# Misleading Advertising of Health-Related Products in Ecuador during the COVID-19 Pandemic
## 2 Materials and Methods  
A cross-sectional study was designed in which, as part of a training course in Basic Pharmacology, virtual training was provided for four hours to 31 medical students from a public university in Ecuador; this virtual training was based on the WHO guide \"Understanding and Responding to Pharmaceutical Promotion\" [10], as well as on the analysis of current legal regulations issued by health, communication, and consumer advocacy regulators in Ecuador [11, 14, 15, 16]. Between June and October 2020, each student was assigned between one and four channels of open signal television, depending on the time availability, signal, and geographic access of the evaluators; they were allowed to use the \"zapping\" technique, which consists of switching channels with the remote control at the will of the viewer [17]. In case television signal was not available, the programming was evaluated on the channel's internet or radio version. A total of 111 h of television were evaluated, distributed over a first period of five days in June (three months of pandemic) for an average of 18 h per day in general programming, and a second period of seven days in October (seven months of pandemic) for three hours per day exclusively in the Ecuadorian television news segment. The advertising spaces or segments (\"spots\") of products that, from the evaluator's perspective, offered to improve health directly or indirectly or prevent disease or death were considered as a unit of analysis. Simultaneously, each advertised product was investigated for whether it had a health registration or notification with a cut-off date as of 10 October 2020, on the official website of ARCSA [18, 19, 20].  
From each advertising spot, verbal, and non-verbal messages, including images, texts and audio, were analyzed, from which the advertised indication and the parameters of compliance with good practices of promotion and advertising in mass media were extracted, according to Ecuadorian current regulations. Each advertising spot is presented as a different unit of analysis since the same product advertisement could be perceived differently by each evaluator. A scale of three parameters was built to evaluate advertising spots, based on the ethical criteria of pharmaceutical promotion and advertising and regulations issued by the Ecuadorian Health Authority [14, 16]; speeches, content, and situational context where the spot was developed were analyzed. We analyzed three parameters of each advertising spot, as follows:  
1. Marketing authorization (granted by ARCSA);
2. Advertised indication (the veracity of information on the indication of use, associated risks in special populations, recommendations for use in healthy or chronically ill people);
3. Use of logos, names of health professionals, offers and prizes.  
When an evaluator reported that an advertising spot broke at least two components of the above three parameters, the advertisement was considered misleading. To improve the intercoder reliability a checklist was used (Appendix A). Finally, the information was verified by the leading author (MBM). When there was inconsistency in the data, the evaluators were contacted, the advertising was re-analyzed, and a common agreement was reached.