Disease Awareness and Prescription Drug Communications on Television: Evidence for Conflation and Misleading Product Impressions

Background

When promoting a new drug, a pharmaceutical company may release disease awareness communications about the disease a new drug is intended to treat. Disease awareness communications typically feature the signs and symptoms of the medical condition, the consequences of not treating it, and a message to speak to a healthcare provider about treatment options, but do not name a particular drug. Though disease awareness communications focus on the disease itself, consumers can confuse information from these communications with information they may be exposed to in prescription drug advertisements for products that treat the condition. This confusion is referred to as conflation. It can lead to misunderstanding the benefits of a drug, and consumers may mistakenly assume that the drug will address all the potential consequences of the condition mentioned in the ad. This misunderstanding may lead consumers to request inappropriate treatment from their healthcare providers. Identifying causes or contributors to conflation in prescription drug promotion is important to help mitigate consumer confusion and ensure they receive the care they need.

Study Design

CDER researchers conducted two experimental studies among adult asthma patients to determine how the similarity, proximity (how close together the disease awareness communication and the prescription drug television ad were shown), and frequency of exposure to a disease awareness communication and prescription drug television advertisement impact consumer perception and understanding of the benefits and risks of a prescription drug (Figure 1).

In Study 1 (n = 2,190), participants were randomly assigned to view one of three different types of a disease awareness communication developed by the research team that varied in the similarity (e.g., setting, actors, and colors) to an advertisement for a fictitious drug used to treat asthma. The proximity between both types of communications also varied and were chosen by the researchers to simulate the different ways consumers may view these advertisements within hour-long television programming. For example, the two communications could be shown back-to-back or separated by other advertisements or television programming.

Study 2 (n = 1,621) examined the impact of viewing a disease awareness communication in one day or over multiple days and at least 24 hours before viewing the drug advertisement. Participants were randomly assigned to one of 12 experimental conditions based on (a) time delay between exposure to the last disease awareness ad and exposure to the product ad (one day or one week), (b) perceptual similarity of the product ad to the disease awareness ad (similar or distinct), and (c) number of exposures to the disease awareness ad (one, three, or six exposures).

In both studies, participants completed a questionnaire designed to assess study outcomes.

Results

Proximity and Similarity

Overall, the researchers found that consumers conflated the drug’s benefits and risks when they were exposed to both a disease awareness communication and drug advertisement, regardless of the similarity and proximity between the advertisements. Participants more often incorrectly attributed benefits of using the drug to treat or manage the disease (asthma) when the disease awareness communications and drug advertisements were more similar. Participants also more often incorrectly attributed risks of using the drug when the disease awareness communications and drug advertisements appeared in closer proximity to one another.

Benefits and Risks

Conflation of risks was very low, while conflation of benefits was relatively high across all experimental conditions in both studies. This finding is consistent with prior CDER research of consumer-directed prescription drug television advertising showing better recall of a drug’s benefits compared to its risks and could be due to the differences in how benefits are usually communicated in the two communications. The benefits of treating a disease featured in a disease awareness communication can be more directly linked to the benefits of a particular drug (e.g., fewer asthma episodes) compared to the risks in disease awareness communications, which communicate the risks of nontreatment. This may make it more difficult to directly link specific drug risks to more general risks of nontreatment.

Repeated Exposures

Beyond a single exposure, the number of exposures participants had to the disease awareness communication did not lead to additional conflation of information from that communication with information from the drug advertisement.

Individual Factors

Higher levels of participant’s existing asthma knowledge and general health literacy, as well as their perception of the advertisement’s effectiveness, increased conflation of the drug’s benefits in both studies regardless of the similarity or proximity.

Among participants who perceived the drug advertisement as less effective (measured by asking participants questions such as “the commercial was interesting”, “attention grabbing”, or “relevant”), there was more risk conflation when the two communication types were more similar and viewed in closer proximity to one another.

Conclusions

These results extend the research team’s previous findings that similarity and proximity  impact consumer understanding of a drug’s benefits and risks when disease awareness and drug promotion materials are viewed in print1 or on the web.2  Knowing that conflation caused by these advertising features occurs across different types of media is important because it offers an opportunity for pharmaceutical companies to consider these features when developing prescription drug advertising and disease awareness communications. For example, companies could space out communications and create greater visual distinctiveness between them.

A key strength of the two studies was their naturalistic design, meaning they reflected the different ways consumers may view disease awareness communications and drug advertising on television. Further, asthma was chosen for this research because it is a very common disease, increasing the likelihood that these results apply to typical prescription drug consumers. Future research could consider testing these concepts with other medical conditions and patient populations.

Overall, this work advances CDER research on how advertising features, such as graphics, format, and disease and product characteristics, impact the communication and understanding of prescription drug risks and benefits.