act, likelihood
of action, perceived benefits and risks of the drug, emotional response, and recall of risk information. Data were analyzed with
ANOVA and ANCOVA.
Results: Results partially supported the hypotheses regarding goal-compatibility and emotional responses to the ad. Surprisingly,
results for recall of risk information were opposite to those hypothesized. Subgroup analysis showed that individuals with a positive
or neutral attitude toward DTCA reacted to ads consistently with our predictions, whereas those with a negative attitude toward
DTCA reacted to the same message in the opposite way to what we predicted.
Conclusions: The motivational themes in DTCA affect consumer behavior. The impact is a function of the interaction between the
themes and the pre-existing attitudes of consumers.
Submitted: February 15, 2004
Motivation & DTC advertising
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Introduction
• Direct-to-Consumer Advertising of Prescription Drugs (DTCA)
– First introduced in UK and USA in the early of 1980s
– 3 types: Product specific ads (brand name + indication +“risk information as fairbalance regulation”), Help-seeking ads (indication w/o brand name), Reminder ads
(brand name w/o indication)
– Recently, help-seeking ads of Rx drugs were found in Thai consumer magazines.
• Effects of DTCA
Positive effects
Negative effects
Create informed consumers
Create consumers’ demand
• Educate or inform consumers
• Misinform or mislead consumers
• Increase discussion and MD-Pt relationship • Create tension on MD-Pt relationship
• Improve consumer health
• Jeopardize consumer health
• Goal of study: To investigate the effects of the motivational themes in
DTCA on consumers’ attitudes, perception of drug’ risks/benefits, ability
to recall of risk information, intention-to-act, and likelihood-of-action.
Motivation & DTC advertising
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Study framework
Theories
Goal Compatibility
Self-regulatory
Promotion focus
focus theory
• 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
Interdependent self
• Goal is to achieve group benefits
(collective goals)
• Focus on connectedness, comply
to duties, maintain harmonious
relationship, avoid conflicts
Independent self
• Goal is to achieve personal
benefits (personal goals)
• Focus on separateness, selfreliance, self-fulfillment
Goal compatibility occurs when:
 Promotion focus is combined with the independent self
 Prevention focus is combined with the interdependent self
Motivation & DTC advertising
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Hypotheses
H7: Risk information
recall
H5-6: Perceived benefit
and risk of taking drug
Stimulus
(Ad)
H1-2: Ad/Brand
attitudes
H3: Intention to act:
seek info or ask
physician
H8: Emotional
responses
H4: Likelihood
of requesting the
advertised drug
H4: Likelihood of seeking
additional information
H 1 – 6: Ads with goal compatibility will elicit 1) more favorable ad attitude, 2) more
positive brand attitude, 3) greater intention-to-act, 4) greater likelihood-of-action,
5) higher perceived drug’s benefits, and 6) lower perceived drug’s risks.
H 7:
H 8a:
H 8b:
Prevention focused ads will elicit better recall of risk information.
Promotion focused ads will elicit more positive emotional responses to the ad.
Prevention focused ads will elicit more negative emotional responses to the ad.
Motivation & DTC advertising
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Methods
Design: A 2 (promotion vs. prevention) x 2 (independence vs. interdependence)
factorial design
Selection criteria:
- Females
- Age 40 years old or older
- Work or used to work at U of M
- Living in Ann Arbor or nearby areas
- Not faculty members or health practitioners
Recruitment:
- An invitation letter with a follow-up postcard
- Incentive
- Accommodating sessions
Data collection procedures:
- A random sample of 234 subjects attended the session (17.7% response rate).
- They were randomly assigned to view one of the four mock ads for cholesterollowering drug (Travacor) and completed a questionnaire.
- Of a total of 234, a sample of 220 yield useable questionnaires.
Motivation & DTC advertising
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Results: Main analysis
#
Hypotheses
Results
Next step
H1-6 Ads with goal compatibility will
increase the effects on ad/brand
attitudes, intention-to-act, likelihoodof-action, perception of drug’s
benefits, and lower perception of
drug’s risks
• Partially supported
• Profile plots were
in a proper direction
Subgroup
analysis
H7
Prevention ad (vs. promotion ad)
elicits better recall of risk information
• Not supported
• Opposite direction
Exploratory
analysis
H 8a
Promotion ad elicit more positive
emotional responses to the ad
• Supported
-
H 8b
Prevention ad elicit more negative
emotional responses to the ad
• Not stat. sig. result
but Proper direction
-
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Subgroup analysis (H1-6)
The purpose of the subgroup analysis is to reduce within group error variance
Total sample N = 220
Reduce within group error variance
• Remove bias cases
• Subgroup analyses
• ANCOVA
Positive/Neutral DTCA
attitude N = 95
Motivation & DTC advertising
Negative DTCA attitude
N = 102
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Results: Effects of goal compatibility
When the self-construal frame matches the
self-regulatory focus, the ad will lead to…
Subgroup Analysis
Main A.
Pos/Neu. DTCA
attitude, N=95
Neg. DTCA
attitude, N=102
Total
N=220
NS
NS
NS
NS (p = 0.07)
NS
NS
H1
Ad attitude
H2
Brand attitude
H3
Intention to talk drug with MD
p = 0.002
p = 0.002*
p=0.001
Intention to talk high cholesterol
p = 0.028
NS
NS
Intention to seek info (non MD
NS
NS
NS
Likelihood of seeking info from
doctor/ pharmacist, nurse
p < .05
NS
p=0.001/
NS
Likelihood of seeking info from
non-health professional sources
NS
NS
NS
Likelihood of requesting an Rx
p = 0.028
NS
NS
H5
Perceived drug’s benefit
p = 0.023
NS
NS
H6
Perceived drug’s risk
NS
NS
NS
H4
Motivation & DTC advertising
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Example of profile plot: Simple main effects
Intention to talk about high cholesterol with doctor
(Scale from 1 = definitely not to talk to 5 = definitely yes to talk with MD)
Positive/Neutral DTCA attitude
5
4
Promotion Ad
Negative DTCA attitude
Prevention Ad
3.92
3.5
3.2
3
3.88
2.8
3.23
3
Promotion Ad
2.6
2
Prevention Ad
2.99
2.71
2.59
2.61
2.4
1
2.2
Independence
Interdependence
- Interaction effects are in the predicted direction
Motivation & DTC advertising
Independence
Interdependence
-Interaction effects are in the opposite direction
to what we hypothesized
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Results: Risk information recall (H 7)
H7: Prevention focused ad (vs.
promotion focused ad) will
elicit better recall of risk info*
Exploratory Analysis
Main A.
Positive/neutral
Negative
DTCA attitude DTCA attitude
N=95
N=102
Total
N = 220
3.1 vs. 4.2,
p = 0.002
3.9 vs. 4.6
p = 0.045
3.5 vs. 4.3,
p = 0.001
* Opposite direction
Prom otion
5
Prevention
4.75
3.78
3.95
3.24
2.5
Independence
Motivation & DTC advertising
Interdependence
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Discussions
• H1 – 6: Opposite patterns between positive/neutral
vs. negative attitude groups
• Advertising acceptance – rejection assumption
• Acceptance – external message conforms to pre-existing attitude
• Rejection – external message differ from pre-existing attitude
• H 7: Promotion focused ad is better in eliciting risk
information recall than prevention focused ad.
• Differences in strategic means: Approach vs. Avoidance
• The role of positive emotions on cognitive function (H8)
• The role of attention
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Conclusions, Limitations &
Public policy implications
•
Conclusions
–
–
•
The motivational power of the ads depend on ads’ and consumers’ characteristics.
Self-regulatory focus as well as self-construal orientation proved to be a useful
framework in understanding the mechanism of how DTCA influence consumer
behavior.
Limitations
–
–
–
–
•
Results may not be generalized to male or general populations
Study design is based on “forced exposure.”
Choice of product is limited to only cholesterol-lowering drugs
Choice of media is limited to print media only
Public policy implications
–
–
It is important for public policy makers to understand the role of pre-existing
attitude toward DTCA in persuasion
They also need to take the role of motivational themes in risk information recall in
to consideration for drug advertising regulations.
Motivation & DTC advertising
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