The effects of involvement and ad type on attitudes toward Direct-to-Consumer advertising of prescription drugs.
Abstract: This article examines consumers' attitudes toward Direct-to-Consumer (DTC) advertising of prescription drugs that are influenced by the use different types of DTC ads and product involvement. Our findings suggest that product involvement and the type of DTC ad are significant predictors of consumers' attitudinal responses toward DTC advertising. High involvement consumers have more favorable attitudes toward the drug's price, DTC ad and brand name, and a higher intention to ask a doctor about the advertised drug than low involvement consumers. In contrast to Informational and Reminder DTC ads, Persuasive ads have more favorable effects on consumers' reactions to DTC prescription drug advertising.
Article Type: Survey
Subject: Advertising (Laws, regulations and rules)
Pharmaceutical industry (Laws, regulations and rules)
Drugs (Prescribing)
Drugs (Usage)
Drugs (Laws, regulations and rules)
Authors: Limbu, Yam
Torres, Ivonne M.
Pub Date: 06/22/2009
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2009 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Summer, 2009 Source Volume: 32 Source Issue: 1
Topic: Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation
Product: Product Code: 7310100 Consumer Advertising; 2834000 Pharmaceutical Preparations NAICS Code: 5418 Advertising and Related Services; 325412 Pharmaceutical Preparation Manufacturing SIC Code: 2833 Medicinals and botanicals; 2834 Pharmaceutical preparations
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 250034400
Full Text: ADVERTISING OF PRESCRIPTION DRUGS

In the United States, the FDA loosened restrictions on Direct-to-Consumer advertising of prescription drugs in 1997. Only two countries i.e., the US and New Zealand allow Direct-to-Consumer Advertising (DTCA) of prescription drugs (Finlayson & Mullner, 2005). Pharmaceutical companies were some of America's most profitable corporations from 1995-2005 (Fortune, 2005). In 2004, they ranked third with profits of 16%, compared to 5% for all Fortune 500 firms. They ranked fifth most profitable companies in 2005 (Fortune, 2006). According to Relman and Angell (2002), more than one third of the US drug industry's workforce is employed in marketing including more than 88,000 sales representatives who are paid more than 7 billion per year. A research report by the Kaiser Family Foundation (2004) found that spending in the U.S. for prescription drugs was $162.4 billion in 2002 and that this number had increased to $179.2 billion in 2003. With the rapid growth of US pharmaceutical companies, advertising expenditure of prescription drugs is increasing rapidly each year, it was $2.47 billion in 2000 (IMS Health, 2000) and reached $4.2 billion in 2005 (IMS Health, 2006). A report by the Kaiser Family Foundation (2003) shows that each additional dollar spent by the drug industry on DTC advertising provides an additional $4.20 in pharmaceutical sales. In this report researchers also conclude that 13% of Americans have gotten a specific prescription in response to seeing a drug advertisement.

Total promotional spending on DTC advertising in 1999 was $1.8 billion, out of which 37% was for print ads (NIHCM Foundation, 2000). Although DTC advertising on TV overrides that on print media, Zoeller (1999) concludes that people prefer to read medical information in magazines. West (1999) found that over half of the respondents preferred print advertisements of prescription drugs because they could refer back and look through them carefully.

With the rapid growth of pharmaceutical marketing, several concerns have been raised. The sale and marketing of prescription drugs should not be governed solely by profit motives and market share incentives. The pharmaceutical industry needs to be cognizant of a duty towards their clients. More prominently, there are growing arguments among various individuals and institutions whether advertising of prescription drugs should be banned. However, little is known about the consumers' attitudes toward DTC advertising (Calfee, 2002; Williams & Hensel, 1995). The major purpose of this research is to examine consumers' responses to DTC advertising including attitudes toward DTC prescription drug brand and advertising, consumers' willingness to ask their doctors, and consumers' perceptions of prescription drug price. The healthcare implications of this research will help us understand why pharmaceutical companies should not only care about profitability but also be aware of the impact they have on society. They have to realize that their marketing efforts influence the way people make health-related decisions. The pharmaceutical industry needs to be aware of their obligation to their customers. If we know more about how marketing in general, and advertising in particular, influence consumers' healthcare perceptions and decisions, we can better understand the current healthcare situation.

REVIEW OF LITERATURE

Intent to Ask a Doctor

According to the informational processing model (McGuire, 1978), the purpose of the advertising campaign is to influence purchase behavior. However, pharmaceutical companies claim that DTC advertising is mainly aimed at informing consumers about a drug and encouraging them to ask their doctors rather than influencing purchase behavior. Holmer (1999) argues that DTC advertising can help consumers and improve public health by encouraging them to consult their physicians. Huh and Becker 2005 found that especially older and less educated consumers benefit from prescription drug advertising since they are more likely to be ready to communicate with their doctors. Their findings also suggest that women are more likely to seek information about prescription drugs and be prepared to communicate with their doctors. A study by Prevention Magazine (1998) based on a national survey conducted with technical assistance from the FDA stated that more than 53 million consumers talked to their physicians about a prescription drug they saw advertised. About 21.2 million consumers were encouraged to talk with their doctors about a medical condition or illness subsequent to seeing a DTC advertisement.

Another survey conducted by Preventive Magazine and the American Pharmaceutical Association in 1999 found that 31% of the respondents said that they had talked with their doctors about a prescription drug they had seen advertised. A survey conducted by the FDA in 1999 reported that about 25% of respondents who had seen an ad said they asked a doctor about a condition or illness. Academic research in the marketing literature has shown similar results. Mehta and Purvis (2003) conclude that more than two out of five respondents say they are very or somewhat likely to ask their doctors about a specific medication they saw advertised. The authors also found that respondents above 45 years old are significantly more likely to ask doctors about specific drugs they saw advertised compared to younger respondents. Weissman et al. (2003) found that about 35% of respondents asked their doctors about an advertised drug after seeing an ad for that prescription drug. A study by West (1999), found that 44% of surveyed respondents talked to their doctors about the advertised drug. Finally, a study the NIHCM foundation (2000) showed that about 10% of people who see a prescription drug ad ask their doctor for that specific drug. Peyrot, Alperstein, Doren, and Poli (1998) found that female, white, professionals, and those with more education were more likely to ask their physicians about a drug they saw in a DTC ad.

The findings discussed above regarding consumers willingness to ask their doctors about advertised drugs range from 10% to 44% of total respondents. These discrepancies may be caused by differences in sample selection, product involvement, media type, and types of advertising. To shed some light on the specific factors driving these differences and develop a conceptual framework that better explains consumers' response to DTC advertising, in the current study we are interested in examining consumers' tendency to ask a doctor under two conditions of product involvement (high and low involvement) and three types of DTC advertising (informational, persuasive, and reminder). By controlling the type of DTC ad and measuring respondents' involvement our study contributes to the marketing literature by examining several factors that interact to generate these differences in DTC advertising response.

Here, the product involvement refers to the extent of interest and concern that a person has in an object (Mittal, 1989). We argue that consumers with high product involvement tend to ask their doctors more than the consumers with low product involvement. We propose that persuasive advertising is more likely to encourage consumers to ask their doctors about an advertised drug than reminder and informational advertising.

Perceived Drug Price

Prescription drugs are costly for everyone and unaffordable for many (Searing, 2003). A study conducted by the Kaiser Family Foundation (2002) reports that nearly one quarter of older people skipped doses of medicine because of high costs. Relman and Angell (2002) argue that prices for prescription drugs are on average much higher in the United States than anywhere else in the world. Bolton, Warlop, and Alba (2003) state that pharmaceutical prices should be regulated because drug companies are making obscenely high profits. According to the Kaiser Family Foundation (2002), increasing drug costs and rising use of drugs are major drivers of the sharply increasing costs of healthcare. One of the main reasons for this trend in healthcare costs is the shifting to newer and higher-priced drugs and this is believed to be caused by advertising (IMS Health Report, 2005).

The theoretical and empirical results on the advertising-pricing relationship are conflicting since some studies suggest that advertising leads to higher product price whereas others indicate opposite (Farris & Reibstein, 1979). Kirmani (1990) argues that high perceived advertising cost implies high perceived advertising effort and people interpret this as a sign of high product quality. The author found that perceived advertising cost is positively related to expected price of the product or service. Herrick (2004) argues that consumers are looking for ways to cope with rising drug costs and reports a variety of techniques of reducing prescription drug costs. On the other hand, some studies have found that advertising does not increase the product price. A study by Steiner (1973) examined the relationship between advertising and prices and found that advertising lowers consumer prices. Greyser and Reece (1971) argue that businesspeople seem to believe that the net effect of advertising is to lower costs.

Even though previous studies have explored consumers' perceptions of drug prices they have not studied the role of product involvement and how this may affect their responses (Steiner, 1973; Greyser and Reece, 1971; Herrick, 2004). The research issue in this study, whether we can define certain consumer characteristics or dimensions that are responsible for the differences in responses to DTC prescription drug advertising, despite its importance, has not been adequately addressed in current advertising studies. Therefore, in this study, we aim to shed light onto what consumer characteristics (i.e. product involvement) and advertising characteristics (i.e. ad type) can influence consumers' perceptions of drug prices. By incorporating different types of advertising and product involvement, this study tries to examine consumers' perceptions of drug prices and whether consumers believe DTC advertising increases prescription drug prices.

Consumers' Attitudes toward DTC Advertising and Brand Being Advertised

Alperstein and Peyrot (1993) found that consumers had favorable attitudes towards prescription drug advertising in general but such attitudes were influenced by overall exposure to prescription drug advertising as measured by awareness of that advertising. Herzenstein et al. (2005) found that consumers' overall attitudes toward DTC ads for prescription drugs were neither extremely favorable nor unfavorable. Their findings suggest that consumers' attitudes toward DTC advertising are related to whether they search for more information about the drug that is advertised and ask their physician about the drug. Attitudes toward DTC ads were significantly related to consumers' intention to seek more information from a friend and a pharmacist (Williams & Hensel, 1995). A recent study conducted by Lee, Salmon, & Paek (2007) concludes that consumer who rely more on mass media and interpersonal channels for health information have more positive attitudes toward DTC advertising.

Past studies have shown that consumers' attitudes toward advertising have a positive relationship with attitudes toward the brand (Gardner, 1985; Mitchell & Olson, 1981; MacKenzie, Lutz, & Belch, 1986). A study by Brown and Stayman (1992) also found a direct relationship between attitude toward the ad and brand attitude. To better understand consumers' feelings about DTC advertising, the current study measures both consumers' attitudes toward DTC advertising and attitude toward the brand being advertised under two levels of product involvement and three types of advertising.

CONCEPTUAL FRAMEWORK AND HYPOTHESES

In the past, several studies have examined the consumers' attitudes and perceptions regarding DTC print advertising. However, these studies did not consider different types of DTC advertising and consumers' level of involvement which may have an immense influence on consumers' attitudes. Thus, the primary objective of this paper is to incorporate these variables and examine consumers' attitudes toward DTC advertising along with their intentions to ask their doctors and their perceptions of drug prices.

Relatively little research has been conducted on the issue of drug price perceptions especially research investigating consumers' perceptions of whether DTC advertising increases drug prices. This study attempts to answer these questions by examining consumers' attitudes toward pharmaceutical advertising, brands being advertised, willingness to ask a doctor, and price perceptions. In this study we also measure consumers' involvement and test three different types of DTC ads (informational, persuasive and reminder) since we believe these two factors interact and influence consumers' attitudes toward DTC advertising.

Types of DTC Advertising

According to Steiner's (1978) Dual Stage Approach, there are four stages of advertising which influence prices. In the case of goods which are not advertised, prices may be very high. Product prices start to decrease at initial stage of advertising. At the growth stage of advertising and product life cycle, price is very low. However, it is high at the maturity period. There are three major objectives of advertising--to inform, persuade, and remind consumers about the product (Kotler, Armstrong, Saunders, & Wong, 2001).

Prescription drugs sometimes more than other product categories follow the inform-persuade-remind approach to advertising. The very nature of the pharmaceutical industry lends itself to this approach which is why we decided to examine how the type of ad (informational, persuasive, reminder) could influence consumers' responses to DTC advertising.

Informational advertising Informational advertising attempts to search for the initial demand of a product by helping develop awareness of the product. According to Cutler, Thomas, and Rao (2000), an Informational ad focuses on providing meaningful facts to the consumer. Hunt (2001) states that Informational advertising conveys a factual advertising message from sender to receiver about the product or service. Moriarty (1987) proposes four processes used in Informational advertising. They are: (1) Identification (brand is identified); (2) Description (product attributes, its physical appearance, product sub-components etc.); (3) Comparison (comparing one brand with one or more competing brands); and (4) Demonstration (showing how to use, handle or prepare a product etc.). Puto and Wells (1984) define an Informational ad as one which provides consumers with factual brand data in a clear and logical manner such that they have confidence in their ability to assess the advantages of buying the brand after having seen the advertisement. Marquez (1977) describes an Informational ad as one that provides specific, relevant, and verifiable facts about an advertised product that are used in creating a desire for such a product.

Informational advertising strategy is usually used in the introductory stage of the product life cycle. The primary goal of this stage is to establish a market by informing consumers about the product and build primary demand for the product class. In this stage, marketing costs may be high in order to test the market, undergo launch promotion and set up distribution channels. The sales volume is typically low which results high product price. Informational ads inform consumers about a product but may not change the consumers' attitudes. At this stage, consumers are more sensitive of product price (Farris & Albion, 1980). Therefore, we hypothesize that consumers who watch informational DTC ads perceive higher drugs prices, have lower intention to ask their doctors, and less positive attitudes toward DTC advertising and brand name than consumers who watch Persuasive DTC ads.

H1: Consumers' attitudes toward an Informational DTC ad, brand name, intention to ask a doctor, and perceived drug price will be less favorable than those elicited by Persuasive DTC Ads.

Persuasive advertising Persuasive advertising attempts to increase demand for an existing product. It is typically aimed at influencing customers to buy a product by elaborating on the quality of the product or lifestyles that the product helps the consumer achieve. According to Hunt (2001), Persuasive advertising normally attempts to persuade consumers to purchase products or services, or to change consumers' attitudes or awareness levels, which may lead to purchase. Crisp (1987) argues that Persuasive advertising overrides the autonomy of consumers, in that it manipulates them without their knowledge. A Persuasive ad creates a desire for the advertised product without using specific, relevant, and verifiable facts about the product (Marquez, 1977).

Persuasive advertising is typically used in the growth and early maturity stage of the product life cycle. In this stage, sales and profits increase rapidly causing a decrease in product cost. Competitors are attracted into the market with very similar offerings. Advertising spending is high and focuses upon building brand awareness and as a result, market share tends to become stable. Farris and Albion (1980) argue persuasive advertising affects consumer preferences, tastes, changes product attributes, and differentiates the product from competitors. As a result, consumers become loyal to the brand and less sensitive to price. Thus, we propose that persuasive ads have a greater influence on consumers' attitudes and especially the ones most involved so that they are more likely to perceive drug prices as low and more likely to ask their doctors about a drug after seeing a DTC ad for that specific drug. Consumers exposed to persuasive DTC ads also tend to show more favorable attitudes toward DTC advertising and brand name.

H2: Consumers' attitudes toward a Persuasive DTC ad, brand name, intention to ask a doctor, and perceived drug price will be more favorable than those elicited by Informational and Reminder DTC Ads.

Reminder advertising Reminder advertising attempts to reinforce previous promotion by keeping the name of the product in the consumer's mind. According to Ivanovic and Collin (2003), Reminder advertising is designed to remind consumers about the product already advertised. It is particularly important in highly competitive markets. Reminder advertising usually follows an extensive advertising campaign, and therefore does not elaborate on the reasons to buy the product. Reminder ads give only the name of the product, but not what it is used for (Rados, 2004). In the case of DTC advertising, a reminder ad is not required to include risk information. Reminder ads call attention to a drug's name, but say nothing about the condition it is used to treat, its effectiveness, or safety information (Dukes, 2001).

Reminder advertising is used in the late maturity and decline stage of the product life cycle. In this stage, competition is most intense as companies fight to maintain their market share. Sales grow at a decreasing rate as the market reaches saturation. In the early stage of product maturity, promotion becomes more widespread and uses a greater variety of media. However, in the decline stage, market share is grabbed by more innovative products. There is intense price-cutting and many more products are withdrawn from the market. Since reminder DTC ads don't have enough information about the drugs they are advertising, consumers may not be as influenced as with persuasive DTC ads. Therefore, a consumer exposed to a reminder DTC ad tends to perceive a higher drug price, have a lower tendency to ask a doctor, and less favorable attitudes toward a DTC ad and its brand.

H3: Consumers' attitudes toward a reminder DTC ad, brand name, intention to ask a doctor, and perceived drug price will be less favorable than those elicited by Persuasive DTC Ads

Product Involvement

Although previous research on DTC advertising has studied several factors influencing advertising responses, an eminent factor is empirically neglected. Researchers suggest that product involvement may affect consumer responses; and they poignantly note that this relationship has received inadequate scholarly attention (Alperstein and Peyrot 1993). To overcome this research lacuna, we examine how people respond to DTC prescription drug advertising, and how their responses are moderated by ad type and product involvement.

Consumers' involvement with a product may be defined as the perceived personal relevance of the product to consumers (Zaichkowsky, 1985; Celsi & Olson, 1988). Product relevance depends on the association of the product attributes and its potential helpfulness in achieving consumers' personal goals and values (McGrath & Mahood, 2004). Laczniak, Kempf, & Muehling (1999) argue that product involvement ultimately leads to an advertising message involvement. Celsi and Olson (1988) also found a direct link between intrinsic sources of product involvement and ad message involvement. In their empirical findings, product involvement is an important determinant of advertising message involvement. Advertising message involvement (AMI) is a motivational state of an individual that induces message processing (Laczniak, Muehling, & Grossbart, 1989). Petty and Cacioppo (1986a, b) state that people form or change attitudes through two routes to persuasion: a central route, in which careful and thoughtful consideration occurs for the true merits of the information presented in support of a message and a peripheral route, in which some cue in the persuasion context permits attitude change without scrutinizing the message arguments. If recipients are highly involved in a subject matter, they will pay more consideration to the strength of the arguments within the message content (Petty & Cacioppo, 1979). As a result, they are motivated to process a message. If recipients are uninvolved, they will give more attention to the cues outside of the message content.

The effects of product involvement on a number of dependent measures like brand attitude, attitudes toward ads, and brand name recall have been explored by several studies (Phelps & Thorson, 1991; McGrath & Mahood, 2004; Gardner, Mitchell, & Russo, 1985). However, the impact of product involvement on DTC advertising especially to investigate consumers' attitudes towards asking a doctor and drug prices have not been explored. While the attitudinal differences between different types of advertising have been studied in the literature, attitudinal differences, in the context of DTC advertising, between high and low involved subjects have not been explored in the literature. In the current research, we examine the consumers' responses to DTC advertising under high and low product involvement. Our argument rests on the idea that the relationship between subjects and DTC advertising should be weaker for low involvement subjects, where by definition, the consumer does not engage in intensive decision making and considers few attributes. For high involvement subjects, the impact of DTC advertising should be more favorable since the consumer considers more attributes. The subject is more likely to ask a doctor since the message affects him personally. We purport that subjects with low product involvement have a positive relationship with perceived high drug cost but a negative relationship with their intention to ask a doctor about an advertised drug, attitude toward DTC advertising, and attitude toward a brand. Results should be the opposite in the case of high involvement subjects.

This study asserts that the consumers' perception of drug's price depends upon their product involvement. Highly involved consumers pay more attention to other drug features rather than price but subjects with low involvement tend to pay more attention to price. Moreover, we hypothesize that high involvement consumers have more positive attitudes DTC advertising and the brand being advertised.

H4: Regardless of DTC ad type, subjects with high product involvement tend to have more positive attitudes toward DTC advertising, brand name, intention to ask a doctor, and perceived drug price than the subjects with low product involvement.

The study anticipates that consumers are less involved with the informational and reminder print advertisements than with persuasive advertisements. The highly involved consumers are more likely to discuss the drugs advertised with doctors during their visits and are more likely to perceive drug prices as low. On the contrary, less involved consumers are less likely to ask their doctors about an advertised drug but more likely to perceive drug prices as high. Consumers' attitudes toward a DTC ad and its brand should be positive in the case of high product involvement and persuasive advertising while low-involvement consumers' attitudes should be less positive for reminder and informational advertising.

METHODOLOGY

Research Design

This study employs a 3x2 factorial design in which three types of advertising (Informational, Persuasive, and Reminder) and two types of product involvement (High and Low) are used as independent variables. Four variables: Intention to Ask a Doctor (IAaD), Perceived Price (PRICE), Attitude toward the DTC Ad (ADTCA), and Attitude toward the Brand (AB) are used as dependent variables. The final survey was pretested with 31 students who did not participate in the main study.

Stimuli

To avoid bias associated with using ads for one or more existing products, a single fictitious product--Dormecil sleep aid--appeared in all potential test ads. Potential test ads were derived from real ads that were digitally modified. To enhance internal validity, only slight changes were made to create three different ads (Informational, Persuasive and Reminder); the only significant difference was the ads' copy. Copy was modified to achieve these three different ad types but the model and featured product were positioned similarly. Different versions of potential test ads--each of the three sets contained three ads--were examined by a panel of experts to investigate if they met the criteria required for informational, persuasive, and reminder ads. One for each category was chosen as better reflecting the requirements needed for an ad to be classified in that category. The final three ads (informational, persuasive, and reminder) pretested with 26 students who did not participate in the main study.

Sample and Procedure

Although we measured respondents' perceived product involvement in our survey for both samples we also included a manipulation check. Prior to data collection, respondents were screened to make sure that the subject in fact suffered from the related ailment, that their current treatment was unsuccessful and that they have an existing relationship with a physician. Respondents were approached and screened for inclusion in our study. To enhance external validity, the study involves two sample groups--undergraduate students and adult patients surveyed while waiting for their doctors. Our student sample was composed of 93 undergraduate students each from a southern US university. In the adult sample, 93 adult patients each were surveyed while waiting for their doctors at several hospitals and clinics. Our final sample consists of 186 subjects.

For the experiment, three types of print ads (Informational, Persuasive, and Reminder) for a fictitious sleep aid "DORMECIL" were designed. Each subject in the experiment was randomly assigned one of three types of ads. After subjects read the print DTC ads, they were asked complete a 10-minute survey.

Measures

To measure the dependent variable "Intention to Ask a Doctor" (IAaD), a five item 7-point unipolar scale developed by Huh and Becker (2005) was employed. Consumers' perception of a drug's price (PRICE) was measured by employing eight item 7-point Likert scale based on the scale of Gaski and Etzel (1986). We also measured consumer's attitudes toward the DTC ad (ADTCA) by using a five item 7-point scale developed by Petroshius, Titus, and Hatch (1995). A five item 7-point Likert scale developed by Putrevu and Lord (1994) was used to assess the consumers' attitudes toward drug's brand (AB). Subjects were asked to provide their involvement with the advertised drug using a twelve item 7-point semantic differential scale. Subjects were also asked some general questions about prescription drug DTC advertising along with demographic questions such as age, sex, race, insurance coverage, education, and income.

Results

Our results show that older and less educated consumers benefit from prescription drug advertising since they are more likely to be ready to communicate with their doctors. Their mean scores of 'IAaD', ADTCA, and AB for all three types of ads (Persuasive, Informational and Reminder Ads) are significantly higher than the mean scores for younger and more educated consumers. Thus, age and education are significant predictors of consumers' health perceptions and behavior (p <.001). Income and having prescription drug coverage by a private or public insurance were significant predictors of consumers' intent to ask their doctors and price perceptions (p <.05). Our findings also show that Caucasian consumers were more likely to ask their physicians about a drug they saw in a DTC ad (p <.05) compared to minority consumers (Hispanic, African American, and Asian consumers in our sample). Finally, gender is a significant predictor of health-related intentions (p <.05). We found that women regardless of age and educational level are more likely to ask their doctors about prescription drugs they see advertised.

Multiple Analysis of Variance (MANOVA) was used to analyze our data. The results of MANOVA show that Bartlett's test is significant (.000) which indicates a significant amount of intercorrelation among dependent variables. It also assures homogeneity of variance since univariate Levene's Tests are not significant for all dependent variables (for IAaD, p>.062; for PRICE, p>.33, for ADTCA, p<.27, and for AB, p>.26).

The mean scores and standard deviations are presented in Table 1. As anticipated, the mean scores of all dependent measures (except perceived drug price) are higher for high product involvement respondents than low involvement respondents. They indicate that high product involvement has positive relationship with attitude toward DTC advertising, brand name, and intent to ask doctors. However, the differences of scores among the three types of advertisement are not always constant. The mean scores of 'IAaD', ADTCA, and AB for a Persuasive Ad are significantly higher than Informational and Reminder Ads. However, we do not find such relationship in the case of PRICE since consumers perceived a higher drug's price for both Informational and Reminder ads than for Persuasive ads.

Table 2 shows overall MANOVA results. Multivariate tests shows that significant main effects were found for ad type (Wilks' Lambda = .733, F =1.729, p<.010) and involvement type (Wilks' Lambda = .847, F = 1.868, p<.027). They show that independent variables (types of DTC ad and product involvement) have significant main effects on dependents variables (IAaD, PRICE, ADTCA, and AB). Univariate f-tests reveal a significant impact of ad type on PRICE (F=3.508, p<.032), ADTCA (F=3.189, p<.044), AB (F=2.636, p<.074) and IAaD (F=2.317, p<.093). There is an effect of product involvement on IAaD (F=3.472, p<.046), PRICE (F=7.069, p<.009), ADTCA (F=3.395, p<.039), and AB (f=5.063, p<.026). The multivariate and univariate results show significant interaction effects i.e., ad type by involvement level interaction (Wilks' Lambda =.746, F=1.629, p<.020).

Hypothesis 1 predicts that consumers' ADTCA, AB, IAaD, and PRICE will be less favorable for an Informational DTCA than for a Persuasive DTCA. Hypothesis 1 is supported since the mean scores of IAaD, ADTCA, and AB for the Informational DTC ad are less than Persuasive DTCA while mean scores of PRICE are higher for an Informational ad than for the Persuasive ad. Our results show Informational DTC ads are less effective to encourage consumers to ask their doctors about a drug than Persuasive DTC ads. Subjects also perceived a higher drug price after seeing an Informational ad than a Persuasive ad. Our data also supports hypothesis 2. Mean scores of all dependent variables except PRICE for Persuasive ads are higher than for Reminder and Informational DTC ads while mean scores of PRICE are lower for Persuasive ads than for both Reminder and Informational DTC ads. This indicates that consumers' reactions toward Persuasive DTC advertising have a positive relationship with ADTCA, AB, IAaD, and PRICE. The mean scores of IAaD, ADTCA, and AB for Reminder ads are lower than for Persuasive ads while mean scores of PRICE are higher for Reminder ads than for Persuasive ads. Thus, hypothesis 3 is supported. Overall, the effect of ad type was significant at the p <.10 level. Results also support hypothesis 4. Subjects with high product involvement tend to have positive attitudes toward DTC ads, brand name, intent to ask a doctor, and perceived drug price in contrast to the subjects with low product involvement and this relationship was significant at the p <.05 level.

DISCUSSION

The present findings suggest that types of advertisement and product involvement are significant predictors of consumers' attitudinal responses toward DTC advertising. One of the main contributions of this research is to shed light on the previous conflicting findings of 'intent to ask a doctor' ranging from 10% to 44%. This study provides empirical evidence that helps explain such variance in previous findings. By incorporating and measuring involvement our study explored its impact on consumer response. Also, based on a conceptual framework, the current study helps explain how involvement interacts with ad type and how this interaction affects consumers' responses to DTC advertising. Finally, by not only studying advertising and brand attitudes but also incorporating and measuring intent to a ask a doctor and price perceptions, our research tries to provide a more comprehensive approach to the study of consumers' response to DTC advertising.

For example, the current study found that consumers with high product involvement were more likely to ask their doctors about a drug after seeing a DTC ad for that drug than low involvement consumers. Similarly, we found that Persuasive DTC ads had a bigger influence on consumers' intent to ask their doctors than Informational and Reminder DTC ads. From these findings, it may be concluded that the inconsistency in previous findings can be attributed to differences in levels of product involvement. To the best of our knowledge, this is the first study in DTC advertising that attempts to examine all of these constructs (DTC ad type, involvement, intent to ask a doctor, attitudes toward DTC ads, brad attitudes and perceived price) and incorporates them in a comprehensive conceptual framework with a sound theoretical foundation.

Findings of this research may have several managerial implications. First of all, the results confirm Persuasive DTC ads have greater influence on consumers' positive perceptions toward DTC brands and advertising since consumers who see a Persuasive DTC ad are more likely to ask their doctors about the advertised drugs than those who see Informational and Reminder DTC ads. Therefore, pharmaceutical companies may focus on persuasive ads to make consumers ask their doctors about their prescription drugs. Based on our results, consumers who see Informational and Reminder DTC ads are more sensitive to drug price than those who see Persuasive ads. Farris and Reibstein (1979) suggest managers should practice consistent pricing and advertising strategies for better financial performance. Thus, managers are recommended to be aware of this findings and adjust price accordingly especially during introductory and decline phases of the product life cycle. The majority of our respondents (74.6%) believe drugs are overpriced and only 47% of them state they are satisfied with the prices they pay for prescription drugs. Thus, these statistics may be valuable for managerial decision-making. Marketing managers and advertisers should also pay close attention to the accuracy and adequacy of information since more than 50% of the respondents in our study reported that DTC ads in general have confusing and inadequate information.

Findings of this research may also have several healthcare implications. Advertising of prescription drugs should not be driven only by profitability. Prescription Drug companies have to be mindful of their influence on society. The main objective of our research was to explore consumers' responses to DTC advertising including attitudes toward DTC prescription drug brand and advertising, consumers' willingness to ask their doctors, and consumers' perceptions of prescription drug price. The healthcare repercussions of our research may help the reader be more aware of drug companies' need to be more watchful of their impact on society and not only be worried with market share incentives and profit motives. These companies need to recognize that their marketing efforts have an impact on the way people make healthcare choices. The pharmaceutical industry needs to be cognizant of their responsibility to their clients. Our research contributes to the literature by studying how advertising of prescription drugs influences consumers' healthcare perceptions and intentions.

Limitations and Future Research

Despite its significance, the current research has several limitations. First of all, it is under-representative of underage, less educated people, and healthy adults. This study attempted to seek consumers' attitude toward DTC print ads. The outcomes may be different in case of other media. There is room for future research to replicate this research in television DTC advertising. Finally, our research studied only DTC advertising, other researchers should be cautious about generalizing in fields other than DTC advertising of prescription drugs. Thus, future research may be conducted in other areas of advertising.

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YAM LIMBU

Montclair State University

IVONNE M. TORRES

New Mexico State University
Table 1
Descriptive Statistics

Dep        ADTYPE   INVTYPE   Mean   Std.       N
Variable                             Deviatio
                                     n

IAaD       INFO     LOW       2.87   1.68       32
                    HIGH      2.90   1.93       30
           PERS     LOW       3.36   2.14       31
                    HIGH      3.53   2.12       31
           REM      LOW       2.51   1.69       30
                    HIGH      3.67   2.05       32
PRICE      INFO     LOW       5.70   1.74       32
                    HIGH      4.90   1.20       30
           PERS     LOW       5.06   1.45       31
                    HIGH      4.03   1.72       31
           REM      LOW       5.74   1.23       30
                    HIGH      5.48   1.12       32
ADTCA      INFO     LOW       3.90   1.02       32
                    HIGH      4.43   1.04       30
           PERS     LOW       4.29   1.03       31
                    HIGH      4.89   1.19       31
           REM      LOW       3.86   1.33       30
                    HIGH      4.21   1.23       32
AB         INFO     LOW       3.58   1.36       32
                    HIGH      4.22   0.62       30
           PERS     LOW       4.16   0.82       31
                    HIGH      4.43   0.99       31
           REM      LOW       3.66   0.95       30
                    HIGH      3.93   1.04       32

Table 2
Summary of Multivariate Analysis of Variance

Effect                           F-Ratio   P- Value

INTERCEPT   Pillai's Trace       1337.45   .000
            Wilks' Lambda        1337.45   .000
            Hotelling's Trace    1337.45   .000
            Roy's Largest Root   1337.45   .000

ADTYPE      Pillai's Trace       1.73      .010
            Wilks' Lambda        1.72      .010
            Hotelling's Trace    1.72      .010
            Roy's Largest Root   2.17      .008

INVTYPE     Pillai's Trace       1.86      .027
            Wilks' Lambda        1.86      .027
            Hotelling's Trace    1.86      .027
            Roy's Largest Root   1.86      .027

ADTYPE *    Pillai's Trace       1.63      .019
INVTYPE     Wilks' Lambda        1.62      .020
            Hotelling's Trace    1.61      .021
            Roy's Largest Root   1.72      .046
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