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Direct-To-Consumer Pharmaceutical Advertising: Context and Meaning in Older Women's Lives

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Direct-To-Consumer Pharmaceutical Advertising: Context and Meaning in Older Women's Lives DIRECT-TO-CONSUMER PHARMACEUTICAL ADVERTISING: CONTEXT AND MEANING IN OLDER WOMEN'S LIVES By JUDITH JOPLING SAYRE A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY * ^ UNIVERSITY OF FLORIDA 2003 ACKNOWLEDGMENTS Completing a project such as this dissertation, especially at this stage in one's life, presupposes a large cast of patient supporters. Let me briefly attempt to thank those whose belief and encouragement made this study possible. Dr. Deborah Treise, my chair, mentor, and friend, truly encouraged and supported me throughout my academic career. She first introduced me to the qualitative paradigm and helped me explore its application to those questions of aging and health-related communication that truly interest me. Later, as my chair, she encouraged, assisted, advised, and, occasionally, prodded me to stay on track throughout the entire process. Drs. Kim Walsh-Childers, Michael Weigold, and Donna Berardo were ideal committee members. Their advice and suggestions were always timely and invaluable. I also would like to add that without the initial encouragement of Dr. Marilyn Roberts, Dean for Graduate Studies, I might never have begun this endeavor. Finally, like so many others who have completed a graduate degree in the College of Journalism and Communications, I want to acknowledge the unflagging-and unflappable-help provided by Jody Hedge, Program Assistant in the Division of Graduate Studies and Research. This qualitative study would not have been possible without the gracious participation of the women of northeast Florida who so generously made available their time, shared their opinions, and, in the interviews, opened their homes to this researcher. This study truly is their story. ii a researcher Finally, before any valid qualitative research can be accomplished, the must acknowledge her own personal history, developing an understanding of the factors influencing her research perspective. My interest in and understanding of issues surrounding health-related communication have been immeasurably enriched through countless discussions with my husband and best friend, Jerry W. Sayre, M.D.— consummate physician communicator. His love and encouragement have been a constant source of strength. Additionally, any accomplishments of mine have been built on the values established by my parents, Wallace and Miriam Jopling. For almost 60 years, their loving support and faith have been a source of strength to many. Their values continue through future generations; I am fortunate, indeed, that my children and grandchildren have been so encouraging and patient during a project that often kept me from participating in their lives as much as I would have liked. Finally, I would like to acknowledge two individuals who, although not here among us, were immeasurably influential to me. The first is my grandmother, Sara Lovett Jopling, a lady who instilled in me a love and respect for the traditions of oral history. The second is my dear friend, Helen Aller, who first believed that I truly could complete a project begun so long ago. iii 1 TABLE OF CONTENTS ACKNOWLEDGMENTS " ABSTRACT CHAPTER 1 1 INTRODUCTION AND PURPOSE OF STUDY Overview ^ Problem ^ Theoretical Framework Guiding the Study 9 Overview of Chapters 12 14 2 LITERATURE REVIEW Symbolic Interactionism: The Research Perspective 16 DTC Pharmaceutical Advertising 21 DTC Advertising and Older Adults 37 Elements of Print DTC Pharmaceutical Advertising 49 Research Questions and Hypotheses 59 3 METHODS 61 Introduction 61 Quality Evaluation Within the Qualitative Paradigm 64 Methods Employed 67 Summary ^2 4 ANALYSIS OF RESEARCH 83 Baclcground 83 Personal Health Concerns 89 Social Context of Health Issues 95 Themes Specific to DTC Advertising 98 Summary 1 1 iv 7 5 DISCUSSION 1 1 Importance of Issue Discussion of Findings ^-^^ Limitations of Study ^23 Directions for Future Research APPENDIX A RESEARCH QUESTIONS AND HYPOTHESIS 128 B INFORMED CONSENT FOR IN-DEPTH INTERVIEWS 129 C INTERVIEW DISCUSSION GUIDE 130 D INFORMED CONSENT FOR FOCUS GROUP INTERVIEWS 132 E FOCUS GROUP GUIDE 133 F SAMPLE INTERVIEW TRANSCRIPT 135 G ST JAMES FOCUS GROUP 140 REFERENCES 153 BIOGRAPHICAL SKETCH 166 V Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy DIRECT-TO-CONSUMER PHARMACEUTICAL ADVERTISING: CONTEXT AND MEANING IN OLDER WOMEN'S LIVES By Judith Jopling Sayre May 2003 Chair: Deborah Treise, Ph.D. Major Department: Journalism and Communications This qualitative study used a triangulation of methodologies—in-depth interviews, focus groups, and observation—to investigate the context and interpretation of direct-to-consumer (DTC) pharmaceutical advertising in the lives of a group of 43 women older than age 65. Study participants were selected because they fit within the parameters of a key target of DTC advertising—older female consumers. The theoretical grounding of this study in a symbolic interactionism perspective helped provide an enhanced understanding of three broad research questions: (1) How do older women use this form of advertising to create and evaluate their sense of personal health? (2) How do older women use group health-related norms in constructing meaning for DTC advertising? (3) How do older women incorporate DTC advertising in their interactions with their physicians? Analysis of the transcribed discourse, augmented by observational data, revealed ten emergent themes grouped into three general areas: personal health issues, social themes related to DTC advertising, and themes related to specific areas of vi their DTC advertising. While women of all ages reported markedly similar agreement in interpretation of the concept of "good health," differences emerged between the respective cohorts of younger (65-75) and older (>75) women. Younger women were group much more likely than older women both to discuss DTC advertising with referent members and to discuss an advertised drug with their physician. Women who expressed negative opinions of DTC advertising also showed age-related differences, with the older women reporting disapproval of the entire concept of DTC advertising, claiming that such a request interfered with the traditional patient-physician role. Younger women who disapproved of DTC advertising reported concerns that this form of advertising was making a negative societal impact through the manipulation of increasingly large numbers of people into seeking medications for problems better solved through lifestyle changes. Finally, study participants of all ages reported problems related to difficulty of reading copy because of small copy size. In addition, no participants voluntarily attended for to the "brief summary" page of any ad unless directed by the researcher, hnplications these findings for the pharmaceutical industry, advertising agencies, and regulatory bodies are discussed. vii CHAPTER 1 INTRODUCTION AND PURPOSE OF STUDY Consumers are notorious for not being able to identify their needs and reasons wants for drug products. They often do not want to give their real hear for their health behaviors. Many times they want to repeat what they reigns. 1 am in the media about correct health habits. Political correctness not saying do not talk to consumers. What I am saying is take what they say with caution and do not suspend good marketing judgment. (Erlich, 2001, p. 10) Overview More and more patients are requesting drugs from their physicians in much the same way 2000; they shop for shoes—by brand name (Freudenhaim, 1998; HoUon, 1999; Huang, new Mclnturff, 2001). "Just prescribe it," rather than Nike's "Just do it," has become a dynamic in patient-physician relationships (Bell, Kravitz, & Wilkes, 2000; Johnson & Ramaprasad, 2000; Wilkes, Bell, & Kravitz, 2000). Direct-to-consumer (DTC) pharmaceutical advertising is a driving force behind this increasingly consumerist approach to prescription medication. Between 1997 and 2001, DTC pharmaceutical advertising increased 145%, reaching $2.7 billion in 2001 (U.S. General Accounting of Office, October, 2002, p. 3). DTC advertising has been cited as a major cause increasing health care costs (Pear, 2001b; Peterson, 2002), patient over-medication patient-physician relationship (Hollon, 1 999), and even a deterioration of the traditional (Dalzell, 1999; Kravitz, 2000). Debate on the usefulness of DTC has been intense, with views ranging from the argument that DTC informs and educates consumers to calls for a curtailing of FDA approval of current marketing practices. 1 2 increasing requests for The effect of DTC advertising on consumer behavior, that is affecting the growth of branded drugs, is unquestionable. In a review of the factors prescription drug spending, a study by the National Institute for Health Care Management Foundation (NIHCM) noted that the growth in spending has been most noticeable in a few therapeutic categories of heavily advertised drugs (McCarthy, 1999b). For example, this study noted that consumer spending on heavily advertised oral antihistamines such as Claritin, Zyrtec, and Allegra increased by 612% percent between 1993 and 1998. According to a recent study by the NIHCM Foundation (2002), the effect of increased spending on advertised drugs is continuing to be a major factor in the rising cost of drugs. For example, in 2001 half of the $22.5 billion increase in spending on prescription
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