# Presentation: 838159

## DTC Advertising of Prescription Medications on the WWW:

**William J. Vigilante Jr., Ph.D.**
**Michael S. Wogalter, Ph.D.**
**September 23, 2003**

**Assessing the Communication of Risks & Benefits**

## Introduction

- Consumers increasingly using the World Wide Web to gather product information & research
- Drug manufacturers increasingly using Web site advertisements to present information on their products
- No specific guidelines on how to present drug risk & benefit information on Web site advertisements
- Fall under guidelines for other mediums
- Little research on the factors that facilitate (or hinder) the communication of this information in Web site DTC ads
- Study’s Purpose:
- What is the best way to present risk information on drug web sites?

## Warnings literature suggest conflicting research on the           best way to present risks with other product information
Some research suggest integrating risks & with benefits: 
People will see risks as they read benefits/indications
Other research suggest separating risks and benefits: 
Allows for highlighting and other means to capture attention

Experiment manipulating drug risk/benefit placement while holding all else constant
Integrated risks within benefits
Separated risks and benefits

- Some research suggest integrating risks & with benefits:
- People will see risks as they read benefits/indications
- Other research suggest separating risks and benefits:
- Allows for highlighting and other means to capture attention
- Experiment manipulating drug risk/benefit placement while holding all else constant
- Integrated risks within benefits
- Separated risks and benefits

**Integrated or separated?**

## Home page or lower level pages?

- Web Usability guidelines:
- Place important information on the home page or other popular entrance pages
- Lose 50% of visitors (searching for specific info) at each page
- 2-3% of visitors who are just browsing click to the next page
- Risk placement within the web site hierarchy was manipulated to examine their effects
- Risks were placed on home page, 2nd level, or 4th level page

## Variables Examined

- Risk/benefit placement  manipulated to determine        effects on the likelihood of people noticing & reading         the information
- Control: no risks or benefits
- Integrated - Home page: R/B same paragraph / home page
- Separated - Home page: R/B separate sections / home page
- Separated – 2nd level page: R/B separate 2nd level pages
- Separated - Mixed level pages: R-2nd level page / B-home page
- Integrated – 2nd level page: R/B same paragraph / same 2nd level page
- Separated – 4th level page: R-4th level page, linked from a 3rd level page
- Used 2 drugs & tasks to determine generalizability of the results
- Item search task
- General browse task

## Item Search Task

- Experiment disguised as a “usability study”
- Participants told that we were evaluating web site design & content
- We did not want the participants to know we were interested in the risk & benefit placement
- Randomly presented 1 of the experimental drug web site versions
- Participants asked to complete 6 tasks:
- 1 pertaining to risk information
- 1 to benefit information
- 4 distractor tasks
- Variables measured during Item Search Task:
- Accuracy
- Amount of time to find risks or benefits
- Number of clicks to find risks or benefits

## Browse Task

- Experiment disguised as a “Marketing study”
- Participants told that we were evaluating attitudes towards          7 product web sites
- We did not want the participants to know we were interested in the risks & benefits
- Randomly presented 7 product web sites
- 6 distracter web sites & 1 of the experimental drug web site versions
- Participants allowed to freely browse each for 3 minutes
- Upon completion participants were given surprise memory tasks
- Variables measured during Browse Task:
- Risk & benefit Recall
- Risk & benefit Recognition
- Scores transformed into % to allow comparison between risk/benefit recall & recognition

## Time-on-Task in Seconds

## Mean Number of Clicks

## Item Search Continued

- When we collapsed across separated conditions:
- Risk found faster and with less clicks they were presented on         a 2nd level page compared to the home page
- Possibly caused by placement of link to risk vs. risk placement on home page
- Link placed prominently in navigation bar, whereas risk placed after other information further down the home page
- Consistent with past usability research that has shown information located further down on a web page is less likely to be seen than information located at the top of a web page
- Risk found faster and with less clicks they were presented on a 2nd level page compared to the 4th level page
- The results highlight a performance decrement when important information is placed at lower levels of the web site hierarchy

## Browse Task Results

- Recall & Recognition scores similar to Item-Search Task results
- Risks:
- Separated 2nd level page conditions highest
- Followed by Integrated-2nd level
- Home page conditions (Integrated and Separated)
- 4th Level page
- Benefits:
- Recall results were not significant
- Home page conditions (Integrated and Separated) highest
- Followed by Second level page conditions
- 4th Level page
- Placement of risk information effected memory of benefit information

## Information Balance

- Examine the balance of risks & benefits in DTC ads required by U.S. Federal regulations
- Overall, participants tended to remember a comparable amount of both risk & benefit information
- Even though the web sites outlined more risks than benefits
- When no risks or benefits were given, participants remember more benefits than risks
- Participants may have successfully guessed or determined more benefits based on the other information presented
- When the risks were more difficult to find than the benefits, more benefits tended to be remembered
- However, if the risks were easier, or as easy to find as the benefits, more risks tended to be remembered

## Discussion

- Most advertisements present the drug in a context        that demonstrates the symptoms it alleviates
- Drug ads mainly focus on the benefits of the drug
- Only a small portion of the ad is aimed at presenting the risks
- An equal balance of drug risk and benefit information is not completely determined by the total amount of information given
- An equal balance may be affected by other factors, such as ease of finding the information or accessibility of the information
- Both of which are affected by the placement of the information on a web page and within the web site hierarchy

## Conclusions

- Results reflect the varying effects of information placement on the ability to find & remember risks & benefits on DTC drug web sites
- DTC prescription medication web sites & guidelines should be designed to facilitate access to important risk & benefit information
- I.e., where and how the information is presented on the web site
- Current FDA regulations simply require the same number of risks and benefits
- Guidelines....

## Guidelines

- Suggested placement for Risk & Benefit information on DTC medication web site ads based on the current results:
- Separate risk and benefit information sections
- Place important risks & benefits in the top half of the home page or on a 2nd level page
- Prominently place a link to the risks and/or benefits in the top half of the home page:
- Top part of the navigation bar or top-center area of the home page
- Explicitly and prominently label "Risk and Side Effects" and "Benefits”

## Backup Slides

## Drug and Task Type Interaction

- Item search scores consistent across both drugs
- Provide support that current results will generalize to other drugs
- 1 drug benefits were easier to remember than 2nd drug
- Suggest that consumers may have more difficulty remembering specific risks & benefits for some drugs compared to others
- Thus a need to facilitate memory of important drug information:
- Use simple words to describe the drug's risks & benefits
- Highlight important information
- Present the risks & benefits in a list format
- Results were consistent across task type
- DTC drug ad web sites can be designed to increase the likelihood that risk information is noticed, read, & remembered by persons specifically searching for the risks & by persons visiting the web site, who are not specifically looking for the risks

## Guidelines Continued

- Additional guidelines based upon previous research include:
- Present risks & benefits in a consistent location on DTC prescription medication web sites
- Use highlighting to draw attention to important risk information
- Use list format rather than paragraph format
- Use the simplest text possible to describe important information on a web site
- Follow existing usability guidelines for the development of easy-to-use web sites
- Web sites should be designed to facilitate finding of important information (risks & benefits) by the least experienced users of the web site
- Employ iterative usability testing during web site development to ensure important risk & benefit information is easily found
- Use participants from the intended user population: potential consumers

## References

- Vigilante, WJ and Wogalter (In press). Assessing risk and benefit communication in Direct-to-Consumer medication web site advertising. *Drug Information Journal*.
- Vigilante WJ, Wogalter MS. Direct-to-consumer (DTC) advertising of prescription medications on the World Wide web: assessing the communication of risks. *Proceedings of  the Human Factors and Ergonomics Society 45th Annual Meeting*. 2001;1279-1283.
- Vigilante WJ. Direct-to-Consumer (DTC) advertising of prescription medications on the World Wide web: assessing the communication of risks and benefits browser (Doctoral dissertation, North Carolina State University, 2001).  *Dissertation Abstracts International*. 2001;63:341.
- Contact:
- Bill Vigilante, Ph.D.
- Robson Lapina, Inc.
- 350 New Holland Ave
- Lancaster, PA 17602
- 1 (800) 813-6736 x 249