The effects of risk disclosure and ad involvement on consumers in DTC advertising

The effects of risk disclosure and adinvolvement on consumers in DTC advertising

Constantina Kavadas

Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada

Lea Prevel KatsanisJohn Molson School of Business, Concordia University, Montreal, Canada, and

Jordan LeBelSchool of Hotel Administration, Cornell University, New York, USA

AbstractPurpose – The importance of consumer involvement is well recognized in marketing theory, but has been absent from past inquiries in consumers’processing of DTC advertisements. The authors believe it is necessary to account for varying levels of involvement between consumers in order to betterappreciate their responses to DTC advertisement claims. The present study aims to shed additional insight into the relationship between consumerinvolvement and the processing of risk information in DTC advertising.Design/methodology/approach – The study was a between-subject factorial design and consisted of 156 students from a North American university.It used an instructional manipulation designed to compare how low and highly involved consumers perceive DTC drug advertisements and morespecifically the benefit and risk information contained in such advertisements.Findings – Findings indicate that consumers’ perception and processing of DTC advertisements resembles consumers’ reaction to fear appeals.Furthermore, consistent with previous studies, consumers react negatively to DTC advertisements containing a high content of risk information.Findings indicate that greater differences in consumer processing of risk information is observed when the sample is categorized as high versus lowinvolved, rather than sufferer versus non-sufferer, and that this consumer characteristic is important enough to include when examining consumerreactions to DTC advertisements.Originality/value – The relationship between amount of risk information and consumer responses has not been empirically examined whilecontrolling for the potential role of involvement. This study is a first step in addressing this gap.

Keywords Advertising, Consumer behaviour, Perception, Drugs, Risk analysis, Brands

Paper type Research paper

An executive summary for managers and executive

readers can be found at the end of this article.

Introduction

Over the last several years, pharmaceutical companies havesteadily increased their direct to consumer advertisingexpenditures (Anderson, 2003). Spending by USpharmaceutical companies has reached US$4.5 billion in2004, and a potential value of $400 million in Canada was

estimated by the Alliance for Access to Medical Information,should restrictions be eased (Kucharsky, 2005). DTCadvertising is a unique form of communication insofar thatit aims to increase brand awareness and also aims to motivateexternal search behavior. Pharmaceutical companies are

hoping that appealing directly to the end-user – in effectapplying the pull strategy – will entice more patients toconsult their doctors about the advertised prescriptionmedication (Mehta and Purvis, 2003; Gonul et al., 2000).

The strategy appears to be working: one study found that 31

percent of consumers who recalled seeing or hearing a DTC

advertisement took some kind of action, most often by

requesting a specific prescription brand from their physician

(McKillen, 2002). Of the various mediums used, television

expenditure at $2.7 billion, comprises more than half of all

industry’s DTC spending in 2004. Television advertisements

generate a higher level of awareness than any other medium or

by word-of-mouth, and that awareness is growing-from a 69

percent level in 2003 to 89 percent in 2004 (West, 2005)As with most advertising, prescription drugs are advertised

in a positive light, displaying healthy and satisfied consumers.

Unlike other products, the potential health risks of the drugs

are also included, which may create a negative tone to the

advertisements. From the perspective of the marketer, a

successful prescription drug advertisement communicates the

risk information of the product but places most of the

emphasis on the benefits hoping the consumer will have a

positive impression of the advertisement. By doing so there

may be an imbalance between the benefits and risks

information of the product communicated in the

advertisements (Roth, 1996; Everett, 1991; Perri and

Nelson, 1987; Morris and Millstein, 1984). The right

amount, emphasis and specificity of the risk information

must be conveyed such that the advertisement will be

perceived as informative and not overshadow the benefits of

the drug (Morris et al., 1985).

The current issue and full text archive of this journal is available at

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Journal of Consumer Marketing

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q Emerald Group Publishing Limited [ISSN 0736-3761]

[DOI 10.1108/07363760710746175]

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Although DTC advertising has proven to be successful, it

has not been without controversy. Proponents believe thatconsumers’ enhanced knowledge about available treatments

as a result of DTC advertisements has led to more accuratediagnosis, and appropriate treatments (Tyndale-Biscoe,

2003). Opponents of DTC advertising argue thatprescription drugs should not be promoted as other

products. Critics believe that many DTC advertisementsoverstate benefits and lack an appropriate representation ofrisk information (Melillo, 1999; Lexchin and Mintzes, 2002).

Many also believe that the emotional appeal often used inDTC advertisements biases consumers preferences toward

more expensive drugs (Coney, 2002). Such emphasis on salesand the recent pull of several popular medications off the

market, such as Voixx and Celebrex, have led to a negativereputation for pharmaceutical companies. According to aHarris Interactive poll in 1997, the year that DTC promotion

became legal in the USA, 79 percent of consumers believedthat the pharmaceutical industry was doing a good job. That

figure has dropped steadily ever since, from 73 percent in1998 to 66 percent in 1999, and 59 percent in 2000. By 2003,

it had dropped to 49 percent, and as of last year, the ratingslumped to 44 percent (Kastner, 2005).

The move from a push to a pull strategy has changed thenature of the relationship between players in the distribution

channel. One important consequence of DTC advertising hasbeen a shift in the physician-patient relationship (Taylor,2003; McKillen, 2002; Gonul et al., 2000). Doctors feel

frustrated at the fact that pharmaceutical companies are notspending enough on educating the public, but rather

companies are marketing- rather than cure-driven (Kastner,2005; Whisenant, 2004; Kaphingst and DeJong, 2004).

Studies have indicated that DTC advertising primarilyinfluences patients who are already diagnosed and are beingtreated, but fails to motivate the undiagnosed and untreated

who represent more than 50 percent of sufferers in many largecategories. Therefore, many believe that pharmaceutical

companies would benefit in emphasizing educating, as wellas selling, to the public (West, 2005).

In response, the FDA has issued warnings or evendiscontinued DTC advertisements largely over claims of

inaccurate risk presentation (Wechsler, 2003). This has alsoled consumers to become critical when viewing DTCadvertisements. For example, Rodale Publishing’s 8th

Annual National Survey on Consumer Reaction to DTCAdvertising of Prescription Medications found that

consumers are looking more closely at the risks of DTCdrugs in television advertisements and less at benefits, such

that: 79 percent of consumers recalled risk in televisionadvertisements (up from 76 percent in 2033); 71 percent

recalled benefits (down from 75 percent in 2003); 49 percentpay “a lot” of attention to risk information in DTC televisionadvertisements, whereas 29 percent pay “a lot” of attention to

benefit information in DTC television advertisements(Thomaselli, 2005). It is thus important that researchers

and practitioners understand consumers’ perceptions of andresponses to DTC advertisements.

Although the importance of consumer involvement is wellrecognized in marketing theory (Andrews et al., 1990), it has

been notoriously absent from past inquiries into consumers’processing of DTC advertisements. It is necessary to accountfor varying levels of involvement between consumers in order

to better appreciate their responses to DTC advertisement

claims. Since DTC advertisements are required by law to

include both risk and benefit information, it is likely that

consumers with different involvement levels will perceive riskdisclosure differently. In this regard, consumers processing of

risk information may resemble consumers’ processing of fear

appeals in advertising where a moderate level of riskinformation may be associate with the most positive

responses.Handlin et al. (2002) identified several problems in

advertising communication research as applied to DTC

pharmaceutical advertising, and the need for further researchin understanding consumers’ processing of these

advertisements. Following the Handlin et al. (2002) review,

the present authors are further examining key issues that mayaffect consumers’ processing of DTC advertisements. The

present authors report on a study intended to shed additional

insight into the relationship between consumer involvementand the processing of risk information in DTC advertising.

Many researchers have examined this unique aspect of

prescription drug advertisements. The focus of the majority ofstudies involving direct to consumer advertising of

prescription drugs, as well as the present study is todiscover the optimum amount of risk disclosure that will

satisfy both the advertisers, whose goal is to sell the product,

and the consumers, who want their rights of being informedprotected (Kopp and Bang, 2000; Morris et al., 1989).

Conceptual framework

The conceptualization and measurement of involvement hasbeen a contentious issue in marketing and advertising

research. However, it is generally accepted that involvement

constitutes “an individual, internal state of arousal withintensity, direction, and persistence” (Andrews et al., 1990).

Direction refers to the temporal stability of involvement:

enduring involvement persists over time while situationalinvolvement is fleeting and momentary. Although a consumer

may not be involved with a prescription drug (the product),

he or she may hold strong beliefs about pharmaceuticals andDTC advertising (the issue), or, for our purpose, that

consumer may still be involved with DTC advertisements (the

communication) for a variety of reasons such as personalconcerns over future health or the suffering of a friend or

family member.Advertising research has shown that attitude towards the

brand as well as purchase intentions are influenced by

consumers’ level of involvement with the advertisement(Andrews et al., 1990; Park and Young, 1986; Gardner et al.,1985). In situations where a consumer is highly involved, he

or she will be “exerting greater cognitive effort to comprehendthe advertisements, focusing more attention on product-

related information, and engaging in more elaboration of the

product information contained in the ads” (Zhang and Buda,1999). As a result, highly involved consumers recall more of

the advertisement claims after exposure.Insight as to how consumers may react to the different

levels of risk information in DTC drug advertisements may be

gleaned from research on fear appeals in advertising.Advertisements using fear appeals are described as

“psychoactive ads which are capable of arousing fear in the

viewer regarding the effects of the viewer’s sub optimallifestyle” (LaTour et al., 1996). Typical fear appeals contain

two components: “ a list of consequences intended to arouse

The effects of risk disclosure and ad involvement

Constantina Kavadas, Lea Prevel Katsanis and Jordan LeBel


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in the recipient a level of fear sufficiently intense to motivate

him/her to seeks a solution”; and “a list of recommendations

intended to reduce fear arousals by providing the necessarysolution” (Tanner et al., 1991). With DTC advertisements the

list of consequences are the potential side effects of the drugs,

though these are not included to motivate any specificbehavior. The recommendation in the case of DTC

advertisements would be the prescription of the drug.Claims typically used in fear appeal advertisements include

the negative consequences of not buying a certain product.

Such claims may be subtle such as “Why trust your picturesto anyone else?” (Kodak), or may be more aggressive such as

the recent depiction of diseased lungs or tar-stained teeth on

cigarette packages. By contrast, DTC advertisements typicallyinclude the potential negative consequences of consuming the

advertised product and the widely different levels of riskinformation divulged in DTC advertisements can create

responses similar to those associated with fear appeals

depending on the balance of risk to benefit informationpresent in the advertisements.

The relationship between the amount of risk information

and consumers’ responses may be described, much like theimpact of fear appeals, by an inverted-U shaped function.

Henthorne et al. (1993) proposed that weak fear appeals elicittension in consumers that causes feelings of energy and that a

more moderate level of fear causes more effective persuasion

while over this optimal threshold strong fear appeals elicitanxiety and negative responses. Protection motivation theory

(Tanner et al., 1991; Rippetoe and Rogers, 1987) suggests

that individuals select responses to cope with the danger thesethreats bring. Such coping responses may be the tendency to

generate more counterarguments and show poorer recall of

the product’s harmful consequences (Keller and Block,1996). The behavioral responses to risk information found

in DTC advertisements may also be very similar to responsesto fear appeals. When faced with a threatening message,

consumers engage in a variety of defensive strategies that may

include “avoiding the message, minimizing the severity of thethreat, selectively attending the message, discounting the

threat, and denying its personal relevance” (Eagly and

Chaiken, 1993, in Keller and Block, 1996). These defensivetechniques inhibit message persuasiveness (Keller and Block,

1996; Henthorne et al., 1993) and are likely to occur whenconsumers are faced with overwhelming risk information in

DTC advertisements. Furthermore, researchers have found

that individual differences may exist such that someindividuals are more likely to resist messages with strong

appeals, and call for a segmentation approach when applying

fear appeals (Keller and Block, 1996).With regard to DTC advertisements, research indicates that

consumers prefer less threatening warnings and perceiveadvertisements containing too much risk information

negatively (Tucker and Smith, 1987). However, the

relationship between amount of risk information andconsumer responses has never been empirically examined

while controlling for the potential role of involvement. This

study is a first step in addressing this gap, and hence usinginvolvement level as a segmentation variable.

Research objectives and hypotheses

This study seeks to predict and explain the reactions of high

and low involved individuals towards varying amounts of risk

disclosure in DTC. The primary objectives of the study aretwofold. The first objective is to examine the impact of theamount of risk information and involvement with the issue(ailment targeted by the drug) on consumers’ involvementwith the advertisement, recall of advertisement claims,attitude towards the advertisement, and attitude towards thebrand. Involvement is examined with the advertisement as aseparate dependent variable because it is believed thatparticipants who are highly involved with the issue (ailment)will also adopt defense mechanisms at higher levels of riskinformation and therefore become less involved with theadvertisement itself. The issue, however, may still beimportant to them. Second, the study was designed toexamine whether predictions inspired from research on fearappeals hold in the context of risk disclosure in DTCadvertisements.

Based on the foregoing overview of the literature, it isexpected that advertisements containing noticeably more riskthan benefit information will have the same effect onconsumers as advertisements containing strong fear appeals.However, participants’ level of involvement may influenceresponses in counter-intuitive ways. At higher levels of riskinformation, low involved participants may be in factreceptive to advertisement claims as they may be less likelyto tune out or selectively attend to the information.Specifically:H1. Research has found that over an optimal threshold

strong fear appeals elicit anxiety and negative responses(Henthorne et al., 1993). As a coping response higherinvolved consumers will become less involved with theadvertisement itself at high levels of risk information.

H2. Highly involved consumers will recall feweradvertisement claims at higher risk level compared tolower levels of risk and will recall fewer than lesserinvolved consumers (Keller and Block, 1996).

H3. Past research has established a relation betweenattitude towards the advertisement and brand(Burton and Lichtenstein, 1988), therefore, it isexpected that the consumers’ attitude towards theadvertisement will also be reflected in their attitudetowards the brand. Following the premise of anoptimal level of fear appeals, regardless of involvementlevels, attitude towards the advertisement and towardsthe brand will follow an inverted-U shaped patternwith peak attitude at balanced (equal) levels of risk andbenefit information.

An instructional manipulation is used to compare how lowand highly involved consumers perceive DTC drugadvertisements and especially the benefit and riskinformation contained in such advertisements. Although lowinvolved consumers may have less of an immediate interest inDTC prescription drug advertisements, they may nonethelessrepresent a potentially viable segment. Therefore, it is veryimportant to understand how both low and highly involvedconsumers process DTC advertisements and their claims toensure that such communication results in the desired positiveattitude towards the advertisement, the brand, themanufacturer, and eventually the industry as a whole.

Methodology

The study utilized two (involvement) by three (riskinformation) between-subject factorial design. Subjects were




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156 undergraduate students from a large Northeastern

university using a convenience sample; then randomly

assigned to groups.

ProceduresInvolvement manipulationTwo levels of involvement were created (low vs high) via

instructional manipulations. Participants in the low

involvement condition were simply instructed to browse

through the booklet of advertisements and to give us their

evaluations. In the high involvement condition, participants

were instructed to:

Imagine that a close family member has just told you that they are sufferingfrom seasonal allergies. They are extremely uncomfortable, and areexperiencing a series of severely unpleasant symptoms. You are sorry tosee a close relative suffer in such a way and this person has asked you to lookfor information on possible treatments for seasonal allergies.

The success of the manipulation was assessed through a

subset of Zaichowsky’s (1985) Personal Involvement

Inventory (Cronbach a ¼ 0:86). One-way ANOVA indicates

the manipulation was successful (MðhighÞ ¼ 3:76,

MðlowÞ ¼ 2:86, Fð1; 155Þ ¼ 14:30 (p , 0:001).

Risk manipulationThree target advertisements were produced with varying

levels of risk information created by manipulating the ratio

of risk to benefit information. In the high risk condition six

statements of risk were used along with two statements of

benefits. Low risk consisted of two risk statements for six

benefit claims and moderate risk included a balance of six

risk and six benefits statements. To assess the success of the

risk manipulation, participants were asked to indicate their

perception of the risk to benefit ratio on a seven-point scale

(1 ¼ more risk than benefits, 7 ¼ more benefits than risk).

One way ANOVA indicates the manipulation was

successful, a higher (MðlowÞ ¼ 5:10, MðmoderateÞ ¼ 4:48,

MðhighÞ ¼ 3:38, Fð2; 155Þ ¼ 18:70, p , 0:001).

MeasuresAttitude toward the advertisement was measured using

Holbrook and Batra’s (1987) scale, consisting of four seven-

point bipolar item (Cronbach a ¼ 0:93). Attitude toward the

brand was measured using Laczniak and Muehling’s (1993)

scale, consisting of five seven-point bipolar items (Cronbach

a ¼ 0:92). Participants’ score of correct answers (out of 12) in

an aided recall task was used as a measure of recall of the

advertisements’ claims. To assess behavioral intentions,

participants were asked to indicate (seven-point scale) the

extent to which they might engage in nine possible behaviors

if they were to see the target advertisement in a magazine

(Everett, 1991).

Results

Sample composition

Table I is a summary of the sample characteristics.ANCOVA was conducted on the four dependent variables

of interest. Involvement with the ailment and risk information

were used as the between-subject factors. Participants self-

report of being afflicted with the ailment were used as a

covariate to select the possible effects of actually having the

condition depicted in the advertisements (i.e. seasonal

allergies). This covariance attributable to suffering from the

ailment was significant only for the involvement with theadvertisement variable and will thus only be discussed then.

H1. Involvement with the advertisment

The first hypothesis held that highly involved participantsexposed to a high degree of risk information will in turnbecome less involved with the advertisement. A significantinvolvement by risk interaction (Fð2; 153Þ ¼ 3:132, p , 0:05)confirmed that participants highly involved with the ailmentremained more involved with the communication at low andbalanced levels of risk information but their involvement fallssharply at higher levels of risk and in fact matches theinvolvement with the advertisement of lesser involvedparticipants. This is illustrated in Figure 1. Suffering fromthe ailment was a significant covariate (Fð1; 152Þ ¼ 6:05,p , 0:05). Participants suffering from seasonal allergies weremore involved (Mean ¼ 3:8) with the advertisement thannon-suffering participants (Mean ¼ 3:0) (tð150Þ ¼ 2:91,p , 0:01).

H2. Recall of advertisement claims

The second hypothesis held that highly involved participantsexposed would recall fewer advertisement claims at a highlevel of risk information (compared to a low level) and wouldrecall fewer than lesser involved consumers who would remainreceptive to advertisement claims, or at least not as defensive.Results (illustrated in Figure 2) confirm an interaction effect(Fð2; 153ÞÞ ¼ 4:09, p , 0:05). Highly involved consumersrecalled 9.2 advertisement claims correctly when exposed tolow risk information but only 6.8 when exposed to high risk.Further, contrast analysis confirmed (Fð5; 155Þ ¼ 3:73,p , 0:01) that lesser involved participants exposed to highrisk information recalled more advertisement claims (8.0)than highly involved participants (6.8).

H3a. Attitude towards the advertisement

Attitude toward the advertisement was expected to follow aninverted-U shaped response and to be qualified by a morepositive attitude by lesser involved consumers at higher levelsof risk as they were expected to be less likely to engage in aperceptual defense mechanism. Although results are in theexpected direction (see Figure 3), none of the effects reachedsignificance.

H3b. Attitude towards the brand

We also expected an inverted-U shaped response pattern forthe attitude towards the brand measure, again with a slightlymore positive response by lesser involved participants at ahigher level of risk. Results showed a main effect of riskinformation (Fð2; 153Þ ¼ 4:35, p , 0:05) but the expectedinteractive effect of involvement at higher level of risk did notemerge (see Figure 4).

Discussion

As postulated, participants responded to advertisementscontaining a greater proportion of risk information as theywould to strong fear appeals. As previous fear appeal studieshave shown, consumers will display various defensivetechniques when faced with what they perceive as athreatening or disturbing advertisement message. Some ofthese responses include either avoiding or selectivelyattending the message, denying its personal relevance, andthus being less attentive to the advertisement message (Keller




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Table I Characteristics of sample

Group 1 Group 2 Group 3 Group 4 Group 5 Group 6

Variable HI inv/ control HI inv/ HI risk HI inv/ LO risk LO inv/ control LO inv/ HI risk LO inv/ LO risk

Gender (%)Male 23 38.5 42 38.5 46 34.5

Female 77 61.5 58 61.5 54 65.5

AgeAvg 26.5 24 25.3 24.8 25.7 25.2

Min 20 19 18 19 19 19

Max 33 36 38 36 35 33

Do you or have you ever suffered from seasonal allergies (S/A)? (%)Yes 38.5 15.4 34.7 23 38.5 27

No 61.5 84.6 65.3 77 61.5 73

Does anyone in your family suffer from S/A? (%)Yes 34.6 23 46 34.6 38.5 30.8

No 65.4 77 54 65.4 61.5 69.2

Figure 1 Involvement with the advertisement

Figure 2 Recall of advertisement claims

Figure 3 Attitude toward the advertisement

Figure 4 Attitude toward the brand




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and Block, 1996; Bush and Bush, 1994). As previous

involvement studies have indicated, consumers displaying low

attention towards an advertisement tend to recognize less of

the advertisement content after advertisement exposure

(Andrews et al., 1990; Petty et al., 1983). The results of the

present study are consistent with these findings, such that

highly involved participants exposed to a high risk did become

less involved with the advertisement due to the risk content.

These participants may have perceived the high content of

risk information as disturbing and therefore disregarded the

advertisement and behaved as low involved participants. This

is further supported by the fact that highly involved

participants exposed to a low risk advertisement remained

highly involved with ad. The low content of risk information

did not affect participants’ level of involvement. This suggests

that differences in the amount of risk content do affect

consumers’ attention levels towards the advertisement.

Interestingly, highly involved participants exposed to a high-

risk advertisement recognized even less than low involved

participants exposed to a high-risk advertisement.Studies (Roth, 1996; Sheffet and Kopp, 1990) have shown

that drugs having too many potential side effects may not be

good candidates for DTC advertising, since a high risk

disclosure gives a negative impression of the advertised

product, and consumers will view these products as too risky

while not providing enough potential benefits. The findings

are consistent with the literature, such that highly involved

participants had a negative attitude towards brands advertised

in high-risk advertisements in comparison to highly involved

participants exposed to a low risk ad. This finding further

supports the notion that some drugs are better suited for

DTC advertising than others. For example, advertisements

for the weight loss drug, Xenical, had to be discontinued since

the potential side effects were so numerous that consumers

felt the risks in taking the medication far outweighed what the

benefits might be.Unlike previous studies, consumers’ advertisement

involvement was included in the study design. Results

indicate that more significant differences were observed

between participants categorized as either low or highly

involved, than when analyzed as sufferers versus non-

sufferers. This may be an indication that more subtle

differences of consumers’ processing of risk information

may be observed when taking into account their level of

advertisement involvement, rather than simply noting if they

suffer or not from the advertised ailment.Results indicate that participants suffering from the

advertised ailment displayed greater advertisement

involvement than non-sufferers when exposed to a high-risk

advertisement. However, no difference in advertisement

involvement existed between seasonal allergy sufferers and

non-sufferers when exposed to a low risk advertisement.

Assuming that a highly involved participant is similar to a

seasonal allergy sufferer and a low involved participant is

similar to a non-sufferer, these findings are contrary to the

results obtained when the sample is categorized as high versus

low involved participants. In the present study, highly

involved participants exposed to a high-risk advertisement

behaved as low involved participants. Furthermore, highly

involved participants had a greater advertisement involvement

than low involved participants when exposed to a low risk

advertisement.

Managerial implications

The present study suggests that different outcomes are

observed when a sample is categorized as high versus low

advertisement involvement, rather than sufferer versus non-

sufferer. Therefore, it can be concluded that researchers

cannot assume that participants suffering from the advertised

ailment would necessarily display a high advertisement

involvement. The results appear to indicate that

advertisement involvement is an important construct to

include in the understanding of risk information processing.

In order to develop effective advertisements, pharmaceutical

marketers must fully understand their target audience. The

audience for DTC advertisements tends to be highly involved

consumers who may or may not require the advertised

medication. Future DTC advertising studies may want to

include participants suffering from the advertised ailment,

and within this group determine if any differences may exist

between high and low involved consumers.With a representative sample, the behavior and responses of

the target audience can be determined. For instance, a highly

involved sufferer may process high or low contents of risk

information differently than a low involved sufferer.

Study limitations and areas for future research

The present study included participants who were young

adults. Though prescription allergy medicine is used by the

present sample, prescription drug advertisements are

generally geared towards middle to older aged adults.

Future studies could include an older sample to examine if

any differences may exist between younger and older

consumers. As well, the current study examines only print

advertisements, and this may also limit some of the findings.The findings of the present study suggest that consumers’

perception and processing of DTC advertisements resembles

consumers’ reaction to fear appeals. Furthermore, consistent

with previous studies, consumers react negatively to DTC

advertisements containing a high content of risk information.

Greater differences in consumer processing of risk

information is observed when the sample is categorized as

high versus low involved, rather than sufferer versus non-

sufferer, and that this consumer characteristic is important

enough to include when examining consumer reactions to

DTC advertisements. Consumer perception and processing

of DTC advertisements seems to be more complex than what

is suggested in prior studies, and due to the seriousness of the

advertised product, it is essential for manufacturers to

conduct extensive research in consumer processing of risk

information. The development of DTC advertisements can be

a good source of information for consumers and can help

manufacturers increase awareness of their products. If done

carelessly, it can lead to misinforming the public regarding

their health and, in turn, be detrimental to the manufacturers’

reputations. It is the responsibility of the manufacturer to

ensure that their advertisements are informative and thereby

achieve and maintain a positive reputation and long-term

success in the marketplace.Participants’ level of involvement was manipulated in order

to create high and low involved participants. For the high

involvement manipulation participants were instructed to

imagine that someone close to them was suffering from

seasonal allergies and, had asked them to search for




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information about available treatments. These instructions

have a limitation such that, someone who is already suffering

from seasonal allergies may be more involved than a non-

sufferer, regardless of the instructions. Analysis indicated thatparticipants in the present study who did suffer from seasonal

allergies were in fact more involved than non-sufferers. In

future studies researchers may want to screen beforehand

sufferers versus non-sufferers, and create both a high and low

involvement manipulation within these two groups.The present study included an advertisement booklet that

consisted of one target advertisement and four filler

advertisements; no other material was included. Generallyprint prescription advertisements are found in magazines.

Participants may have paid attention to these advertisements

because there was no other material to distract them and,

therefore this setting may seem unnatural. Future studies maywant include additional reading material to create a more

realistic setting.The present study only examined print advertisements.

Researchers may examine the association of consumer

involvement and risk content in television advertisements.

Criticism of DTC advertising of prescription drugs has been

more prevalent for television advertisements becausepromoters have the opportunity with print advertisements to

include more information concerning the drug, whereas

television advertisements allow only 30 seconds to give as

much information as possible to the consumer.Future studies may include other consumer characteristics

and how they relate to DTC advertising of prescription drugs.

The present study only examined consumers’ level ofinvolvement; however, other constructs may include need

for cognition and level of trust the consumer has toward

prescription drug advertising.

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Corresponding author

Lea Prevel Katsanis can be contacted at: lkats@

jmsb.concordia.ca

Executive summary and implications formanagers and executives

This summary has been provided to allow managers and executivesa rapid appreciation of the content of this article in toto to takeadvantage of the more comprehensive description of the researchundertaken and its results to get the full benefit of the materialpresent.

During recent years, US pharmaceutical companies have

gradually increased their budget for direct to customer

advertising (DTCA) to the extent that spending reached $4.5

billion in 2004. While DTCA spans various media, television

advertisements are the most effective and consequently thismedium accounts for over half of the budget allocated.

The pros and cons of DTCA

The marketing of prescription drugs is no different to other

advertisements in that the aim is to depict the product inhighly favorable terms. However, organizations in this context

must also point out the potential risks involved with using the

product. The aim, therefore, is to provide the consumer withhelpful information without impairing the positive character

of the ad. But opponents of DTCA claim that this balance isnot achieved because marketers exaggerate benefits and

understate risks. The industry has also come under attackfrom doctors, who argue that pharmaceutical companies have

an obligation to educate the public as well as sell their

products. Evidence suggests that DTC advertisements mainlyinfluence patients whose condition is known rather than those

yet to be diagnosed.Although plenty point out that DTCA helps consumers

obtain a more accurate diagnosis and appropriate treatment,

the growing dissent has affected the level of faith in thepharmaceutical industry. When DTCA became legal in 1997,

79 percent felt that the industry was doing a job but this figurehad virtually halved by the end of 2004. The discontent has

also alerted the attention of the US Food and DrugAdministration (FDA) and led to warnings and sanctions

against advertisements containing insufficient risk

information.Research indicates that these developments have prompted

consumers to analyze advertisements more closely and that agrowing number are likelier to recall risk information rather

than product benefits.

Key factors: involvement and risk

Against this background, Kavadas et al. carry out an

investigation into consumer processing of DTCA and

specifically examine whether an individual’s level ofinvolvement influences perception and recall of risk

information. The authors hope that the study will assisttowards helping marketers provide the level of risk

information to satisfy both organization and consumer

needs alike.Various studies have indicated that correlation exists

between involvement levels and attention to a brand, andthat consumers who are more highly involved recall more of

an advertisement’s claim because they will scrutinize it ingreater detail than their lesser involved counterparts. The

authors point out that involvement in this case could relate to

opinions about pharmaceutical organizations, DTCA itself orperhaps personal concerns over the health of a family member

or close friend.Kavadas et al. draw attention to marketers’ use of “fear

appeals” whereby consumers are reminded of the likelynegative consequences of not using a particular product or

service. Another manifestation of this type of marketing is

when the advertiser recommends a solution that will reducefears that a certain outcome will occur. However, research has

shown that the desired outcome may only result if a moderatelevel of fear appeal is used. Too strong an emphasis can

produce anxiety and trigger use of defense mechanisms that




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help consumers manage what they perceive as threatening tothem. Such mechanisms can include counterargument,discounting the threat or dismissing the message aspersonally irrelevant. The outcome of this can often bepoorer recall of information relating to the potentially negativeconsequences of taking/not taking a certain course of action.

The authors hypothesize that consumers will likewise preferto receive moderate levels of risk information in DTCA, asother research has previously suggested. But empirical testingof this factor has to now not included the involvementvariable.

A total of 156 students from a North American universityparticipated in the present study. In order to create high andlow involvement, half read through a booklet containingadvertisements relating to a seasonal allergy while the otherswere instructed to imagine that a close family member wassuffering from the condition and had asked them to acquireinformation about possible treatments. The amount of riskinformation contained in the advertisements was alsomanipulated so that participants could be exposed to benefitand risk information in different ratios.

The findings showed the combination of involvement andrisk levels to be significant. When the risk informationpresented was low or moderate, highly involved participantspaid considerable attention to the advertisements and showedgood recall of the claims made. But, as predicted, at highlevels of risk information their response changed. Attention tothe advertisement decreased as did the amount of recall. Atthis point, highly involved respondents actually recalled fewerclaims than those less involved whose level of recall is usuallylower. The response to risk therefore broadly mirrored theresponse to fear appeals. Kavadas et al. also hypothesized thatproviding a balanced level of benefit and risk informationwould maximize feelings towards the advertisement andbrand but the evidence proved insignificant.

Implications and further research

Some respondents were suffering from the ailment and werethus found to be more involved than were non-sufferers.

However, the authors stress that involvement and suffering

are not the same and illustrate this by pointing out the

different responses at high risk levels. In contrast to the effect

of high and low involvement, sufferers pay greater attention

and recall more advertisement claims than do non-sufferers.

Kavadas et al. also believe that the “subtle differences” in

advertisement processing results more from the involvement

level rather than whether or not the individual is suffering

from the condition advertised. Further study could examine

sufferers to see if there are any differences between the high

and low involved categories within this group.But for now, marketers should regard suffering and

involvement separately within any strategy devised to

effectively target different audience segments. The authors

also reiterate claims made in earlier research that some drugs

will prove more suited to DTC advertising than others.

Specifically, advertisements for medicines with potentially

greater numbers of side effects will invariably carry levels of

risk information that will influence the perceptions of highly

involved consumers.That students participated in this study may be important.

Advertisements for prescription drugs are typically aimed at

older audiences, so future studies could prove more relevant if

those involved are representative of this age band. Likewise,

the relationship between other consumer characteristics and

DTCA is another possible avenue of exploration.Kavadas et al. also note the significance of using print

advertisements. This format permits the inclusion of larger

amounts of information, whereas television commercials have

a limited time frame in which to broadcast all the relevant

information. Since criticism of DTCA relates more to

television advertisements, future research should perhaps

focus more on this media.

(A precis of the article “The effects of risk disclosure and ad

involvement on consumers in DTC advertising”. Supplied by

Marketing Consultants for Emerald.)




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