Nithima Sumpradit, PhD 1 Frank J. Ascione, PharmD. PhD 2 Richard P. Bagozzi, PhD 3

1. “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

2. 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. Self-regulatory 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 anti-hyperlipidemia 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-Slide 1- 04.01.04

3. 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 fair-balance 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 • 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-Slide 2- 04.01.04

4. Study framework • Goal compatibility occurs when: • Promotion focus is combined with the independent self • Prevention focus is combined with the interdependent self Motivation & DTC advertising-Slide 3- 04.01.04

5. Hypotheses 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: Prevention focused ads will elicit better recall of risk information. H 8a: Promotion focused ads will elicit more positive emotional responses to the ad. H 8b: Prevention focused ads will elicit more negative emotional responses to the ad. Motivation & DTC advertising-Slide 4- 04.01.04

6. 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 cholesterol-lowering drug (Travacor) and completed a questionnaire. - Of a total of 234, a sample of 220 yield useable questionnaires. Motivation & DTC advertising-Slide 5- 04.01.04

7. Results: Main analysis Motivation & DTC advertising-Slide 6- 04.01.04

8. 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 Negative DTCA attitude N = 102 Motivation & DTC advertising-Slide 7- 04.01.04

9. Results: Effects of goal compatibility Motivation & DTC advertising-Slide 8- 04.01.04

10. Intention to talk about high cholesterol with doctor (Scale from 1 = definitely not to talk to 5 = definitely yes to talk with MD) Example of profile plot: Simple main effects Positive/Neutral DTCA attitude Negative DTCA attitude - Interaction effects are in the predicted direction • Interaction effects are in the opposite direction • to what we hypothesized Motivation & DTC advertising-Slide 9- 04.01.04

11. Results: Risk information recall (H 7) * Opposite direction Motivation & DTC advertising-Slide 10- 04.01.04

12. 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 Motivation & DTC advertising-Slide 11- 04.01.04

13. 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-Slide 12- 04.01.04