Drug manufacturers have been increasingly marketing their prescription medications using Direct-to-Consumer (DTC) advertisements. This research examines the effects of integrating and separating risks and benefits within prescription drug DTC Website ads and presenting the risk and benefits at different levels of the Website. Two different drug Websites and two different task types (general browsing and item search) were used. Risk and benefit recall, recognition, time-on-task, click rate, and task success for risk and benefit search, as well as risk noticeability, were measured. The risks and benefits were found faster, with fewer clicks, and remembered more often when they were placed higher in the Website and in separate sections. Risks on a fourth level page without a link from the home page were difficult to find. Risks were rated most noticeable when they were presented separately on the home page. Guidelines are provided for the development of DTC Websites.
Key Words
Prescription medications; Website advertisement; Direct-to-Consumer
INTRODUCTION
Since the mid 1980s, considerable research has been conducted on how warnings influence people's knowledge and cautionary behavior. However, experimental research into the effectiveness of pharmaceutical warnings is relatively limited. Effective pharmaceutical labeling is crucial, as the general public is often unaware of the associated risks and side effects (1). Besides the information provided by physicians and other healthcare providers, the primary sources of prescription medication information have traditionally been drug labels and inserts, and more recently Direct-to-Consumer (DTC) advertising.
Some DTC ads are used to market prescription drugs directly to the general public. Drug companies employ many different types of media in their prescription drug DTC ad campaigns, including print, broadcast and the World Wide Web.
The U.S. Food and Drug Administration (FDA) (2) promulgates regulations for communicating risks and benefits on prescription drug DTC ads. For example, print ads must include a section with all of the risks, whereas broadcast ads only require the most important risks with a pointer to all of the risk information given elsewhere. Although there has been some research conducted with respect to print and broadcast DTC ads, there has been little research on the factors that facilitate (or hinder) the communication of this information on the World Wide Web. Little research has been published to date concerning how best to present risks and benefits in DTC drug ad Websites. Should risks be integrated with a drug's benefits to increase the likelihood that they are both encountered and read (3), or should the risks be separated from the benefits allowing for the use of highlighting to attract attention (4)?
Related to this question is the effect of risk placement within a Website's hierarchy on the likelihood of seeing and reading the information. Should risks be placed on the drug's home page with the benefits to ensure that they are seen and read (5) or can the risks be placed on a different page, at a lower level of the Website's hierarchy, and still be as likely to be found and read? The most effective method of presenting the risks and benefits may also depend on the strategies (or task type) that individuals use while browsing a Website.
Research has shown that task type can influence the strategies people use while visiting a Website (6). For example, when browsing, an integrated risks/benefits section might better convey the information. Conversely, if searching for specific information then a separate and distinct risk section might best capture people's attention.
In the present research, the placement of risk and benefit information within the Websites for two prescription drugs (Celebrex® and Singulair®) was manipulated to determine their effects on the likelihood of people noticing and reading the risks. The risks and benefits were either integrated together or separated, and placed on the same page or on different pages at different levels of the Website. Two different drugs and task types (general browse and item search) were employed. Finally, ratings of how well participants noticed risk were also conducted.
METHOD
MATERIALS
Websites for two existing prescription drugs (Celebrex®, Pharmacia Corporation, Peapack, NJ, and Singulair®, Merck & Co., Inc. Whitehouse Station, NJ) were used. For each drug, seven Website versions were created differing only by their placement of the risks and benefits. The risks and benefits were:
1. Either placed in the same paragraph (integrated) or in separate sections (separated),
2. Either placed on the same page or different pages of the Website, or
3. Either placed on the same level of the Website or on different levels of the Website's hierarchy.
See Table 1 for descriptions of the conditions.
To control for the amount and complexity of risk information the same set of 12 risks was used for both of the drug Websites. Six other product (nondrug) Websites (distractor sites), comparable in size and complexity to the experimental Websites, were used. These Websites were realistic in appearance and functionality, and represented a wide range of consumer products (soap, kitchen/bath cleaner, photocopying service, beverage distributor, a restaurant, and art supplies). All Websites were saved to a local hard drive to control download times and to keep users with delimited Web domains.
A dedicated computer system with a 17-inch IBM P-70 monitor was used to view the Websites (IBM® 300-GL personal computer: Intel® Pentium I 200 MHz processor, 8 GB hard drive, 64 MBRAM running Windows® 98). The monitor resolution was set to 1024 X 768 (pixels) and 16bit color. A timer with an audible buzzer alarm was used during the browse task.
PROCEDURE
Upon entering the study, participants completed a consent form and the demographics questionnaire (see Tables 2 and 3 for demographic questions). To conceal the true nature of the study, the consent form did not mention the purpose of the study or the manipulation of the drugs' Websites. Only participants with some experience surfing the Web were allowed to participate.
Participants were then provided with a general overview of the tasks that they would be asked to perform. Participants were randomly assigned to one of the two tasks and drug conditions. Within each task, product Website order, drug Website, and experimental version were randomized. Tasks not concerning risk and benefit information about the drug and other nondrug products were included to further conceal the true nature of the study.
Item Search Task. The item search task required participants to find specific pieces of information using a predetermined version of one of the experimental Websites. This condition was rotated an equal number of times across participants. Participants were told that:
1. They were involved in a usability study of a drug Website,
2. They were going to search for particular pieces of information on the Website, and
3. When they found that information, they were to record the answer on a response sheet.
Participants were instructed on how to use the Web browser and completed three practice tasks before starting. ErgoBrowser® (ErgoSoft Laboratories®, Austin, TX) was used to track participants' progress through the Websites (clicks per task), their time on task, and whether they found the correct information (risk/benefit task success). ErgoBrowser is a software package that provides basic Web browser functionality (eg, forward/back buttons, and up/down left/right scrolling) and contains a task-tracking mode requiring participants to press a "start task" and "stop task" button upon starting and completing a task. All tasks started at the home page.
Upon completing the practice tasks and becoming familiar with the ErgoBrowser, participants were given six drug-specific tasks to complete as listed on separate response sheets. Two tasks required participants to find the drug's risks and benefits.
Browse Task. Participants freely browsed seven different product Websites and then rated them on: the usefulness of the information, its attractiveness, and willingness to use the product. Participants were encouraged to freely browse the Websites without drawing specific attention to the drug's risks or benefits. The order of the six distractor Websites and one of the experimental drug's Websites was randomized for each participant. Participants were given a threeminute time limit to browse each Website before making their ratings.
