Direct-to-Consumer-Advertising-of-Prescription-Drugs-A ...

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DIRECT TO CONSUMER ADVERTISING OF PRESCRIPTION DRUGS: A

STUDY OF THE IMPACT OF SOCIAL MEDIA ON WORKING YOUTH IN

SELECT CITIES OF MAHARASHTRA & GUJARAT

Thesis Submitted to the D. Y. Patil University, Navi Mumbai

Department of Business Management

in partial fulfilment of the requirements for the award of the Degree

of

DOCTOR OF PHILOSOPHY

in

BUSINESS MANAGEMENT

Submitted by

Ms. SHWETA VATS

(Enrollment No.DYP-PhD-116100002)

Research Guide

PROFESSOR Dr. PRADIP MANJREKAR

DEAN

D.Y. PATIL UNIVERSITY, NAVI MUMBAI

DEPARTMENT OF BUSINESS MANAGEMENT,

Sector 4, Plot No. 10,

CBD Belapur, Navi Mumbai – 400 614

August 2014

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DIRECT TO CONSUMER ADVERTISING OF

PRESCRIPTION DRUGS: A STUDY OF THE IMPACT

OF SOCIAL MEDIA ON WORKING YOUTH IN SELECT

CITIES OF MAHARASHTRA & GUJARAT

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DECLARATION

I hereby declare that the work presented in the thesis entitled “Direct to

Consumer Advertising of Prescription Drugs: A Study of the Impact of Social

Media on Working Youth in Select Cities of Maharashtra & Gujarat” submitted

for the Award of Doctor of Philosophy in Business Management at the D.Y. Patil

University, Navi Mumbai Department of Business Management is my original

work and the dissertation has not formed the basis for the award of any degree,

associateship, fellowship or any other similar titles.

The material borrowed from other sources and incorporated in the dissertation

has been duly acknowledged.

I understand that I myself could be held responsible and accountable for

plagiarism, if any, detected later on.

The research papers published based on the research conducted out of and in the

course of the study are also based on the study and not borrowed from other

sources.

Place: Navi Mumbai Ms. Shweta Vats

Date: 10th

August 2014 PhD Scholar

Enrollment No.: DYP-PhD-116100002

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CERTIFICATE

This is to certify that the thesis entitled “Direct to Consumer Advertising of

Prescription Drugs: A Study of the Impact of Social Media on Working Youth in

Select Cities of Maharashtra & Gujarat” and submitted by Mrs. Shweta Vats is

a bonafide research work for the award of the Doctor of Philosophy in Business

Management at the D. Y. Patil University, Navi Mumbai Department of Business

Management in partial fulfilment of the requirements for the award of the

Degree of Doctor of Philosophy in Business Management and that the thesis has

not formed the basis for the award previously of any degree, diploma,

associateship, fellowship or any other similar title of any University or

Institution. It is also certified that the thesis represents an independent work on

the part of the candidate.

Prof. Dr. R. Gopal Prof. Dr. Pradip Manjrekar

Director & Head of Department Dean & Ph. D. Guide

Dept. of Business Management Dept. of Business Management

DY Patil University, Navi Mumbai DY Patil University, Navi Mumbai

Place: Navi Mumbai

Date: 10th

August 2014

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ACKNOWLEDGEMENTS

I am indebted to the D.Y. Patil University, Navi Mumbai Department of Business

Management, for accepting me for Doctorate Program and providing me with an

excellent opportunity to carry out the present research project “Direct to

Consumer Advertising of Prescription Drugs: A Study of the Impact of Social

Media on Working Youth in Select Cities of Maharashtra & Gujarat”. I would

like to specially thank Prof. Dr. Pradip Manjrekar, Dean, D.Y. Patil University,

Navi Mumbai, Department of Business Management for his unconditional

support and guidance in carrying out this research work. I would also like to

gratefully acknowledge the support and encouragement and constant guidance

and valuable feedback that I received from Prof. Dr. R. Gopal, Director, Head of

Department, D.Y. Patil University, Navi Mumbai, Department of Business

Management. Last but not the least I would like to acknowledge my family for

the enormous support provided by them in pursuit of completing my research

work.

Signature of the Student

Ms. Shweta Vats

Place: Navi Mumbai

Date: 10th

August 2014

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TABLE OF CONTENTS

CHAPTER TITLE

PAGE

NO.

Executive Summary

Chapter 1 Introduction 1-43

1.1 Direct to Consumer Advertising 1-2

1.2 Prescription Drugs 3

1.3 Direct to Consumer Advertising of

prescription drugs

3-14

1.4 Transition from DTCA to Digital DTCA 14-16

1.5 Internet and Direct to Consumer

Advertising

16-17

1.6 Social Media 17-24

1.7 Social Media Engagement of

Pharmaceutical Companies

24-27

1.8 Direct to Consumer Advertising through

Social Media

27-29

1.9 Fair Balance 30

1.10 US FDA and Direct to Consumer

Advertising

30-42

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1.11 Advertising 42-43

Chapter 2 Direct to Consumer Advertising 44–54

2.1 DTCA and Pharmaceutical Market 44-45

2.2 Detailing 45

2.3 Direct to Consumer Advertising 46-48

2.4 Prescribers 48

2.5 Consumers 48-49

2.6 DTCA and Patient Empowerment 49-50

2.7 Physician-Patient Relationship 50-54

Chapter 3 Social Media and its Role in DTCA 55–61


3.2 Role of Internet and Social Media in

Healthcare Management

57-59

3.3 Use of Electronic Media in Tier II Cities 59

3.4 Social Media Promotion of Prescription

Drugs with Emphasis on Youth

59-61

Chapter 4 Pharmaceutical Advertising with

respect to Social Media

62–68

4.1 DTCA Trends in Pharmaceutical Market 62-63

4.2 Pharmaceutical Advertising 64-66

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4.3 Digitisation of Pharmaceutical

Advertising

66-68

Chapter 5 Adoption of Social Media 69 – 74

5.1 Impact of Social Media on Youth 69-71

5.2 Adoption of social media for prescription

drugs information

71-72

5.3 Impact of Adoption and Diffusion of

Social Media on Consumer Behaviour

72

5.4 The Adoption Process 73

5.5 The Diffusion Process 73-74

Chapter 6 Social Media Advertising and

Consumer Behaviour

75-81

6.1 Interplay of Awareness, Perception and

Attitude

75-77

6.2 Social Media Advertising and its Effect

on Consumers

78-80

6.3 Information Search and Evaluation 80-81

Chapter 7 Review of Literature 82–122

7.1 Direct to Consumer Advertising of

Prescription Drugs

82-94

7.2 DTCA of Prescription Drugs through 95-108

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Social Media


7.4 Impact of Advertising on Consumer

Behaviour

117-121

7.5 Literature Gap 121-122

Chapter 8 Objectives and Research Methodology 123– 134

8.1 Problem Statement 123-126

8.2 Research Objectives 127

8.3 Research Hypothesis 127-128

8.4 Research Methodology 128-134

8.5 Limitations of the Study 134

8.6 Scope for Future Research 134

8.7 Utility of the study 134

Chapter 9 Data Analysis 135-219

Chapter 10 Conclusions 220-229

Chapter 11 Recommendations 230-231

Chapter 12 Bibliography 232-244

ANNEXURE I Questionnaire 245-254

ANNEXURE II Details of Cities 255-263

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EXECUTIVE SUMMARY

Australian Medical Association, 2007 has defined direct-to-consumer advertising

(DTCA) as any statement or pictorial design directed at the general public and

intended to promote the use or supply of medical goods or services. The only two

countries to allow direct to consumer advertising are United States and New Zealand

(Rajani, C. H., 2012). In United States prescription drugs advertisement directly to the

consumers is expanding and there is some sentiment in favour of allowing this

practice in various other countries. Canada, EU and Australia are in favour of relaxing

the restrictions on DTCA, as the consumers are already exposed online DTCA content

with origin in the US, as DTCA content generated in the United States cannot be

restricted to American consumers because of its viral effect. Digital content has the

potential to traverse geographical boundaries.

Prescription drug DTCA is a promotional tool used by pharmaceutical companies to

promote prescription drugs directly to the consumers. The 1938 Federal Food, Drug,

and Cosmetic Act, defined labelling guidelines for prescription and over the counter

drugs. Although this act, gave the authority over labelling of both prescription and

OTC drugs to the US FDA, the control over marketing of drug remained with the

Federal Trade Commission. But with the 1962 Kefauver-Harris amendments to the

Federal Food, Drug, and Cosmetic Act the US FDA got the responsibility of

monitoring the promotion of prescription drugs.

For a long time Indians have been exposed to the television advertisements of various

over the counter drugs. But it will still take several years for an innovative concept

like prescription drug DTCA to be accepted in Indian market (Rajani, C. H., 2012).

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Internet evolved as an additional medium for information dissemination in the year

1997. Internet communication is more specified and effective interaction (Jothi, et al.,

2011). It is the medium of choice for Indian youth. Electronic or digital DTCA is

advertisement of drugs to consumers through internet or social media. It has evolved

from one-way communication or web 1.0 to an interactive two way communication

technology called web 2.0. Electronic media makes use of interactive platforms like -

social media facebook, twitter and youtube. This platform allows users to post

comments which can be followed, monitored and directed by both consumers and

companies.

The healthcare industry has also embraced social media as a promotional medium.

The existing regulatory framework of US FDA does not have guidelines to govern

digital DTCA. Owing to this lack of regulatory guidelines for prescription drugs

DTCA using social media and internet, pharmaceutical companies are demanding

new guidelines. This study has tried to analyse the impact of social media DTCA on

working youth in select tier two cities of India, Pune, Aurangabad, Surat and

Vadodara. This study is an effort to understand the effectiveness of social media in

generating awareness for prescription drugs and prescription drug DTCA.

This is a study to understand working youth‘s perception of direct to consumer

advertisements and interrelationship between attitude, perception and consumer

behaviour. It is an investigation into the role played by the demographic factors and

social media sites in generating awareness for DTCA.

An effort has been made to understand the favourable and unfavourable perception of

consumers for DTCA and a correlation between perception and behaviour of working

youth for therapeutic choice and healthcare decision making.

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This study analyses consumers‘ perception of DTCA? Whether social media DTCA

presents a fair balance of risk and benefit information? Whether the information

contained in these DTCAs is used by working youth?

It is known that consumers indulge in information seeking post exposure to DTCA

but the various other behavioural manifestations are not studied widely, hence this

study also studies the various behavioural manifestations and working youth‘s perception of

the authenticity and utility of the information contained in these advertisements.

The study revolved around the following objectives:-

1. To study the preference of social media sites by working youth for collecting

information about prescription drugs.

2. To study the relationship between the social media sites i.e. Face book,

Twitter, You tube, Linkedin and Google plus used for collecting information

on prescription drugs and awareness for prescription drugs.

3. To study the relationship between satisfaction with social media advertisement

of prescription drugs and demographic factors.

4. To study the favourable and unfavourable perception and attitude of working

youth for social media advertisement of prescription drugs.

5. To study the impact of social media based direct to consumer advertisement

on working youth.

6. To study the correlation between awareness, attitude, perception and youth

behaviour for prescription drugs.

To study the above objectives following hypotheses are designed:-

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H01: Working youth do not have any preference for social media sites for collecting

information on prescription drugs

H11: Working youth have a preference for social media sites for collecting information

on prescription drugs

H02: There is no association between the social media platform used for advertising

prescription drugs and awareness for prescription drug

H12: There is association between the social media platform used for advertising


H03: Satisfaction with social media advertisement of prescription drugs is independent

of demographic factors like gender, occupation, qualification, income and age.

H13: Satisfaction with social media advertisement of prescription drugs is dependent

on demographic factors like gender, occupation, qualification, income and age.

H04: Consumers have no favourable or unfavourable perception of social media

DTCA of prescription drugs

H14: Consumers have both favourable and unfavourable perception of social media


H05: Consumers have no favourable or unfavourable perception of the impact of social

media DTCA

H15: Consumers have either favourable or unfavourable perception of the impact of

social media DTCA

H06: There is no correlation between various parameters like awareness, attitude,

perception and behaviour for prescription drugs

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H16: There is correlation between various parameters like awareness, attitude,


Both exploratory and conclusive research have been used for this study. Four tier II

cities Pune, Auragabad, Surat & Baroda have been selected for the research.

Sample population used for this study is working youth in the age group of 18-35

years, who use social media and have 24X7 access to the internet. The sample size

used was 1025.

Use was made of Judgement Sampling for selecting the study sample. Judgement

sampling is a type of non-probability sampling. In this method researchers select

samples based on their knowledge and professional judgment. Those subjects who are

most advantageously placed or in the best position to provide the information required

are selected.

Both primary and secondary sources were used to collect data. While secondary data

was collected by using secondary sources like published papers, US Food and Drug

Administration (FDA) website, World Health Organization (WHO) website, IMS

health, Indian Federation of pharmaceutical Manufacturers (IFPMA) website, Internet

and Mobile Association of India (IAMAI) website and various other authentic

websites, dissertations and thesis, ebscohost, proquest and published reports. Survey

of working youth by using the research instrument i.e. questionnaire was used for

collecting primary data.

A closed ended structured questionnaire was used to collect primary data. The

questionnaire includes questions based on different scales i.e. nominal, interval and

ratio scale. Questions make use of 4 and 5 point likert scale from one to five where

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―1‖ is strongly disagree and ―5‖ is strongly agree. There are two sections in the

questionnaire; section I contains questions related to demography, while section II

contains questions relevant to the field of research.

A pre-test was conducted with 246 consumers from the population as the sample to

assess whether or not there were misunderstandings or ambiguity of expressions in the

questionnaire. Statistical tools employed for analysing the data collected through

pretest were same as those used for the main study.

Data collection was done in 2 stages:

1. Pilot Study - conducted to ascertain the research parameters and to test the

validity and reliability of the instruments used in the study.

2. Survey - primary data was collected using the instruments in the study

(Questionnaires).

The collected data was analysed with the help of statistical package SPSS 16. The

mean scores arrived were put to various statistical analyses to test the hypotheses used

for the study.

SPSS version 16 was used to analyse the collected data. The different statistical tools

used for the study are: Frequency Table with percentages, One sample T test, Rank

Order, Analysis of Variance (ANOVA), Chi-Square Test. To draw the logical

inferences from the data descriptive and inferential statistical techniques were used.

The type of statistical techniques used i.e. Univariate and Bivariate analysis was used

based upon the level of measurements of the questions pertaining to those variables.

While performing pilot study the reliability test done by using Cronbach‘s Alpha

came to 79% which showed the reliability of the scale adopted.

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This study shows that working youth use social media and internet for seeking

information related to prescription drugs. They are using social media platforms for

getting first hand advice from experienced patients online. Consumer satisfaction with

social media DTCA plays an important role in shaping consumer perception for social

media DTCA. It is found from the study that social media is an effective

communication and advertising media. Demography is another important factor

impacting consumer satisfaction and perception with use of social media for

prescription drug DTCA.

This study shows that although consumers use social media for collecting information

on prescription drugs for mild and frequently occurring diseases like fever, acidity,

allergy, and nutritional deficiency, in case of life threatening and serious diseases

consumers depend on medical fraternity. Additionally the present study shows that

that consumers‘ attitude towards the drugs advertised is shaped by their perception of

DTCA for the drug and the authenticity of the media used for advertisement. Hence a

consume having a positive perception of the information contained in prescription

drug advertisement will have a positive attitude towards the advertised drug.

The present study also shows that there is a strong relationship between awareness,

perception, attitude and consumer behaviour. A consumer with a positive perception

of prescription drug will have a positive attitude towards that drug and this converts

into positive behaviour for that drug. The study has shown that consumers react in

several different ways after being exposed to social media DTCA. The different

manifestations are - clip the advertisement for later reference, call toll-free numbers

given in the advertisement, discuss with friends and family and some of the

consumers are influenced by DTCA to an extent that they buy the advertised medicine

only on the basis of the information obtained from DTCA.

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It can be concluded based on the study findings that social media DTCA does affect

working youth‘ s awareness for prescription drugs and ailments. It helps in educating

the patients about the usage and associated risk and benefits. It also affects

consumer‘s perception of DTCA and prescription drugs and ultimately affects their

behaviour towards an advertised drug in specific and prescription drugs in general.

Based on the above findings it can be recommended that marketers can make use of

the information gained from this study to allocate resources to different social media

platforms. They can also formulate social media strategy to include tools to generate

awareness and affect perception and behaviour of working youth.

Following are the limitations of the study-

1. Limitation is with respect to time constraint.

2. The samples were working youth, although non-working youth are equally

social media savvy.

3. The restriction of the study is only to four tier II cities of India. Hence

generalisation of results for entire India may not be there.

4. The media selected for study was social media however other media like

Broadcast, Print, Internet and Physicians were excluded.

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CHAPTER 1

INTRODUCTION

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CHAPTER 1

INTRODUCTION

1.1 Direct to Consumer Advertising

The Australian Medical Association defines Direct to Consumer Advertising (DTCA)

as any statement or pictorial design directed at the general public and intended to

promote the use or supply of medical goods or services. United States and New

Zealand are the only two developed countries to allow direct to consumer advertising

(Rajani, C. H., 2012). Direct to consumer advertising (DTCA) of prescription drugs is

expanding dramatically in the United States, and there is some sentiment in favour of

allowing this practice in different countries like United Kingdom. While countries like

Canada, EU and Australia are considering relaxing of restrictions on direct to

consumer advertising, because consumers are exposed to U.S. originated DTCA via

internet. Any online DTCA content generated or posted in USA cannot limit its access

to American consumers as internet spreads it across geographical boundaries and

hence this viral effect cannot be curbed.

Direct-to-consumer advertising (DTCA) of over-the-counter or prescription drugs is a

highly controversial issue relating to public health care. Advocates highlight the

advantages of direct to consumer advertising in terms of patient awareness and

autonomy. Direct to consumer advertisement helps in diagnosis and treatment of

under-diagnosed diseases which convert into low overall healthcare cost. Opponents

voice concerns about safety and patients‘ best interests (Chaar and Kwong, 2010).

Most of the drugs advertised directly to consumers are new drugs, market leaders in

their therapeutic class, target a broad consumer base and treat chronic and frequently

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occurring diseases. The promoted drugs treat diseases and associated symptoms

which are easily understood relative to other diseases. The promotion of high-cost,

patent-protected drugs puts the spotlight on disorders treated by these products,

regardless of whether they are widespread or severe (Wang, and Kesselheim, 2013).

Consumers mostly engage in preventive health behaviours when they perceive

themselves to be susceptible to a condition and believe the condition to be severe.

Larger is the potential market for a drug it is more likely for pharmaceutical firms to

engage in DTCA. There is little rationale for direct-to-consumer advertising of new

drugs, as most new drugs offer little if any therapeutic advantage over existing

products. Direct to consumer advertisements frequently downplay safety information.

Although marketers claim that enhancing awareness and understanding of diseases,

symptoms, and treatments are the major contributions of DTCA, there is no evidence

that direct-to-consumer advertising results in any improvement in health outcomes

(Lexchin and Mintzes, 2002). In light of drug manufacturers‘ claims that direct to

consumer advertising promotes consumers‘ awareness about drugs and medical

conditions and facilitates patient–physician discussion about therapeutic options, it is

important to analyze the extent of consumers‘ actual utilization of information

obtained from direct to consumer advertisement (Deshpande, Menon and Perri, 2004).

This is a new practice which threatens the autonomy of medical professionals and

especially doctors in deciding the mode of treatment on behalf of the patients. DTCA

empowers patients and gives them knowledge and confidence to discuss with their

doctor about their therapeutic options. Direct to consumer advertising has been

widespread in the U.S. for as long as prescription drugs have been for sale. As direct

to consumer advertisement of medical products has evolved, it has remained a

controversial subject.

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1.2 Prescription Drugs

The modern distinction between prescription (Rx) and OTC (over the counter) drugs

began with the 1938 Federal Food, Drug, and Cosmetic Act, which defined different

labeling guidelines for Rx and OTC drugs. Under the 1938 act, even though the

authority over the labeling of both prescription and OTC drugs was given to the US

FDA, control over drug marketing remained with the Federal Trade Commission. The

1962 Kefauver-Harris amendments to the Federal Food, Drug, and Cosmetic Act gave

the US FDA its current responsibility for monitoring Rx (prescription) drug

promotional materials. The 1962 amendments outlined basic requirements for Rx

marketing: Rx promotional materials cannot be false or misleading; they must provide

―fair-balance‖ coverage of risks and benefits of using the drug; they must provide a

summary of contraindications, side effects, and effectiveness; and they must also meet

specific guidelines for readability and size of print. Since then, Rx drugs have been

marketed not only to physicians, but also more directly to consumers (Ling, Berndt

and Kyle, 2002).

1.3 Direct to Consumer Advertising of Prescription Drugs

Direct to consumer advertising of prescription drugs is a promotional effort by a

pharmaceutical company to present prescription drug information to the consumers. It

can be categorised into three basic categories: (i) Product claim advertisement, these

are meant to promote a specific product (product name and therapeutic claims); (2)

Reminder advertisements, meant to promote product name only; (iii) Help seeking

advertisements, meant to inform consumers about new treatment options and

encourage consumers to consult their doctor and discuss treatment options.

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Prescription drug DTCA serves as an important source of public health information,

and exerts a significant influence on consumer behaviour.

From 1938, with the passage of the Food, Drug and Cosmetic Act, until the mid-

1980s, the industry focused its efforts almost entirely on physicians. Correctly

recognizing physicians as their principal customer, drug manufacturers deployed large

armies of sales representatives who marched into physicians‘ offices bearing

promotional materials (Kravitz, R. L., 2000). Before 1975 health care marketing was

considered a very controversial subject as it was a new concept. Direct to consumer

advertising of prescription drugs is even a more recent concept (Chandra and Cheek,

2001). The first direct to consumer advertisement for a prescription drug appeared in

Reader‘s Digest in 1981 in USA (Woloshin, et al., 2001). In 1981, Merck ran the first

direct to consumer print advertisement for its new anti-pneumococcal vaccine,

Pneumovax (pneumococcal vaccine polyvalent) in Reader‘s Digest (Ventola, C. L.,

2011). UK-based Boots Pharmaceuticals aired the first television DTCA of a

prescription drug in 1983 (Herzenstein, Misra and Posavac, 2004).

Although pharmaceutical companies have been attempting to influence physicians‘

prescribing habits through advertising and other means for decades, since the US

Food and Drug Administration (US FDA) released guidelines in 1997 that facilitated

broadcast advertising for drugs, direct to consumer advertising has become far more

prevalent and visible (Weismann, et al., 2004). In 1997 the US FDA reinterpreted its

regulations such that major statements in advertisements could be much simpler than

previously required. Furthermore, a concise summary of the risks associated with the

drug and additional information about the drug did not have to be presented, but

sources for more complete information should be given (e.g., toll free numbers, web

sites). Restrictions on direct to consumer marketing were relaxed and clarified in 1997

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when the US FDA issued new draft guidelines. In 1997, the US Food and Drug

Administration (US FDA) allowed pharmaceutical companies to advertise their drugs

through mass media like print ads, TV, radio and internet. Since then, television

advertisements for prescription drugs have become common (Herzenstein, Misra and

Posavac, 2004). US FDA in 1997 came out with guidelines on consumer centric

promotion of prescription drugs allowing pharmaceutical manufacturers to include

drug‘s name and disease that the drug treats in the advertisement while exempting

them from including the additional safety information on product insert. Unlike earlier

when drug‘s brand name appearing in an advertisement, had to be accompanied by

detailed product insert information.

Although providers might have felt threatened when DTCA spending grew rapidly

during the late 1990s, they are learning to deal with increasingly active patients who

are obtaining health information from a variety of sources, and perhaps developing

ways to turn these discussions into positive interactions (Weismann, et al., 2004). A

manufacturer is now permitted to advertise an Rx (prescription) drug‘s name and the

condition for which it is indicated without needing to issue a fully detailed summary

regarding the product‘s side effects and other risks. The US FDA requirements for

risk disclosure in advertisements may be met if the advertisements contain

information on the product‘s main risks and refer to other sources from which

consumers may obtain additional product information and full product labeling. For

instance, a prominently positioned toll-free phone number (or web address) must now

be found on the advertisement, which the consumer can use to obtain further

information. Usually, there is explicit encouragement for readers and viewers of direct

to consumer advertisements to discuss the product with their physicians (Ling, Berndt

and Kyle, 2002).

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DTCA of prescription drugs has indeed caught consumers‘ attention and sparked

many people to ask their doctors about the drugs they see advertised (Findlay, S.,

1999). People are beginning to ask their doctors for newer and costlier medicines

when less expensive drugs may work just as well in many cases. Direct to consumer

advertising (DTCA) is an innovative practice of promoting prescription drugs through

popular media, which is currently allowed only in US & New Zealand (Rajani, C. H.,

2012). It has grown rapidly during the past several decades and is now the most

prominent type of health communication that the public encounters. Pharmaceutical

industry is one of the most advertising-intensive industries, with expenditures on

promotion even higher than the R&D expenditures (Brekke and Kuhn, 2002).

Recently, drug manufacturers have been increasingly marketing their prescription

medications using direct to consumer advertisements (Vigilante Jr. and Wogalter,

2001). Particularly likely to advertise to consumers are companies whose drugs are

market leaders, are in the early stages of their life cycle, have relatively few side

effects, target a broad customer base, and address chronic conditions in categories that

are relatively well understood and are not particularly complex (Roth, M. S., 1996).

Pharmaceutical companies already spend less, on an average, on consumer advertising

for drugs in classes with more competitors because patients for those drugs already

know that treatments are available for their condition.

Gaining sales for a new entrant in those cases may depend more on physicians

deciding to switch patients to the new drug than on patients being made aware that a

new medication exists and seeking treatment they otherwise would not have looked

for (Campbell, S., 2011). Patients who see an advertisement and recognize their own

symptoms or risk factors may then contact their physician to discuss their treatment

options, thus participating in their own healthcare management (West, J., 2012). Such

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advertising is a powerful tool, designed to create a demand, in order to maximise

profits. Extending the scope of already ubiquitous promotions about ―postnasal drip,‖

―unsightly rashes,‖ or ―cures‖ for baldness has little to do with educating patients or

relieving suffering. It will, however, inevitably drain healthcare dollars, dramatically

increase unnecessary prescribing, and strain patientdoctor relationships (Hoffman

and Wilkes, 1999).

Depending on the category of drug the nature of the marketing mission is different.

There are basically two types of drugs; over the counter (OTC) drugs and prescription

drugs. Over the counter medicines can be purchased at a pharmacy, grocery, or

convenience store without a prescription. Over the counter (OTC) drugs by tradition

have been promoted to the end consumers directly additionally it is also promoted to

doctors and other medical professionals. In USA both OTC and prescription drugs can

be promoted directly to consumers, although DTCA is generally focused on over the

counter drugs (OTC). Unlike United States, New Zealand has never had any law

against DTCA for prescription drugs. Although recently some guidelines have been

framed to govern direct to consumer promotion of prescription drugs. While the US

FDA regulates DTCA in the US, New Zealand relies on industry self-regulation, like

many European countries (Mintzes, 2002).

Promotion of prescription drugs directly to consumers is a rapidly growing

phenomenon. Pharmaceutical manufacturers claim that through Direct to consumer

promotion of prescription drugs, they intend to provide consumers with information

about drugs, but its use is also related with increase in drug expenditures, preference

of costly branded medicines over cheap generic versions, and patient safety risks.

Most advertisements omit information on the potential for drug misuse and directions

for proper usage (Roth, M. S., 1996). DTCA induces a range of behavioural patterns

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in some consumers, which compromises pharmacist‘s health-care-providing and gate-

keeping roles. Doctors also have to succumb to the patient‘s demand based on the

information collected from DTCA.

The sudden increase in direct to consumer advertising of prescription drugs could be

assigned to various factors: (i) Pharmaceutical companies find it difficult and

expensive to reach doctors; (ii) DTCA has the ability to communicate directly with

consumers; (iii) Prescription drug promotion targeting consumer enables consumers

to access healthcare related information and contributes to a more knowledgeable and

healthier society; (iv) Information contained in these promotions related to drug‗s

benefits and associated side effects helps consumers in balanced decision making; (v)

These advertisements can increase prescription for diseases with no clear clinical

indication.

There have been a lot of arguments about the quality of information in DTCA and the

ability of consumers to comprehend it. Most advertisements focus on diseases and

associated symptoms and treatments that are relatively less complex compared to

other prescription drug products (Roth, M. S., 1996). DTCA typically focuses more

on benefits and less on risks and potential side effects (Herzenstein, Misra and

Posavac, 2004). Concerns have also been raised on use of emotional appeals in these

advertisements, coupled with lack of detailed risk information. Lay consumers lack

the knowledge necessary to understand and interpret DTCA. Consumers lacking

technical knowledge and understanding may over-estimate a prescription medicine‘s

relevance to their medical condition and fail to realize the risks associated with it.

DTCA increases demand for more expensive drugs at the expense of cheaper generic

drugs, it may escalate the overall pharmaceutical drug bill (Weismann, et al., 2004

and Kravitz, R. L., 2000).

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Overall, empirical research indicates that, despite consumers‘ desire for greater

information exchange with the healthcare provider, they remain hesitant to challenge

their healthcare providers to seek such an information exchange (Levy, 1999). Most

DTCA visits do not result in a prescription for the advertised drug. Most common

reasons being that a different drug is more appropriate or that another equally

effective but less costly drug is available (Weismann, et al., 2004). Consumers should

have sufficient knowledge of a drug to make an informed choice. Contrary to the

perception that many DTCA discussions are for minor ailments, a large proportion of

DTCA visits are for high-priority conditions (Weismann, et al., 2004).

DTCA is both beneficial and detrimental to the public health (Ventola, C. L., 2011).

Consumers believe that DTCA helps them to provide knowledge about treatments,

makes them concerned about prescribing medication and results in diagnosis of

under-diagnosed condition (Rajani, C. H., 2012). Certain disease states are already

heavily advertised e.g., antihistamines and decongestants, anti-hypertensive, smoking

cessation products (Roth, M. S., 1996). Consumers have an indadequate

understanding of the characteristics that would determine the drug's suitability for

their condition. Most of the marketers & physicians disagree that DTCA will help

patients and give clinical benefits by making them more conscious for preventive

health care and diagnosis of under-diagnosed condition (Rajani, C. H., 2012).

After 1985 direct to consumer promotion of prescription drugs has evolved to be an

important part of marketing strategy of pharmaceutical companies. The different

objectives of promotion of prescription drugs to consumers could be to stimulate

consumer demand, to provide information that promotes public health, by increasing

diagnosis of disease and improving compliance with prescribed drug regimes. Initially

the regulatory requirements that direct to consumer advertising must satisfy were

28

developed for professional audiences but with DTCA becoming more consumer

centric policymakers will have to reconsider these requirements. It is important to

ensure that consumers can understand the benefit and risk information contained in

these DTCA of prescription drugs.

Promotion of prescription drugs directly to consumers has proved successful in

stimulating consumer demand. Patients exposed to advertisement of prescription

drugs are very likely to discuss with their physicians the advertised medications and

even ask for them. But are the physicians well equipped to respond to such requests,

especially when the universe of approved drugs continues to expand. At times patients

request for medications or treatment which may not be required otherwise. Physicians

believe that DTCA familiarizes patients with treatment options but are clearly wary of

its information content and its influence on patients‘ behaviour, specifically,

encouraging patients to seek treatments they do not need (Weismann, et al., 2004).

Direct to consumer advertising of prescription drugs has shifted health care decision

from the hands of healthcare professionals to a more shared decision-making process.

Shared decision making is characterized by the equal involvement of both consumer

and healthcare professionals in the decision-making process. Flow of information in

this process is both ways, doctors educating the patients about the disease and

therapeutic options & outcomes and the patients voicing their therapeutic preferences.

In shared decision making both the parties weigh the pros and cons of the therapeutic

options under consideration, and then reach a collaborative decision.

In 1997, the US FDA clarified guidelines on direct to consumer marketing of Rx

drugs that allow manufacturers to place both the drug‘s name and the condition that

the drug treats in an advertisement without requiring manufacturers to include all the

29

additional safety and efficacy information that are traditionally found in the product

insert. Prior to this change, whenever a drug‘s brand name appeared in an

advertisement, such detailed product insert information was required as well (Ling,

Berndt and Kyle, 2002). The exponentially growing number of prescription drugs

advertised directly to consumers after the relaxation of US FDA guidelines in 1997,

and the growing number of consumers resorting to DTCA for disease and treatment

related information has resulted in a new generation of more informed participants in

the health care decision-making process.

Direct to consumer advertising is more prevalent in drugs meant for treating

conditions like gastrointestinal disorder (gastric ulcers), acid indigestion, and

heartburn, smoking, cough and cold, and allergy. For some of these drugs, DTCA has

been used for both prescription and OTC formulations. As per the new US FDA

guidelines for direct to consumer advertising of prescription drugs framed in1997, a

manufacturer is allowed to advertise a prescription (Rx) drug‘s name and the

condition for which it is indicated without a detailed summary of its side effects and

other risks.

In keeping with US FDA‘s requirements for risk disclosure, advertisements should

carry information related to product and main risks and provide leads to other sources

of information – corporate website and toll free number. Additionally some DTCA

encourages patients to discuss the advertised medicine or course of treatment product

with their physicians. Consumers actively participating in healthcare decision making

are known to have a better adherence to treatment regimens and more satisfactory

health outcomes. Some of the studies claim that consumer centric promotion of

prescription drugs improves the awareness level of patients with respect to the drugs

and medical conditions, thus preparing the patients for consulting their doctors and

30

seeking advice on the authenticity of the information gained from DTCA. This form

of promotion of prescription drugs is a departure from the traditional form which

targeted physicians and other healthcare professionals (push strategy). Patients seem

to welcome this new trend where they can take their own healthcare related decisions.

For seeking information they depend on different sources depending upon their

demography and availability/easy access (pull strategy).

Physicians no longer enjoy the autonomy of selecting the therapeutic option due to the

constraints placed on their prescribing behaviour by managed healthcare, hence

DTCA affects doctors‘ prescribing pattern. This kind of promotion aims at stimulating

consumer demand. Advocates suggest that DTCA is beneficial, because patients as

customers are likely to be more participative in the decisions that affect their health

(Wolfe, 2002). Supporters of DTCA promote the potential of DTCA to empower

patients through health education. Similar to a coin DTCA has two faces, both good

and bad, the growing importance of DTCA has raised following concerns; it may add

to spending on drugs by consumers, without providing enough benefits to justify that

spending, it encourages drug abuse, it could lead patients into new approved drugs

whose potential risks are not discovered fully.

With a view to address those concerns, US Food and Drug Administration (US FDA)

has imposed a moratorium on DTCA of prescription drugs in the first two years post

drug‘s approval. The moratorium addresses the safety concerns of newly launched

drugs, although it also has its negative aspects, as some of the patients who could

benefit from the new drug may not be aware of it. The American Medical Association

continues to push the US FDA for more strict regulations to govern DTCA.

31

The rise in DTCA comes at a time when more attention is being shifted to the

consumers' role in health care (Roth, M. S., 1996). At the same time, US FDA is

under close scrutiny and is often criticized for its hands-on role in regulating DTCA

of prescription drug. Direct to consumer advertisement of prescription drugs is the

new tool used by pharmaceutical firms for promoting therapeutic options for a variety

of disease states. Some of the medical conditions already heavily advertised are

hypertension, cough and cold, allergy, acidity & heartburn and smoking.

Indians are already exposed to television advertisements of many OTC drugs like

inhalers in bronchial asthma, insulin for diabetes mellitus, medicine for fever, cough

and cold etc. it will still take five to six years down the line for an innovative concept

like prescription drug DTCA to be accepted in Indian market (Rajani, C. H., 2012).

Although DTCA for prescription drugs is catching the pharmaceutical industry, the

number of drugs with potential for direct to consumer advertising is much more

compared to the number that is advertised.

Pharmacists should be encouraged to further their communication skills and acquire

greater ethical literacy and understanding of the balance between patient autonomy

and professional judgement in pharmacy practice. This may be achieved by tailored

training programmes designed by professional or academic bodies (Chaar and

Kwong, 2010). The benefits of DTCA (preventive care) must be balanced against

increased health care costs caused by clinically inappropriate requests generated by

DTCA (Rajani, C. H., 2012). Patients who see an advertisement and recognize their

own symptoms or risk factors may then contact their physician to discuss their

treatment options, thus participating in their healthcare management (West, J., 2012).

32

Many advertised medicines are easily accessible in local pharmacies; hence it

becomes more obligatory for the pharmaceutical manufacturers and advertisers to

keep a control on the prescription drug‘s movement from pharmacy shelves. Although

according to a study conducted by Chaar and Kwong (2010), some pharmacists

expressed frustration with the increased vigilance needed for advertised OTC

medication. The effect of DTCA, markedly increasing demand of certain products,

along with easy access to medicines in a pharmacy, synergistically promoted self

medication.

Physicians and Pharmacists were traditionally viewed as gatekeepers of prescription

medicines and a source of health information for the patient. DTCA undermines their

traditional gate-keeping role, by usurping their traditional position. Drug companies

employ many different types of media in their DTCA campaigns, including- print

advertisements, television and radio advertisements, and the internet information on

the websites for prescription drugs (Vigilante Jr. and Wogalter, 2001).

1.4 Transition from DTCA to Digital DTCA

Digital DTCA refers to DTCA by using electronic media like internet and social

media. Advances in telecommunications have played a significant role in making the

international consumer more informed. Advances in the healthcare industry in any

part of the world can now be transmitted to any other part of the globe quite quickly,

and much of this is due to the astonishingly rapid advancements in the use of internet.

It has been observed that consumers are more aware of their health status and

conditions, as well as health care products related to a particular disease than they

were a few years ago. This has prompted the need for promoters of healthcare

33

products and services to adopt more social marketing concepts in order to provide

beneficial information to the general public.

There are several hospitals located in remote rural areas where there is no primary

healthcare provider. Also some places lack well-trained specialists in certain fields of

healthcare. In the absence of these primary health care providers, the remotely located

pharmacy or health care institution, doctors and medical experts is used as feasible

settings for a telemedicine centre. New companies are spreading to smaller cities

because of different reasons; less rent, availability of talent pool at lower cost and less

government interference and in case of special economic zone (SEZ) incentives are

provided by the government. Although the companies come up in these areas but the

infrastructure cannot match this growth. Hence some basic and primary facilities like

hospitals, doctors and especially the specialised doctors are not available. The

educated workforce, with access to the internet in these cities prefers to search health

information online. Especially the working youth depend on advice from best doctors

or hospitals from big cities and metros, obtained via social media. They also check the

authenticity of new drugs or therapeutic options for newly acquired disease through

online communities of patients who have experience with the advertised or prescribed

drug. The above reasons coupled with 24x7 access to internet and social media has

resulted in the spread of eDTCA in the remote and upcoming tier II and III cities.

Picking the new trend most of the pharmaceutical manufacturers and many

pharmacies have invested in ensuring their presence on the internet and social media.

Vigilante Jr. and Wogalter (2001) have suggested following guidelines for the

development of direct to consumer prescription drug websites based on the findings of

their study; It is beneficial (a) to present separate risk and benefit information sections

34

and (b) to place risk and benefit information in the top section of the home page or to

prominently place a link to this information on home page.

1.5 Internet and Direct to Consumer Advertising

In the past, doctors were considered to be the most authentic source of information on

prescription drugs. Drug related information was primarily disseminated by doctors

following a paternalistic model. This traditional paternalistic model has been

disrupted because of the availability of health-related information, on the internet.

Consumers depend on these secondary sources for information on medical condition

and therapeutic options.

In 1997 internet evolved as an additional information outlet for consumers and

doctors searching for health-related material. One-third of the population using the

internet to find health information then made a decision about their health or health

care based on the material they found. In its current form, internet is primarily a

source of communication, information and entertainment, but increasingly, it also acts

as a vehicle for commercial transactions (Jothi, et al., 2011). Only the availability of

a huge amount of information on the internet does not warranty whether DTCA is

good or bad. Its widespread use guarantees that people are going to get the

information they seek. It is better for consumers to at least have the option to get the

majority of their information from companies whose internet presence is highly

regulated, and thus likely to be accurate, rather than from unregulated sources which

may contain inaccurate and biased information (West, J., 2012). Consumers are able

to purchase all kinds of prescription drugs online often without need for a prior

prescription. Most internet pharmacies provide poor quality information, fail to have

35

adequate safeguards to ensure medicines are dispensed correctly, and also charge

more for both products and services (Buckley, 2004).

Internet is the emerging information technology with the credibility of immediacy and

fastness, thus, it brings globalization in every aspect of communication.

Communication through internet is more specified, with effective interactive strategy

among its users (Jothi, et al., 2011). It has become the medium of choice especially by

young population of India. Internet is preferred over other media because of the

multitude of benefits it provides to its users.

1.6 Social Media

Social media includes different platforms like Internet forums, Message boards,

Texting via mobile devices, Blogs, Social networks such as Facebook, Twitter,

MySpace, Wikis, Podcasts, Youtube, Linkedin and Googleplus. Social media

marketing refers to the process of gaining website traffic or attention through social

media sites. Social media marketing programs usually center on efforts to create

content that attracts attention and encourages readers to share it with their social

networks (Bajpai, Pandey and Shriwas, 2012). Using social networks or blogs,

companies are able to open up a line of communication with customers. The second

role of social media is less traditional; customers often communicate with each other.

Thus, social media is a technological extension of traditional word-of-mouth. This

social media frenzy has invaded health care on multiple fronts with content created by

providers such as hospitals and pharmaceutical companies and locations created by

patients or other interested parties (Myers S. D., 2012). Even though social network

marketing is still in its infancy, it holds a potential success for businesses if it is

carefully integrated in the marketing mix (Bolotaeva, and Cata, 2011).

36

Digital promotion has evolved from one-way communication or web 1.0 to a new

interactive technology called web 2.0. This new platform makes use of interactive

web programs like - social media (facebook, twitter, youtube and googleplus), blogs

and podcast. It is an interactive platform which allows the user to post comments

which can be followed, monitored and directed by companies. It includes various

activities that combine technology and social interaction between people.

Social media typically provides a variety of ways for users to interact, through chat,

messaging, email, video, voice chat, file-sharing, blogging and discussion groups

(Jothi, et al., 2011). These are websites which allow users to communicate, share

knowledge about similar interests, discuss favourite topics, review and rate

products/services, etc.

Social media is a new generation of platforms and applications on the internet that

make it easier than before for individuals to share and receive information on the web.

Social networking sites are transforming the internet landscape.

Social media is not only about technology, but also about the way it enables

individuals to interact online, its ability to communicate information in real time, and

link people together on common issues. Companies include social media Platform in

their marketing to reach a broader audience base as irrespective of age group people

use social media for searching information on different products.

Social media is an internet supported platform which facilitates communication,

collaboration, and content sharing across networks and boundaries. These platforms

allow users to create and manage profiles online. It allows users to repost comments

posted by a company about its promoted product. This helps in spreading the message

to a large audience as all user connections are able to see the message. Online social

37

networking sites ‗virtually‘ connect users, who may or may not ‗know‘ each other and

may be separated by geographical boundaries. They enable instant exchange of

knowledge, high levels of dialogue and collaborative communication through text,

audio and video (Manjunatha, S., 2013).

Development of social media has changed the way individuals interact in our society,

engaging large number of people online. Even though social network marketing is

still in its infancy, it holds a potential success for businesses if it is carefully

integrated in the marketing mix (Bolotaeva, and Cata, 2011). Social media sites like

facebook, linkedin, twitter, googleplus, myspace and others allow individuals to

instantly communicate with large networks of friends, acquaintances and colleagues,

and large communities and support multimedia content linked to other social media

applications such as youtube and Flickr.

Engagement is the new terminology used with social media. Users of social media are

active participants and not passive viewers. This new platform allows users to post

their views and ideas on the site. Social networks provide a wealth of word of mouth

information regarding the brands and products (Bolotaeva, and Cata, 2011). They can

share their viewpoint and post comments which can be read by others and reposted,

thus spreading the message to their connections who, in turn repost and spread the

message further to their connections. Hence social media makes use of word of mouth

for promoting the product. In the category of users of this media majority are youth

(Manjunatha, S, 2013). Most of the companies include interactive platforms in their

marketing mix to amplify awareness, and impact attitudes and health behaviours.

Some of the common ways in which consumers use social media are - Networking,

Building new contacts, Creating online profile, Searching for information, Connecting

38

with similar communities, Connecting with virtual communities and people, Joining

communities for professional purpose and Getting expert opinion or advise on

important matters. While some of the ways in which interactive social media

platforms may be used by companies are - Group discussions on Linkedin, Trade

show and event updates on Twitter, Patient enrolment on Facebook, Sharing

constructive and exclusive content on Twitter, Authorship with Googleplus and Video

on Youtube.

Twitter is a social media platform which can be used by companies for product

promotion. Products‘ features can be posted in the form of a short message called

tweets. These tweets can be accessed by followers through their home pages.

Sometimes companies provide links to product‘s website or other information

sources. This is done to overcome the limitation of 140 characters in a tweet, which

may not be enough to give a complete picture of the product.

Facebook profiles give sufficient space to companies to provide complete details

about a product. They can also upload videos, images, and detailed descriptions about

the promoted product. It also allows followers to post comments which can be seen by

other users.

Blogs are used by companies to provide complete details about their product.

Blogging is a very common practice used by individuals and companies to stay

connected with other individuals and consumers. All these sites are interactive and

information exchange happens in real time, as the content keeps updating regularly.

In recent years, the expansion of web 2.0 and the ever increasing advancement and

popularity of online social networks have had a tremendous impact on the way

companies conduct marketing (Bolotaeva, and Cata, 2011). Because of the

39

opportunity to avoid face-to-face interaction, people appear to not be too concerned

about the immediate consequences of what they said online. This gives people greater

freedom to express themselves honestly. Their level of comfort increases greatly

when interacting online.

Electronic word of mouth (e-WOM) marketing on social media captures up-to-date

information posted by users which could include their positive or negative

experiences with a product or brand (Hooper, V. and Kalidas, T., 2012). Hence, it is

this ability of consumers to communicate and share information with many

individuals ‗online‘ that represents the biggest opportunity that exists for marketers of

goods and services. Huge number of consumers, especially youth, view social media

as providing them with a platform for socializing and entertainment, as opposed to a

platform for marketing. Thus, youth consumers are drawn to these social media

platforms primarily because it has something different to offer, as opposed to

traditional media where a ‗push‘ strategy is adopted by marketers. For marketers, this

has created several opportunities in that they need to employ marketing activities

around social media platforms which can provide value and benefit to consumers,

acting as a ‗pull‘ factor, growing usage also indicates that social media platforms

present a good interactive platform for marketers to capitalize and influence the

purchasing behaviour of youth consumers.

Social networking websites are online communities of people who share interests and

activities or who are interested in exploring the interests and activities of others. They

typically provide a variety of ways for users to interact, through chat, messaging,

email, video, voice chat, file-sharing, blogging and discussion groups (Jothi, et al.,

2011). Social media or Social networks are websites which allow users to

40

communicate, share knowledge about similar interests, discuss favourite topics,

review and rate products/services, etc.

Social media represents the ‗online‘ technologies and practices that individuals make

use of to share opinions, insights, experiences and perspectives with each other,

affects how marketers connect and communicate with consumers, and influence their

purchasing decisions (Hooper, V. and Kalidas, T., 2012). The top benefits are

increased brand awareness and ability to engage in dialogue directly with their

customers (Hooper, V. and Kalidas, T., 2012). Social media allows users to

communicate and exchange information with others, depending on the purpose.

Most of the companies have their presence on social media platforms and the

company executives are actively participating in knowledge exchange and networking

with the customers. This gives consumers an opportunity to interact with experts in

real time. The usage of interactive internet sites is increasing in India and abroad,

particularly among the youth. In general, youth are more interested in using advanced

technology in every field compared to any other age group. In the category of users of

social media the majority are youth.

In India too this fact is acknowledged by the various studies and hence today the

usage of social media has become large part of the student‘s lives in India

(Manjunatha, S, 2013). Social media is an internet supported platform which

facilitates communication, collaboration, and content sharing across networks and

boundaries. These platforms allow users to create and manage profiles online. Social

media platforms viz: Youtube, Google Plus, Twitter and Facebook, allow users to

repost comments posted by a company about its promoted product. This helps in

41

spreading the message to a large audience as all user connections are able to see the

message.

Online social networking sites ‗virtually‘ link individuals, who may or may not

‗know‘ each other. They enable rapid exchange of knowledge, high levels of dialogue

and collaborative communication through text, audio and video (Manjunatha, S.,

2013). Users of social media are active participants and not passive viewers. This new

platform allows users to post their views and ideas on the site. The users can share

their views and post comments which can be accessed by other users. It has a viral

effect because the message spreads through electronic word of mouth. Hence social

media marketing basically makes use of word of mouth for promoting the product. In

the category of users of social networking sites or social media majority are youth

(Manjunatha, S, 2013).

Social media has a competitive edge over other popular public media like Television

because there is a time gap between social event occurrence and the time it is being

broadcasted. Social media sites help companies connect with their consumers. Blogs

are good platforms for posting comments on events needing publicity and can be used

as a promotional technique. Now users are acquiring followers & subscribers and

directing them to social networking page (Bajpai, Pandey and Shriwas, 2012). Twitter

is an interactive internet platform which can be used by companies for product

promotion. Products‘ features can be posted in the form of a short message called

tweets. These tweets posted by social media users can be further accessed by

followers through their home pages. Twitter limits the posts to 140 characters, which

is not sufficient for advertisers of high involvement products like prescription drugs to

psot tweets as space constraint prevents them from posting detailed information.

Advertisers of prescription drugs provide links to detailed product information, which

42

may be helpful in overcoming the limitation of 140 characters per tweet. Unlike

Twitter, Facebook profiles give sufficient space to companies to provide complete

details about a product. They can also upload videos, images, and detailed

descriptions about the promoted product. Blogs are used by companies to provide

complete details about their product. Blogging is a very common practice used by

individuals and companies to stay connected with other individuals and consumers.

These sites are interactive and information exchange happens in real time, as the

content keeps updating regularly.

In recent years, the expansion of web 2.0 and the ever-increasing advancement and

popularity of online social networks have had a tremendous impact on the way

companies conduct marketing (Bolotaeva, and Cata, 2011). Electronic word of mouth

marketing on social media platforms captures up-to-date information posted by users

about their experiences with a product (Hooper, V. and Kalidas, T., 2012). Even

though social media marketing is still in its infancy, it holds potential for success if it

is carefully integrated in the marketing mix (Bolotaeva, and Cata, 2011).

1.7 Social Media Engagement of Pharmaceutical Companies

Companies across product categories are working to learn the nuances of social media

as it continues to grow in popularity and wide spread adoption. Pharmaceutical

companies are no different, except that they must also adapt government regulation

and industry standards to the new medium, making the topic important for

pharmaceutical companies, consumers, and policy makers (Myers, 2012). Almost all

online patients have searched and read about other‘s experience with their health or

medical issues via social media. This makes social media the best media for

pharmaceutical companies looking at DTCA, although many companies have not

43

gone social as the lack of guidance on social media has encouraged caution.

Pharmaceutical companies use electronic DTCA on interactive platform (eDTCA 2.0)

to market themselves and their top-selling drugs. eDTCA 2.0 is also used by illicit

online drug sellers. Regulators worldwide must take into account the current eDTCA

2.0 presence when attempting to reach policy and safety goals. People view on an

average 30 hours of DTCA per year (Liang and Mackey, 2011).

As per Advertising Age (2010), the following 12 companies are ranked top 100 global

marketers; Procter & Gamble Co., Pfizer, Johnson & Johnson, GlaxoSmithKline,

Merck & Co., Eli Lilly and Co., Bristol-Myers Squibb Co., Bayer, Novartis, Sanofi-

Aventis Group, Abbott Laboratories, and Boehringer Ingelheim. Almost all of these

companies today have a facebook page, twitter feed, and sponsored blogs. Pfizer has

the most robust social media website, including links to YouTube, Facebook, and

Twitter, as well as SlideShare, LinkedIn, Flickr, and blog resources (Liang and

Mackey, 2011). Social Media marketing may not be limited to where DTCA is

permitted by law. Social media sites such as GlaxoSmithKline‘s blog site and

AstraZeneca‘s community facebook page indicate they are ―intended for US

residents/customers only,‖ but appear to offer no access restrictions to non-US users.

Further, mobile applications such as those advertised on Apple‘s iTunes media store

are marketed by large pharmaceutical firms such as Pfizer, Novartis, and Roche, and

target Canadian, French, and Korean audiences. Hence, social media marketing may

occur outside the United States and New Zealand (Liang and Mackey, 2011).

Lau (2012) in his paper ―Social media in health – what are the safety concerns for

health consumers?‖ has quoted Maskell, Cross & Gluckman (2010), ―Clinicians need

to anticipate the psychological impact and misconceptions patients may already have

about their condition, prognosis, treatment plans, and procedures due to accessing

44

inappropriate and incorrect content online. This is especially important with younger

patients‖.

Novartis Oncology has come up with social media platform called ―CML earth‖ here

CML stands for Chronic Myelogenous Leukemia. Targeted towards patients suffering

from leukemia (around the world) this site provides a platform to connect with other

patients, doctors, healthcare professionals and online communities. It is a global

interactive social network dedicated to connecting the CML community from around

the world. This application has a global map and a take a tour video to help new users

to understand the interface. The site supports multiple languages. Through this site,

Novartis aims at communicating directly with the patients for promoting its products.

Novartis has also launched a YouTube channel which allows patients to upload their

stories. The video story ends with Novartis company name on the screen. Although

users are not permitted to name Novartis‘s products because of restrictions on

promoting medical products directly to consumers, it is implied that patients have

used Novartis products. Negative comments are controlled by Novartis by preventing

users from posting contents with adverse event reporting, related to its products or

companies. Novartis is one of those pharmaceutical companies which have made use

of social networking sites like facebook, twitter and youtube to promote their drugs.

Traditionally pharmaceutical companies followed a push strategy for promoting drugs

and only OTC drugs were promoted directly to consumers, while prescription drugs

were promoted primarily to doctors, through detailing, free samples, brochures, gifts

(cash/kind). Additionally some companies also promoted prescription drugs to

hospitals and other healthcare professionals. This gave autonomy to doctors to decide

and prescribe drugs of their preference. To break this monopoly, pharmaceutical

companies have now shifted the focus to direct to consumer promotion (DTCP).

45

Customer also seems to be enjoying this newborn status. The patients now believe

more in self medication. While some patients depend solely on information gained

from DTCP to decide on their therapeutic options, others use the information to

discuss with the doctors or pharmacist before making a purchase decision. This trend

is picking with youth and India being a young country, pharmaceutical companies are

turning to internet and social media for promotion of prescription drugs, as social

media is preferred media for youth. Companies utilise various social media constructs

like customer created information and buzz; Electronic word of mouth (e-WOM) &

Customer oriented brand related activity (COBRA), and Information from the

manufacturer of drugs.

1.8 Direct to Consumer Advertising through Social Media

DTCA has important implications for the consumerism movement in healthcare.

Technologies like smart phones and wireless internet connectivity allow consumers to

access promotional information about prescription drugs. The new and emerging

forms of digital or electronic DTCA (eDTCA) marketed online through internet or

social media is a growing concern in global health which has yet to be adequately

studied. These technologies pose new challenges for policy makers, patient safety

advocates and stakeholders in protecting population based health and in combating

rising healthcare costs (Mackey & Liang, 2012).

Digital promotion of prescription drugs has evolved from passive internet media to a

new interactive technology called social media. These sites make use of web 2.0

(interactive sites). Although web 2.0 platforms are highly influential marketing

platform for promotion of prescription drugs and hence cannot be ignored, they also

carry great risks. In case of searches for Prozac (prescription drug for depression) on

46

the internet if one visits the manufacturing company website s/he can take self-

diagnostic test which allows a person to self-diagnose depression. Many

pharmaceutical companies have established a formal presence on social media sites.

Web 2.0 social media is a new way for pharmaceutical companies to interact with

consumers. Pharmaceutical companies can develop youtube page and upload videos

of customer testimonials or start a campaign involving different social media sites -

twitter campaign to alert consumers about new drugs or encourage customers to

follow new developments in prescription drugs through facebook.

Internet may not have changed so much as the way we use it, we have moved from

‗passive‘ browsing to ‗active‘ participation through collaboration and engagement

with user-generated content on the web platform. Emergent uses include: social

networking, image-sharing, production of wikis, podcasts, blogs, and the practice of

tagging and commenting (Roberts, J., 2009). On-line patient communities like patient

support groups found at ―www.patientslikeme.com‖ use tagging to provide their own

ranking of the quality of on-line health information.

Health services are also beginning to embrace web 2.0. AstraZeneca‘s asthma channel

and the companion website ―myasthmastory.com‖ directly calls for patient testimonial

videos and Sanofi Aventis‘s diabetes channel with the website ―goinsulin. com‖ also

features testimonial videos (Roberts, J., 2009). Pfizerpedia is Pfizer‘s internal,

company wide, user-generated Wiki of R&D information, directories, discussions

groups and databases. It enables communication and sharing of information in a

global company between people who might never have got together and who may

never meet in person. As a result of its success, Pfizer is now apparently considering a

―Pfacebook‖ social network (Roberts, J., 2009). The last five years have seen social

media platforms like Facebook, YouTube, Twitter and Linkedin gain unprecedented

47

community acceptance, and many similar commercial sites for health are now in

operation. However, consumers are likely to experience harmful effects when

accessing social media that is unsafe.

The open nature of social media also presents limitless opportunities for stakeholders

to misuse the online community to promote their products and services. Although

social media may break down many of the traditional reading and writing barriers in

health literacy, navigating safely in the social media world requires a new set of e-

health (electronic health) literacy skills. In practical terms, not only should consumers

be informed of social media channels that are credible for health purposes, they

should also be aware of their responsibilities to (a) avoid potentially harmful material,

(b) report incidents of discerning content, (c) consider the consequences before

commenting and disseminating harmful and disrespectful content, (d) be cautious of

commercially motivated objectives, and (e) be aware of undue social influences from

other users in the online community (Lau, et al., 2012).

US FDA has issued no guidance for DTCA through internet / social media. The only

guidance issued is that websites or internet advertisements promoting prescription

drugs must comply with current DTCA regulations which govern print or broadcast

advertisements. With the growing percentage of internet users seeking health

information online there is a need to have appropriate regulations for governing the

drug related information disseminated on the internet and social media. This makes

social media a truly revolutionary trend. Just as corporate web pages and e-commerce

dominated the late 1990s social media has emerged as a user-generated platform for

sharing information—and marketers are beginning to embrace it as a real opportunity

(Myers, D. S., 2012).

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1.9 Fair Balance

Majority of advertisements present a "fair balance" of benefit and risk information but

they occasionally omit information that may be useful to consumers (Roth, M. S.,

1996). To address this difficulty, the US FDA considers a standardised presentation of

benefits and side-effects in advertisements (Woloshin, et al., 2001). The US Food and

Drug Administration (US FDA) is responsible for monitoring the information content

of DTCA; before being placed into media, all advertisements are reviewed by the US

FDA.

The overall balance of benefit and risk information contained in the advertisement is a

key criterion used by the US FDA in evaluating prescription drug DTCA. Balance is

not meant to imply that there must be an equal number of benefit and risk claims.

Rather, the advertisement must accurately communicate the drug's known benefits

and risks in a way that fairly portrays the pharmacological properties of the product

(Roth, M. S., 1996).

1.10 US FDA and Direct to Consumer Advertising

Division of Drug Marketing and Communications (DDMAC): Division of the US

FDA which is responsible for overseeing direct to consumer advertisements within

US FDA‘s Center for Drug Evaluation and Research (FDA website).

US FDA regulates DTCA, to ensure that pharmaceutical companies complied with the

brief summary requirement, as per the mandate of ―Federal Food, Drug, and Cosmetic

Act‖. Consumer oriented advertising of prescription drugs and the economic and

health concerns that surround it have been an issue since at least the late 1990s, when

pharmaceutical manufacturers intensified their efforts to promote prescription drugs

49

directly to consumers. Until then, drug makers had focused their marketing efforts on

physicians and other health care providers.

Because DTCA can facilitate consumer interest and action yet often reach people with

imperfect knowledge of diseases and treatments, the regulatory role of the US FDA is

critical (Roth, M. S., 1996). The US FDA governs DTCA of prescription drugs. In

case of violation of regulations US FDA issues regulatory letter directing the

pharmaceutical manufacturing company to take specific actions. US FDA reviews a

small portion of the direct to consumer (DTC) materials it receives. To identify

materials that have the greatest potential to impact public health, US FDA has

informal criteria to prioritize materials for review. However, US FDA has not

documented these criteria, does not apply them systematically to all of the materials it

receives, and does not track information on its reviews. As a result, the agency cannot

ensure that it is identifying or reviewing those materials that it would consider to be

the highest priority (GAO report, 2006).

According to US FDA regulations, pharmaceutical companies are required to submit

the final draft of the advertisement to US FDA when it is first disseminated to the

public. Also some drug companies voluntarily submit the draft to US FDA before

releasing the advertisement. If a violation is identified in the advertisement, US FDA

can issue a regulatory letter asking the company to stop the dissemination of the

advertisement. In case of serious violations US FDA can direct the companies to run

another advertisement to correct misleading impressions left by the earlier

advertisement. Although these letters are issued by US FDA, they are drafted by

DDMAC. Since January 31, 2002, at the direction of HHS (US Health and Human

services), all draft US FDA regulatory letters, including the letters drafted by

DDMAC, are reviewed and approved by US FDA‘s Office of the Chief Counsel

50

(OCC) before they are issued in order to ensure the letters‘ ―legal sufficiency and

consistency with agency policy (GAO report, 2006). Common violations are failure of

the advertisement to accurately communicate information about drug safety,

overstatement of the drug‘s effectiveness, and misleading claims. Regulatory letters

are issued for those advertisements which are serious and impact public health. All

prescription drug advertisements whether directed to physicians or consumers are

regulated by US FDA.

DTCA can be categorised into different categories depending on the media used viz

broadcast advertisements (TV and radio), print advertisements (newspaper, magazines

and pamphlets), and internet advertisements (websites and social media). There is no

need for the pharmaceutical companies to submit advertising materials to US FDA

before they are disseminated. DDMAC created DTC Review Group in March 2002.

This group is responsible for overseeing DTCA. Following are the responsibilities of

the review group:

i. To review final DTC materials

ii. To review and provide advisory comments on draft DTC materials.

iii. To monitor television, magazines, and corporate website advertising

iv. To identify advertising materials that were not submitted to US FDA at the

time they were first disseminated

v. To review advertising materials cited in complaints submitted by competitors,

consumers, and others.

Final draft of DTCA materials submitted to US FDA, are forwarded to the review

group. In case concerns are identified US FDA decides whether it represents a

violation and merits a regulatory letter.

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Regulatory letters are of two types: ―warning letter‖ and ―untitled letter.‖ Warning

letters are typically issued for violations that may lead US FDA to pursue

enforcement action if not corrected; untitled letters are issued for violations that do

not meet this threshold. US FDA generally posts issued letters on its website within

seven days of issuance (GAO report, 2006). There seems to be a link between DTCA

of prescription drugs and increase in adverse event reporting. A moratorium on

DTCA gives sufficient time to uncover the side effects and associated risks of new

drugs. However, a moratorium on DTCA that delays the widespread use of new drugs

could also worsen rather than enhance public health in some ways (Campbell, S.,

2011).

In August 1997, the US FDA issued a preliminary ―Guidance for Industry‖ that

reinterpreted US FDA regulations without actually changing any regulations.

Reiterating traditional requirements, the Guidance stated that in addition to being

nondeceptive, prescription drug advertising must (1) Present a fair balance between

information about effectiveness and information about risk, (2) Include a ―major

statement‖ conveying all of the product‘s most important risk information in

consumer-friendly language, and (3) Communicate all information relevant to the

product‘s indication (including limitations to use) in consumer-friendly language. The

new interpretation made clear, however, that the ―major statement‖ in radio and

television advertisements could be far simpler than what had previously been required

(Calfee, J. E., 2002). Adequate provision of required information could be achieved

by including a concise summary of risks and related information (often through voice-

over), while identifying sources for more complete information: a toll-free number; an

internet website address; either concurrent print advertisements or information about

52

specific, publicly accessible locations such as pharmacies; and a statement that

information is available from all physicians and pharmacists.

The US FDA stated that it would review its policy after two years and invited

interested parties to provide information and research on the effects of DTCA.

Perhaps the most important aspect of US FDA advertising regulation is that it is

essentially never challenged in court by pharmaceutical firms, which accede to US

FDA demands to modify or drop challenged claims and advertisements.

In the year 1983, US FDA came out with a moratorium on DTCA of prescription

drugs. This was lifted in 1985 after concerns were raised related to freedom of speech

and that regulations already in place were sufficient to protect the consumer. After

this DTCA for prescription drugs was allowed with a clause that it should meet

certain criteria; specifically, presentation of true and balanced information about drug

associated side-effects and risks and benefit. The US FDA monitors compliance with

these criteria. However, prior approval of drug advertisements is not required

(Woloshin, et al., 2001). The US Food and Drug Administration after a long

moratorium decided that these advertisements required no new regulation beyond the

―fair balance provision‖ of the 1962 Kefauver-Harris amendments, which requires

that manufacturers truthfully present a fair balance of risks—side effects and

contraindications—and effectiveness (Kravitz, R. L., 2000).

The 1962 amendments to the Food, Drug, and Cosmetic Act, which charged the US

Food and Drug Administration with regulating pharmaceutical effectiveness in

addition to regulating safety. It transferred responsibility of prescription drug

advertising from the Federal Trade Commission (FTC), which still regulates

advertising of over-the-counter (OTC) drugs to the US FDA (Calfee, J. E., 2002).

53

The US FDA has not yet issued formal guidelines regarding online DTCA. In the

absence of formal guidelines regarding online media, drug companies have asked the

US FDA for guidance on what is acceptable, particularly in the context of social

media advertising.

Many companies also requested that the US FDA should have a rule on whether

companies or their surrogates could directly interact with patients or physicians via

online chat rooms or social media sites (Ventola, C. L., 2011). DTCA in increasing

patient contact with health care providers could also be beneficial by promoting

dialogue about lifestyle changes that improve patients‘ health, whether or not a drug is

prescribed.

Dialogue inspired by DTCA doesn‘t always benefit the manufacturer of the advertised

drug, because physicians do not usually prescribe a medication simply because it is

requested by a patient. Doctors usually prescribe requested drugs only for patients

who had been advised by other health care providers, such as pharmacists and other

physicians, not by the advertisement. Small print in DTCA encourages patients to

seek the advice of their doctor. Small, but statistically significant, improvements in

adherence occur among patients exposed to DTCA. This increased compliance is

believed to be due to drug advertisements serving as a reminder about a patient‘s

medical condition and prescription. DTCA is also thought to reinforce physician

recommendations and make patients more likely to follow treatment instructions.

DTCA has been credited with decreasing the underdiagnosis and undertreatment of

medical conditions. Consumer drug advertising for health problems that could be

embarrassing to a patient, such as depression, can reduce the stigma associated with

these conditions. Patients may also lack the skills needed to evaluate comprehensive

54

medical information, even if it has been provided. Prescription drug advertisements

over-emphasize potential benefits. Physicians believe that most patients who initiate a

request for a new drug understand the benefits much better than they understand its

risks. Risk information sometimes also lack quantitative data regarding the incidence

of adverse events, which could assist consumers in evaluating drug risks.

Clinical trials required for US FDA approval are typically not designed to detect rare

adverse effects. Current methods of post-marketing surveillance often fail to connect

adverse events that have a high rate of occurrence with the use of a particular drug.

Drugs that are expected to be ―blockbuster‖ sellers are also most heavily promoted

early in the product‘s life cycle, which can present a public health risk because the

drug‘s safety profile is not fully known at that point. DTCA aggravates dissatisfaction

about normal experiences and also creates heightened expectations of drug benefits. If

a patient‘s request for an advertised drug is clinically inappropriate and the health care

provider is unable or unwilling to correct the patient‘s perception, this situation may

lead to unnecessary or harmful prescribing.

The US Food and Drug Administration (US FDA) oversees prescription drug

advertising with the Federal Food, Drug, and Cosmetic Act and related regulations.

Through its Division of Drug Marketing, Advertising, and Communications

(DDMAC), US FDA ensures that all prescription drug promotion provided by drug

firms is truthful, balanced, and accurately communicated. US FDA encourages

companies that offer DTCA to include accurate information in their ads. Through a

comprehensive surveillance and enforcement program, the agency ensures that

consumers are not misled or deceived by advertisements that violate the law. In

addition, US FDA advances and encourages better communication of labeling and

55

promotional information to health professionals and to consumers (US FDA,

Consumer Health Information, 2010).

1.10.1 Online US FDA Guide for Consumers

US FDA‘s Website, ―Be Smart About Prescription Drug Advertising, A Guide for

Consumers,‖ is designed to educate consumers about how to view direct-to-consumer

advertising (DTCA), prepare them for discussions with their doctor or healthcare

professionals, and helps improve patient understanding of the medical condition, drug

use and associated risk and benefit. The site includes the following directions for

safeguarding the interest of the users/consumers:-

i. Healthcare professional is the best source of information on the right

medicine.

ii. Prescription drug DTCA can provide useful information to consumers and

helps them in discussing with their physician by educating them and

enhancing their knowledge.

iii. In case a prescription drug DTCA violates the law, consumers can contact US

FDA‘s Division of Drug Marketing, Advertising, and Communications

(DDMAC).

The online guide offers examples of different direct to consumer advertisements

illustrating various requirements for different types of advertisements. It has FAQ‘s

(frequently asked questions) link to help consumers find answers to their common

querries post exposure to prescription drug advertisement. The site ―Be Smart About

Prescription Drug Advertising, A Guide for Consumers,‖ has a ―give us feedback‖

link which leads the consumers to a survey demanding consumer‘s view of the utility

of the site.

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1.10.2 Basics of Prescription Drug Advertisements

A drug is "prescription only" when medical professionals must supervise its use

because patients are not able to use the drug safely on their own (US Food and Drug

Administration website). While prescription drug advertisements are governed by the

regulations issued by US FDA, over-the-counter (OTC) drug advertisements are

governed by Federal Trade Commission (FTC). These advertisements can be

categorised into following five broad categories:-

i. Product Claim Advertisements

ii. Reminder Advertisements

iii. Help-Seeking Advertisements

iv. Other Product Claim Promotional Materials

v. Risk Disclosure Requirements for Different Types of Advertisements

Product Claim Advertisements:

Only these advertisements can name a drug and discuss its benefits and risks, but they

should not be false or misleading. Companies are encouraged to use understandable

language in advertisements directed to consumers.These advertisements irrespective

of media should include following key components in the body of the advertisement-

i. Drug name

ii. At least one US FDA approved use of drug

iii. Most significant drug associated risks

It is obligatory for product claim advertisements to adhere to the ―fair balance

principle‖ of the US FDA i.e. benefits and risks of a prescription drug should be

presented in a balanced way. Print adverttisements are required to include a "brief

summary" of the drug associated risks as listed in the approved prescribing

information. Brief Summary is the detailed information appearing in prescription drug

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advertisements. The law requires that product claim advertisements in print should

include a "brief summary" with all the risks listed in drug's "prescribing information"

and at least one US FDA-approved use of the drug. Brief summary includes the

following -:

i. Who should not take the drug

ii. When the drug should not be taken

iii. Possible serious side effects of the drug and, measure to prevent or reduce

these side effects

iv. Frequently occurring, but not necessarily serious, side effects.

Prescribing information is also called product information, product labelling, or

package insert. Drafted by the drug company and approved by US Food and Drug

Administration, it moves from company to pharmacist. It includes details and

directions for drug prescription by doctors. It includes the following (FDA website):-

i. Its chemical description

ii. How it works

iii. How it interacts with other drugs, supplements, foods, and beverages

iv. What conditions or diseases it treats

v. Who should not use the drug

vi. Serious side effects, even if they occur rarely

vii. Commonly occurring side effects, even if they are not serious

viii. Effects on specific groups of patients, such as children, pregnant women, or

older adults and how to use it in these populations

ix. Patient Packaging Inserts: These are inserts with prescription drug information

(US FDA approved) drafted by drug manufacturers for patients. It is called

―Medication Guide‖ in case of especially risky or difficult to use drug.

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Major Statement: It is relevant only to broadcast (TV or radio) advertisements of

prescription drugs. It is a statement of drug‘s most important risks that should be

spoken or included in video of broadcast advertisements. The extent and type of risk

varies depending on drug. In case of broadcast, product claim advertisements (TV,

radio, telephone) must include the following -

i. Drug's most important risks / major statement presented in the audio.

ii. Either all risks listed in drug's prescribing information or different sources

with prescribing information for the drug.

This means that drug companies do not have to include all drug associated risk

information in a broadcast advertisement. Instead, the advertisement can provide

sources which could be used by the consumers for seeking further information about

the drug in the US FDA approved prescribing information. This is called the

"adequate provision‖ requirement. In product claim advertisements, drug companies

have to include all risks associated with a drug. This is possible in print

advertisements, through brief summary. This is not possible in case of broadcast

advertisements as it will take a long time and incur cost. Hence to meet the "adequate

provision" requirement, broadcast advertisements should suggest ways to find the

drug's US FDA approved prescribing information. This can be done by giving

following sources and links for consumers interested in seeking further information:

i. Contacts of healthcare providers (e.g. physicians)

ii. Toll-free telephone number

iii. Magazine issue with the corresponding print advertisement

iv. Web/ Url link

MedWatch: It is the ―Safety Information and Adverse Event Reporting‖ program of

the US Food and Drug Administration.

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Reminder Advertisements

These advertisements include the name of a drug, but do not delineate drug‘s uses

hence they are exempted from presenting drug associated risk information. Unlike

product claim advertisements, these advertisements cannot use text or pictures

suggesting drug's benefits or risks. For drugs with serious risks these advertisements

are banned. As such prescription drugs with serious risks carry special warning

"boxed warning‖ summarising the associated risks. Drugs with serious side effects,

particularly those that can cause death or serious injury, have this warning

information displayed within a box in their advertisement. This is called "boxed" or

"black box" warning. Such drugs are not permitted to have reminder advertisements.

Help-Seeking Advertisements

They describe the disease without recommending any specific drug. These

advertisements encourage patients to visit their physician for seeking medical advice.

Sometimes these advertisements include company's name and may also provide a

telephone number for further information.

Fair Balance: Product claim advertisements should give a "fair balance" of

information related to drug risks and benefits. Content and presentation of important

risks must be similar to that of benefits. Print product claim and reminder

advertisements must include the following statement:"You are encouraged to report

negative side effects of prescription drugs to the US FDA. Visit Med Watch or call 1-

800-US FDA-1088‖. Broadcast product claim advertisements: Must include most

important risk information "Major Statement" clearly and conspicuously. They must

also enlist either every risk or provide links to different sources for consumers to

collect drug's prescribing information ―Adequate Provision‖.

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Major Statement: Presentation of the most important risks associated with the drug

in audio form (only for broadcast advertisements).

Adequate Provision: An alternative way to include drug associated risk information

in a broadcast advertisement. Prescription drug advertisements must include all risks

associated with the drug in a product claim advertisement. In print advertisements,

this is done by way of "brief summary". Although it is not possible in a broadcast

advertisement, it would take a long time. Hence broadcast advertisements are allowed

to include only the most important risk information with links for collecting further

information. To meet this provision broadcast advertisements should provide links to

find the drug's US FDA-approved prescribing information. Broadcast advertisements

can meet the "adequate provision" requirement by giving following:

i. A healthcare provider (for example, a doctor) reference

ii. A toll-free telephone number

iii. The current issue of a magazine that contains a print advertisement

iv. A website address

1.11 Advertising

Advertising for most products is intended to make consumers aware that such a

product exists, inform them of its purpose, and, in some cases, persuade them that the

advertised product is better than its rivals. The ultimate aim of the advertising is to

encourage a consumer to choose a product and purchase it through whatever retail

channel is available (Campbell, S., 2011).

Advertisement is a tool used by compaies to shape their consumer‘s behaviour.

Traditionally advertisement was a one way communication and used mediums like

print and broadcast. Online advertising is the new form of advertising which makes

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use of platforms like internet and social media. It makes use of different platforms

like search engine, Social network other websites and e-mail. Internet offers a

widegamut of media tools, interactive services, and global reach. The marketers need

to understand their audience and accordingly select the media to gain maximum

benefits and reach.

Online advertising is a type of mass communication which is based on traditional

form of advertising but develops its own communication strategies in correlation with

the new technical and medium based requirements. Broadly, online advertising is

about delivering advertisements to internet/online users via websites, e-mail, ad-

supported software and internet-enabled smart phones (Bakshi, G. and Gupta, S. K.,

2013).

Advertising can help companies develop consumers' awareness to an unmet need or

introduce a product that consumers may see as valuable. This influence is often

present when new products enter the market. Customer awareness is often low for

these items until companies promote them and attempt to drive customer demand

through advertising (Dinu and Dinu, 2012).

Studying the attitude of consumers, it can be stated that if a consumer observes

messages for two different firm‘s products, one product‘s message containing a better

advertisement and the other not, believes the better advertisement‘s product will

definitely have more features and so be of higher value (Rai, N., 2013).

Advertising is basically undertaken by marketers or product manufacturers to shape

consumer behaviour. It tries to persuade consumers into purchasing the product.

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CHAPTER 2

DIRECT TO CONSUMER ADVERTISING

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CHAPTER 2

DIRECT TO CONSUMER ADVERTISING

2.1 DTCA and Pharmaceutical Market

Pharmaceutical companies have always promoted over the counter drugs to the

consumers but DTCA for prescription drugs was not so prevalent before 1997.

Traditionally prescription drug promotion was targeted at doctors who were

considered to be the most authentic source of information on prescription drugs. But

with the liberalisation of restrictions on direct-to-consumer advertising (DTCA) post

1997 pharmaceutical companies shifted their focus to the consumers. Proponents

claim that DTCA affects the pharmaceutical demand in two ways: (i) Educates and

informs consumers about prescription drugs and sometimes also disease specific

drugs (informative). (ii) Persuades consumers to discuss the advertised drugs with

their physician and request for prescription (persuasive).

Depending on the type of risk associated with the drug and need for expert opinion,

firms decide whether to use direct promotion to physicians (detailing) or direct to

consumer advertising (DTCA). Although on a very small level there is positive

interaction between detailing and DTCA. Direct to consumer advertising has a dual

effect (i) market expansion (ii) share increase. By informing and educating consumers

about prescription drugs DTCA helps in market expansion and due to its persuasive

role DTCA helps in increasing the market share of the advertised drug. Another point

of difference between informative and persuasive DTCA is that firms using

informative advertising aim at providing disease related information with details on

symptoms, possible remedies and side effects and do not emphasise on the advertised

brand. Quite contrary to this, persuasive advertising emphasises more on the

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advertised brand as it is assumed that consumers are aware of the disease and the

available therapeutic options.

2.2 Detailing

Unlike other markets where consumers make their own choice, in pharmaceutical

market choice of prescription drugs is limited to the doctors. Hence a doctor needs to

be well equipped to make this decision. To achieve this pharmaceutical manufacturers

resort to detailing which can take different routes like face-to-face interaction between

the doctor and the sales representative, brochures with details about the promoted

drugs, pamphlets, presentation on the use and other details of the drug.

Researchers claim that DTCA increases the return on investment (ROI) on detailing

hence the pharmaceutical firms should have a proper admix of detailing and DTCA in

their marketing strategy. Opponents of DTCA feel that detailing has a more

favourable effect on patient welfare and health as compared to DTCA. The growing

interest of consumers in self- health management has given way to DTCA and

liberalisation of US FDA regulations towards consumer advertising acts as a booster

for pharmaceutical marketers to actively participate in direct to consumer advertising

for prescription drugs. This paradigm shift in consumers‘ role from passive,

information-accepting to active information-seeking has changed the traditional

doctor-patient relationship. The doctor no more has the authority to decide

prescription drugs on behalf of the consumers and consumers are actively

participating in deciding their therapeutic options and healthcare management.

Consumers exposed to direct to consumer advertisements have a better understanding

of their disese and treatment options. They are also better listners as they are informed

and have an understanding of the different options available to them.

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2.3 Direct to Consumer Advertising

Direct to consumer advertisement encourages consumers to recognize undiagnosed

and under diagnosed symptoms and seek medical care at an early stage. The U.S. and

New Zealand are the only countries that allow DTCA that includes product claims.

Most other countries don‘t allow DTCA at all; however, Canada does allow

advertisements that mention either the product or the indication, but not both

(Ventola, C. L., 2011). Channels most commonly used to advertise prescription drugs

directly to consumers are television, print, radio, internet, and social media.

Marketers are beginning to recognize the enormous potential of online DTCA, which

reaches millions of potential consumers globally. Though the vast majority of DTCA

budgets are still allocated to traditional media (television, newspaper, magazine,

radio), marketers are beginning to shift some of their promotional spending to digital

promotion, such as product websites, online display advertising, search engine

marketing, social media campaigns, and mobile advertising (Ventola, C. L., 2011).

DTCA is the fastest growing promotional expenditure category for the pharmaceutical

industry (Rafalovich, and Adams, 2007).

Finally, there is the question whether DTCA confers positive externalities on the

marketplace, such as by increasing drug therapy compliance and conveying

usefulinformation about non-branded drug therapy or lifestyle changes (Calfee, J. E.,

2002). Patients and consumers must play an active role in their own health care. In

particular, consumers need to acquire information about medical therapies, talk to

their physicians about medical symptoms and conditions, and decide with their

doctors how to deal with illnesses and conditions (Calfee, J. E., 2002).

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DTCA is a new tool for promoting new products which are strongly dependent on

information communication. It leads to an increased consumption of therapeutic

categories being promoted (Calfee, J. E., 2002). DTCA is here to stay but the real

question is how it should be delivered so as to maximize the benefits while

minimizing potential harms. Drug manufacturers should do more educating and less

selling. This means focusing on conditions rather than drugs; assisting patients with

home-based self-care; presenting information on treatment alternatives, including

non-pharmacological therapies; helping patients who decide on medication to

optimize adherence; and promoting partnerships with physicians. As an example of

partnership, drug manufacturing and marketing firms should alert physicians before

launching DTCA campaigns and help them prepare for questions their patients are

likely to ask (Kravitz, R. L., 2000).

DTCA could be a help seeking advertisement stating that a treatment existed for a

condition, without mentioning a drug by name or making suggestions and

representations about drug treatments. Reminder advertisements emphasize drug

brands without mentioning what conditions the drugs could treat (Calfee, J. E., 2002).

Although getting prominence, DTCA of prescription drugs raises a lot of concerns.

Obvious issues include DTCA‘s impact on pharmaceutical prices and expenditures,

its impact on consumer information, and the extent to which DTCA is deceptive. Also

important are the questions whether DTCA affects physician‘s prescribing behaviour

and the patient–physician relationship.

The government should partner with medical professionals and institutions to create

different sources of consumer information, such as a ―Medical Letter‖ to consumers,

and public service announcements alerting consumers of undertreated conditions

(Kravitz, R. L., 2000). Online medical marketplace now poses serious risks to

67

consumers/patients related to direct to consumer advertising (DTCA) of medical

products and services as well as online direct to consumer sale of medical products

(Liang an Mackey, 2011).

2.4 Prescriber

The reason behind the pharmaceutical manufacturers spending so much on promotion

to prescribers/ doctors is that they believe that doctors are the gatekeepers governing

the healthcare decisions of the patients. In a practice called ―detailing,‖ drug makers

send representatives to visit physicians, nurse practitioners, and physicians‘ assistants

to discuss their products and to provide samples and reprints of academic literature on

their company‘s products (Campbell, S. 2011). Detailing involves pharmaceutical

sales representatives visiting physicians to inform about new products, and to

maintain goodwill by bringing free samples and gifts of various sizes (Brekke and

Kuhn, 2002). Prescription drug advertisements targeted at physicians could be in the

form of cash, gifts, sponsorships and free drug samples.

Although Physicians are highly ambivalent about prescribing advertised drugs

requested by patients, they are amenable to patients asking for drug information and

medications, but they are less receptive to questions arising from DTCA (Zachry,

Dalen and Jackson, 2003).

2.5 Consumer

There has been history of patients not taking medicines as per the prescription, this

has its own repercussions like unnecessary disease progression, complications, lower

quality of life, and could ultimately lead to death. Even though DTCA has been

widely accepted by physicians and consumers at large, the question remains: who

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actually benefits from DTCA- consumers or industry? Claims have been made that

DTCA benefits public health in the following ways: Aims at educating consumers;

Helps in early diagnosis and needed care of some chronic and critical medical

condition; Improves patient compliance in taking prescribed medicines; Provides

autonomy to consumers in their own healthcare management.

2.6 DTCA and Patient Empowerment

The last few decades have seen a dramatic transformation of the consumer‘s role in

health care. The current period of consumer involvement in health care harkens back

to the drug market in the early twentieth century when self-treatment was highly

valued and most drug advertising was aimed directly at consumers. Physicians‘

authority over the prescribing of drugs has been directly challenged by DTC

advertising campaigns urging consumers both to self-diagnose and to demand specific

medications from their provider (Donohue, J. 2006).

Today‘s patient population is completely different from those of years past. They are

involved, well educated, and not afraid to question the advice of their physicians

(Gupta and Udupa, 2011). DTCA serves as a useful informational tool for consumers

(Deshpande, Menon and Perri, 2004). Consumers (especially youth) are informed and

aware of the medicines being promoted through different sources including internet

and social media and are interested in their own health care decisions.

Direct to consumer advertisement serves an educational mission it educates the

consumers about different prescription drug options, their usage, side effects and

aasociated risk. Although some DTCA message is difficult to understand because of

the use of technical language, mostly DTCA use simple and easy to understand

69

language. The growing interference of consumers in healthcare decisions is posing a

threat to doctor‘s authority.

2.7 Physician -Patient relationship

DTCA results in patients making almost as many inappropriate requests as

appropriate ones. This puts physicians in a quandary, facing 3 conflicting ethical

obligations. First, physicians aim to ―do no harm.‖ Second, physicians seek to

maintain and develop a strong doctor-patient relationship because it enhances future

care and health outcomes. In addition, patient satisfaction is now used as a benchmark

for quality of care and, as such, may determine physician income. Third, physicians

have a duty to ensure fair allocation of health care resources and avoid wasteful

expenditure (Murray, et al., 2003).

Most of the physicians and consumers believe that DTCA would give rise to drug

cost, discourages use of generic products and promotes the healthy competition

among pharmaceutical companies (Rajani, C. H., 2012). Physicians find responding

to inappropriate requests time-consuming and that they often seem to acquiesce to

such requests as long as the patient is not harmed (Murray, et al., 2003). When

physicians prescribe advertised drugs, a large majority predict that it would result in

positive patient outcomes, including improved overall health, relief of symptoms,

reduced severity of illness, and better compliance (Weismann, et al., 2004). Thus,

physicians attempt to mitigate negative effects of DTCA but at the cost of physician

time or health care dollars.

Furthermore, more doctors perceive the effect on the relationship as beneficial, but

this is dependent on physicians doing what the patient wants. Patients need stronger

skills in critically appraising drug advertisements to determine whether the material is

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personally relevant and accurate (Murray, et al., 2003). Patients should seek the

physician‘s opinion on the relevance and accuracy of information in DTCA. This

would both strengthen the doctor patient relationship and avoid clinically

inappropriate interventions (Murray, et al., 2003). Just as physicians need to

acknowledge that patients are expert in knowing their own health utilities, patients

need to recognize physician‘s clinical judgment. Finally, physicians need to learn how

to negotiate inappropriate requests efficiently without jeopardizing the doctor-patient

relationship or feeling (Murray, et al., 2003).

Electronic health (e-health) empowers patients, fosters clinician patient relationships,

and promotes evidence based medicine (Liang and Mackey, 2011). Higher

misconception rates seem to be tied to strong visual signals within the advertisement,

misunderstandings about the treatment of the disease, and commonly held beliefs

about the type of medicine in the advertisement. Overall, benefits are recalled at a

higher rate than risks presented in the adsvertisements (Zachry, Dalenand Jackson,

2008). Once patients have formed impressions based on an advertisement, the

possibility exists for these impressions to influence behaviour. This includes the

possibility that patients will seek information, a specific medication, and even

different care if their requests are denied (Zachry, Dalenand Jackson, 2008).

As pharmaceutical advertisers and marketers continue to refine their techniques, their

ability to market specific drugs to particular audience segments is likely to increase.

From a health communication perspective, DTCA may be useful in increasing

awareness and knowledge among the consumers with specific conditions for available

treatments, but they also may lead to inaccurate self-diagnoses or incorrect

perceptions of illness risk or treatment efficacy (Brownfield, et. al., 2004). There are

generally two schools of thought regarding the effects of direct-to-consumer drug

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advertising. Proponents of DTCA assert that pharmaceutical companies are providing

a service for patients and the medical community by creating more informed

consumers who can play a more active role in their own health care decision making.

Opponents of DTCA counter that some advertisements are misleading and many are

overly emotional in content (Brownfield et. al. 2004).

Direct-to-consumer advertisements for prescription drugs undoubtedly help to educate

consumers about available options. They encourage consumers to believe that a

problem might exist and that a pharmacological solution is the appropriate way to

deal with it. These characteristics are shared by advertisements for over-the-counter

drugs. What is unique in the case of prescription drug DTCA, however, is that

consumers are also being asked to see their doctor (Woloshin et al., 2001).

Direct-to-consumer advertising (DTCA) of prescription drugs has elicited various

concerns. One concern is that DTCA may add to spending on drugs by consumers,

insurers, and the federal government without providing enough benefits to justify that

spending; specifically, some observers worry that DTCA encourages broader use of

certain drugs than their health benefits warrant. Another concern is that DTCA for

newly approved drugs may lead people to use drugs whose potential risks were not

fully discovered during the drug approval process. Those concerns have spurred

recent proposals for a moratorium on advertising brand-name prescription drugs to

consumers during the first two years following a drug‘s approval by the US Food and

Drug Administration (US FDA). Although such a moratorium would allow more time

for safety concerns about a new drug to be revealed, it would entail health risks of its

own, because some individuals who would benefit from a new drug might be unaware

of its availability in the absence of consumer advertising.

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A moratorium on direct to consumer advertising might affect promotional marketing

strategies used by pharmaceutical companies and the volume and price of drugs sold.

The expected effects of a moratorium could be one of the following: Drug

manufacturers would expand their promotion to doctors to substitute for banned

advertising to consumers. The number of prescriptions filled would probably decrease

for some drugs. For other drugs, the number of prescriptions might be little changed,

owing both to the likely substitution of other types of promotions and to the various

other factors that influence a drug‘s reach in the prescription drug market. Any change

in prescription drug prices would depend on changes in demand; to the extent that the

effects on demand are likely to be limited, so too are the effects on prices. In addition,

a moratorium could affect public health. Impact is uncertain, depending on whether

the benefits of fewer unexpected adverse health events were larger than the health

costs of possibly reduced use of new and effective drugs (Campbell, S., 2011). In

1985 US FDA lifted the moratorium as it was considered that the existing regulations

governing prescription drug DTCA provided sufficient safeguards to protect

consumers (Rajani, C. H., 2012). Treatments for common conditions that affect a

large portion of the population are a primary focus of DTCA.

Drug makers usually do not promote drugs that treat rare illnesses because they would

have to spend considerable amounts to reach the relatively few individuals affected by

that condition. Although drugs that address rare conditions are not likely to be the

subject of television or print advertising that reaches a broad audience, they may be

promoted in a more targeted way, ―online‖ through search and banner advertisements

or social networking sites such as facebook or twitter. Information available in

internet advertisements of prescription drugs, however, makes analysis difficult.

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The US FDA has issued warnings about the incompleteness of risk information in

pharmaceutical advertising in online searches and is studying advertising through

social media platforms (Campbell, S., 2011). DTCA for prescription drugs can

influence consumer health attitudes, beliefs, and behaviours (Roth, M. S., 1996). Most

common form of DTCA features a particular company's drug. These advertisements

seek to educate consumers about a disease state and the drug's benefits as a viable

treatment. They include relevant risk and side effect information and encourage

consumers to contact their physician. Some drug companies engage in advertising that

focuses on a disease state but does not mention a specific product. These

advertisements are designed to generate disease awareness and encourage consumers

to contact their physician to learn more about possible treatments. Because these

advertisements do not mention a specific product, they are not held to the fair balance

criterion by the US FDA. Other direct to consumer advertisements not requiring the

US FDA fair balance regulation, are reminder advertisements and those that solely

inform patients of new dosage formats (e.g., Glaxo's extension of the Zantac oral

tablet to an effervescent dosage).

Enhancing awareness and understanding of diseases, symptoms, and treatments could

be a major contribution of DTCA. Advertising would seem more attractive when

consumers can associate their identifiable symptoms easily with the advertised

products and when the treatment appears easy to follow (Roth, M. S. 1996).

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CHAPTER 3

SOCIAL MEDIA AND ITS ROLE IN DTCA

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Chapter 3

Social Media and its Role in DTCA

3.1 Social Media

Out of 80 million active internet users in Urban India, 72 percent (58 million

individuals) have accessed some form of social media (IAMAI & IMRB, 2013). They

may have accessed social media using a personal computer, laptop or even a mobile

device. Social media usage ranks only after email (80 percent) in terms of usage.

Essentially, social networking often serves to be among the first use of internet in

India, besides the usual reasons like email, music and gaming. Facebook is the most

accessed website with 97 percent of all individuals using it followed by Googleplus

and Linkedin. However, Linkedin has the highest proportion among women and users

above 25 years. In fact, Linkedin has the second highest average time spent only after

Facebook. The average time spent by Indian netizens (internet citizens) on social

media is 29.6 minutes on weekdays as compared to 28.8 minutes on weekend days

(IAMAI & IMRB, 2013).

Majority of the social media users, come from the urban India. Social media sites like

facebook, twitter, linked in and youtube are rampantly used for promoting products.

An estimated 13% of digital advertising budget was spent on social media in FY2012-

2013 compared to 10% in FY2011-12 in India. In the year 2013 internet user base saw

an increase of 42 per cent from 150 million in 2012 to 213 million in 2013 (IAMAI &

IMRB, 2013). The increasing internet user base has resulted in the growth of other

digital industries like e-commerce and digital advertising. India is the second-largest

online community in the world after China.

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Social media has matured as an important distinct digital entity. From being an

avenue for simply connecting with family & friends, it is increasingly used for

customer engagement, and is grabbing news headlines for other reasons.

Although highest proportion of social media usage in the Top 4 Metros & the Non

Metros is among the demographic segment ―Young Men‖ with 30% and 26%

penetration levels respectively, the number of young female users has also risen. Also

overall highest proportion (84%) of Social Media Users (among Active Internet users)

is for the demographic segment ―Young Men‖. Essentially, Young Men contribute

about 35% to the overall urban social networking base of 58 Mn (IAMAI & IMRB,

2013). Social media holds a particular appeal for 18-to-35 year old health searchers.

Overall men appear more likely than women to use online social media to research

health and wellness issues. Two-thirds of online adults have used general search

engines (e.g. Google, Yahoo!, MSN and Ask) to find health-related information,

making them the default gateway for this as well as many other topics (Gupta and

Udupa, 2011).

There is a growing trend of social media usage for health related purpose. It is seen

that awareness and acceptance of social media sites is high amongst doctors, mostly

young doctors. A major percentage of patients resort to self- medication based on

information obtained from internet and social media. The growing acceptance of

social media by consumers especially youth, makes social media a powerful

promotional tool, which can be explored by the pharmaceutical industry. For an

optimal use of social media for health related purpose it is important to take into

confidence medical professionals and their insecurities answered. The content of these

sites should be strictly regulated to ensure maximum benefit to patients and doctors.

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Considering the reach of social media, one cannot ignore its potential to generate

awareness and influence consumer opinion. These sites are used where patient

education plays important role like health and nutrition, chronic and frequently

occurring diseases. But marketers have to be very cautious in using social media

while promoting prescription drugs through this interactive media.

3.2 Role of Internet and Social Media in Healthcare Management

Easy availability of health-related information on internet has helped develop a

culture of concern over one‘s health. Prescription drug promotion provides a way to

cope with health anxieties and fears by alleviating health threats. Internet empowers

patients and makes them confident enough to discuss specific health related questions

with their doctor, without feeling uncomfortable. It provides user anonymity which

enables people to seek advice on embarrassing issues. Access to on-line doctors,

support groups and forums facilitate communication among those with similar

interests. This has led to a shift in the patient - physician role; patients have become

more proactive in learning about healthcare issues. On the other hand concerns are

raised regarding the quality of information available on the net. Another concern is

the digital divide according to which educated and high income group members of

society are more likely to use the internet for health purpose than their less-educated

counterparts.

Over the past few years the growth in technology has played an important role in

improving the state of healthcare. While metro and tier I cities have access to good

doctors, tier II and III cities still lack experts for consultations. Medical second

Opinion (MSO) has bridged this gap by offering consultations from renowned

doctors. The structure seeks to provide the best consultations to consumers hailing

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from remote areas lacking proper medical facilities. The patients are not required to

travel as they can access this platform via internet and social media. Patients can

benefit from discussions on these open forums. These platforms allow patients to ask

questions and receive answers. Partnership of these websites with hospitals,

pharmacists, doctors and other medical experts helps consumers in self-healthcare

management in an efficient way. Although these websites are very useful and

promising concerns are raised regarding the authenticity of information and expert

opinions available on these sites.

Marketers and consumers need to take measures to ensure that safe and accurate

information is disseminated through these social media channels. With a plethora of

false and misleading information disseminated through social media, it is important to

educate the consumers about therapeutic options, uses and associated benefits and

risks. Consumers should read the information available on US FDA website to

understand the guidelines governing these advertisements. This will help them to

make their choice better. Social media plays an important role in our day to day

activities, but consumers have not been able to sharpen their social media

understanding of prescription drug promotion.

Social media certainly offers many benefits like educating and informing the

consumers, provides access to doctors community, allows consumer to get

consultation and opinion from experts. It also benefits the pharmaceutical company‘s

business by understanding consumer perception and changes through feedback and

following and monitoring the user‘s conversations and postings. Many pharmaceutical

firms use social media sites to reach out to their followers and monitor useful news

updates and feeds, provide reminders about treatment, filling prescription and free

medical camps or other brand promotional campaigns. Some companies also use these

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sites for distributing general health information, thus in process they do parent brand

promotion. These social networking tools have revolutionized health management.

A new term has been coined ―Health 2.0‖, indicating the use of interactive social

media for healthcare. ―Patientslikeme.com‖ is a social media site that provides a

common platform for people dealing with a common disease. Users can connect with

lakhs of other people for sharing their experiences with different therapeutic methods

and drugs. These social media sites help in alerting the consumers about fake and

misleading DTCA by allowing adverse event reporting by users.

3.3 Use of Electronic Media in Tier II Cities

The growing migrant population in Tier II and III cities in India has led to an

explosive growth in electronic commerce in these cities. With the growing economy

India is witnessing the emergence of new consumption centres. Unlike earlier when

marketers were focussed on metropolitan and big cities, focus is shifting to the tier II

cities. Due to rapid urbanization and economic growth these cities are witnessing a

surge in consumerism. Although traditional brick and mortar companies are

expanding to these cities, but e-commerce players have gained a first mover

advantage. It is estimated that non-metro cities generate around 40- 45 percentage of

business for e-commerce portals (Jones Lang LaSalle India‘s 2013).

3.4 Social Media Promotion of Prescription Drugs with Emphasis on Youth

Social networks are not new, but the reach of the internet allows them to form faster

and go further than before. Unlike static websites, online social networks are more

dynamic because they are controlled by many instead of a few. Physicians‘ and

patients‘ activity on social networks is changing healthcare and causing manufacturers

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to take note. At a time when regulatory constraints are increasing, access to these

groups comes at a premium, the communities where consumers discuss diseases and

treatments are becoming an increasingly attractive venue for the industry (A deloitte

research study, 2010). Although since 1980 people have used internet to connect with

others it is only in the last decade that social networking services have proliferated

and their use has become a widespread practice – particularly amongst young people.

Social media is popular amongst youth. Emergence of Web 2.0 version of social

media has brought about a renaissance in the field of communication and social

interaction. Social networking site is generally used to indicate collaborative media

platform for sharing and exchange of information on a large scale. It could also be

extended to cover smaller user-generated content sites. The evolving trend in the

application and use of social media by youth shows a paradigm shift in social media

consumption from entertainment to information seeking to communication.

Today‘s youth are multitasking- consuming, producing, sharing and remixing

media.Youth spend more time online compared to other age groups. Many young

people are able to access quality internet at home: 67% of households have internet

access with 78% connected through broadband (ABS, 2010). They are also early

adopters in the mobile phone market with 97 per cent owning a mobile phone of

which 64% are internet capable (Nielson, 2010). Young people are increasingly using

their mobile phones to access the internet, making it the fifth most common use of

mobile phones in that age group (AIMIA, 2009). In addition to downloading content,

looking up information and emailing, mobile engagement with SNS is rapidly gaining

popularity: 26% of SNS users access these services via their mobile devices (Nielson,

2010).

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While the reading and writing of blogs are the main activities on social media carried

out by young people, these are being replaced by microblogging practices via twitter

and facebook status updates. Use of social media also has associated risks and

challenges. These include encroachment of privacy and cyber bullying. Although

social media has its pros and cons the manifold benefits it unfolds for youth has led to

its ever growing importance. Some of the ways in which it contributes towards youth

empowerment and upliftment are - media literacy, formal / informal education,

creativity, individual identity and self-expression, belongingness, collective identity,

developing social networks, and community membership. Social media constitutes

new platform for social engagement including information seeking and exchange.

The open nature of social media also presents limitless opportunities for stakeholders

to misuse the online community to promote their products and services. In 2007, a

pharmaceutical firm found editing articles on Wikipedia and deleting side effects of

certain medicines. Also some pharmaceutical companies are sponsoring e-patients to

blog about their disease, which includes writing about some drugs in their blog

entries. Social media is not just about designing and publishing content; it is also

crucial to consider the way content is disseminated because it has the potential to

‗become viral‘ in the online community (lau et. al, 2012).

With so much to offer pharmaceutical manufacturers are also switching to social

media for advertising prescription drugs. Although this shift is not easily aceepted by

the medical professionals, it is picking up with the consumers as it gives them an

opportunity to participate in their own healthcare management. Use of social media

for advertising prescription drugs is a new trend and needs some amount of

surveyllaince from the US FDA and pharmaceutical industry, because if left

ungoverned it can prove hazardous.

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CHAPTER 4

PHARMACEUTICAL ADVERTISINGWITH RESPECT TO

SOCIAL MEDIA

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CHAPTER 4

PHARMACEUTICAL ADVERTISING WITH RESPECT TO

SOCIAL MEDIA

4.1 DTCA trends in Pharmaceutical Market

Pharmaceutical industry in India has evolved over the years to become a world class

industry. A common structure of a pharmaceutical industry would comprise of a

Research and Development, Manufacturing, Sales and Promotion (marketing).

Although pharmaceutical industry has big players with their business spread across

countries, pharmaceutical advertising is restricted and regulated by US FDA. It needs

regular monitoring by government agencies and organisations authorised to supervise

the advertising of drugs both over the counter and prescription drugs. Legislative

bodies like US FDA have the right to determine which pharmaceutical product should

be promoted, although it is required to prevent health related hazards it limits the

creativity in pharmaceutical advertising. Because of the involvement of multiple

stakeholders there is a need to maintain transparency and regular exchange of

information and ideas amongst the key stakeholders like Patients, Physicians,

Manufacturing Company, Marketers and Key Opinion Leaders. In-spite of all

restrictions in the past several years, pharmaceutical industry has witnessed an

increase in the advertising and promotional expenditure.

Pharmaceutical drugs belong to either over-the-counter (OTC) or prescription drugs

category. OTC drugs are available and can be bought without a doctors‘ prescription

but consumers need a doctors‘ prescription for acquiring prescription drugs.

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Prescription drugs are also called ethical or Rx drugs. Traditionally doctors were

considered the sole authority and most authentic source for prescription drug

information. But with the liberalisation of US FDA regulations companies have

started promoting prescription drugs directly to consumers. Hence consumers can

participate in their own healthcare decision. Although DTCA empowers consumers to

understand their therapeutic options by enhancing knowledge, consumers are still

expected to abide by advice and prescription of their physicians. Hence a major share

of prescription drug advertising expenditure is used for detailing i.e. promotion to

physicians and other doctors. Prescription drugs are meant to treat conditions

requiring expert medical opinion and diagnosis. There are some prescription drugs

which can have life threatening side effects, hence need medical supervision and

administration under an experts guidance as inappropriate use may result in public

health hazard. It becomes imperative on the marketers to limit the promotion and

advertisement of such prescription drugs with serious side effects to medical

professionals only.

Over-the-counter (OTC) drugs do not require doctors‘ prescription and can be

obtained from shelves in case of need. The most common symptoms for which OTC

drugs are used rampantly are cough, pain, fever, acidity and nutritional supplement. It

has always been promoted to the end consumers. Because these drugs have always

been promoted to consumers and do not require prescription, their package inserts

have clear and brief indications. These over-the-counter drugs can be advertised like

any other product which does not need expertise and technical knowledge but some

basic information like usage and side effects needs to be included on the package

insert. Although in case of confusion patients can seek advice from their physicians

and even pharmacists

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4.2 Pharmaceutical Advertising

In an industry with multiple players pharmaceutical manufacturer and marketers have

to follow a differential communication strategy. Based on the need of the audience the

information communicated should be customised. Similar is the case with different

media used for advertising the drug. In case of print advertisement available space is

more and cost is less but for broadcast and internet/ social media advertisement the

space and time span availability is low while the cost is high. Although a print

advertisement can be elaborate and detail, the broadcast and internet/ social media

advertisement should project only the most important and useful information related

to drug benefits and associated risk and side effects. As per the norms prescription

drug advertisements should carry only those facts which can be backed by clinical

trials‘ success. It should adhere to the fair balance clause of US FDA. From

consumers‘ perspective a prescription drug DTCA should use easy and non-technical

language if it is intended to enhance the knowledge of consumers.

Use of internet as an advertising medium is common for fmcg products but promotion

of prescription drugs through internet is a recent practice. A new entrant to this field is

social media, which is more common amongst the youth. With the growing popularity

and acceptance of internet and social media pharmaceutical companies off late have

started including this medium in their promotional mix. Because of its wide reach and

interactivity social media has emerged as the most popular advertising medium.

Although very useful this medium has its disadvantages and pharmaceutical industry

being a highly regulated industry has to follow a set of guidelines as formulated by

US FDA. Prescription drug marketing is a very sensitive issue as these drugs have a

defined audience because of the hazard associated with drug misuse but it is

impossible to define an audience or limit the information communication to a specific

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audience in case of internet/ social media advertising. Internet or social media

advertisements spread across boundaries and traverse countries but since different

countries have different laws and guidelines governing the advertising and

administration of prescription drugs it can lead to adverse consequences. Additionally

since most of the pharmaceutical companies are new to this type of advertising,

unrestricted use of social media or internet may give rise to ethical issues. Lack of

complete information regarding interaction of different drugs or with different types

of food, precaution in case of multiple ailments and contraindications can lead to

adverse event reporting causing defamation of the company or the product.

Pharmaceutical firms need to balance between promotion and education in case of

prescription drug DTCA. This also holds true when promoting new drugs to

physicians. Today the consumers are more aware, more conscious, more confident

and better educated and hence are interested in their own healthcare management.

While the abundance of material available from different source on the one hand leads

to confusion on the other hand gives more material to help consumers analyse better.

Ultimately the aim of drug promotion is to earn profits and if the consumers

understand the drug features and use well then they are directly shifted from

information seeking stage to action stage. Advertisers of prescription drugs make it

possible by increasing the perceived value of the advertised drug. Although in the

process they compromise two basic criteria of prescription drug marketing ―the fair

balance clause‖ and ―ethics‖.

A very important aspect of pharmaceutical marketing / advertising is to find out the

stage where people are in the purchase behaviour- Unaware, Aware, Interested,

Evaluating alternatives, Product test, Use, Repeat use. Based on this knowledge the

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advertisers of prescription drugs formulate advertisements to motivate them to move

to the next stage.

The demand for prescription drugs is directed by the advertisement. Although patients

have started participating in their own health care, the ultimate decision lies in the

hands of the physicians as ―gatekeepers‖ to ensure appropriate use of drugs. But the

final consumption of a prescription drug by patients is determined by patient‘s

compliance with the prescribed drug.

Patient‘s understanding of a medical condition and benefits from an advertised

medicine determines patients‘ readiness for the treatment and readiness to seek

medical advice. Hence DTCA can play an important role by educating and

empowering patients to help them decide better.

Advertisers of prescription drugs release well timed advertisements directed to both

physicians and consumers to gain maximum profit. Marketing of prescription drugs to

consumers is intended to increase sales while marketing prescription drugs to doctors

and medical professionals is aimed at persuading them to prescribe the advertised

drug.

4.3 Digitisation of Pharmaceutical Advertising

Approaching doctors in person has become difficult in this fast paced world hence

pharmaceutical companies are resorting to internet and social media to reach doctors.

Because of the interactivity and open nature of social media physicians can be easily

reached. Since social media provides a virtual platform doctors can be reached at any

time of the day and can devote more time if they find the advertisement or promotion

useful and authentic.

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Companies advertise their drugs through virtual conferences, physician social

networks, search engines, online journals, and other websites. Google is a very

important search engine used by all for information search hence it is a very important

online advertising tool for prescription drugs. Marketers indulge in search engine

optimisation to direct physicians to the desired drug advertisement or link. Youtube a

social media is a very important tool used to upload presentation and demonstration of

the new drugs. This can be linked to the most commonly searched pages on the search

engine and corporate website of the manufacturing company. Because of the

variability in habits of different individuals the information should be disseminated in

multiple formats to suit heterogeneous audience like text, HTML, images, video,

podcasts, blogs, tweets, animations and presentation. Going further some

pharmaceutical firms offer access to live video detailing and online customer service

reps to give physicians access to product information and support from medical

representative in real time.

Consumers have become social media savvy and spend a major percentage of their

time on social media and internet in the present era. Hence it has become easy to

reach mass audience simultaneously and in a very short time. Marketers make use of

internet, social media and search engines to reach their consumers. For seeking

information on prescription drugs consumers depend on search engine, internet, social

media, virtual communities of doctors, friends and experienced patients, key opinion

leaders and electronic word of mouth by some experts. Hence marketers can

formulate strategies to incorporate these widely used channels for communicating

with their customers. Frequently asked questions revolve around associated side

effects and alternate options. Consumers are also interested in getting expert advice in

case of confusion whether to opt for treatment or not. Other information searches

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include drug benefits and usage, contraindication and period of treatment. They

search for videos, online community and interactive quizzes, to find answers to their

queries. Use of online expert communities and expert testimonials can help engage

patients and conversion in some cases. The companies can also employ online/ virtual

counsellors to counsel the patients in case of life threatening diseases or diseases with

social stigma. Link to ―ask the doctor‖ webpage can be incorporate in the corporate

website of the pharmaceutical company and the search engines and regular feedback

should be provided to consumers. This can go a long way in motivating the patients to

either consult their doctors or buy the product. There should be provision for

providing customised and comprehensive healthcare solutions to help patients get all

solutions under one roof. This option can be provided as a separate link on the website

and linked to search engine.

Pharmaceutical companies should abide by the regulatory framework as prescribed by

US FDA while formulating and releasing the advertisements for prescription drugs.

This is more important in case social media advertising which caters to a larger

audience. These companies should hire persons with expertise in handling social

media and with knowledge of the laws governing social media advertising in general

and social media advertising of prescription drugs in specific.

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CHAPTER 5

ADOPTION OF SOCIAL MEDIA

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CHAPTER 5


5.1 Impact of Social Media on Youth

Social media has become very important for product promotion especially to youth.

Social media sites like facebook, twitter, youtube and linked in are gaining

importance especially with youth.

A very important reason leading to social media popularity is the huge traffic and

large number of people logging on to it. These sites help in connecting with old

friends and acquaintances. The changing socio-cultural trend has contributed to the

growth of social media in India. Unlike earlier people do not indulge in socialising.

Working professionals and youth have a lot of work and academic engagement

respectively. Social media offers abundant opportunities for youth to meet new people

and expand social horizons. Social media offers a wide gamut of platforms suitable

for different purposes and different age groups. Customers can choose from various

available options the one which serves their purpose. Facebook is basically used by

youngsters to connect with friends informally; twitter is a micro-blogging site which

is used for news updates in real time, youtube is used for uploading or viewing videos

for different purposes and linkedin is perfect for professional networking. With such

high stakes, Indian firms are increasingly using social media for capturing the

domestic market.

Although social media has many benefits for India, rise of social media also raises

security concerns. Hence regulation is needed to prevent users from exploiting this

medium for agendas which are against national interest. India has multi-faith

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communities and sensitive issues should not be capitalized on social media sites for

profit. Social Media is a very effective tool for networking and information exchange.

The number of users having access to social media is growing, but the same goes with

the time spent online. Social media has both advantages and disadvantages. Following

are some of the advantages and disadvantages of social media.

Advantages of Social Media

When used in the right way, social media can act as a morale booster and help

people feel less isolated.

Liberty to create own ―home page‖ allows users to express themselves and

discuss their interests and connect to other people with similar interest.

Youth learn to adapt to new technologies and get prepared for future

technologies.

It helps youth in connecting with others for different purposes.

Youth can also use social media for improving their health and collecting

information on therapeutic options.

Social media provides platform for community participation.

It provides youth a platform to voice their opinion more easily and without

fear of rejection or social stigma.

Youth feel more comfortable asking for health online as compared to face-to-

face communication.

Disadvantages of Social Media

Sharing personal information with the wrong people can put users at risk.

People looking to do harm could use posted information to their victim and

gain their trust.

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Harassment may occur online or it may also spill to real life by a person who

has located his victim online.

Once information has been shared online it cannot be retrieved or removed.

Inappropriate photographs and comments could cause problems in future.

Youth are far bolder and less discretionary when sharing information on social

media. There is a greater risk of divulging important and personal information

un-intentionally.

The process of empowering youth to make safe and responsible decisions online is

like helping a child to safely cross the road. Educating youth about social media

dos and don‘ts should be incorporated in the academic curriculum. This would

help them become good and responsible net citizens.

5.2 Adoption of social media for prescription drugs information

Although pharmaceutical manufacturing and marketing firms are increasingly using

social media for both over the counter and prescription drugs, unlike other products

pharmaceutical companies need to have a cautious approach to social

media. Prescription drug advertising is regulated by the U.S. FDA. Although the draft

guidance addresses how pharmaceutical companies should answer online inquiries

about off-label uses of prescription drugs, there is no clarity on how should the

companies advertise prescription drugs through social media.

Inspite of a lack of clarity on the use of social media for prescription drug advertising

pharmaceutical firms have started exploring this area. The pharmaceutical companies

need to have a presence on social media as an increasing number of physicians and

patients are actively sharing and collecting information about products online. But

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still in order to effectively monitor and communicate authentic information on

prescription drugs, companies need learn how to use social media.

Social media is a platform which promotes two way communications. It makes use of

web 2.0 an interactive form of website which allows consumers to comment on online

promotional material and exchange their idea and opinions with other consumers. It

works by word of mouth promotion where one satisfied consumer can help promote

the product to millions while on the other hand a dissatisfied customer discourage

several others form purchasing a product.

5.3 Impact of Adoption and Diffusion of Social Media on Consumer Behaviour

New-product innovation is a vital element of dynamic economy and an important

activity for marketers. The popularity and longevity of a new product or technology

launched in the market is determined by consumers. The adoption and diffusion of

social media has been very fast, especially with the youth population of India. The

main reason for this fast process is the interactivity offered by social media platforms.

Never in the history did we come across a communication media allowing two way

communication. Hence this interactive media gives the consumers/youth a feeling of

authority. It allows them to manage and monitor their communication in the real time.

The consumers feel free to voice their opinion without any fear of being exposed or

falling in an embarrassing position because of something posted by them on social

media. Social media also allows the consumers to correct their wrong entries and

delete their posts in case of need. In any adoption process the most important thing is

the acceptance and likability of a new product by its users. Another important aspect

is its utility as against the time and money invested in acquiring the new product. A

product can become successful only if it fulfils the above mentioned criteria.

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5.4 The Adoption Process

The acceptance and continued use of a product or new technology is called adoption.

Following are the basic stages of an adoption process:

Awareness: Consumer finds out about a product (technology) but has little

information and no well-formed attitude.

Comprehensive: Consumers try to gain knowledge and understanding of the

product (technology).

Attitude: Consumer develops feelings positive or negative towards the

product (technology). In case of positive feeling adoption process is likely to

be terminated.

Legitimation: Consumer becomes convinced that the product (technology)

should be adopted.

Trial: Consumer tests or tries the product (technology) to determine its

utility.

Adoption: Consumer determines whether or not to use the product on a full-

scale.

5.5 The Diffusion Process

Adoption is an individual phenomenon which encompasses the stages through which

an individual consumer passes for adopting the product (technology). Diffusion is a

group phenomenon and refers to the penetration of the product (technology) by many

consumers. Hence a product is called successful only if it is able to penetrate to

multiple consumers and across societal strata. But different individuals have different

level of readiness to adopt a new product or technology.

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Consumers can be classified into five categories based on their readiness to adopt a

new technology:

Explorers

Pioneers

Skeptics

Paranoids

Laggards

Explorers:

They are first to adopt a new technology. They are thought leaders and source of

information for others. They are younger and more educated compared to the other

segments.

Pioneers:

Although they are open to adopt a new technology, they suffer from insecurity and

need guidance from the marketers. They are also young.

Skeptics:

Low on motivation and are not excited about a new technology. They wait for others

to test the new technology and adopt the product if the feedback is positive

Paranoids:

They do not take any initiative until they are sure that there are no risks.

Laggards:

They are the last ones to adopt the new technology.

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CHAPTER 6

SOCIAL MEDIA ADVERTISING AND CONSUMER

BEHAVIOUR

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CHAPTER 6

SOCIAL MEDIA ADVERTISING AND CONSUMER

BEHAVIOUR

6.1 Interplay of Awareness, Perception and Attitude

For several years companies have considered the customer as king, and today this

concept is gaining momentum. With the ever growing competition and consumer

awareness the challenge before the marketers is to understand the various

manifestations and influencers of consumer behaviour. Companies can use their

knowledge of consumer behaviour to strategize their marketing plan. It helps them

develop a suitable marketing mix using the 4 P‘s of marketing; product, price, place

and promotion.

Consumer behaviour and purchase behaviour are influenced by multiple factors.

Although the common factors affecting consumer behaviour can be categorised into

following five broad groups; personal/personality, demographical, social and

psychological; different individuals or groups have different set of influencers.

Personality affects both consumer behaviour and self-concept. Self-concept indicates

how a consumer sees her/himself and how s/he evaluates her/his own attributes. The

self-concept affects consumer purchase behaviour as consumers belongings often

demonstrate what they are like. Also people have an ideal self-concept indicating the

way they would ideally like to see themselves. A third concept is how the person

thinks that other people see him. Hence consumer behaviour is influenced by any of

these three self-concepts what s/he thinks he is? what s/he wants to be? and what

others think about them? Advertisement can influence and shape the self-concept of

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consumers. People exposed to an advertisement tend to compare themselves with

what they see in advertisements.

Demography is another important factor affecting consumer behaviour. Consumers of

a similar age, qualification, occupation or class may behave in a similar manner

because of similar taste, opinion, location, economic status and knowledge. It could

also be as a result of similar experiences which shape their attitudes and perception.

Hence based on any of the above demographic factors consumers can be grouped

depending on the need addressed. Similarly advertisers should have knowledge of

their target audience. For the present study the sample selected is working youth with

knowledge of social media and residing in tier II cities of India. Here the sample is

formed based on three demographic factors age, occupation and location added on to

it is the niche segment which is defined as techno savvy with knowledge of social

media.

Motivation is another factor influencing consumer behaviour it drives a person to

achieve a goal. Consumer develops perception for a product through the process of

choosing, organizing and interpreting stimuli (in this case social media

advertisement). This perception helps in developing an attitude which is seen in

consumer behaviour. A relatively permanent change in behaviour called learning

happens through personal experience and observation. It has an effect on consumer

behaviour. Learning being an on-going process which can happen even when not

intended, marketers should ensure that consumers comprehend the message as

required.

While attitude is a manifestation of perception it is difficult to change. Whether a

consumer will have a positive or a negative approach towards a product depends on

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whether s/he has a favourable or unfavourable attitude. Advertisement (through social

media) plays an important role in shaping the attitude. Consumers‘ belief in a product

is shaped by either previous knowledge or their interpretation of an advertisement.

Consumer with a favourable attitude towards a product is more likely to buy it.

Similarly people with a positive attitude towards an advertisement are more likely to

revisit it. Attitude is a feeling either favourable or unfavourable towards a product/ or

service / and 4Ps. It is formed through the evaluation of an object (product, service,

price, advertisement and promotion). Attitude cannot be observed, as it is impacted by

motivation, perception, and learning. It is inferred from consumer behaviour (what

they do and how they behave). Attitude is composed of three components; knowledge

or cognitive component, feeling or affect component and behavioural or conative

component. Consumer acquires knowledge from own experience or observation,

feeling component is reflected by evaluation resulting in favourable or unfavourable

feeling and behavioural component is reflected in action (purchase) based on

evaluation. Attitudes are directed towards an object and can be positive or negative

with varying degrees. Although attitude is consistent it may change if the cognitive

component is changed i.e. if a consumer is exposed to new information or experience.

Attitude is affected by need, motivation, perception and learning. Attitude is inferred

from behaviour but it is synonymous to behaviour. Consumer attitude is also formed

based on the information received through different sources like word of mouth,

family, friends, peers and marketers‘ source. This information is retained in memory

and shaped by beliefs and opinions, which in turn give rise to attitude. Attitude plays

a very important role in shaping consumer behaviour. Hence while making an

advertisement marketers project the product in a way that oit leads to positive attitude

formation.

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6.2 Social Media Advertising and its Effect on Consumer Behaviour

Advertising is an unpaid form of communication meant to affect consumer behaviour.

Advertising is a part of subset of promotion one of the 4P‘s in the marketing mix

(product, price, place and promotion). Advertising is a major tool in generating

awareness for the product. The evolution of advertisement dates back to the ancient

times when symbols and pictorial signs were used get the attention of the consumers.

With time this phenomenon has gained momentum. In the present era advertisement

has evolved as the major promotional tool. Although advertisers make use of

traditional media for advertising their product, focus is shifting to digital advertising.

Further advancement has led to an increase in demand for use of interactive digital

media like social media for advertising. When talking of youth social media is the

most preferred medium and hence modern day marketers have shifted their attention

from traditional to interactive digital media.

Advertiser‘s primary aim is to influence consumer awareness, attitudes and ultimately

consumer behaviour.

Awareness is also the first step in the purchase process, hence the advertisers and

marketers should come up with programs intended to enhance consumer awareness

for a particular product. The marketers‘primary aim in case of a new product is to

Social Media

Advertising

Awareness &

knowledge

Perception &

Attitude

Consumer Behaviour

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generate awareness for product. The present research studies the effect of DTCA of

prescription drugs on consumer awareness for prescription drugs. Further the

relationship between awareness & attitude and attitude & behaviour are studied.

When consumers have to deal with a complex or unfamiliar product and cannot

decide the desirable and undesirable attributes due to a lack of technical knowledge

their behaviour is complex purchasing behaviour and they indulge in extensive

problem solving. Since this study deals with prescription drugs and consumers lack

technical knowledge to analyses the product, the consumers go through extensive

problem solving process. In such cases the advertisers have to focus more on

educating the consumers about the product and risk associated with it. The

promotional information should help the consumer to evaluate and decided.

Marketers assume that consumers are more interested in benefits associated with the

product and less in product attributes, suggesting in the advertisement. Especially in

case of prescription drugs they are interested in both benefits and risks associated with

the product and also the side-effects of the drug. Consumers are very sensitive while

making a choice for a prescription drug as it is involved with their life. Hence while

including risk and benefits information in the prescription drugs advertisement the

marketers should keep to the fair balance clause of the US FDA. Consumers usually

devote a lot of time in interpreting and elaborating on information relevant to their

needs. Consumers pass through the following behavioural stages before arriving at a

purchase decision:

Awareness (exposure to information)

Evaluation (preference, attitude formation)

Behaviour (purchase)

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Attitude Measurement

Attitudes are individual attributes of consumers. Consumers may differ along a

number of attitudinal dimensions. Psychologists have devised different methods for

measuring attitude. One of the common measurement scales is likert scale.

Likert Scales

It is developed by utilizing item analysis approach where an item is evaluated based

on how well it discriminates those with high total score from those with low score.

The items which best meet this criterion are included in the final instrument. These

scales contain different statements expressing degrees of favourable or unfavourable

attitude for a given object. The respondent has to indicate agreement or disagreement

for the different statements in the instrument. Each response is assigned a numerical

score, which are totalled to measure the attitude of the respondent. A respondent is

asked to respond to statements in terms of degrees like five, seven or three degrees.

6.3 Information Search and Evaluation

An aware consumer may or may not search for more information. If the consumer is

interested then s/he is more likely to search further. Consumer can obtain information

from the following sources.

Personal sources (Family, friends , acquaintances)

Commercial sources (advertising, promotion, dealers, displays)

Public sources (mass media, consumer-rating organizations)

Experimental Sources (experience).

Consumers mostly receive information from commercial sources, controlled by the

marketer and manufacturers of the product. Personal source is considered to be most

effective as it helps consumers in product evaluation unlike commercial source which

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only informs. Word of mouth is a very good example of personal source and

marketers are interested in developing positive word of mouth as it is free and more

effective. Word of mouth is the only promotion which is of consumers, by consumers,

and for consumers. In the present era where a consumer is bombarded with

information from multiple sources it becomes very difficult for the consumer to

decide. Hence consumers depend on personal sources like friends, family, relatives or

even word of mouth from experienced and authentic people. Marketers make use of

word of mouth marketing which is atype of viral marketing. They try to promote their

products by developing a loyal customer base which could be used for advertising the

product to new and potential customers. It is especially important in case of high

involvement products like prescription drug, where consumers are worried about

safety. A new concept called electronic word of mouth is picking up. The marketers

make use of online platforms like internet and social media for word of mouth

promotion especially to youth. Communities of experienced patients and testimonials

of patients and doctors with hands on experience with the prescription drugs are

uploaded on the website and links are provided on social media and other websites.

This is useful in generating trust amongst the potential cutomers for the advertised

prescription drug.

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CHAPTER 7

REVIEW OF LITERATURE

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CHAPTER 7

REVIEW OF LITERATURE

7.1 Direct to Consumer Advertising of prescription Drugs

According to Gu, Williams, Aslani and Chaar, (2011) Direct to consumer advertising

(DTCA) refers to promotional material on therapeutic goods presented to the general

public. The world health organisation (WHO) defines medicine promotion as all

informational and persuasive activities by manufacturers and distributors, the effect of

which is to induce the prescription, supply, purchase and/or use of medicinal drugs.

Kalyanara, Gurumurthy, Phelan and John (2013) found that DTCA was prohibited by

the US Food and Drug Administration (US FDA) prior to the late 1980's.

Pharmaceutical drugs are among the few consumer products that require federal

approval prior to entering commerce. US FDA has to approve a New Drug

Application (NDA) before the product can be placed in the market. US FDA also

determines and regulates whether a drug should be prescribed by a physician called

prescription drugs (Rx) or can be purchased by consumers without a prescription from

a physician, called an over the counter (OTC) drug. Advertising and promotion in the

pharmaceutical industry take two forms: direct to physician advertising (DTPA) and

direct to consumer advertising i.e. DTCA.

Findlay, S. (1999) claimed that the growth of DTCA is altering the way prescription

drugs are perceived. The advertisements send a strong signal that prescription drugs

are just like any consumer product- soap, cereal, cars, snack foods, etc. While

consumers bring a healthy skepticism to the claims made in prescription drug

advertisements, they believe the information is approved by the government. That

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likely raises the credibility of prescription drug advertisements over those for other

products. The primary aim of drug advertisements as with all advertising is to create

name and brand recognition, a context for the use of a product and to boost sales and

profits. Only secondarily do prescription drug advertisements aim to inform

consumers about diseases or treatment options. To their credit, the advertisements

have apparently raised awareness for many medical conditions.

Roth, S. (1996) identified several patterns in direct-to-consumer prescription drug

advertisements. In general, advertised brands are market leaders within their

therapeutic class, targeted at a broad patient base, and new drugs used for chronic and

frequently occurring diseases. Most of the disease states and associated symptoms and

treatments for which prescription drugs are advertised to consumers are easily

understood relative to other diseases. Thus, advertisements attempt to communicate

information about diseases and products that consumers are likely to understand.

Brekke and Kuhn (2002) conducted an examination of the efficiency aspects of

promotional competition in pharmaceutical markets, and found that DTCA lowers

promotional spending. When prices are regulated, firms benefit from the availability

of DTCA because this reduces the fraction of the market they have to compete in

terms of promotion. Resources devoted to promoting prescription drugs towards

consumers are limited, mainly because of regulatory restrictions on such activities.

Since prescription drugs can be obtained legally only by prescription from a

physician, the distribution of information in the physician-patient relationship is

important.

Authors Calfee, J. E., Winston. C., and Stempski, R. (2002) attempted to estimate the

effect of direct to consumer advertising on demand. Large variation in DTCA

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spending indicates that firms are experimenting with their new promotional tools.

Several steps may occur between the time an advertisement motivates a consumer to

explore drug therapy and when the drug is purchased, which makes it difficult to rule

out the possibility that DTCA does influence demand. These steps typically include a

visit to a doctor, advice to try dietary changes and exercise.

Brownfield et al. (2004) conducted an exploratory study and found that direct-to-

consumer advertisements of prescription drugs and over the counter drugs (OTC)

appear with great frequency on different media and that prescription drug and OTC

drug advertisements occupy similar amounts of commercial space and airtime. Many

prescription drug advertisements are being targeted primarily at viewers who are older

or female or both.

In a study by Datti and Carter (2006) examining the factors associated with requesting

a prescription drug from a physician following exposure to DTCA among older

adults, and whether the drug was prescribed during the encounter, results suggested

that DTCA influences patient-doctor relationship and prescription drug acquisition

behaviour of patients; however, the nature of the effect of DTCA on older adults is

complex.

Lee-Wingate and Xie (2010) examined consumer perception of persuasive intent and

informativeness associated with product-claim and help-seeking advertisements,

respectively. The results suggested that consumers perceived help-seeking DTCA as

being highly informative without persuasive intent, whereas they perceived product-

claim DTCA as having high-persuasive intent with little informativeness. Help-

seeking DTCA was more effective in generating stronger behavioural intention to

seek treatment for the ailments advertised.

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Herzenstein, Misra, Posavac (2004) explored consumers‘ attitude towards direct-to-

consumer advertising (DTCA) of prescription drugs, and the relation between these

attitudes and health related consumption behaviours. The paper delineated how

consumers‘ attitude towards DTCA considered generally is related to their behaviour,

as well as that of their physicians. The findings reported the favourableness of

consumers‘ reactions to DTCA, and more importantly, demonstrated that consumers‘

attitude towards DTCA is related to whether they search for more information about a

drug that is advertised, and ask their physician about the drug.

Deshpande, Menon, and Perri (2004) reported that most consumers have positive

opinions about the utility of DTCA. It serves as a useful informational tool for

consumers. Consumer opinions of DTCA utility vary across patient types; since

DTCA caters to only a certain section of the population who are affected either

directly or indirectly (e.g., illness in the family, being at risk for developing the

disease) by the condition for which the drug is advertised. Consumers in poorer health

perceive DTCA to be more useful in decision making than those in better health.

Another important finding was that females perceive DTCA to be more useful in

decision making compared to their male counterparts.

Calfee, J. E. (2002) suggested that there is high level of awareness for DTCA. Direct-

to-consumer advertisements appear to provide valuable information (including risk

information); induce information-seeking (mainly from physicians); prompt patients

to discuss conditions not previously discussed; and generate significant, positive

externalities including the possibility of improved patient compliance with drug

therapy. By reminding patients to take their medicine and refill their prescriptions,

DTCA tends to encourage patients to persist in their drug therapy.

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Chin, H. M. (2005) explored the challenge of involving patients more actively in

medication choice through DTCA and patient decision aids. Findings indicated that

explicit patient involvement in the selection of medications has become more

frequent. Pharmaceutical companies have targeted lay persons for direct-to-consumer

advertising (DTCA), and the rise of the patient empowerment movement has helped

lead to more egalitarian models of shared decision making between patient and

physician. DTCA holds promise for improving patient education and patient

empowerment, making patients more effective partners in their care, and encouraging

patients to seek treatment for conditions that may be under-diagnosed.

Rajani, C. H. (2012) in a study exploring the scope of direct to consumer advertising

of prescription drugs in Indian market, indicated that there are certain benefits and

harm associated with DTCA. Key benefits of DTCA are preventive care for under

diagnosed conditions and patient‘s psychological confidence for improving treatments

which must be balanced against adverse factors like self-medication, rising drug costs,

confusion and fear of side effects. DTCA gives patients psychological benefits &

personally relevant DTCA would develop confidence and encourage consumers to

disclose their health concerns to physicians. DTCA provides useful information on the

risk associated with prescription drugs. While physicians disagreed that DTCA will

promote unnecessary fear of side effects, consumers claimed that it promotes

unnecessary fear of side effects. DTCA contributes to rise in health care costs without

commensurate with health gains, which leads to increase in self-medication, frequent

change in medication and refers to specialist.

According to Lipman, M. M. (2006) the goal of DTCA or any advertising is to sell a

product. But main problem is the means by which that end is achieved.The demand

for drug therapy when no drug therapy is warranted is a practice labelled by some as

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―disease mongering,‖ defined as ―extending the boundaries of treatable illness to

expand markets for new products. The main purpose is to earn profit. Any educational

benefit is shrouded in factual inaccuracies, false implications, and unwarranted

puffery. Such advertising has been harmful to patients. A complete ban might not be

legally feasible, severe restrictions and limitations should be applied.

Shin, J. and Moon, S. (2005) recognized direct to consumer advertising (DTCA) as a

positive force for the public health and at the same time identified its potential

negative effects on the economic and clinical aspects of the health care markets.

Consumers overestimate drug effectiveness when the advertisements vaguely convey

the benefit information and subsequently, seek unnecessary treatments. Consumers

rate information contained in DTCA as important.

According to Kallen, A. et al. (2007) Direct-to-consumer prescription drug

advertisements for HIV antiretrovirals have been criticized for including deceptive

images and underplaying drug limitations. Currently advertisements have addressed

previous concerns, but following problems still exist; lack of information on drug‘s

role in treatment, drug efficacy and life-threatening side effects. Although these

omissions do not technically violate current US FDA regulations, they do violate

regulations‘ real intent: to provide true and balanced information on drugs‘ side

effects and effectiveness, to not be misleading, and to support the claims made.

Hoffman and Wilkes (1999) viewed DTCA as a powerful tool, designed to create

demand, and maximise profit. It has little to do with educating patients or relieving

suffering rather it will drain healthcare dollars, increase unnecessary prescribing, and

strain patient doctor relationships. These advertisements always focus on benefits,

not problems. They are not intended to educate or empower patients. If doctors

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believe that patients want and expect a drug then doctors will prescribe them even

when it is not indicated. Some patients ask and doctors begin to believe that many

patients will be dissatisfied without the advertised drug. Frequent misleading claims

could reduce the credibility of true claims or cause consumers to exaggerate the safety

or appropriateness of drug therapy.

Dana, Carter, Chou, and King (2012) said that evidence based DTCA may have a

beneficial role to play in health care awareness and patient autonomy. However,

DTCA by virtue of its powerful outreach and underlying marketing intent attracts

consumers to purchase medicinal products regardless of professional advice, thereby

compromising the pharmacist‘s role in safeguarding consumers from the

inappropriate use of medicines. Pharmacists in this study described a sense of

disempowerment when dealing with DTCA-exposed patients not amenable to

professional advice. DTCA can cause harm through persuasive promotion of self-

diagnosis and self-medication. It is therefore in the public interest that authorities

support and enable pharmacists to maintain their ability to guard against inappropriate

use of medicines. Potential strategies to achieve this, such as strict pre-screening for

misleading or inappropriate DTCA and tighter monitoring, have been suggested.

Counter advertising by promoting the appropriate use of medications and to seek

pharmacists‘ advice was another suggested approach.

Wolfe, S.M. (2002) suggested that there has been an irreversible change in the nature

of the doctor-patient relationship. Patients are seeking much more medical

information and are actively participating in decisions affecting their health. Intruding

into this trend has been the rise of direct-to-consumer promotion, which, in its initial

thrust, bypasses primary care doctors and other physicians.

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Murray, E. et al. (2003) in an examination of physicians‘ views on the effects of

direct-to-consumer advertising on health service utilization, quality of care, and the

doctor-patient relationship suggested that majority of the patients discuss information

from DTCA in a visit because they want a specific intervention, such as a test, change

in medication, or specialist referral. Mostly physicians perceive DTCA as damaging

to the time efficiency of the visit. The effect on the relationship was strongly

associated with doing what the patient wanted.

According to Myers, M.F. (2011) physicians feel that DTCA can help to educate

consumers about available treatments and medical issues and can facilitate better

discussions with their patients if emphasis is laid on quality and authenticity of

information. But they were also of the opinion that DTCA encourages consumers to

seek medications that they do not need; it does not provide balanced information on

costs, adverse events and alternative treatment options. It increases both appropriate

and inappropriate prescribing of advertised drugs by physicians. Treating patients

with a new DTCA medication, which is a substitute for a less expensive generic drug

or an existing less-expensive drug results in increased costs without benefit.

Stremersch, Landsman and Venkataraman (2013) found that patients increasingly

request their physicians to prescribe specific brands of pharmaceutical drugs.

Requests are triggered by direct-to-consumer advertising (DTCA). It was found that

although the effect of requests on prescriptions is significantly positive, the mean

effect of DTCA on patient requests is negative. It was found that specialists receive

more requests than primary care physicians but translate them less into prescriptions.

Weismann, et al. (2004) suggested that physicians perceived that DTCA improved

communication and education but also thought that direct-to-consumer advertising

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(DTCA) led patients to seek unnecessary treatments. Most of the physicians did not

prescribe the advertised drug rather recommended lifestyle changes and suggested

other treatments. Four out of five doctors believed that DTCA did not provide

information in a balanced manner, and a similar number felt that it encouraged

patients to seek treatments they did not need. Physicians as a group were more

equivocal about other impacts of DTCA, with 46 percent agreeing that it increased

patients‘ compliance and 32 percent, that it made patients less confident in their

doctors‘ judgment. Doctors with neutral or negative overall views toward DTCA were

more likely to take actions other than prescribing the advertised drug or to take no

action at all.

Zachry, Dalen and Jackson (2003) proved that clinicians are amenable to patients

asking for drug information and medications, but they are less receptive to questions

arising from DTCA. The clinicians respond favourably to patient inquiries, regardless

of the source of drug information. Although clinicians are less likely to provide drug

information and medication samples or prescriptions to the patient if the basis of their

questions was a DTCA rather than a drug reference. Furthermore, clinicians reported

that they were more likely to become annoyed and/or frustrated with DTCA prompted

questions than they were with those sparked by a drug reference. Health care

professionals are generally concerned with the potential of these advertisements to

convince patients that they need a medication which they actually do not.

Chaar and Kwong (2010) highlighted that the impact of DTCA is not restricted to

prescription medicines, but extended also to over-the-counter, pharmacist-only and

other pharmacy-related products. Pharmacists perceive that DTCA disempowered

them, compromising their role in safeguarding the community from inappropriate

medicine use. As health care professionals mainly responsible for the safe and quality

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use of medicines, pharmacists have the ethical responsibility of safeguarding the well-

being of the client in addition to their responsibility to respect patient autonomy.

A report by National Institute for Health Care Management Foundation Research

(2000) shows that DTCA has apparently raised awareness of many medical conditions

but there is also a danger that DTCA will add to physician-targeted promotion in a

negative way. Doctors strive to please their patients, and are open to patients‘ requests

to try treatments. A doctor is more likely to prescribe a new medicine if (a) it is being

promoted to him and (b) his patients ask for it. DTCA has also entered cyberspace.

Health care web sites are already supported in part by prescription drugs advertising.

Some advertising companies are already positioning themselves to monitor visitors

(doctors and consumers) to the burgeoning number of health care web sites and sell

information. Information contained in DTCA is inaccurate or unbalanced considering

that its purpose is to promote a drug, but not to educate the public, and thereby to

increase unnecessary use of medication. Even if information is accurate or balanced,

consumers may miscomprehend it, thereby may decide wrongly.

Medawar, C. (2001) argued that benefits and risks of DTCA would tend to differ in

different communities, but overall picture gives rise to serious concerns. Whatever the

benefits of DTCA might be for some, risks for others might be immense. In most

countries, DTCA might bring fewer benefits than risks and ‗it presents a major threat

to global public health‘. Many patient groups struggle for survival, and DTCA

campaigns can empower them. Consumers need much better information about

medicines and health than they presently get.

Hoek, Gendall and Feetham, (2001) concluded in their study that benefit information

is communicated more effectively than risk information. Continuation of DTCA

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depends not on its effectiveness as a creative showcase, but on its ability to meet

standards of social responsibility that, appropriately, are set at a high level. A

reduction in the level of detail currently provided in advertisements could improve

consumers‘ recall of details.

Ling, Berndt and Kyle, (2002) in one of their researches found that recent

deregulation of prescription drug marketing, leads to rivalry and facilitates

competition.

According to Mudher, E. (2013) direct to consumer advertising is adopted by

pharmaceutical companies for promoting drugs directly to patients and thus increase

sales. DTCA is useful for patient education and should be carefully regulated to avoid

misleading patients with inaccurate information. An examination of the type, accuracy

and the ethical status for DTCA based on WHO and US FDA criteria for medicinal

drug promotion, proved that there are many unethical tactics for DTCA that may

mislead patients and negatively affect their health.

According to Campbell, S. (2011) direct-to-consumer advertising (DTCA) of

prescription drugs has elicited various concerns. One concern is that DTCA may add

to spending on drugs by consumers, insurers, and the federal government without

providing enough benefits to justify that spending. DTCA encourages broader use of

certain drugs than their health benefits warrant. Another concern is that DTCA for

newly approved drugs may lead people to use drugs whose potential risks were not

fully discovered during the drug approval process. Those concerns have spurred

recent proposals for a moratorium on advertising brand-name prescription drugs to

consumers during the first two years following a drug‘s approval by the US Food and

Drug Administration (US FDA). Although such a moratorium would allow more time

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for safety concerns about a new drug to be revealed, it would entail health risks of its

own, because some individuals who would benefit from a new drug might be unaware

of its availability in the absence of consumer advertising.

Lyles, A. (2002) claimed that direct marketing of pharmaceuticals to consumers

follows social and economic trends that recognize patient autonomy in medical care

and increasingly require consumers to consider costs in their prescription drug

decisions. The post-marketing period for a new drug requires pharmaco-vigilance,

i.e., active identification and follow-up of unexpected consequences as experience is

gained with new drug. Although US FDA has imposed a two year moratorium on new

drugs third party postings on internet cannot be governed. Rescinding DTCA

guidance would not curb consumer‘s exposure to drug information. DTCA is unlikely

to disappear; consequently, the central issues are how to create and how to regulate

the communications most effectively.

Ventola, C. L. (2011) said that although there have been calls to ban or severely

curtail consumer drug advertising, remedies to maximize the benefits and minimize

the risks of DTCA are more frequently suggested. DTCA can be defined as an effort

(usually via popular media) made by a pharmaceutical company to promote its

prescription products directly to patients. The US FDA‘s ―Division of Drug

Marketing, Advertising, and Communications‖ (DDMAC) is responsible for the

regulation of DTCA. The US FDA was given the authority to approve pharmaceutical

products for marketing in the U.S. as a result of the Federal Food, Drug, and Cosmetic

Act, passed in 1938. In 1962, Congress specifically granted the US FDA statutory

authority to regulate prescription drug labeling and advertising. In 1969, the agency

issued final regulations for prescription drug advertising, which stipulated that these

advertisements must (1) not be false or misleading, (2) present a ―fair balance‖ of

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information describing both the risks and benefits of a drug, (3) include facts that are

―material‖ to the product‘s advertised uses, and (4) include a ―brief summary‖ that

mentions every risk described in the product‘s labeling. In recent years, drug

marketers have also increased their expenditures for marketing efforts on the internet,

as searching for health-related information has become the third most common

activity for online users. In April 2009, the US FDA did send warning letters to more

than a dozen pharmaceutical manufacturers regarding company-sponsored search

engine links that failed to mention product risks. The advertisements typically

contained the product name, the disease or condition it treats, the potential benefits,

and a link to a product‘s Web site. The US FDA stated that because the links

mentioned the product name and its use (and sometimes even other product claims),

risk information also had to be provided. In response, drug company– sponsored links

now include the indication or the name of the drug—but not both. DTCA educates

patients and allows them to take charge of their health. The Internet, including online

DTCA, has become an increasingly popular source of medical information for

consumers. Small, but statistically significant, improvements in adherence occur

among patients exposed to DTCA.

According to Donohue, J. (2006) Technological change has spurred an increase in

health information seeking and self-treatment. Consumers use internet to collect

information about their health and discuss with their doctors. Consumers accept that it

makes them feel empowered to talk to their doctors. Because of the unique history of

prescription drugs and physicians‘ important role as intermediaries between drug

manufacturers and patients for more than a half century, DTCA represents a challenge

to physicians‘ roles as agents for their patients.

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7.2 DTCA of Prescription Drugs through Social Media

Pantelic, D. (2009) found that pharmaceutical market is highly regulated, and it can be

stated that prescription (legal or ethical) drugs have a status of ―substances in

controlled circulation‖. Promotional activities are also under strict legislation, further

burdened with ethical consideration and public scrutiny. Internet as liberal and hard to

control medium brings entirely new sets of solutions and/or problems to

pharmaceutical marketers. Marketers in pharmaceutical industry have all the

instruments of promotional mix and all their combinations at their disposal, so as to

convey the intended message to the target audience. The nature of the product, legal

regulations and ethical principles create an environment in which the marketers need

above average creativity and care of the target audience, message content and choice

of appropriate communication channels for the message to produce the desired effect.

According to Bhagat and Dutta, (2012) Social media as a new communication

channel has grabbed the attention of all. Also in terms of promotional effectiveness

and efficiency of select campaigns to specific target groups and specially the youths,

the social media is the undisputed choice. Truly social media is being selected as the

most preferred choice because of its uniqueness in comparison to traditional media on

account of richer engagement opportunities where brands easily communicate

providing a platform for audience to talk, express and exchange opinions both inside

and outside. The most interesting part of social media is that it‘s an on-going

conversation among the company and its target audience. New social media

capabilities are being used by the account managers and in some instances companies

have specifically hired social media managers undertaking the promotion of the

company‘s stated objectives on the social media platforms. Facebook, twitter,

linkedin etc. stand testimony to the fact of the growing engagement being used by

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companies to have their social media presence and getting connected with the target

consumers thereby becoming part of their active lifestyle. It can be said that social

media is allowing companies to have relationship with tomorrow‘s potential

customers also. Thanks to the general purpose technologies namely digitalisation,

networking and individualisation that has propelled and fuelled the growth of getting

engaged in social media activities with the active use of these general purpose

technologies. The amazing popularity of such devices and their network integration

capabilities costing much less and offering on the go 24 x 7 seamless integration has

been one of the major drivers being seen by promotional managers to create a distinct

image portraying their brand association and relationship thereby coming out of the

clutter. It can be said that social media acts as a direct, interactive and engaging

medium. The key to success lies in the right method and level of engagement,

credibility of information and its transparency. Those companies who will be able to

move beyond the numbers and improve upon the engagement level with the

customers through their social media pages will be able to rise above the clutter.

Myers, D. S. (2012) found that companies across product categories are working to

learn the nuances of social media as it continues to grow in popularity and wide

spread adoption. Pharmaceutical companies are no different, except that they must

also adapt government regulation and industry standards to the new medium, making

the topic important for pharmaceutical companies, consumers, and policy makers.

Delayed guidance has not stopped many of the world‘s largest pharmaceutical

companies from establishing a presence on Facebook. This is an important stepping

stone for understanding the potential benefits and pitfalls associated with Facebook

both for pharmaceutical companies and health-related companies. These

pharmaceutical companies have been cautious in the use of social media

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concentrating on science or social responsibility while keeping away from user-

generated content and specific product information. These companies do not currently

have Facebook pages relating to any specific drug therapies. This is likely to change if

the US FDA guidance provides companies the assurance that such an activity is not a

violation.

Liu and Combs (2013) in their survey on ―social media practices at large

pharmaceutical and biotechnology companies‖ indicated that although manufacturers

are frustrated by the lack of US FDA guidance for online DTCA, they are cognizant

of the regulatory issues implicated by new media platforms and careful in how they

approach them. Company stakeholders tend to be risk-averse when it comes to social

media initiatives, making sure to vet them adequately before launch and re-evaluate

them periodically and in response to new developments. Promotion of prescription

drugs has been revolutionized in recent years by the proliferation of social media

outlets such as Facebook, Twitter, Pinterest, Tumblr, message boards, and chat rooms.

Despite US Food and Drug Administration promises and industry pleas, the agency

has not proposed regulations or guidance to address drug promotion through social

media. Instead US FDA has chosen to regulate piecemeal, issuing warning and

untitled letters to companies it concludes have violated the law by promoting their

products through these avenues. The lack of agency guidance has not prevented

pharmaceutical and biotechnology companies from utilizing social media, but it has

required them to proceed with caution and to develop their own best practices. In the

absence of clear guidance, companies are left in the meantime to scrutinize US FDA

warning and untitled letters related to social media in an attempt to glean rules about

the use of these new platforms. Those enforcement actions are of limited value,

however, largely because they are so fact-specific. Although all the companies

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participate in social media, the platforms they use and the information they share

varies. Facebook is used most extensively by almost all pharmaceutical companies. A

few companies also host branded pages dedicated to specific products, designed for

groups of patients with particular diseases or conditions, or developed to promote

product-focused events (e.g., consumer education programs). Pharmaceutical and

biotechnology companies‘ presence on Facebook largely predates an important

change that Facebook made to its policy in 2011. Previously, companies could disable

the commenting function on their pages. Drug companies could thereby ensure that

users could not post information related to an adverse event or information that was

inaccurate, off-label, or otherwise inappropriate. This practice, known as

‗‗whitelisting,‘‘ made Facebook a relatively low-risk option from a regulatory

perspective, because it obviated the need for constant monitoring of Facebook pages,

and given the lack of space constraints on the site, allowed pharmaceutical and

biotechnology companies to share meaningful information about their products

without compromising their ability to comply with US FDA requirements. Although

not as extensive as Facebook use, most of the pharmaceutical companies have

developed an active presence on Twitter, which limits user messages to 140

characters. Each company must operate within the space constraints without

sacrificing adherence to US FDA requirements, such as fair balance. The type of

information communicated with Twitter, however, differs significantly from company

to company. In addition to Facebook and Twitter, pharmaceutical companies also use

other forms of social media like Flickr, Pinterest, SlideShare, Tumblr and YouTube.

The companies make decisions to utilize these platforms on a case-by-case basis,

implicitly acknowledging the unique characteristics inherent to each (e.g. space

constraints, sharing features). A few of the companies also use or are currently

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exploring the use of controlled-access platforms, such as speaker communities or

medical information chat rooms, where licensed health care professionals would

obtain a password for access and the companies could strictly manage the format and

content of communication. But there is a general presumption againstthe use of a new

social media tool, and that advocates within the company must fully vet an initiative

with members of a product review committee and other stakeholders before launch.

Chan-Olmsted (2010) reported that although internet and social media have various

degrees of impact on consumers, it has not delivered extra revenues. In fact, the social

media based content utilization windows have not been adequately explored and are

relatively dependent on their relations with the print-based ones.

According to Scott and Scott (2014) direct-to-consumer advertising of prescription

medicines to consumers is only permitted in two developed countries; New Zealand

and the US. But due to the growing importance and use of internet there is no

restriction on people from other countries on accessing the DTCA content available

on online even though their origin is from USA and New Zealand. A related category

of promotion, ―disease-state advertising‖ aimed at intensifying the awareness of

treatments for specific illnesses is more commonly seen on internet and social and

may motivate consumers to seek specific medicines to treat their illnesses. Although

this can be dangerous as the consumers have less (imperfect) information about health

and health care interventions than do healthcare providers and may have difficulty

interpreting information available to them. The answers does not lie in banning direct-

to-consumer advertising of prescription medicines in a country‘s print, radio,

television media and domestically domiciled websites will be ineffective if

somewhere in the world such advertising is permitted and is thus available to

consumers.

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Chatterjee, S (2012) found that social media provides a great opportunity for the

pharmaceutical industry to reach both domestic and international audience. It allows

companies to traverse boundaries. The enormous growth in the social networking will

be replicated in the developing countries like India after an extensive coverage in the

developed markets. Social media could be a very strong and effective medium for the

pharmaceutical industry for communicating their values and strategies to their

customers.

Gu, Williams, Aslani and Chaar, (2011) suggested that Australia is a DTCA-restricted

country and the advertising of prescription medicines is prohibited by the

―Therapeutic Goods Act 1989‖ and restricted to over–the–counter (OTC) medicines

and herbal or complementary preparations. There are strict regulations in place to

protect the consumer from direct–to–consumer advertising (DTCA) of prescription

medicines. However, the degree of infallibility of these restrictions is unclear.

Consumers are not exempt from exposure to advertising of pharmaceutical products,

including prescription medicines, on the internet. DTCA of some drugs is often

hidden within disease awareness campaigns, e-Pharmacy web pages and online

communities. DTCA is more prominent in searches conducted from a medicine

perspective than from a health condition perspective. More than half of the web sites

accessed for prescription drug information are from the USA and all of the web sites

with evident DTCA originate from the USA or New Zealand. Australian consumers

can easily access DTCA-infiltrated web sites originating from countries where DTCA

is less regulated or unrestricted. The DTCA is in various forms – strong pictorials to

subtle linguistics. In some instances, DTCA is easily distinguished from unbiased

information on web sites with labels such as ‗advertisement‘ or ‗sponsored by‘, while

other web sites weave marketing strategies into health information and appearing to

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be provided for the benefit of consumers. In such instances, it may be difficult for

consumers to determine the nature or quality of the information. Consumers are

exposed to various advertising strategies that although do not strictly fit the definition

of DTCA, yet promote medicinal products. Clearly, DTCA restrictions are not fool

proof. Hence policy makers in the interests of public health must take measures to

address the gaps.

West, J. (2012) in a study comparing the government regulation of direct to consumer

advertising in the U.S. and the EU and the problems presented by the internet to

pharmaceutical manufacturers in both regions suggested that DTCA through internet

can be an opportunity to educate patients and consumers about their health condition

and possible treatment options. The internet poses obstacles on DTCA by

pharmaceutical companies in the U.S. because there has not been much guidance from

the US Food and Drug Administration (US FDA) relating to its use as an advertising

platform, other than that any advertising on the internet must comply with the

regulations controlling DTCA in any other medium. The US FDA has considerable

work ahead of it. Implementing changes of the magnitude necessary to fully

standardize the way DTCA is practiced on the internet will take time and ingenuity,

primarily because the way that users interact with the internet is constantly changing.

Of some consolation is the fact that the US FDA already has many of the necessary

regulations in place, and many may only require clarification or extensions relating to

their application to DTCA on the internet specifically. Confusion over how to fulfil

the brief summary requirement, for example, could easily be mitigated by

standardization of sponsored links and the endorsement of the one-click rule.

Ultimately the US FDA must provide clarification for the pharmaceutical industry.

The US FDA must issue guidance indicating what forms of advertising on the Internet

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are acceptable. US FDA has not issued any guidance for digital DTCA, this leaves the

pharmaceutical companies largely in the dark about what is expected of them in a

medium of unlimited time and space, unlike television or print advertising. Despite

this lack of guidance, pharmaceutical manufacturers have attempted to keep their

DTCA on the Internet within the bounds of current legislation.

Gupta and Udupa (2011) conducted a study on awareness, perception, attitudes,

responses and expectations of the doctors and the patient population, which are the

two key targets of a majority of pharmaceutical marketing strategies, towards this

emerging and potentially resourceful strategy of social media marketing. Although

there has been a lot of research in developed western countries on this topic, but data

from a rapidly developing economy like India is lacking in the existing literature. This

study intends to fill in this gap. Findings suggest that awareness and acceptance of the

concept of social media marketing is high amongst both the doctors and the patients.

Amongst doctors, it is positively and significantly associated with young age and

having a postgraduate degree after MBBS. Amongst the patients, a high proportion

take self-medication based on reference to the internet, most common ailments for use

of self-medication being aches, respiratory illnesses and gastrointestinal illnesses. The

increasing positive response of the key consumer groups, especially in the young age

group, makes social media a powerful marketing tool, which can be explored by the

pharmaceutical industry. Social media encompasses a wide range of web forums

including blogs, discussion boards, video logs, video sharing sites, and virtual life

websites. Consumers, with their new-found empowerment of making their own

healthcare purchase decisions, are increasingly turning online for healthcare answers.

The result is more transparency, a trend that health plans and pharmaceuticals must

prepare for. The newer avenues, in terms of effective marketing, provided by the

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social media have a tremendous potential. However, there is a pressing need to

understand and research about a few issues related to social media marketing. There is

a need for a better understanding of how social media can be of benefit to the

pharmaceutical industry, which is critical to stay at the forefront in terms of digital

media communication. There is a need to recognize the benefits and limitations of

social media, particularly in the pharmaceutical sector, which will ensure that PR and

marketing communicators maximize the opportunities provided by the web in both

ethical and mutually beneficial manner. It is incumbent upon us, to use our collective

efforts to bring some regulation and standardization of procedures into the field, being

guided by evidence. A better understanding of the consumer psyche and behaviour

will in turn help the pharmaceutical industry to formulate an effective strategy to

explore the social media for a dynamic marketing plan in the setting of a developing

country like India.

Mack, J. (2010) said that physicians today are likely to receive drug information from

a variety of sources and more often than not these sources are accessed via the

Internet. Devices such as iPhone and soon iPad—will make it even more convenient

for physicians and patients to receive online content.

Rehmani & Khan, (2011) in a research found that social media is being considered

playing an important role in customer buying decisions, however little studies have

explored its impact over the customer purchase intention.

Vigilante, Mayhorn and Wogalter (2007) concluded that consumers frequently

encounter DTCA and some report information seeking as a result. DTCA influences

interaction between doctors and their patients. People appear to be engaging in

information seeking after they encounter direct to consumer advertisements. Although

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people might notice and seek out information from a variety of different sources, there

still is the medical health professional to limit its use to appropriate users. Another

trend occurring with the proliferation of DTCA is the explosion in the use of the

Internet. Internet provides opportunity to purchase drugs online that might bypass

physician‘s restrictions. DTCA cause the consumers to look for or request more

information about the drug. Direct to consumer advertisement of prescription drugs

prompts consumers to discuss advertised drugs with their physicians. Although some

of the doctors declined to prescribe them a drug that they had seen advertised via

internet and social media. They were somewhat likely to talk to their doctor about a

drug they had seen advertised online for an ailment they have. Although due to the

widespread of DTCA and rising awareness consumers are taking a more active role in

healthcare decision making, internet purchasing of prescription drugs is relatively

infrequent -- possibly due to current law and beliefs that it is unsafe, with respect to

health and civil penalties. Thus, it can be concluded that online purchasing of

prescription drugs without a prescription is not so prevalent as yet.

According to Wang, and Kesselheim, (2013) DTCA is relatively rare outside the U.S.;

New Zealand is the only nation that allows this type of advertising, despite numerous

attempts by the pharmaceutical industry. But with internet geographical boundaries

have lost their meaning. The Internet, has served as an increasingly important forum

for drug advertising. The Internet offers substantial patient empowerment through

self-directed learning, but online DTCA has been criticized for using seemingly

neutral third parties to present biased information about drugs without appropriate

sponsorship disclosure. Adding to this concern is the concordant rise of online

pharmacies selling counterfeit medications, many of which use the same marketing

tactics as the drug manufacturers themselves, leading to increased confusion and

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potential harm for patients seeking to learn more about their conditions. While

physicians are the primary source of patients‘ information about prescription drugs,

the courts have long recognized that print and broadcast DTCA undercuts physicians‘

educational role. So-called web 2.0 technology, including YouTube channels, iTunes

applications, and social networking sites, can offer increasingly personalized

information to patients, allowing them to play an even more active role in their health.

However, this effect is salutary only when the information is true and it is

communicated in an accurate and balanced way that takes into account the totality of

the evidence. DTCA alone does not adequately support patient autonomy and

consumerism. Given the substantial dangers that can arise from use of prescription

drugs and the decades of evidence showing that advertising drives use of medical

products, reasonable restrictions are necessary to ensure that DTCA information is

presented in a clear, neutral, and patient-accessible manner. Drug advertisements

remain pervasive and therefore exert an undeniable influence on the way the public

learns about available therapies and how patients and physicians communicate.

Because advertisements‘ primary purpose is to sell products, rather than to inform

patients in an unbiased manner, reasonable oversight is essential for the public health.

The current rise of highly personalized online DTCA should be a primary focus of

this vigilance. Input from all stakeholders is required to ensure that ―fair balance‖ is

achieved in all types of drug advertising.

In their study Vigilante Jr. and Wogalter (2001) examined the effects of integrating

and separating the risks and benefits of prescription medication in DTCA via internet.

It also examined the effects of presenting the risk and benefits at different levels of

website in online advertisements. Results from the study indicated that risk

information was found faster, with less clicks, and remembered more often when

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placed on a second level page linked from the home page. However, the risk

information is more difficult to find when it was placed on a fourth level page without

a link on the home page.

Lau, et al. (2012) were of the view that social media has the potential to overcome

many of the reading and writing barriers in health literacy. However, due to the salient

nature of social media and the social influences surrounding its use, consumers and

patients are likely to be subjected to greater risks when unsafe content is consumed

than in the pre-social media world. The potential harm associated with the use of poor

quality health information on the internet has been a concern since the rise of the

internet. However, this does not mean that we should not engage in the use of new

technologies to improve the way we communicate and learn about health. What is

needed is a better understanding of how consumers digest online content, and how

potential harm operates and disseminates. More experimental and observational

studies are needed to investigate the prevalence and mechanisms of potential harm

related to the use of social media. From the consumer perspective, incorporating new

skill-sets in e-health literacy, such as promoting online etiquette to become

responsible consumers and producers of online content, and encouraging the reporting

of adverse events on the internet, should deter the spread of harmful influences in

social media.

Mackey and Liang, (2012) in their paper said that pharmaceutical marketing has

rapidly evolved over the past century and has now entered the digital revolution. This

is exemplified by the rise of direct-to-consumer-advertising (―DTCA‖), which has

traditionally been only allowed in the United States and New Zealand in developed

countries, but is now expanding in reach to other jurisdictions. Enabling the

―globalization‖ of pharmaceutical DTCA is Internet-related technologies that are not

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limited to geographical borders and are highly unregulated. Pharmaceutical

advertising has undergone a rapid evolution due to globalization, emerging health-

related technologies, changing patient-provider relationships, and the growing

importance and expanding ―business‖ of global health. Yet, pharmaceutical marketing

can have adverse health and economic outcomes, especially if left unregulated and

allowed to proliferate and cross geopolitical borders in the uncontrolled digital

environment. This DTCA digital ―spillover‖ into markets that prohibit it can have

adverse impact on health outcomes and health-related spending. Emerging markets

may represent the next logical step for digital DTCA proliferation, given their

untapped market potential and explosive growth, but they are especially at risk given

their enormous market potential, rapid growth in health spending, and ambiguous

regulatory treatment of digital DTCA. Further research and global health policy

reform is necessary to address this ―emerging‖ global health issue.

Mackey and Liang, (2013) in their research found that digital forms of direct-to-

consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and

open information exchange. Yet, the unregulated expansion of eDTCA has resulted in

unaddressed global public health threats. Specifically, illicit online pharmacies are

engaged in the sale of purportedly safe, legitimate product that may in fact be

counterfeit or substandard. These cybercriminal actors exploit available eDTCA

mediums over the Internet to market their suspect products globally. Despite these

risks, a detailed assessment of the public health, patient safety, and cybersecurity

threats and governance mechanisms to address them has not been conducted. Illicit

online pharmacies represent a significant global public health and patient safety risk.

Existing governance mechanisms are insufficient and include lack of adequate

adoption in national regulation, ineffective voluntary governance mechanisms, and

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uneven global law enforcement efforts that have allowed proliferation of these

cybercriminals on the web. In order to effectively address this multi-stakeholder

threat, inclusive global governance strategies that engage the information technology,

law enforcement and public health sectors should be established.

7.3 Social Media

According to Todi, M (2008) ever since the first pop-up advertisement hit the internet

in 1994, internet users have accepted advertising as a necessary evil on the internet.

However, consumer preferences have evolved along with the internet: they no longer

want intrusive, flashing and irrelevant ads that taint their online experience.

Advertisers have had to adapt their tactics to reach out to consumers. There are four

main reasons leading to the growing importance of social media in advertising mix:

large reach, cost efficiency, targeted advertising and increasing number of people

spending increasing time online. Facebook, MySpace and YouTube are some of the

most heavily trafficked websites on the internet today. Even though there may be

some overlaps in user bases among the three, this still gives advertisers relatively

cheap platforms to easily target and reach out to a large global audience. As these

websites are among the largest and most popular internet properties, it comes as no

surprise that most businesses would use them to reach out to consumers. Businesses

have a number of ways to develop unique advertising methods on these three

websites. With the launch of Facebook Platform and MySpace Developer Platform,

businesses can advertise through the creation of applications: widgets that can be

added to a use‘s profile in order to provide them with increased functionality such as

entertainment, more information about the user and so on. Other customizable

advertising methods include Facebook and MySpace pages/groups, Facebook gifts

and YouTube channels for businesses.

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According to Jain, Gupta and Anand, (2012) social media sites are web-based services

allowing individuals to construct a semi-public or public profile in a bounded system

as well as to articulate a list of others so as to share connections, views and thoughts.

Uniqueness of social media not only allows individuals to meet strangers but enables

users to discuss and make visible their social networks. This results into connections

between individuals which otherwise is not possible through any other media already

existing. Maximum of the time social media sites are used to communicate with

people who are already friends or acquaintances in the social network sharing same

mindset or same interests and views. However the type, classification and nature of

these connections may differ from site to site. These sites provide a platform for

discussion on different issues as it is this media which majority mass rely on and

extend warm support. One such burning issue that has been overlooked in today‘s

scenario is the impact of social media in the changing mind-set of the youth. Social

networking sites are acting as great medium for view mobilization. Youth are feeling

free in sharing their thoughts on any issue. Social media helps in generating

awareness on different issues.

Khan, S. (2010) in a study explored the impact of social media sites on students. The

survey aimed at determining the factors of social networking websites that have

impact on students. Variables identified were age, gender, education, social influence

and academic performance. It was concluded that students whose age range from 15

to 25 mostly use social networking websites for entertainment. Male students

commonly use social networking websites for knowledge. Graduation students

generally prefer social networking websites for entertainment. From this research

study it was also found that people can use social networking websites due to social

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influence. Students are socially connected with each other for sharing their daily

learning experiences and do conversation on several topics.

Naidu and Agrawal (2013) stated that in today's scenario social media has become a

very useful tool in buying behaviour. It is influencing consumers in a dynamic

manner. Consumers depend on social media for making purchase decision. Social

media has emerged as a powerful and cost effective approach to promote product to

consumer. According to the author almost 75% Indian youth are using social media

for sharing their thoughts, views and comments in different parts of the country.

Consumers have knowledge about social media and use social media not only for

communication but also for collecting information regarding product. Face book is the

most commonly used social networking site. Social media is a major tool used by

marketers for affecting buying behaviour directly and indirectly. In today‘s

competitive environment and social media became very useful technique for

promoting and marketing products.

Ramnarain and Govender (2013) found that despite the growing usage of social

media, little evidence exists of academic research which explores the potential of

social media as a marketing and communication tool for marketing to youth. Youth

are fairly computer literate and thus have access to social media platforms, which

invariably increases their potential as customers. They actively seek out social media

platforms daily and spend several hours on these platforms, exposing themselves to

greater influence and persuasion by marketers. However, due to the unique

characteristics of social media, inter-alia, its search capabilities and ability to

―congregate‖ consumers and archive their views, marketers using social media

platforms need to do so differently from traditional media. Most importantly, they

need to familiarize themselves with how these social media platforms function, as

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social etiquette has now crossed over into social media and there are now standards

with regards to the types of behaviour that are acceptable on these platforms.

Marketers cannot afford to overlook or downplay the value of social media, since it

has become a preferred means of direct communication with youth consumers which

significantly influences their purchasing behaviour. The constantly developing media

landscape and changing consumer behaviour presents new challenges and

opportunities for marketers. The growing popularity and usage of social media

platforms has forced marketers to re-evaluate their marketing strategies in order to

remain prevalent amongst the youth. The youth actively seek social media platforms

daily and, spend hours on these platforms, exposing themselves to greater influence

and persuasion by marketers.

Miller and Lammas (2010) were of the view that social media presents attractive

opportunities for new forms of communication and commerce between marketers and

consumers. As advertisers typically want to find some way to follow their target

audiences, many new media opportunities are presented to advertisers. The boom in

social marketing appears persuasive with a high percentage of consumers visiting a

social website for information. Advertisers will be forced beyond the ―old school‖

approaches to adopt many of the principles and techniques of relationship marketing

in order to effectively use social media.Web 2.0 (interactive) social media is a

potentially powerful medium for finding key consumer influencers, engaging them,

and generating brand advocates. However, in order to build viral campaigns and foster

online word of mouth (WOM), trust must be established and subsequently reinforced

in order to overcome any reluctance on the part of the would be consumer. This

means moving beyond ―old-school‖ approaches to website advertising to embrace the

principles of relationship marketing; building virtual environments in which

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customers can connect with each other to share insights and relevant information. One

tactic for success is for brands to move away from the hard-sell to instead embrace the

notion of ―co-creation‖. By tapping into or creating their own online social networks,

social media marketers can influence a brand community and potentially influence

consumer behaviour. To capitalise on currently available opportunities, marketers

need to find or establish real brand communities, listen to them, and then create

special programs and tools that will empower potential and existing community

members, rewarding existing consumers and eliciting behavioural change from

potential consumers. Perhaps advertising effectiveness in the rapidly digitalising

world of television (and other audio and visual media) will be improved through the

adoption of synergistic paradigms of multiple-niche co-creation. The often

unanswerable prediction is whether online viral marketing campaigns will be effective

in the short and long terms. Viral marketing is notoriously difficult to execute

successfully and measure adequately. Much of what happens in social marketing is

little more than experimental, or simply about ―insights‖ rather than metrics. Many

marketers feel the need to ―tick‖ the social media box and demonstrate how cutting

edge they are, while the primary drivers of their campaign remain embedded in

traditional media.

Bajpai, Pandey and Shriwas (2012) found that in an era when people do not find time

to come & interact with each other, social media provides a platform for connecting

with each other. From marketers perspective media like Facebook create a loyal

connection between product and consumers which leads to large advertising

opportunities. Similarly, other social media like Blogs create a platform to post

comment on any event which needs to be publicized and can be utilized as a

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promotional technique. Social media has a competitive edge over other popular

traditional media like television, print etc.

Bhavana, S (2014) highlighted that social media has both positive as well as negative

effect on youth. Proponents claim that social media has brought people all over the

world very close. It is a medium which helps in spreading information and educate

the public. It plays an extensive role in an individual‘s daily life. With the arrival of

advanced technology, there has been a drastic shift from the telegraph, radio,

newspapers and magazines to the most widely used medium - the internet. Social

media is mainly focused on youth. Youth are spending a major portion of their time

with Computer, Texting, Face book, YouTube, Smart phones with apps, iPods,

Television, Tweeting, MySpace etc. One of the most important things that social

media does for the youth is keeping them informed and engaged. Media also

encourages them to move in the right direction. However, opponents claim that it has

done more harm than good, especially to the youth.

Bolotaeva and Cata (2011) in their study discussed the advantages and risks that

social network marketing holds. This paper attempted to understand the working

behind social network advertising, determine whether it is profitable for businesses to

promote their products and services via the social network platforms, and determine

the opportunities and pitfalls of social network marketing. Findings were indicative of

the fact that social networks are popular places for people of different backgrounds

and experiences to meet. They can be powerful tools for businesses to establish brand

presence, build brand awareness, as well as save advertising costs in economically

dismal times. There are opportunities for businesses to grow public awareness and get

involved in the communities, as well as continue to research for other ways to

advertise on social platforms, such as incorporate mobile handset devices into the

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marketing model. However, businesses must also be wary of ethical issues such as

intruding user privacy, aggressive advertising, and spamming, in addition to legal

pitfalls and data mining issues. Moreover, the businesses must have a strategic e-

commerce plan, as social networks are not quite up to par on e-commerce

transactions. Protecting user privacy and securing the user‘s personal data has become

one of the most imperative goals of today‘s society. It is particularly important in the

age of rapid expansion and tremendous popularity of social networking sites. Social

media advertising is flourishing in the era of Web 2.0 end-user interaction. Therefore,

it is advisable that businesses not ignore the opportunities to jump in and expand their

customer base.

Constantinides, E (2004) suggested that marketers need to address one of the

fundamental issues of online marketing: how to attract and win over the consumer in

the highly competitive internet marketplace. They need to analyse the factors

affecting the online consumer‘s behaviour and examine how e-marketers can

influence the outcome of the virtual interaction and buying process by focusing their

marketing efforts on elements shaping the customer‘s virtual experience, the Web

experience. Identifying the web experience components and understanding their role

as inputs in the online customer‘s decision-making process are the first step in

developing and delivering an attractive online presence likely to have the maximum

impact on internet users. Click-and-mortar firms delivering superior web experience

influence their physical clients‘ perceptions and attitudes, driving additional traffic to

traditional sales outlets. Provides a contribution to the theoretical debate around the

factors influencing the online consumer‘s behaviour and outlines some noticeable

similarities and differences between the traditional and virtual consumers. Research

on the buying behaviour and the factors influencing the decision-making process of

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online consumers has revealed similarities as well as differences between them and

the traditional customers. The uncontrollable factors (external and personal ones)

affecting consumer behaviour are similar for both types of consumers. The tools

however used by traditional and online marketers in order to influence the buying

behaviour of their customers are not quite the same. In the case of traditional

consumers the 4Ps of the marketing mix are considered as the main controllable tools

influencing the buying behaviour. Research indicates that in the case of the Web

consumer a set of elements experienced during the virtual interaction are indeed the

controllable factors affecting the online buyer.

Hadija, Barnes and Hair (2012) studied the college students‘ usage behaviour for

social media, and their perception of social media advertisements. It was concluded

that users of social media do not dislike online advertisements but simply do not

notice them. Brand recognition in social media advertisements was found to be much

lower compared to other media.

Hooper, V. and Kalidas, T. (2012) claimed that social media offers many benefits,

especially for the youth who are striving to establish their identity as young adults.

The youth are the most active users of social media but are also the biggest

perpetrators of behaviour that would not be tolerated offline. In a face-to-face

environment people were not able to talk freely. The ability to talk to someone

without having to see their facial expressions and determine the consequences of what

was being said, means that youth have the freedom to say what they want without

hesitation – and this includes discussing their personal problems and issues. In recent

days, internet advertising has taken new forms which have more advantages over the

traditional mediums like print, television and radio.

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Jothi et al. (2011) concluded that marketing communication is becoming precise,

personal, interesting, interactive and social. Different strategies of communication are

followed in various social media sites like Face book, Twitter and Youtube. They not

only create impact over the audience but also make them interact with the marketing

statistics created. These networking sites bring more interactive communication with

advertising. Social media sites will become the primary arena for highly targeted

marketing and advertising.

Manjunatha, S. (2013) in a study presented the usage pattern of social media by the

Indian college students, hours spending per week, gender differentiation in its usage

and purpose of membership. The findings acknowledged the rampant usage of Social

media among young college students in India. The primary objective of the research

was to shed light on the evolution of the dominance of social media among the Indian

college students. As with many technologies, adoption of the internet especially for its

social uses has seen its highest levels of usage among young college students in India.

Majority of them have access to the Internet and computers for a large percentage of

their lives. These digital natives see these technologies as a logical extension of

traditional communication methods, and perceive social networking sites as often a

much quicker and more convenient way to interact. That they are aware of the danger

and risk involved in these sites is a positive indicator that Indian college students are

not only techno-savvy and socially active through social networking sites but they

also possess social consciousness. Today in India particularly among the Indian

college students the usage of Social media has significantly increased and it certainly

has far reaching impacts the students. And these impacts are so widespread that they

have also caught the attention of social scientists worldwide.

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Ramnarain, Y. and Govender, K. K. (2013) found that youth are fairly computer

literate, have access to social media platforms, thus, increasing their potential as

customers and increasingly turning away from traditional advertising media and

actively seeking out social media platforms, and make frequent purchases using

information obtained from social media platforms because they regard it as being

sufficient for decision-making, reliable, convenient, and results in less time wastage.

Marketers cannot afford to overlook or ‗downplay‘ the value of social media, since it

has become a preferred means of direct communication with youth consumers which

significantly influences their purchasing behaviour. The findings could be considered

by marketers targeting the youth market when developing their marketing and

communication strategies.

According to Vinerean, S. et al. (2013) Social media allows youth (prospects) to

communicate directly to company representatives or other users of the product. Peer

communication through social media, a new form of consumer socialization, has

profound impacts on youth‘s buying behaviour and decision making. Social media

provides a virtual space for youngsters to communicate through the internet, which

also might be an important agent of consumer socialization.

7.4 Impact of Advertising on Consumer Behaviour

Bakshi and Gupta (2013) defined online advertising as a type of mass communication

which is based on traditional form of advertising but develops its own communication

strategies in correlation with the new technical and medium based requirements. The

extent and variety of online advertisement is growing dramatically. Businesses are

spending more on online advertisement than before. Understanding the factors that

influence online advertisement effectiveness is vital. With the increased adoption of

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the internet, world-wide-web is becoming gradually a standard advertisement

platform. The Web is offering business advertisement world with more rich media

tools, interactive services, and global reach. The need is to understand the target

consumers and then strategize wisely in order to gain maximum out of this new

medium. Social media will become an effective tool in the hands of discerning

advertisers. Facebook, in its promotional posts and offers allows marketing within the

mobile environment, which is where the majority of users access Facebook. Promoted

posts provide businesses with the ability to push a post out to not only fans, but

‗likers‘ of fans, increasing the reach dramatically. This is only the tip of the iceberg

social media is projected to ramp up its revenue generating activities.

According to Bishnoi and Sharma (2009) rural teenagers like television advertising

more than their urban counterparts. TV advertising has enhanced their involvement in

product selection and purchase, they prefer to buy TV advertised products and it is

helpful in buying the new products. The urban teenagers do not buy TV advertised

products if they do not require those brands. They also like the advertisements of the

products that they are using and believe that products are as good as expected from

TV advertisements. Rural teenagers collectively decide with their family members,

products to be purchased due to exposure to TV advertisements while it is not so with

their urban counterparts. The urban teenagers like the advertisements of the products

they are already using and believe that the quality of the product is as good as

expected from TV advertisements. It can also be concluded that there is a

considerable variation in the perception of both rural and urban teenagers on the issue

that demand for product purchase is influenced by TV advertisements.

Gabriel and Loredana (2012) viewed the paradigm of economics as one where

consumers will maximize their own utility and will prefer low-costs, high quality

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products to high priced, added value brands. Marketing managers are driven by the

need for consistency which is an innate of their own influences. The online

advertisement influences the desire to buy and consumers look up information on the

web. The behavior of the consumer is influenced by exogenous and endogenous

factors, but the decision to buy is taken according to the information about the product

that is shown, lately, on the internet. Doing shopping on internet means fashion,

pleasure and utility. Most of the sites that offer the possibility of doing shopping

online had started from the idea of maintaining the traditional sales helped by the

electronic environment or they had started a business that is only in the virtual

environment.

Jakstien, Susnien and Narbutas (2008) believed that advertising plays a major role in

modern life. It shapes the attitudes of the society and the individual and inevitably

influences consumer behaviour. The cosumer has to contend with a huge amount of

information and be able to make a choice, draw conclusions and make important

decisions. The most important task for a business advertising itself is to present its

product in such a manner that the whole environment around the buyer turns into a

positive emotional stimulus. The main goal of advertising a certain product or service

is to attract the customer‘s attention and analyse the impact of advertising on

customer behaviour, which is determined by a multitude of aspects, although the

psychological-cognitive, emotional and behavioural-ones play the most important

role.

Kumar, Gangal and Singh (2011) said that language and presentation are very

important components of any advertisement to influence consumers‘ purchasing

decision. Today the firms or marketers are using the advertising as a major tool to

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affect the consumer buying behaviour and mould in their favour. This paper was an

attempt to know the impact of advertisement on consumer buying behaviour. In order

to stay in business a company must make adequate sales from its products to cover

operating costs and post reasonable profits. For many companies, sales estimate is the

starting point in budgeting or profit planning. Sales decisions are a challenging one

which has to take by each business executive in his / her life. The external factors like

– income of the consumers, government policies, competitive environment oppose

number of challenges to forecast the potential customers‘ demands accurately.

Considering, hence, the importance of sales for business existence and the connection

between customers and sales, it is necessary for organizations to launch such

programs that can influence consumers‘ decision to purchase its products. This is,

where, advertising is relevant. Advertising is a subset of promotion mix which is one

of the 4P‘s in the marketing mix i.e. product, price, place and promotion. As a

promotional strategy, advertising serves as a major tool in creating product awareness

and condition the mind of a potential consumer to take eventual purchase decision.

Mechanic, D. (2005) were of the view that media simply serves as the rope in a ―tug

of war‖ among many ideas and interests. While some interests clearly have more

money, power and influence, the heterogeneity of interests and the abundance of

communication channels provide outlets for almost any view. Media is, of course, a

business, and will market almost anything that will sell. The challenge for health

promoters is establishing their credibility and reaching broad audiences.

According to Rai, N. (2013) in the current era of information explosion and the world

of media, advertisements play a major role in changing the behaviour and attitude of

consumers towards the products shown in the advertisements. The advertisements not

only change the way a product is consumed by user but alter the attitude with which

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they look at the product. All over the world, advertisements have been used since ages

for a wide variety of brands. For over the last two decades, a sharp increase in

advertisements per brand can be witnessed. Advertisements have great influence in

purchasing decision of customers for particular brands. It is a ubiquitously accepted

fact that advertisements can bestow special attributes upon a product or service that it

may have lacked otherwise. The study focused on identifying the influence of

advertisements on the consumer behaviour and attitude with special reference to

consumer durables. The findings of the study suggested that advertisements influence

the behaviour and attitude formation of consumers not only in India but also

worldwide. The consumers of durables products have their motivational sources

which are advertisements and study revealed that advertisement motivates them to

materialize the purchase of durables. The consumers are induced significantly by

advertisements when the target is on quality and price. Purchase attitude and

behaviour is influenced by variety of advertisements which cover product evaluation

and brand recognition.

7.5 Literature Gap

Most of the studies of DTCA are based out of USA.

Very little literature is available on the impact of DTCA on consumers in

countries where direct to consumer advertising is banned.

There are few studies on impact of DTCA on youth behaviour.

Not much is known about the potential impact of DTCA on youth.

Various researches have studied the effect of DTCA on awareness, attitude,

perception and consumer behaviour, but few have examined the correlation

between these parameters.

There are few studies on social media promotion of prescription drugs

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More experimental and observational studies are needed to investigate the

prevalence and mechanisms of potential harm due to the use of social media.

Very little research has measured the relationship: consumers engaging in

information seeking after they encounter DTCA on social media.

Little is known about how DTCA affects people‘s health-related beliefs and

behaviours beyond prescription requests.

Study of consumer‘s comprehension of social media DTCA, particularly

content with difficult vocabulary is a high priority area for future research.

More experimental and observational studies are needed to investigate the

prevalence and mechanisms of potential harm related to the use of social

media for prescription drug advertisement.

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CHAPTER 8

OBJECTIVE AND RESEARCH METHODOLOGY

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CHAPTER 8

OBJECTIVES AND RESEARCH METHODOLOGY

8.1 Problem Statement

The advent of direct-to-consumer advertising of prescription drugs has facilitated the

dissemination of prescription drug information directly to consumers. Proponents

suppose that direct to consumer advertising educates consumers about advertised

drugs, although opponents believe that it results in increased drug expenditures,

misleading, and overutilization of the advertised drug in specific and other drugs in

general. Although spending on direct to consumer advertising has been rising

continuously, US FDA has not been able to define proper and stringent regulations on

advertising of prescription drugs to consumers. Promotional labelling and advertising

of prescription drugs is overseen by the US FDA through its Division of Drug

Marketing, Advertising and Communications (DDMAC). DDMAC exercises its

authority by reviewing the advertisement materials for any false or misleading claims,

advisory review of pre-release drafts submitted by pharmaceutical companies and

issue post release regulatory letters to suggest remedial action. Since the present

regulatory framework of the agency is not effective in governing direct to consumer

advertising a different approach may be more useful. By educating the patients about

complex therapies, drug associated contraindications and comparative effectiveness

disclosure backed by real life examples, DTCA could prove to be a more effective

medium for communicating with the consumers. Traditionally drug companies

promoted prescription drugs to the physicians because of this paternalistic trend in

twentieth century consumer oriented advertisement of prescription drugs was

inconceivable till 1981. Readers digest released first direct-to-consumer

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advertisement for a prescription drug in US in the year 1981. Many others were

published after this advertisement. This change was not accepted initially and

concerns were raised about the consequences that would follow. To address these

concerns US FDA announced a moratorium on consumer oriented advertisements of

prescription drugs, in 1983. This moratorium prohibited the advertisement of

prescription drugs till it was lifted. The US FDA explored different options to regulate

these advertisements and concluded that direct to consumer advertising was against

the interest of the consumer. In 1985 the US FDA lifted the moratorium with a clause

that the advertisements should abide by the fair balance principle, according to which

a prescription drug advertisement should include a balanced disclosure of both risk

and benefits. The moratorium was lifted as a result of the issues raised regarding

freedom of speech. Also there was a common view that regulations governing these

advertisements at that time were effective in protecting the consumer‘s interest. With

the liberalisation of guidelines in 1997 by US FDA patients were exposed to

prescription drug advertisements through different media. This liberalisation also saw

the evolution of internet as a new platform for prescription drug advertisement. Direct

to consumer advertising of prescription drugs is legal only in the USA and New

Zealand. However, with more and more consumers going online for therapeutic

options these regulations have no meaning and US FDA cannot control the online

content. Direct to consumer advertising has become a global threat because of its viral

nature. A bigger problem is the third party postings disseminated via internet and

social media that can traverse geopolitical boundaries. It cannot be governed by US

FDA‘s existing regulatory framework. Hence the pharmaceutical companies are

demanding new guidelines for regulating the practice of direct to consumer

advertising of prescription drugs via internet and social media. The present study is an

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effort to understand the usage and adoption of social media by working youth and the

site preferred by them for collecting information related to prescription drugs. This

study also analyses the role played by social media in generating awareness for

prescription drugs and prescription drug advertisements. It also analyses working

youth‘s understanding of the regulations governing such advertisements and how

working youth conceptualize the purchase of prescription drugs through internet and

social media. Although there are researches on digital DTCA there is no or limited

research on prescription drug advertisements encountered by consumers on the

internet and social media by users from a country where direct to consumer

advertising is restricted. It is known that direct to consumer advertisement affects

consumer behaviour but very less is known about howit affects behaviour. This study

explores working youth‘s attitude and perception for direct to consumer

advertisements and correlation between attitude, perception and consumer behaviour.

This study also investigates the role played by demographic factors and social media

sites in consumer awareness for these advertisements. An effort has been made to

understand the favourable and unfavourable perception of consumers for DTCA and a

correlation between perception and behaviour of working youth for therapeutic choice

and healthcare decision making. This study determines the influencers of consumers‘

opinion of the utility of these advertisements and whether consumers use information

in these advertisements for health care decision making. This research is a survey of

working youths‘ receptivity to direct to consumer advertising, their understanding of

direct to consumer advertising regulation, their attitude towards direct to consumer

advertising. It is an analysis of consumers‘ perception of direct to consumer

advertising. Whether social media affects working youth‘s behaviour while selecting

prescription drugs? Whether these advertisements affect behaviour? Whether working

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youth read an advertisement carefully and completely? Whether the information

contained in the advertisement is easy to understand and written in non technical

language? Whether they are satisfied with the advertisements posted on the social

media? Whether these consumer oriented advertisements of prescription drugs posted

on the social media present a fair balance of risk and benefit information? Whether

working youth make use of information contained in DTCA to supplement more

traditional sources of information like physicians? What are the different behavioural

manifestations of exposure to direct to consumer advertisements of prescription

drugs? Whether working youth seek further information on advertised drug post

exposure to direct to consumer advertisement? Whether working youth ask the doctor

to prescribe the advertised drug? Whether they directly buy the advertised drug from

pharmacist? Whether working youth save the advertisement for later reference?

Working youth‘s perception of the authenticity and utility of the information

contained in these advertisements. What is the impact of demographic factors on

awareness for prescription drugs? In which of the following ways does the youth

utilise these advertisements - drug inquiry, drug request (requesting a prescription)

and disease inquiry (discuss with the physician about their disease). Consumers seem

to be indulging in information seeking post exposure to direct to consumer

advertisement. Still the number of researches measuring this correlation is very less.

Also utility of prescription drug advertisement is questionable. It is unethical to

advertise a product to an audience which is ill equipped to understand its potential

risks and benefits.

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8.2 Research Objectives

7. To study the preference of social media sites by working youth for collecting

information about prescription drugs.

8. To study the relationship between the social media sites i.e. Facebook,

Twitter, You tube, Linkedin and Google plus used for collecting information

on prescription drugs and awareness for prescription drugs.

9. To study the relationship between satisfaction with social media advertisement

of prescription drugs and demographic factors.

10. To study the favourable and unfavourable perception and attitude of working

youth for social media advertisement of prescription drugs.

11. To study the impact of social media based direct to consumer advertisement

on working youth.

12. To study the correlation between awareness, attitude, perception and youth

behaviour for prescription drugs.

8.3 Research Hypothesis

To study the above objectives following hypotheses are designed.

H01: Working youth do not have any preference for social media sites for collecting


H11: Working youth have a preference for social media sites for collecting


H02: There is no association between the social media platform used for advertising




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H03: Satisfaction with social media advertisement of prescription drugs is independent

of demographic factors like gender, occupation, qualification, income and age.

H13: Satisfaction with social media advertisement of prescription drugs is dependent

on demographic factors like gender, occupation, qualification, income and age.



H14: Consumers have both favourable and unfavourable perception of social media


H05: Consumers have no favourable or unfavourable perception of the impact of

social media DTCA

H15: Consumers have either favourable or unfavourable perception of the impact of

social media DTCA





8.4 Research Methodology

Research methodology is an outline of research design/ method used for the study. It

includes data collection, sample selection, questionnaire, data processing and

interpretation. This study makes use of both exploratory and conclusive (descriptive)

study. While exploratory study was used to define the problem statement and define

the variables, conclusive research was used to prove the hypotheses and objectives.

Descriptive study is used for consumer perception and behavior studies. This study

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determines the impact of direct to consumer ―advertisement‖ on working youth‘s

―behavior‖ for prescription drugs, descriptive method has been used. A total of four

cities (Pune, Auragabad, Surat & Baroda) have been selected for the research, but for

synopsis data was collected from only two cities Pune and Aurangabad.

8.4.1 Sources of Data

Secondary Data: It was collected through various sources like published papers, US

Food and Drug Administration (FDA) website, World Health Organization (WHO)

website, IMS health, Indian Federation of pharmaceutical Manufacturers (IFPMA)

website, Internet and Mobile Association of India (IAMAI) website and various other

authentic websites, dissertations and thesis, ebscohost, proquest and published reports.

Primary Data: It was collected through a survey of working youth by using the

research instrument i.e. questionnaire.

8.4.2 Sampling Framework

Sample population selected for this research is working youth in the age group of 18-

35 years, who are social media savvy and have access to internet. The study was

conducted in 4 selected cities of India i.e. Aurangabad and Pune (Maharashtra),

Baroda and Surat (Gujarat).

Sampling Technique: Judgement Sampling was adopted for the present research. It is

a non-probability sampling technique where researchers select units to be sampled

based on their knowledge and professional judgment. Judgement sampling involves

the choice of subjects who are most advantageously placed or in the best position to

provide the information required. It is used when a limited number or category of

people have the information that is sought. It may curtail the genralizability of the

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findings as use is made of a sample of experts conveniently available. However it is

the only viable method for obtaining the information required from very specific

pockets of people who are very knowledgeable. In the present study working youth

with knowledge of internet and social media and exposed to prescription drug

advertisements on social media were selected as the sample.

8.4.3 Sample Size Calculation

Population considered for the study

State City Working Youth Using Internet in mn.

Maharashtra Pune 0.972

Maharashtra Aurangabad 0.932

Gujarat Vadodara 0.579

Gujarat Surat 0.292

The sample size was calculated based on the following statistical formula

ss =

Z 2

* (p) * (1-p)

c

2

ss= (1.96*1.96)*(50)*(1-50)/ (3.06) = 1025.67

Where:

Z = Z value (e.g. 1.96 for 95% confidence level)

p = percentage picking a choice, expressed as decimal

(.5 used for sample size needed) = 50

c = confidence interval, expressed as decimal = 3.06

Sample size needed is 1025.

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Sample size distribution for the selected four cities is given in the below table.

State Cities PopulationofWorking

Youth Using Internet

in million.

No. of

Respondents

Part of

population

Taken

Maharashtra Pune 0.972 320 1/3037

Aurangabad 0.932 323 1/2885

Gujarat Vadodara 0.579 305 1/1898

Surat 0.292 280 1/1043

Total 2.775 1228 1/2260

Total number of questionnaires distributed was 1228, while the total number of filled

in questionnaires obtained from the respondents was 1025.

8.4.4 Questionnaire Design

The data was collected through primary survey by using a closed ended structured

questionnaire. The questionnaire is closed ended because the respondents were given

options to choose from and were not allowed to give their own answers. The

questionnaire consists of questions based on different scales i.e. nominal, interval and

ratio scale. Some questions are framed on the likert scale by using four and five point

scales from one to five where one is strongly disagree and five is strongly agree. The

questionnaire has two sections; section I contains questions related to demography,

while section II contains questions relevant to the field of research, the questions in

section II are meant to analyse adoption of social media by working youth, awareness

for DTCA, attitude towards DTCA and behaviour post exposure to DTCA.

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8.4.5 Pre- Test

Questionnaire was pre-tested with 246 consumers from the population as the sample

to assess whether or not there were misunderstandings or ambiguity of expressions in

the questionnaire. Data gained through pre test was analyzed using the same statistical

methods as in final analysis especially reliability and validity of the scale.

8.4.6 Data Collection

Data collection is done in two stages: in the first stage a pilot survey was conducted

to ascertain the research parameters and to test the validity and reliability of the

instruments used in the study. In the second stage the primary data was collected

using the instruments in the study (Questionnaires).

8.4.7 Processing of the data

The data collected through the questionnaire was analyzed with the help of statistical

package SPSS 16. The mean scores arrived were put to various statistical analysis to

test the hypotheses used for the study.

8.4.8 Analysis of Data

The data was analyzed in SPSS version 16 using different statistical tools viz:

Frequency Table with percentages, One sample T test, Rank Order, Analysis of

Variance (ANOVA), Chi-Square Test and Correlation. The raw data was collected

from primary source i.e. working youth with knowledge of social media with the help

of questionnaire consisting of the questions at two different level of measurements i.e.

nominal and interval scale. To draw the logical inferences from the data descriptive

and inferential statistics techniques were used. The type of statistical techniques used

i.e. Univariate and Bivariate analysis was used based upon the level of measurements

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of the questions pertaining to those variables. The Univariate procedure deals with

one variable at a time, so for that purpose the researcher used frequency table with

percentages to get an idea about the data. Inferential statistics was used for testing the

different hypotheses. The first inferential statistics used was one sample T test, it

helped to understand the favourable and unfavourable perception of the responses for

the different factors which were considered for the study. Analysis of variance was

used to test whether the samples were drawn from more than two populations having

the same mean; it helped to understand the perception of the respondents for all the

factors in more than two groups. Chi square test was used to find the association

between two qualitative variables. While performing pilot study the reliability test

done by using Cronbach‘s Alpha came to 79% which showed the reliability of the

scale adopted.

8.5 Limitations of the Study

5. Limitation is with respect to time constraint.

6. The samples were working youth, although non working youth are equally

social media savvy.

7. The restriction of the study is only to four tier II cities of India. Hence

generalisation of results for entire India may not be there.

8. The media selected for study was social media however other media like

Broadcast, Print, Internet and Physicians were excluded.

8.6 Scope for Future Research

This research had certain limitations which could provide scope for future research

like similar study could be conducted in other cities of India. The sample selected is

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from two tier cities of India. Hence there is scope of a similar study on a larger

audience.

8.7 Utility of the study

This research can aid the Indian pharmaceutical industry in understanding how

informal social media forums influence healthcare decisions of youth. Findings can

help discover how to engage with different types of audiences in order to maximize

the effect of the online marketing strategy. This would help marketers and

pharmaceutical companies allocate budget to different social media based on their

effect on awareness and change in youth behaviour. This research would help the

marketers to find out the popularity of different social media platforms amongst

working youth. Based on this knowledge obtained from research the marketers can

accordingly allocate their resources to the different platforms for getting the best

results.

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CHAPTER 9

DATA ANALYSIS

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CHAPTER 9

DATA ANALYSIS

DESCRIPTIVE ANALYSIS

9.1 Respondents using social networking sites for collecting information on

prescription medicine

1. Respondents using facebook for collecting information on prescription medicine.

Frequency Percent Valid

Percent

Cumulative

Percent

Valid Yes 240 23.4 23.4 23.4

No 785 76.6 76.6 100.0

Total 1025 100.0 100.0

From the above table, it is observed that out of 1025 respondents 23.4% of the

respondents use facebook and 76.6% respondents are not using face book.

2. Respondents using twitter for collecting information on prescription medicine

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 706 68.9 68.9 68.9

No 319 31.1 31.1 100.0

Total 1025 100.0 100.0

From the above table, it is observed that out of 1025 respondents 68.9% of the

respondents use twitter and 31.1% respondents are not using twitter.

163

2. Respondents using social networking site i.e. linkedin for collecting information

on prescription medicine

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 596 58.1 58.1 58.1

No 429 41.9 41.9 100.0

Total 1025 100.0 100.0

It is observed from the above table, that out of a total of 1025 respondents 58.1%

of the respondents use linkedin for collecting information related to prescription

drugs and 41.9% respondents do not use linkedin for prescription drug

information.

3. Respondents using using social networking site i.e. youtube for collecting

information on prescription medicine

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 213 20.8 20.8 20.8

No 812 79.2 79.2 100.0

Total 1025 100.0 100.0

From the above table, it is observed that out of a total of 1025 respondents 20.8%

of the respondents use youtube for collecting prescription drug information and

79.2% respondents are not using youtube for this purpose.

164

4. Respondents using social networking site i.e. googleplus for collecting

information on prescription drugs.

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 861 84.0 84.0 84.0

No 164 16.0 16.0 100.0

Total 1025 100.0 100.0

From the above table, it is observed that out of a total of 1025 respondents 84.0%

of the respondents use googleplus and 16.0% respondents are not using

googleplus.

9.2 Respondents trust on the following sources for collecting information on

prescription drugs

1. Key Opinion Leader

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 713 69.6 69.6 69.6

No 312 30.4 30.4 100.0

Total 1025 100.0 100.0

From the above table it is observed out of the total 1025 respondents 69.6%

respondents are having trust of key opinion leaders for collecting information on

prescription drugs and 30.4% do not have trust of key opinion leaders for

collecting information on prescription drugs.

165

2. Online Doctor Committee

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 548 53.5 53.5 53.5

No 477 46.5 46.5 100.0

Total 1025 100.0 100.0

From the above table it is observed that out of the total 1025 respondents 53.5%

respondents trust online doctor committee for collecting information related to

prescription drug and 46.5% do not trust online doctor committee for prescription

drug information.

3. Patients Communities

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid yes 156 15.2 15.2 15.2

no 869 84.8 84.8 100.0

Total 1025 100.0 100.0


respondents trust patients communities for collecting information on prescription

drugs and 84.8% do not trust patient communities for prescription drug

information.

166

4. Company‘s Social Media Devoted Pages

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid yes 235 22.9 22.9 22.9

no 790 77.1 77.1 100.0

Total 1025 100.0 100.0

From the above table it is observed that out of the total 1025 respondents 22.9%

respondents trust company‘s social media devoted pages for prescription drugs

information and 77.1% do not trust company‘s social media devoted pages for

collecting information on prescription drugs.

5. Pharmaceutical Company Website

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 704 68.7 68.7 68.7

No 321 31.3 31.3 100.0

Total 1025 100.0 100.0

From the above table it is observed out of the total 1025 respondents 68.7% trust

pharmaceutical company website for collecting information on prescription drugs

and 31.3% do not trust pharmaceutical company website for prescription drug

information.

167

6. Pharmacist

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid yes 782 76.3 76.3 76.3

No 243 23.7 23.7 100.0

Total 1025 100.0 100.0


respondents trust pharmacist for prescription drug information and 23.7% do not

have trust on pharmacist for prescription drug information.

9.3 Reasons for using social media sites for prescription drug advertisements

1. General Knowledge

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid

Yes

833

81.3

81.3

81.3

No 192 18.7 18.7 100.0

Total 1025 100.0 100.0

It is observed from the above table that out of a total of 1025 respondents 81.3%

respondents use social media DTCA collecting general knowledge about

prescription drugs and 18.7% are not using it for collecting general knowledge on

prescription drugs.

168

2. Cannot Consult Doctor because of social stigma on disease

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 56 5.5 5.5 5.5

No 969 94.5 94.5 100.0

Total 1025 100.0 100.0

It is observed from the above table, out of total 1025 respondents 94.5%

respondents do not shy from consulting a doctor because of social stigma while a

small percentage (5.5%) do not consult doctor for prescription drugs because of

the social stigma attached with the disease.

3. To Know the Treatment for Ailments

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 702 68.5 68.5 68.5

No 323 31.5 31.5 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of a total of 1025 respondent‘s 68.5%

respondents use social media DTCA for information on prescription drugs to treat

their own ailments and 31.5% do not use social media DTCA for getting

information on therapeutic options for their own ailments.

169

4. To find new and better version of medicines use

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 736 71.8 71.8 71.8

No 289 28.2 28.2 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of total 1025 respondents 71.8%

respondents use social media DTCA to find new and better version of medicines

they use and 28.2% do not use social media DTCA for finding better and

improved options for their medicines.

5. Doctor/medical professional

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 222 21.7 21.7 21.7

No 803 78.3 78.3 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of a total of 1025 respondents only 21.7%

respondents agreed to be using social media DTCA because they were doctor /

medical professionals but a major percentage i.e. 78.3% did not support this

claim.This could be because they were not doctors or other reasons.

170

6. For Parents/ Relatives/ Friends

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid yes 558 54.4 54.4 54.4

no 467 45.6 45.6 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of 1025 respondents 54.4% respondents

use social media DTCA for finding prescription drug options and information

their parents, relatives and friends suffering and from some ailment. But 45.6% do

not use social media DTCA for any of the above mentioned reasons.

7. High Consultation Fee

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 107 10.4 10.4 10.4

No 918 89.6 89.6 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of 1025 respondents only 10.4%

respondents use social media DTCA because of high consultancy fee of doctors

and 89.6% do not quote this as a reason for using social media DTCA for

prescription drugs.

171

8. Busy Schedule

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 168 16.4 16.4 16.4

No 857 83.6 83.6 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of a total of 1025 respondents 16.4%

respondents use social media DTCA because their busy schedule does not allow

them to visit a doctor but 83.6% do not support this cause for using social media

DTCA for collecting information on prescription drugs.

9.4 For the following diseases respondents are using social media sites for

prescription drug

1. Fever, Cough and Cold

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 795 77.6 77.6 77.6

No 230 22.4 22.4 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of total 1025 respondents 77.6%

respondents use social media for the finding prescription drugs to cure ailments

like fever, cold and cough and 22.4% do not.

172

2. Anti- Smoking

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 577 56.3 56.3 56.3

No 448 43.7 43.7 100.0

Total 1025 100.0 100.0


use social media for information related to antismoking prescription drugs and

43.7% do not use social media DTCA for information on antismoking prescription

drugs.

3. Allergy

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 744 72.6 72.6 72.6

No 281 27.4 27.4 100.0

Total 1025 100.0 100.0


use social media for finding prescription drug options for allergy and related

information but 27.4% do not use social media DTCA for finding prescription

drugs for allergy.

173

4. Heart burn and Acidity

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 666 65.0 65.0 65.0

No 359 35.0 35.0 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of 1025 respondent‘s 65.0% respondents

use social media for heartburn/acidity and 35.0% do not.

5. Nutrition Supplement

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 752 73.4 73.4 73.4

No 273 26.6 26.6 100.0

Total 1025 100.0 100.0

It is observed from the above table; out of 1025 respondent‘s 73.4% respondents

are using social media for nutrition supplements and 26.6% are not using social

media for nutrition supplements.

174

INFERENTIAL STATISTICS

IMPACT OF SOCIAL MEDIA ON WORKING YOUTH

H01: Working youth do not have any preference for social media sites for

collecting information on prescription drugs

H11: Working youth have a preference for social media sites for collecting


The above hypothesis is tested based on two factors- adoption of social media by

working youth and preference of different social media sites by working youth for

searchinginformation on prescription drugs.

Social Media is either adopted or not adopted by working youth for collecting

information on prescription drugs:

Chi-square test is used to test adoption of social media by working youth for

collecting information on prescription drugs. Following parameters have been

considered to prove the adoption of social media by working youth.

Sl. no. Parameter

1 Time spent online

2 Time spent on social media

1 Authenticity of information

2 Satisfaction with social media DTCA

3 Perception of prescription drugs DTCA

4 Medical condition

175

Chi square test and Cramer V statistics have been applied to the individual parameters

and the test results are presented in the table below.

Parameter Test Test result

Adoption of social media by working

youth is independent of the time spent

online in a week

Chi-square It is dependent on time spent

online


youth is independent of the time spent

on social media

Chi-square It is dependent on the time

spent on social media


youth is independent of the

authenticity of information contained

prescription drug advertisement

Chi-square It is independent of the

authenticity of the

information contained in

social media DTCA

There is no association between

respondent‘s satisfaction with social

media advertisement of prescription

drugs and use of social media

Chi-square There is association between

satisfaction with social

media DTCA and use of

social media


perception of prescription drugs and

use of social media

Chi-square Perception of prescription

drugs and use of social

media are not related


medical condition and use of social

media for prescription drug

information

Chi-square Medical condition and use of

social media for prescription

drug information are not

related

176

Following is the detailed analysis of the above mentioned parameters

Adoption of social media by working youth is independent or dependent on the

time spent online in a week:

Chi-Square Tests

Value Df Asymp. Sig.

(2-sided)

Pearson Chi-Square 28.990(a) 6 .000

Likelihood Ratio 29.620 6 .000

Linear-by-Linear

Association

1.099 1 .295

N of Valid Cases 1025

From the above table, it is observed at 5 % level of significance p < α (0.05). It can

be concluded that there is association between the time spent online in a week and

adoption of social media by working youth. Further to check how much dependency

is present Cramer‘s V coefficient is used.

Symmetric Measures

Value

Approx.

Sig.

Cramer's V .659 .000


From the above table, it is observed that only 65.9% dependency exists between the

time spent online by the respondents and adoption of social media.

177

Adoption of social media by working youth is independent or dependent on the

percentage of total time spent online on social media (facebook, twitter, linked in,

youtube):

Chi-Square Tests


(2-sided)



Linear-by-Linear Association 4.193 1 .041


From the above table, it is observed at 5 % level of significance p < α (0.05). It is

concluded that there is association between the percentage of total time spent online

on social media (facebook, twitter, linked in, youtube). Further to check how much

dependency is present Cramer‘s V coefficient is used.

Symmetric Measures

Value

Approx.

Sig.



From the above table, it is observed that only 72.3% dependency exists between the

time spent on social media (facebook, twitter, linked in, youtube) as a percent of total

time spent online.

178

Use of social media is independent or dependent onthe authenticity of

information contained in prescription drug advertisement:

Chi-Square Tests


(2-sided)





From the above table, it is observed at 5 % level of significance p > α (0.05). It is

concluded that there is no association between authenticity of information contained

in social media DTCA and adoption of social media for prescription drug information.

There is association or no association between consumers’ satisfaction with social

media advertisement of prescription drugs and use of social media:

Chi-Square Tests

Value Df Asymp. Sig. (2-sided)






concluded that there is association between consumers‘ satisfaction with social media

179

advertisement of prescription drugs and use of social media. Further to check how

much dependency is present the contingency coefficient is used.

Symmetric Measures

Value Approx. Sig.

Contingency .789 .000


From the above table, it is observed that only 78.9% dependency exists between

respondent‘s satisfaction with social media advertisement of prescription drugs and

use of social media.

There is association or no association between perception of prescription drugs

and use of social media:

Chi-Square Tests

Value Df Asymp. Sig. (2-

sided)






concluded that there is association between perception of prescription drugs and use

of social media.

180

Further to check how much dependency is present between the two variables

contingency coefficient is used.

Symmetric Measures

Value Approx. Sig.

Contingency .812 .000


From the above table, it is observed that only 81.2% dependency exists between

perception of prescription drugs and use of social media.

There is association or no association between medical condition and use of

social media for prescription drug information:

Chi-Square Tests

Value df Asymp. Sig. (2-

sided)






concluded that there is no association between medical condition and use of social

media for prescription drug information.

181

Comparative preference of different social media sites by consumers for

collecting information on prescription drugs:

Rank correlation is used to test the comparative preference of different social media

sites by consumers for prescription drug information. Result is presented below.

Ranks →Products

↓ 1 2 Rank Order

Face Book 239 784 1807

Twitter 706 319 1344

LinkedIn 596 429 1454

You Tube 213 812 1837

Google Plus 861 164 1189

Result shows the following preference of social media for prescription drug

information-

YouTube

Face book

LinkedIn

Twitter

Google Plus

So, it can be concluded that the most preferred social media site for collecting

information on prescription drug is You Tube and least preferred is Google Plus.

The hypothesis H01 is validated on the basis of “Chi-square test” and “Cramers

V test”.

182

AWARENESS FOR PRESCRIPTION DRUGS

H02: There is no association between the social media platform used for

advertising prescription drugs and awareness for prescription drug.


prescription drugs and awareness for prescription drug.

Social media platforms considered for the study are facebook, twitter, linkedin,

youtube, and googleplus. Chi square test is applied to test the association between

individual social media sites and awareness for prescription drugs. Following are the

test results.

Parameter Test Test Result

There is no association between facebook

and awareness for prescription drugs

Chi-square Test result proves

there is association

There is no association between twitter and

awareness for prescription drugs



There is no association between youtube




There is no association between linkedin





googleplus and awareness for prescription

drugs



183

Find below the detailed analysis of the association between awareness generated for

prescription drugs and different social media sites i.e. facebook, twitter, youtube,

linkedin and googleplus.

There is either association or no association between facebook as a medium for

advertising prescription drugs and awareness of prescription drugs:

The Chi–square test used to test this association proves that there is association

between use of facebook as a medium for advertising prescription drugs and

awareness generated for prescription drugs.

Cramer‘s V test further proves there is a strong relationship between the two

variables.

Chi-Square Tests

Value Df Asymp.

Sig. (2-

sided)






concluded that use of facebook as a medium for advertising prescription drugs is

related to awareness for prescription drugs. This means that facebook as an

advertising medium helps in generating awareness for prescription drugs.

184

Further to check the degree of association Cramer‘s V test is used. The result is

presented in the table below.

Symmetric Measures

Value Approx. Sig.

Nominal by Nominal Phi .620 .000



From the above table, it is observed that there is a strong relationship between

facebook as an advertising medium and awareness for prescription drugs.

There is either association or no association between twitter as a medium for

advertising prescription drugs and awareness of prescription drugs:

Chi–square test proves there is association between twitter and awareness for

prescription drugs. Cramer‘s V test proves there is a moderate relationship between

the two variables.

Chi-Square Tests







concluded there is association between twitter and awareness for prescription drug.

185

Further to check how much association exists, Cramer‘s V test is used.

Symmetric Measures

Value Approx. Sig.




From the above table, it is observed that there is moderate relationship between

twitter used for advertising prescription drugs and awareness for prescription drugs.

There is either association or no association between linkedin used for

advertising prescription drugs and awareness for prescription drug:

Chi–square test proves there is association between linkedin used for advertising

prescription drugs and awareness generated for prescription drugs. Cramer‘s V test

further proves there is a moderate relationship between the two variables.

Chi-Square Test






From the above table, it is observed at 5 % level of significance p < α (0.05).It is

concluded that there is association between linkedin used for prescription drug

advertising and awareness for prescription drug.

186

Further to check the degree of association Cramer‘s V Statistics is used.

Symmetric Measures

Value Approx. Sig.




From the above table, it is observed that there is strong relationship between the

between linkedin and awareness for prescription drug.

There is either association or no association between youtube used for

advertising prescription drugs awareness for prescription drug:

Chi–square test proves there is association between youtube used for advertising

prescription drugs and awareness generated for prescription drugs and Cramer‘s V

test proves there is a strong relationship between the two variables.

Chi-Square Tests







concluded that there is association between youtube and awareness for prescription

drugs.

187


Symmetric Measures

Value Approx. Sig.




From the above table, it is observed that there is strong relationship between

youtube and awareness for prescription drugs.

There is either association or no association between googleplus used for

advertising prescription drugs and awareness for prescription drug:

Chi–square test proves there is association between googleplus used for advertising

prescription drugs and awareness generated for prescription drugs. Cramer‘s V test

further proves there is a moderate relationship between the two variables.

Chi-Square Test







concluded that there is association between google plus and awareness for

prescription drug.

188


Symmetric Measures

Value Approx. Sig.




From the above table, it is observed that there is moderate relationshipgoogle plus

used for advertising prescription drugs and awareness for prescription drug.


V test”.

SATISFACTION WITH SOCIAL MEDIA DTCA

H03: Satisfaction with social media advertisement of prescription drugs is

independent of demographic factors like gender, occupation, qualification,

income and age.

H13: Satisfaction with social media advertisement of prescription drugs is

dependent on demographic factors like gender, occupation, qualification, income

and age.

Demographic factors considered for the study are gender, age, qualification,

occupation and income. Chi-square test is applied to test the association of

satisfaction with the different demographic factors i.e. gender, qualification,

occupation, age and income. While crames‘ V test is used to find how much

association exists between the two variables.

189

The t test has been applied to prove the relationship between demographic factor and

satisfaction considering one demographic factor at a time.

Find below the table showing the test results.

Parameters Test Test Result

Satisfaction with social media DTCA

is independent of gender

Chi-square Test result proves that


media DTCA is dependent

on gender


is independent of occupation




on occupation


is independent of qualification




on qualification


is independent of income




on income


is independent of age




on age

190

Following is the detailed analysis testing the above mentioned parameters.

Satisfaction with social media DTCA is either dependent or independent of the

demographic factor gender:

Chi–square test proves there is association between satisfaction with social media

DTCA and gender. Cramer‘s V test proves there is strong relationship between the

two variables.

Chi-Square Tests







concluded that satisfaction with social media DTCA is dependent on gender. Further,

to check how much dependency exists, Cramer‘s V test is used.

Symmetric Measures

Value Approx. Sig.




From the above table, it is observed there is strong relationship between consumer

satisfaction with social media DTCA and gender.

191

A further analysis using crosstab is done to compare the male and female on their

satisfaction with social media DTCA for prescription drugs.

Crosstab

Gender Total

Male Female

Satisfaction level Yes 540 393 933

No 71 21 92

Total 611 414 1025

From the above table, it is observed that malesare more satisfied with social media

advertisement of prescription drug as compared to the females.


demographic factor occupation:

Chi-square test proves that satisfaction with social media advertisement for

prescription drugs is independent of occupation. Following are the test results.

Chi-Square Tests







concluded that satisfaction with social media DTCA is independent of occupation.

192


demographic factor qualification:

Chi-square test is applied to test the above hypothesis. Following table shows the test

result.

Chi-Square Tests


sided)






concluded that satisfaction with social media DTCA is dependent on qualification.

Further, to check how much dependency exists, Cramer‘s V statistics is used.

Symmetric Measures

Value Approx. Sig.




From the above table, it is observed there is a strong relationship between

satisfaction with social media advertisements of prescription drugs and qualification.

193

A comparative analysis of the different qualifications based on their relationship with

satisfaction is done by using crosstab. The results of the test are presented in the

following table.

Crosstab

Qualification

Total

HSC Graduate

Post

Graduate

Professional

course

Satisfaction

Level

Yes

22 759 47 103 931

No 0 77 1 16 94

Total 22 836 48 117 1025

From the above table, it is observed that from the various qualifications considered for

the study (HSC, graduation, post-graduation and professional course), graduates are

more satisfied with social media advertisement of prescription drug as compared to

those having HSC, Post Graduate or Professional degree.


demographic factor income:

Chi-square test used for the analysis proves that satisfaction with social media DTCA

is dependent on the demographic factor income.

Further cramer V test proves that there is a moderate relationship between the two

variables.

194

Following are the results of the analysis of the association between satisfaction with

social media advertisement of prescription drugs and income of consumers.

Chi-square Test


sided)






concluded that satisfaction with social media advertisement of prescription drugs is

dependent on the demographic factor income.

Further, to check how much dependency exists, Cramer‘s V statistics is used.

Symmetric Measures

Value Approx. Sig.




From the above table, it is observed there is moderate relationship between

satisfactions with social media advertisement of prescription drugs and demographic

factor income.

195

Crosstab

Monthly Income Total

less than

5000

5000-

20000

21000-

31000

31000-

50000

greater

than

50,000

Satisfaction

Level

Yes

56 167 337 306 67 933

No 7 25 28 27 5 92

Total 63 192 365 333 72 1025

From the above table, it is observed that consumers having income 21000-31000 are

more satisfied with social media advertisement of prescription drug compared to

those falling in the range < 5000, 5000-20000, 31000-50000 and greater than 50,000.

Satisfaction with social media DTCA is either dependent or independent of age:

Chi-square test is applied to test the above hypothesis. Following are the test results.

Chi-Square Tests

Value df Asymp. Sig. (2-sided)



Linear-by-Linear Association .002 1 .967



concluded that satisfaction with social media DTCA is dependent on age group.

196

Cramer‘s V statistics is used further, to check how much dependency exists.

Symmetric Measures

Value Approx. Sig.




From the above table, it is observed there is strong relationship between satisfaction

with social media DTCA and demographic factor age group.

Further crosstab is used to test the comparative relationship between satisfaction with

social media DTCA and different age groups considerd one at a time.

Crosstab

Age group Total

18 - 25 yrs 26 - 30 yrs 31-35 yrs

Satisfaction Level Yes 443 358 132 933

No 34 38 20 92

Total 477 396 152 1025

From the above table, it is observed that consumers in the age group 26-30 years are

more satisfied with social media DTCA as compared to those in the age group 18-25

and 31-35 years.


V test”.

197

PERCEPTION AND ATTITIUDE TOWARDS SOCIAL MEDIA DTCA


DTCA of prescription drugs.

H14: Consumers have both favourable and unfavourable perception of social

media DTCA of prescription drugs.

Following parameters were considered for testing perception and attitude of working

youth towards social media DTCA.

Sl No. Parameter

1 Information available about drug quality and associated

benefits

2 Information available about drug quality and associated

benefits

3 Brings down overall drug cost

4 Social media DTCA is an authentic source of information on

new drugs

5 Leads to confusion and inaccurate perception of a drug‘s

effectiveness and safety

6 Provides valuable information about medical treatments

7 Many DTCAs lack important details like success rate and

treatment duration

8 Information contained in social media advertisement of

prescription drugs is vague and without evidence

9 Focus is on benefits and less on risks and potential side effects

198

T test has been performed to test the above mentioned parameters and prove the

association between consumer perception and attitude towards prescription drugs and

social media DTCA. Following are the results of the tests.


Consumers have no favourable or

unfavourable opinion of the information

available on social media DTCA about

drug quality and associated benefits

T test Consumers think that

information available about

drug quality and associated

benefits is satisfactory


unfavourable opinion of information

available about drug associated risk on

social media DTCA


information available about

drug associated risk is not

satisfactory


unfavourable opinion of the parameter that

social media DTCA reduces drug cost

T test Consumers think social

media DTCA does not

reduce overall drug cost



social media DTCA is an authentic source

of information on new drugs


media is an authentic source

of information on new drugs

Consumers have no opinion of the

parameter that social media DTCA leads to

confusion and inaccurate perception of a

drug‘s effectiveness and safety


media leads to confusion

and inaccurate perception of

a drug's effectiveness and

safety

199




social media DTCA provides valuable

information about medical treatments


media provides valuable

information about medical

treatments



many social media DTCA lack important

details like success rate and treatment

duration

T test Consumers think that many

social media DTCA lack

important details like

success rate and treatment

duration



information contained in social media

DTCA is vague and without evidence


information available on

social media is vague and

without evidence



social media focuses more on benefits and

less on risks and potential side effects

T test Consumers think that social

media focuses more on

benefits and less on risks

and potential side effects

Find below the detailed analysis of the above hypotheses to find the favourable and

unfavourable perception of consumers for social media advertisement of prescription

drugs based on the above mentioned parameters.

One sample t test has been used to find the perception of consumers about the social

media advertisement of prescription drugs.

200

Consumers perceive the information contained in social media DTCA about

drug quality andassociated benefits as either satisfactory or dissatisfactory:

T test proves that consumers perceive the information obtained from social media

DTCA on drug quality and benefits as satisfactory. Following are the test results.

One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence Interval of

the Difference

Lower Upper

4.730 1024 .000 .09883 .0578 .1398

It is observed from the above table, that at 5% level of significance the p < α (0.025).

Consumer perception of information contained in social media DTCA about quality

and benefits of drug is satisfactory‖, is different from 2.5 i.e. Neutral. To identify the

favourable or unfavourable perception of the information obtained from social media

DTCA about the quality and benefits of drugs, referred to mean score; standard

deviation and standard error of their mean are presented in the following table.

One-Sample Statistics

Information about quality of product and benefits of drug is satisfactory

N Mean Std. Deviation Std. Error Mean

1025 2.7888 .66794 .02089

The above table proves that consumers have a favourable opinion of the information

available on social media DTCA about drug quality and benefits as satisfactory.

201

Consumers perceive the information available on social media DTCA about drug

associated risk as either satisfactory or dissatisfactory:

T test has been used to prove the hypothesis. The results are presented in table below.

One-Sample Test

Information about drug associated risk is also available and satisfactory

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference


the Difference

Lower Upper

-3.253 1024 .001 -.06802 -.1091 -.0270

It is observed from the above table that at 5% level of significance the p < α (0.025).

Consumer perception of the information about drug associated risk is also available

and satisfactory on social media is different from 2.5 i.e. Neutral.

To identify the favourable and unfavourable perception, referred to the mean score;

standard deviation and standard error of their mean are presented in the table below.


N Mean

Std.

Deviation

Std. Error

Mean

1025 2.4320 .66366 .02091

The above table proves that consumers think that information about drug associated

risk is not available on social media DTCA.

202

Consumers have either favourable or unfavourable perception of the parameter

that social media advertisement brings down overall drug cost:


One-Sample Test

Test Value = 2.5

T Df Sig. (2-tailed) Mean Difference

95% Confidence Interval

of the Difference

Lower Upper

-11.433 1024 .000 -.22000 -.2578 -.1822


It is concluded that consumers‘ perception of the parameter social media brings down

overall drug cost is different from 2.5 i.e. Neutral.


standard deviation and standard error of their mean are computed and presented in the

table below.


N Mean

Std.

Deviation

Std. Error

Mean

It brings down overall drug cost 1025 2.2800 .61606 .01924

From the above table it is concluded that consumers think social media DTCA does

not bring down overall drug cost.

203


that social media is authentic source of information on new drugs:


One-Sample Test

Test Value = 2.5



of the Difference

Lower Upper

5.300 1024 .000 .10488 .0660 .1437

It is observed from above table that at 5% level of significance the p < α (0.025). It is

concluded that consumers‘ perception of the parameter social media is authentic

source of information on new drugs.

To identify favourable and unfavourable perception, referred to mean score; standard

deviation and standard error of their mean are computed and presented in below table.



authentic source of

information on new drugs

1025 2.6049 .63352 .01979

From the above table it is concluded that consumers think social media is an authentic

source of information on new drugs.

204


that social media DTCA leads to confusion and inaccurate perception of a drug’s



One-Sample Test

Test Value = 2.5



of the Difference

Lower Upper

20.807 1024 .000 .36049 .3265 .3945

Above table shows that at 5% level of significance the p < α (0.025).To

concludeconsumer perception of the parameter social media leads to confusion and

inaccurate perception of a drug's effectiveness and safety is different from 2.5 i.e.

Neutral. To identify favourable and unfavourable perception, referred to mean score;

standard deviation and standard error of their mean are presented in the below table.


N Mean

Std.

Deviation

Std. Error

Mean

leads to inaccurate perception of drug's

effectiveness and safety 1025 2.8605 .55468 .01733

From above table it is concluded that consumers think social media leads to confusion

and inaccurate perception of a drug's effectiveness and safety.

205


that social media provides valuable information about medical treatments:


One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference


of the Difference

Lower Upper

13.721 1024 .000 .27366 .2345 .3128

It is observed from the above table that at 5% level of significance the p < α (0.025) It

is concluded that consumer perception of the parameter social media provides

valuable information about medical treatments is different from 2.5 i.e. Neutral.

To identify favourable and unfavourable perception, referred to the mean score;

standard deviation and standard error of their mean are presented in below table,


N Mean

Std.

Deviation

Std. Error

Mean

Provides valuable information

about medical treatments

1025 2.7737 .63852 .01994

It is concluded from the above table that consumers think social media provides

valuable information about medical treatments.

206

Consumer perception of the parameter i.e. many social media DTCA lack

important details like success rate and treatment duration


One-Sample Test

Test Value = 2.5


95% Confidence

Interval of the

Difference

Lower Upper

17.275 1024 .000 .32244 .2858 .3591

It is observed from the above table, that at 5% level of significance the p < α (0.025)

Consumer perception of the parameter i.e. many social media DTCA lack important

details like success rate and treatment duration is different from 2.5 i.e. Neutral.


standard deviation and standard error of their mean are presented in below.


N Mean

Std.

Deviation

Std. Error

Mean

Many social media DTCA lack

important details like success

rate and treatment duration

1025 2.8224 .59759 .01867

It is concluded from above table that consumers think that many social media DTCA

lack important details like success rate and treatment duration.

207


information in social media DTCA is vague and without evidence:


One-Sample Test

Test Value = 2.5



of the Difference

Lower Upper

18.900 1024 .000 .35171 .3152 .3882


It is concluded that consumer perception of the parameter i.e. information is vague

and without evidence is different from 2.5 i.e. Neutral. To identify the favourable and

unfavourable perception, referred to the mean score; standard deviation and standard

error of their mean are presented in the below table.


N Mean

Std.

Deviation

Std. Error

Mean

information in social

media DTCA is vague

and without evidence

1025 2.8517 .59577 .01861

It is concluded from above table that consumers think that information available on

social media is vague and without evidence.

208


focus is on benefits and less on risks and potential side effects:


One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference


of the Difference

Lower Upper

22.983 1024 .000 .38770 .3546 .4208


It is concluded that consumer perception of the parameter focus is on benefits and

less on risks and potential side effects is different from 3 i.e. Neutral.




N Mean

Std.

Deviation

Std. Error

Mean

Focus is on benefits and

less on risks and side effects

1025 2.8877 .53980 .01687

It is concluded from above table that consumers think that social media focuses more

on benefits and less on risks and potential side effects.

209

PERCEPTION OF KNOWLEDGE ENHANCING POTENTIAL OF SOCIAL

MEDIA DTCA

Different knowledge factors considered for the study are enlisted in the table below

Sl No. Knowledge Related Factor

1 Educates consumers about drug‘s benefits and associated

risks

2 Empowers consumers to handle their ailments better

3 Helps patients understand their medical condition better

4 Makes consumers confident

5 Helps patients develop a positive attitude towards health

issues

6 Prepares patients to comply with prescribed treatment or

medical advice

7 Gives information about new improved version of medicines

8 Encourages consumer to participate their own health

management

9 Encourages consumers to seek additional information from

doctors

10 Benefits interaction with doctors due to increased patient

knowledge

T test has been performed for the above mentioned parameters to prove the

association between consumer perception and attitude towards prescription drugs and

social media advertisement of prescription drugs.

210

A summary of the test results is presented in the following table.


Social media DTCA

educates consumers about

drug benefits and associated

risks


media DTCA educates

consumers about drug benefits

and associated risks

Social media DTCA

empowers consumers to

handle their ailments better

T test Consumers perceive social

media DTCA to be helpful in

handling their ailments better

Social media DTCA helps

patients understand their

medical condition better

T test Consumers think social media

DTCA helps patients understand

their medical condition better

Social media DTCA makes

consumers more confident


DTCA makes consumers more

confident

Social media DTCA Helps

patients develop a positive

attitude towards health

issues


DTCA helps patients develop a

positive attitude towards health

issues

Social media DTCA

prepares patients to comply

with prescribed treatment or

medical advice

T test Consumers have no favourable

or unfavourable opinion of the

parameter tsocial media DTCA

prepares patients to comply with

prescribed treatment

211


Social media DTCA gives

information about new

improved version of

medicines


media DTCA gives information

about new improved version of

medicines

Social media DTCA

encourages consumer to

participate their own health

management


media DTCA encourages

consumer to participate their

own health management

Social media DTCA

encourages consumers to

seek additional information

from doctor


media DTCA encourages

consumers to seek additional

information from doctor

Social media DTCA

benefits their interaction

with doctors because of

increased patient knowledge


media DTCA benefits their

interaction with doctors because

of increased patient knowledge

Find below the detailed analysis of the above parameters. One sample T test has been

used to test favourability of consumer opinion of social media DTCA basd on the

different parameters as listed in the table above. The analysis results are computed

and presented in table format, followed by interpretation of the test result.

212

Consumers have either favourable or unfavourable perception of knowledge

related factor i.e. educates consumers about drug’s benefits and associated risks:

One sample T test has been applied to the above parameter. The results are presented

in table below.

One-Sample Test

Test Value = 3

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence Interval of the

Difference

Lower Upper

18.959 1024 .000 .57073 .5117 .6298


Consumer perception of the parameter i.e. educates consumers about drug benefits

and associated risks is different from 3 i.e. Neutral. To identify the favourable and


error of their mean are presented in the table below.



Educates consumers about

drugassociated risk and benefit

1025 3.5707 .96376 .03010

It is concluded that consumers think that social media DTCA educates consumers

about drug benefits and associated risks. The results are found to be statistically

significant.

213


related factor i.e. empowers consumers to handle their ailments better:

One sample T test has been used to prove the hypothesis. The results are presented in

table below.

One-Sample Test

Test Value = 3



of the Difference

Lower Upper

10.797 1024 .000 .34634 .2834 .4093


It is concluded that the consumer perception for knowledge related factor i.e.

empowers consumers to handle their ailments better is different from 3 i.e. Neutral.

So to identify the favourable and unfavourable perception, referred to the mean score;

standard deviation and standard error of their mean are presented in table below.


N Mean

Std.

Deviation

Std. Error

Mean

Empowers consumers to handle

their ailments better

1025 3.3463 1.02700 .03208

It is concluded that consumers perceive social media DTCA to be helpful in handling

their ailments better. The results are found to be statistically significant.

214


related factor i.e. Helps patients understand their medical condition better:


One-Sample Test

Test Value = 3



of the Difference

Lower Upper

14.484 1024 .000 .44000 .3804 .4996


It is concluded that consumer perception of knowledge related factor i.e. Helps

patients understand their medical condition better is different from 3 i.e. Neutral.


standard deviation and standard error of their mean are presented in below table.


N Mean

Std.

Deviation

Std. Error

Mean

Helps patients understand

their medical condition better

1025 3.4400 .97255 .03038

It is concluded that social media DTCA helps patients understand their medical

condition better. The results are found to be statistically significant.

215


related factor i.e. Makes consumers confident:


One-Sample Test

Test Value = 3


95% Confidence

Interval of the

Difference

Lower Upper

17.468 1024 .000 .52976 .4702 .5893


It is concluded that consmer perception of knowledge related factor i.e. makes

consumers confident is different from 3 i.e. Neutral.




N Mean

Std.

Deviation

Std. Error

Mean

Attitude & Perception Makes

consumers more confident

1025 3.5298 .97094 .03033

It is concluded that consumers think that social media makes consumer more

confident. The results are found to be statistically significant.

216

Consmers have either favourable or unfavourable perception of knowledge

related factor i.e. helps patients develop a positive attitude towards health issues:


One-Sample Test

Test Value = 3

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

18.060 1024 .000 .54341 .4844 .6025


It is concluded that consumer perception of knowledge related factor helps patients

develop a positive attitude towards health issues is different from 3 i.e. Neutral.




N Mean

Std.

Deviation

Std. Error

Mean

Helps patients develop a positive

attitude towards health issues

1025 3.5434 .96335 .03009

It is concluded that consumers think social media DTCA helps patients to develop a

positive attitude towards health issues. The results are statistically significant.

217


social media DTCA prepares patients to comply with prescribed treatment:


One-Sample Test

Test Value = 3

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

2.766 1024 .233 .07707 .0224 .1318

It is observed from the above table that at 5% level of significance the p > α (0.025).

It is concluded that consumer perception of knowledge related factor i.e. Prepares

patients to comply with prescribed treatment or medical advice is not different from 3

i.e. Neutral. So there is no favourable and unfavourable opinion.


related factor i.e. social media DTCA gives information about new improved

version of medicines:

T test has been used to prove the favourability of consumer perception towards the

potential of social media DTCA in enhancing consuer knowledge and inform

consumer about bthe new and improved prescription drugs. The detailed analysis and

test results are presented in the following table.

218

One-Sample Test

Test Value = 3

T Df Sig. (2-tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

14.319 1024 .000 .46244 .3991 .5258


It is concluded that consumer perception of knowledge related factor i.e. gives

information about new improved version of medicines is different from 3 i.e. Neutral.




N Mean

Std.

Deviation

Std. Error

Mean

Gives information about

new improved version of

medicines

1025 3.4624 1.03399 .03230

It is concluded that consumers think that social media DTCA gives information about

new improved version of medicines. The result is found to be statistically significant.

219


social media DTCA encourages consumers to participate in own health

management:

One sample T test used for the analysis proves that consumers have a favourable

opinion of the potential of social media DTCA to encourage consumers to participate

in own health management. The test results and detailed analysis are presented in the

following table.

One-Sample Test

Test Value = 3

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

Encourage consumers

to participate their own

health management 21.412 1024 .000 .61659 .5601 .6731

It is observed from the above table, that at 5% level of significance the p < α (0.025. It

is concluded that consumer perception of knowledge related factor i.e. social media

DTCA encourages consumers to participate their own health management is different

from 3 i.e. Neutral.

220

To identify favourable and unfavourable perception, referred to the mean score;



N Mean

Std.

Deviation

Std. Error

Mean

Encourage consumers to participate

their own health management

1025 3.6166 .92191 .02880

It is concluded that consumers think social media DTCA encourages consumers to

participate in their own health management. The results are statistically significant.


related factor i.e. social media DTCA encourages consumers to seek additional

information from doctors:


One-Sample Test

Test Value = 3



of the Difference

Lower Upper

27.345 1024 .000 .72683 .6747 .7790


It is concluded that consumer perception of knowledge related factor i.e. encourages

consumers to seek additional information from doctors is different from 3 i.e. Neutral.

221

To identify the favourable and unfavourable perception, referred to the mean score,

standard deviation and standard error of their mean were computed and presented in

the table below.



Encourages consumers to

seek additional information

from doctors

1025 3.7268 .85096 .02658

It is concluded that consumers think that social media encourages consumers to seek

additional information from doctors. The results are statistically significant.

Customer perception for knowledge related factor i.e. Benefits their interaction

with doctors because of increased patient knowledge is not different


One-Sample Test

Test Value = 3

T Df

Sig. (2-

tailed)

Mean

Difference


of the Difference

Lower Upper

20.490 1024 .000 .58927 .5328 .6457


It is concluded that consumers think that social media DTCA benefits their interaction

with doctors because of increased patient knowledge is different from 3 i.e. Neutral.

222



below table.


N Mean

Std.

Deviation

Std. Error

Mean

Attitude & Perception

- Benefits their

interaction with

doctors because of

increased patient

knowledge

1025 3.5893 .92073 .02876

The implications of rejections of hypotheses corresponding to the parameter i.e.

Benefits their interaction with doctors because of increased patient knowledge is in

favourable agreement. It is concluded that consumers think that social media

benefits their interaction with doctors because of increased patient knowledge.

The results are found to be statistically significant.

The hypothesis H04 is validated on the basis of “t test”.

223

IMPACT OF SOCIAL MEDIA DTCA ON CONSUMER

H05: Consumer has no favourable or unfavourable perception of the effects of

social media DTCA

H15: Consumer has either favourable or unfavourable perception of the effects of

social media DTCA

Following parameters have been considerd for postitve effects of social media DTCA

Sl No. Positive effects of social media DTCA

1 Informs and empowers patients

2 Used as preventive health care

3 Helps in early diagnosis of medical condition

4 Gives psychological confidence to patients

5 Makes patients more likely to follow treatment

instructions

6 Encourages patients to disclose health

concerns

7 Provides more and cheaper therapeutic options

leading to consumer satisfaction

8 Knowledge about side effects helps patients

select right drugs

9 Removes the stigma associated with certain

diseases

T test has been performed for the above mentioned parameters of positive effects of

social media DTCA.

224

Following table presents a summry of the test results for the above mentioned

parameters.

Parameters Test applied Test Result


unfavourable opinion of the parameter

that social media DTCA informs and

empowers patients

T test Social media DTCA

informs and empowers

patients



that social media DTCA helps in

preventive health care

T test Social media DTCA helps

in preventive healthcare



that social media DTCA helps in early

diagnosis of medical condition

T test Social media DTCA helps

in early diagnosis of

medical condition



that Social media DTCA gives

psychological confidence to patients

T test Social media DTCA gives

psychological confidence to

patients



that social media DTCA makes

patients more likely to follow

treatment instructions

T test Social media DTCA makes

patients more likely to

follow treatment

instructions

225




that social media DTCA Encourages

patient to disclose health concerns


encourages patients to

disclose health concerns



that social media DTCA provides

more and cheaper therapeutic options


T test Social media DTCA does

not provide more and

cheaper therapeutic options

leading to consumer

satisfaction



that knowledge about side effects

helps patients select right drugs

T test knowledge about side

effects helps patients select

right drugs



that social media DTCA removes the

stigma associated with certain diseases


removes the stigma

associated with certain

diseases

One sample T test has been applied for testing the above parameters. Detailed analysis

and test results are given below.

226

Consumers have either favourable or unfavourable perception of the positive

effect of social media DTCA i.e. patients are informed and empowered:

T test has been applied for testing the hypothesis. Test results are given below.

One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference


of the Difference

Lower Upper

Patients are

informed and

empowered

19.887 1024 .000 .36022 .3247 .3958


It is concluded that the consumers‘ perception of social media as informing and

empowering patients is different from 2.5 i.e. Neutral. To identify favourable and


error of their mean are computed and presented in the table below.


N Mean

Std.

Deviation

Std. Error

Mean

Patients are informed and empowered 1025 2.8602 .57933 .01811

It is concluded that social media DTCA informs and empowers patients. The results

are found to be statistically significant.

227

Consumers have either favourable or unfavourable perception of the potential of

social media DTCA to help in preventive health care:


One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

Helps in preventive

health care

15.917 1024 .000 .28244 .2476 .3173


is concluded that consumer perception of positive effects of social media DTCA i.e.

Helps in preventive health care is different from 2.5 i.e. Neutral. So to identify the

favourable and unfavourable perception, referre to the mean score; standard deviation

and standard error of their mean are computed and presented in the table below.


N Mean

Std.

Deviation

Std. Error

Mean

Helps in preventive health care 1025 2.7824 .56810 .01774

It is concluded that social media DTCA helps in preventive health care. The results

are found to be statistically significant.

228

Consumers have either favourable or unfavourable perception of positive effect

of social media i.e. diagnosis of under-diagnosed condition:

T test has been applied for testing the hypothesis. Test results are presented in the

following table.

One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

Diagnosis of

under-diagnosed

condition

-.483 1024 .629 -.00977 -.0494 .0299

It is observed from the above table, that at 5% level of significance the p > α (0.025).

It is concluded that consumer perception of positive effect of social media i.e.

Diagnosis of under-diagnosed condition is not different from 2.5 i.e. Neutral.

So there is no favourable and unfavourable opinion of customers for the potential of

social media to help patients diagnose under-diagnosed condition.

229

Consumers have either favourable or unfavourable perception of the impact of

social media i.e. promotes early diagnosis of medical condition:


One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference


the Difference

Lower Upper

12.309 1024 .000 .25562 .2149 .2964


is concluded that consumer perception of positive effect of social media i.e. Promotes

early diagnosis of medical condition is different from 2.5 i.e. Neutral. So to identify

the favourable and unfavourable perception, referred to the mean score, standard

deviation and standard error of their mean are computed and presented in below table.


N Mean

Std.

Deviation

Std. Error

Mean

Promotes early diagnosis of

medical condition

1025 2.7556 .66423 .02077

It can be concluded that social media DTCA helps in early diagnosis of medical

condition. The results are found to be statistically significant.

230


social media DTCA i.e. gives psychological confidence:

One sample T test is used for testing consumer perception. Test results are given

below.

One-Sample Test

Test Value = 2.5



of the Difference

Lower Upper

25.854 1024 .000 .38976 .3602 .4193


It can be concluded that consumer perception of positive effect of social media i.e.

Gives psychological confidence is different from 2.5 i.e. Neutral. So to identify the

favourable and unfavourable perception, referred to the mean score; standard

deviation and standard error of their mean were computed and presented in below

table.


N Mean

Std.

Deviation

Std. Error

Mean

Gives psychological confidence 1025 2.8898 .48265 .01508

It is concluded that social media DTCA gives psychological confidence to patients.

The results are found to be statistically significant.

231

Consumers have either favourable or unfavourable perception of the potential of

social media DTCA tomake patients more likely to follow treatment instructions


One-Sample Test

Test Value = 2.5



of the Difference

Lower Upper

9.255 1024 .000 .19756 .1557 .2394


Consumer perception of the impact of social media DTCA i.e. Makes patients more

likely to follow treatment instructions is not different from 2.5 i.e. Neutral. So to

identify the favourable and unfavourable perception, referred to the mean score,



N Mean

Std.

Deviation

Std. Error

Mean

Makes patients more likely to

follow treatment instructions

1025 2.6976 .68340 .02135

From the above table it is concluded that social media DTCA makes patients more

likely to follow treatment instructions. The results are found to be statistically

significant.

232


social media DTCA i.e. encourages patients to disclose health concerns:

One sample T test has been applied for testing the hypothesis. Test results are given

below.

One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference


of the Difference

Lower Upper

18.898 1024 .000 .34000 .3047 .3753


It is concluded that consumer perception of the impact of social media DTCA i.e.

encourages patient to disclose health concerns is different from 2.5 i.e. Neutral. So to

identify the favourable and unfavourable perception, referred to the mean score,



N Mean

Std.

Deviation

Std. Error

Mean

Encourages patient to disclose

health concerns

1025 2.8400 .57602 .01799

It can be concluded that social media DTCA encourages patient to disclose health

concerns. The results are found to be statistically significant.

233


social media DTCA i.e. improves doctor-patient relationship.


below.

One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95%

Confidence

Interval of the

Difference

Lower Upper

-8.566 1024 .240 -.17024 -.2092 -.1312


It is concluded that consumer perception of positive effects of social media i.e.

Improves doctor-patient relationship is not different from 2.5 i.e. Neutral. So, there is

no favourable and unfavourable opinion of consumers on that social media improves

doctor-patient relationship.

234


social media DTCA i.e. provides more and cheaper therapeutic options:


One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference


of the Difference

Lower Upper

-6.968 1024 .000 -.14195 -.1819 -.1020

It is observed from above table, that at 5% level of significance the p < α (0.025).

Consumer perception of the positive impact of social media DTCA i.e. provides more

and cheaper therapeutic options leading to consumer satisfaction is different from 2.5

i.e. Neutral. To identify favourable and unfavourable perception, referred to the mean

score, standard deviation and standard error of their mean are presented below.


N Mean

Std.

Deviation

Std. Error

Mean

Provides more and cheaper options


1025 2.3580 .65222 .02037

So it is concluded that social media DTCA does not provide more and cheaper

therapeutic options leading to consumer satisfaction. The results are found to be

statistically significant.

235


social media DTCA i.e. knowledge of side effects helps patient select right drug:


One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference


of the Difference

Lower Upper

13.746 1024 .000 .25512 .2187 .2915


It is concluded that consumer perception of positive effects of social media DTCA i.e.

Knowledge about side effects helps patients select right drugs is different from 2.5 i.e.

Neutral. Tto identify the favourable and unfavourable perception, referred to the mean

score, standard deviation and standard error of their mean are presented below.


N Mean

Std.

Deviation

Std. Error

Mean

Knowledge about side effects


1025 2.7551 .59419 .01856

So it is concluded that knowledge gained from social media DTCA about drug

associated side effects helps patient select right drugs. The results are found to be


236

Consumers have either favourable or unfavourable perception of positive effects

of social media DTCA i.e. removes the stigma associated with certain diseases:


below.

One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Lower Upper

Removes the

stigma associated

with certain

diseases

10.463 1024 .191 .21317 .1732 .2531


It is concluded that consumer perception of positive effects of social media i.e.

Removes the stigma associated with certain diseases is not different from 2.5 i.e.

Neutral. So, there is no favourable and unfavourable opinion of consumers on that

social media removes the stigma associated with certain diseases.

237

CONSUMER PERCEPTION OF THE THE IMPACT OF SOCIAL MEDIA

DTCA ON YOUTH BEHAVIOUR OTHER THAN PURCHASE

Here youth behaviour refers to consumers indulging in information seeking after

exposure to social media DTCA.

One sample T test has ben applied to test the above parameter. The detailed analysis

and test results are presented below.

Consumer perception of the attribute i.e. carefully read the advertisement is

equal to or different from 2.5 i.e. Neutral:

T test proves that consumers carefully read the advertisement after seeing the

advertisement of prescription drug on social media.

One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Carefully read the

advertisement on

being exposed to

social media DTCA

-5.853 1024 .000 -.11073 -.1479 -.0736


It can be concluded that consumer perception of the attribute i.e. carefully read the

advertisement is different from 2.5 i.e. Neutral.

238

So to identify the favourable and unfavourable perception, referred to the mean score;




Carefully read the

advertisement

1025 2.3893 .60570 .01892

It is concluded consumers carefully read the advertisement after seeing the

advertisement of prescription drug on social media. The results are found to be


Consumers perception of the attribute i.e. Ask the doctor for more information

as a result of a DTCA is equal to or different from 2.5 i.e. Neutral:

One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Youth behaviour - Ask

the doctor for more

information as a result

ofsocial media DTCA

-13.413 1024 .000 -.1134 -.1345 -.0336


It is concluded that consumer perception of the attribute i.e. Ask the doctor for more

information as a result of a DTC advertisement is different from 2.5 i.e. Neutral.

239

So to identify the favourable and unfavourable perception, referred to the mean score,




Ask the doctor for more

information as a result of

social media DTCA

1025 2.123 .6777 .02333

It is concluded that consumers do not ask doctor for more information post exposure

to social media DTCA. The results are found to be statistically significant.

Consumer perception of the attribute i.e. Call toll-free number given in the

advertisement for more information is equal or different from 2.5 i.e. Neutral:


One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Differenc

e

95% Confidence

Interval of the

Difference

Call toll-free number

for more information

-18.999 1024 .000 -.2333 -.1145 -.0456


It is concluded that consumer perception for the attribute i.e. Call toll-free number

given in the advertisement for more information is different from 2.5 i.e. Neutral.

240



below table.



Call toll-free number for

more information

1025 2.746 .8557 .0034

So it is concluded that consumers call toll-free number given in the advertisement for

more information. The results are found to be statistically significant.

Consumer perception for the attribute i.e. try to seek information from virtual

communities on social media is either equal or different from 2.5 i.e. Neutral


One-Sample Test

Test Value = 2.5

T Df

Sig. (2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Try to seek information

from virtual communities

-17.899 1024 .000 -.4777 -.1255 -.0667

It is observed from the above table, that at 5% level of significance the p < α (0.025)

It is concluded that consumer perception for the attribute i.e. Try to seek information

from virtual communities on social media is different from 2.5 i.e. Neutral.

241



below table,


N Mean

Std.

Deviation

Std. Error

Mean

Try to seek information

from virtual communities

1025 2.200 .8889 .0311

So it is concluded that consumers do not try to seek information from virtual

communities on social media after seeing the advertisement of prescription drug on

social media. The results are found to be statistically significant.

Consumers’ perception of the attribute “clip the advertisement for later

reference” is either different or not different from 2.5 i.e. Neutral:


One-Sample Test

Test Value = 2.5

T df

Sig. (2-

tailed)

Mean

Difference


of the Difference

-16.177 1024 .000 -.1777 -.1234 -.0778


It is concluded that consumer perception of the attribute i.e. Clip the advertisement for

later reference is different from 2.5 i.e. Neutral.

242



below table,


N Mean

Std.

Deviation

Std. Error

Mean

Clip the advertisement for future 1025 2.767 .9991 .0122

So it is concluded that consumers keep clips of advertisement for later reference after

exposure to social media DTCA. The results are found to be statistically significant.

Consumer perception for the attribute i.e. Discuss with friends and family is

either different or not different from 2.5 i.e. Neutral:


One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Discuss with

friends and family

-20.334 1024 .000 -.4555 -.1256 -.0445


It is concluded that consumer perception of the attribute i.e. Discuss with friends and

family is different from 2.5 i.e. Neutral.

243




N Mean

Std.

Deviation

Std. Error

Mean

Youth behaviour -

Discuss with

friends and family

1025 2.800 .7645 .0022

So it is concluded that consumers discuss with friends and family after seeing social

media DTCA. The results are found to be statistically significant.

Consumer perception of the attribute patients buy the advertised drug is not

different from 2.5 i.e. Neutral:


One-Sample Test

Test Value = 2.5

T Df

Sig.

(2-

tailed)

Mean

Difference

95% Confidence

Interval of the

Difference

Buy advertised drugs -16.000 1024 .000 -.4556 -.4555 -.0445


It is concluded that consumer perception of the attribute i.e. Buy the advertised

medicine is different from 2.5 i.e. Neutral.

244



below table.


N Mean

Std.

Deviation

Std. Error

Mean

Buy the

advertised

drug

1025 2.788 .4455 .0111

It is concluded that the consumers buy the advertised medicine after seeing the

advertisement of prescription drug on social media. The results are found to be


The hypothesis H05 is validated on the basis of “t test”.

245

Relationship between awareness for social media DTCA, attitude towards social

media DTCA, perception of social media DTCA and working youth behavior for

prescription drug.





Factors Correlation P significance Value

Awareness with Perception 0.72 0.000

Awareness with Perception

(Knowledge related Factors)

0.63 0.001

Awareness with positive effects of

social media factors

0.70 0.000

Awareness with negative effects of

social media factors

0.01 0.326

Awareness with effect on youth

behaviour

0.80 0.001

From the above it is observed that, awareness is strongly positively related with the

factors i.e. Perception, Perception (Knowledge related factors), Positive effects of

social media and youth behaviour except Negative effects of social media Factors. All

the correlation coefficients are statistically significant except the Negative effects of

social media Factors. There is strong relationship between the awareness and effect on

youth behaviour.

246

Relationship between attitude towards social media DTCA and working youth

behavior in prescription drug selection

Correlation analysis proves that consumer attitude towards social media DTCA

affects the behaviour of working youth in prescription drug selection.

Factors Correlation P significance Value

Attitude with youth

behaviour

0.65 0.000

From the above it is observed that, attitude towards DTCA is strongly positively

related with the factor i.e. youth behaviour. The correlation coefficient is

statistically significant

The hypothesis H06 is validated on the basis of “correlation test”.

247

CHAPTER 10

CONCLUSIONS

248

CHAPTER 10

CONCLUSIONS

1. Adoption of Social Media by Working Youth for Prescription Drug

Information

In the past few decades, social media has evolved to be the media of choice.

In the wake of the growing use and importance of this interactive media

pharmaceutical companies are also incorporating this in their communication

strategies so as to match the increasingly influential and rapidly evolving

social media revolution. Findings of the study strongly support this fact. From

this study it is also found that working youth are increasingly using social

media and internet for seeking information related to prescription drugs,

getting consultation from experts and for a comparative study of the different

therapeutic options available for an ailment. They are also using the social

media to get first hand advice from experienced patients online. The study

showed that although with varying degrees, all the five social networking sites

(facebook, twitter, youtube, linkedin, googlepus) considered for the study are

used for collecting information on prescription drugs and healthcare

management. The analysis showed that adoption of social media by working

youth is dependent on both time spent online and the percentage of total online

time spent on social media. It also proved that use of social media by working

youth for prescription drug information is governed by consumer satisfaction

with the advertisement and consumer perception of the utility of prescription

drug advertisement. The perception of authenticity of the medium used for

advertising (social media in this study) decides whether consumers will use

the medium for searching information related to prescription drugs as this is a

249

very sensitive issue. The results show the following preference of the social

networking sites for collecting information on prescription drugs-

YouTube

Face book

LinkedIn

Twitter

Google Plus

The most preferred being Facebook and Youtube followed by Linkedin and

Twitter while least preferred site is googleplus. An analysis of the potential of

social media as effective communication and advertising media showed that

social media sites were effective in communicating the desired message and

generating awareness for the advertised prescription drugs. The study showed

a strong positive relationship between use of social media for therapeutic

options and consumer‘s awareness for the advertised prescription drug and

disease states. Results obtained from statistical analysis show that there is a

strong relationship between Facebook used by working youth for collecting

information on prescription drugs and awareness for prescription drug.

Facebook plays an important role in spreading awareness for advertised

prescription drugs.Similarly Linked in and Youtube also play an important

role in generating awareness for prescription drugs as they are strongly related

to awareness. Although Twitter and Googleplus also help in generating

awareness for the advertised drugs, findings show that they are only

moderately related to awareness.

250

Ananlysis of the consumers‘ perception of utility of social media for

prescription drug DTCA shows that working youth usually search for

prescription drug advertisements on social media for some of the common and

frequently occurring diseases like fever, cold and cough, allergy, acidity.

While a large majority also uses social media for nutritional supplement.

Working youth searching for options to quit smoking also use social media

advertisements to get the information on anti-smoking drugs.

2. Satisfaction with Social Media DTCA

From this study it was found that demography has an immense impact on

consumer satisfaction with use of social media for prescription drug DTCA.

The findings show that demographic factors like gender, qualification,

occupation, income and age group are the more prominent factors which have

a significant impact on consumer‘s satisfaction with social media as a medium

for advertising prescription drugs. It was found that males are more satisfied

with social media advertisement of prescription drugs as compared to females.

While an analysis of different levels of qualification like HSC, graduate, post

graduate and professional degree, shows that graduates are more satisfied with

social media advertisement of prescription drugs compared to those with HSC,

Post Graduate and Professional degree.

There seems to be a strong relationship between consumer satisfaction with

social media DTCA and age group. Consumers in the age group 26-30 years

are more satisfied with social media advertisement of prescription drug as

compared to the consumers in the age group 18-25 and 31-35 years. Hence

this proves the fact that youth are more inclined to use social media for

251

searching information related to prescription drugs and disease related

information.

There is a moderate relationship between satisfaction with social media DTCA

and monthly income. Working youth with an income between INR 21000-

31000 are most satisfied amongst the different income ranges (<5000, 5000-

20000, 31000-50000 and > 50,000) used for the study. The findings of the

study also proves that working youth are more inclined to use social media for

searching information on prescription drugs compared to non- working youth.

This could be accountable to various factors like – higher spending capacity,

access to internet 24x7, membership to professional communities on social

media, busy schedule which prevents them from visiting a doctor, availability

of best consultants online, to get multiple expert views. -

3. Consumer’s Trust on Social Media as a Source of prescription Drug

Information.

It is found from this study that from the various information sources like key

opinion leaders, online doctors, patient community, company‘s devoted social

media pages, company website and pharmacist, the most trusted source for

seeking information on prescription drug is pharmacist followed by key

opinion leaders and pharmaceutical company website. This trend shows that

still consumers mostly believe the pharmacists and experts like doctors or

medical professionals with knowledge of medicines and who can give

opinions and shape consumer opinions, as the most authentic source of

information when it comes to therapeutic option. While they also trust the

drug manufacturing company a majority of the patients also depend on the

consultation from online doctors. This is more prevalent in cases where

252

availability and access to the best doctors and medical facilities is difficult,

hence consumers resort to online consultations from those doctors or other

experts. An emerging trend that has been noticed from this study is that

consumers are increasingly using social media for collecting information on

prescription drugs for mild and frequently occurring diseases like fever,

acidity, allergy, and nutritional deficiency. But for life threatening and serious

diseases needing emergency treatment consumers depend more on medical

fraternity especially the specialised doctors. In case of chronic diseases that

prolong for several months, years and may be lifetime, consumers supplement

their doctor‘s consultation with opinions from online communities of doctors

and experienced patients. They also seek information on availability of better

or cheaper therapeutic options from online pharmaceutical company expert

community and corporate websites of drug manufacturing companies. Twitter,

linkedin and facebook come handy in getting in touch with these online

communities, youtube is useful for knowledge on drug usage. From the study

it was found that the consumers mostly search for prescription drug

advertisements on social media for collecting information on available

therapeutic options and find better options of treatment. Although many of the

respondents were also interested in these advertisements to find therapeutic

options for their relatives, friends or parents. Another very important reason

that was projected by the findings is that many consumers develop interest in

social media DTCA if they are suffering from some disease, this could also be

linked to their past experience when the advertised drug was successful in

treating their condition. Many a time consumers search social media for

medical information because they are young doctors with trust in social media

253

information. Sometimes consumers feel uncomfortable in discussing their

condition with physicians due to the stigma associated with their disease state

hence they prefer making their own choice of therapy so they take help from

online advertisements or they feel more comfortable discussing their condition

with online expert communities because of the privacy provided by online

media.

4. Consumer Attitude towards Social Media DTCA and its Knowledge

Enhancing Potential.

Consumer attitude towards an advertised drug is shaped by their perception of

DTCA for the drug and the authenticity of the media used for advertisement.

Hence if they perceive the information contained in prescription drug

advertisement reliable and perceive it positively they will have a positive

attitude towards the advertised drug. Similarly if they trust the media used for

advertising a drug they believe the information posted on the media. This

study shows that while working youth perceive the information about quality

of product and benefits available in social media DTCA as satisfactory, they

think that information about drug associated risk is not available and not

satisfactory. According to them social media DTCA is an authentic source of

information on new drugs, provides valuable information about medical

treatments, educates consumers about drug‘s benefits and associated risk,

helps consumers to handle their ailments nicely, makes them more confident,

helps patients to develop a positive attitude towards health issues, gives

information about new improved version of medicines, encourages consumers

to participate their own health management, encourages consumers to seek

additional information from doctors, benefits their interaction with doctors

254

because of increased patient knowledge, encourages consumers to participate

in their own health management, encourages consumers to seek additional

information from doctors and benefits their interaction with doctors because of

increased patient knowledge. Along with these positive effects social media

DTCA also has some ills associated with it like it leads to confusion and

inaccurate perception of a drug's effectiveness and safety and focuses more on

benefits and less on risks and potential side effects. Many DTCA lack

important details like success rate and treatment duration and the information

available on social media is vague and without evidence.

5. Consumers’ Perception of the Positive Effect of Social Media DTCA on

Behaviour

Proponents of DTCA claim that it is advantageous for consumers in different

ways but opponents claim that it is harmful to the consumers. Hence similar to

a coin DTCA has two faces both advantages and disadvantages and hence it

becomes imperative for the consumers to understand the implications of

DTCA and learn to differentiate between useful and harmful and authentic and

unauthentic DTCA, especially in case of treatment options for life threatening

diseases. This study tries to understand consumer‘s perception of advantages

and disadvantages of DTCA, with emphasis on working youth. Findings show

that working youth believe that DTCA informs and empowers patients and can

be used as preventive health care. These youths believe that DTCA promotes

early diagnosis of medical condition, gives patients psychological confidence,

makes patients more likely to follow treatment instructions, encourages

patients to disclose health concerns, provides knowledge about side effects

and helps patients select right drugs. But on the negative side consumers feel

255

that DTCA does not provide more and cheaper therapeutic options and India

being a price conscious country, DTCA may not always end up in consumer

satisfaction.

6. Effect of Social Media DTCA on Consumer Behaviour and the

Behavioural Manifestations Post Exposure to DTCA.

Consumer awareness, perception and attitude for a particular prescription drug

play a vital role in shaping consumer behaviour for prescription drug. This

study proves there is a strong relationship between awareness, perception,

attitude and consumer behaviour. A consumer having a positive perception of

prescription drug will have a positive attitude towards that drug and this

converts into positive behaviour for that drug. None of the earlier studies have

proved the effect of DTCA on consumer behaviour beyond prescription. The

findings of this study show that post exposure to prescription drug DTCA a

consumer goes through different stages of purchase behaviour something

similar to AIDA (Awareness, Interest, Desire and Action). The span between

consumers‘ first exposure to DTCA and final purchase decision varies

depending on the urgency of the treatment and whether the consumer or a near

one is suffering from the disease or not. The study shows that post exposure to

DTCA a consumer can react in several different ways. There is strong proof

that consumers carefully read the advertisement, many also ask doctor for

more information, others clip the advertisement for later reference, Call toll-

free number given in the advertisement for more information, discuss with

friends and family and some of the consumers are influenced by DTCA to an

extent that they buy the advertised medicine only on the basis of the

information obtained from DTCA. Although, this may be harmful because of a

256

lack of expert opinion and unknown risk of drug associated side effects and

contraindications.

7. Interrelationship Between Awareness, Attitude, Perception and

Consumer Behaviour for Prescription Drugs

The study shows that awareness is strongly positively related with the factors

i.e. Perception, Perception (knowledge related factors), Perception (positive

effects of social media factors) and Youth behaviour except attitude (negative

effects of social media factors). All the correlation coefficients are statistically

significant except the attitude (Negative effects of social media factors). There

is a strong relationship between awareness and effect on youth behaviour.

There is a strong positive relationship between the awareness generated for

prescription drugs and working youth‘s behaviour in selection of prescription

drugs.

8. Relationship Between Attitude Towards DTCA and Working Youth

Behaviour in Prescription Drug Selection

From the above it is observed that, attitude towards DTCA is strongly

positively related with the factor i.e. youth behaviour. The correlation

coefficient is statistically significant. Social media based advertisements for

prescription drugs have an impact on working youth awareness for

prescription drugs, their attitude towards prescription drugs, their perception

of advertised prescription drugs and ultimately their behaviour in selection for

prescription drugs. Findings of the study prove that social media used by

working youth for collecting information on prescription drugs helps in

generating awareness for advertised drugs, which in turn affects working

youth‘s attitude towards advertised prescription drug. The favourable or

257

unfavourable attitude thus formed leads to positive or negative perception of

the prescription drugs which ultimately converts into their behaviour while

selecting therapeutic options.

9. Behavioural Manifestations of Consumer Other Than Prescription

Request After Exposure to Social Media DTCA

People are engaging in information seeking post exposure to DTCA. Although

many respondents are seeking information from different sources, medical

health professionals still hold the authority when it comes to purchase decision

making. But the paradigm shift in healthcare decision making cannot go

unnoticed. Consumers especially the youth seem to be enjoying this new born

responsibility. With the proliferation of DTCA, healthcare decision making

has become shared decision making, here consumers are equally involved in

deciding their mode of therapy and therapeutic options. They are welcoming

the growing importance of DTCA. Perceptions about DTCA are important in

determining whether consumers will use health information from the

advertisements.

258

CHAPTER 11

RECOMMENDATIONS

259

CHAPTER 11

RECOMMENDATIONS

1. Pharmaceutical companies should work towards increasing the positivity of

consumers towards DTCA, and social media could prove helpful in this.

Social media helps companies monitor and direct consumer conversations, this

helps them understand the concerns and viewpoints of consumers which can

be addressed and communicated to millions of users simultaneously in real

time.

2. Out of the five social media platforms included in the study (facebook, twitter,

youtube, linkedin and googleplus) the most preferred media are Facebook and

Youtube followed by Linkedin and Twitter while least preferred site is

googleplus. Advertisers and marketers of prescription drugs can use the social

media platforms like facebook, linkedin and youtube for advertising

prescription drugs. While other sites like twitter and googleplus although not

so famous can also be used in the advertising mix for prescription drugs.

Marketers need to engage working youth with social media DTCA.This could

be done by way of health promotional campaigns, free health check up

information and discount for visitors checking the prescription drug

advertisements on internet and social media. This could help in increasing the

impact of social media in awareness generation for prescription drugs.

3. Marketers should consider the demographic factors while developing

promotional strategies for prescription drug promotion as demography plays

an important role in consumer satisfaction and attitude for a product.

260

4. Positive perception of the quality of risk and benefit information in the

advertisement significantly improves consumers‘ opinion of DTCA‘s utility.

Hence leveraging social media DTCA requires marketers to be more

transparent, honest, interactive, relevant, and engaging. Consumers expect

prescription drug marketers to be honest, transparent and provide value. The

information contained in social media DTCA should be productive, authentic

and should have utility to the consumers.

5. Manufacturers should include effective risk information in DTCA since better

communication of product risks positively influences consumer opinions of

advertisements‘ utility. Testimonials of real patients who sought help and had

positive outcomes as a result of seeing a DTC A can be included.

6. While making online marketing strategy the marketers should leverage on the

strong correlation proved in this study between awareness, perception, attitude

and behaviour.

7. There is a strong positive relationship between the awareness generated for

prescription drugs and working youth‘s behaviour. This information can be

used by marketers of prescription drug. This would help them allocate budget

to different media based on their effect on awareness and change in youth

behaviour.

261

CHAPTER 12

BIBLIOGRAPHY

262

CHAPTER 12

BIBLIOGRAPHY

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ANNEXURE I

276

ANNEXURE I

QUESTIONNAIRE

Direct to Consumer Advertising of Prescription Drugs: A Study of the Impact of

Social Media on Working Youth in Select Cities of Maharashtra & Gujarat

The information is collected only for academic purpose.

The information given shall be strictly held in confidence.

Giving the name is optional.

Tick in the appropriate box.

PERSONAL DETAILS

Gender: Male Female

Qualification of the respondent:

HSC Graduate Post Graduate Professional course

Monthly income (INR): <5,000 5,000 -20,000 21, 000- 30, 000

31, 000- 50, 000 >50, 000

Age group: 18 to 25 yrs. 26 to 30yrs. 31 to 35yrs.


1. How often do you use internet?

Daily Twice a week Weekly Monthly

2. How much time do you spend on line in a week?

Less than 2 Hrs 2 to 5 Hrs 5 to 10 Hrs > 10 Hrs

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3. How much time do you spend on following sites? (Percentage of total time

spent online)

Media site < 10% 10 % -

25 %

25% -

50%

> 50 %

A Social Media

(facebook, twitter,

linked in, youtube)

B Search Engine

(google, yahoo)

C News

4. I find the information contained in social media advertisements of

prescription drugs, authentic?

Yes No

5. Which of the following social media do you use for prescription drug

information?

Social Media Yes No

A Face book

B Twitter

C Linkedin

D Youtube

E Google plus

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6. Which of the following sources do you trust for collecting information on

prescription drugs?

AWARENESS

7. For which of the following reasons do you search for prescription drug

advertisements on social media?

Source Yes No

A

Key opinion leaders (experts in

healthcare)

B Online doctors committee

C Patients communities

D

Company‘s social media devoted

pages

E Pharmaceutical company website

Reason Yes No

A General knowledge

B

Cannot consult doctor because of social

stigma on disease

C To know the treatments for my ailments

D

To find new and better versions of the

medicines I use

E I am a doctor/ medical professional

F For my parents / relatives/ friends

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8. For which of the following diseases have you seen advertisements promoting

prescription drugs on social media?

9. Do you read the instructions in advertisements carefully and completely?

Yes No

10. Please answer about your satisfaction with social media advertisement of

prescription drugs?

Parameter Yes No

A Language of the advertisement is

easy to understand

B Risk and benefit is easy to

understand

C Message is uses easy and non-

medical terminologies

Medical condition Yes No

A Fever, cough and cold

B Anti- smoking

C Allergy

D

Heartburn/ Acidity/

Gastritis

E

Nutritional Supplement /

Vitamins

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ATTITUDE AND PERCEPTION

11. Please answer about your perception of advertisement of prescription drugs

through social media.

Perception Strongly

Disagree

Disagree Agree Strongly

Agree

A Information on drug

quality and benefits is

satisfactory

B Information about drug

associated risk is

satisfactory.

C It brings down overall drug

cost

D It is authentic source of

information on new drugs

E Provides valuable

information about

medicines

F Information is vague and

without evidence

G Focus is on benefits and

less on risks and side

effects

281

12. Which of the following holds true for advertisement of prescription drugs

through social media?

Knowledge related

Factor

Strongly

Disagree

Disagree Neutral Agree Strongly

Agree

A Educates consumers

about drug‘s benefits

and associated risks

B Helps patients

understand their medical

condition better

C Knowledge about side

effects helps patients

select right drugs

D Prepares patients to

comply with prescribed

treatment or medical

advice

E Gives information about

new improved version

of medicines

F Increased knowledge

encourages patients to

participate their own

healthcare

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G Encourages consumers

to seek additional

information from

doctors

H Benefits patient‘s

interaction with doctors

because of increased

patient knowledge

13. Which of the following do you think are positive effects of social media

DTCA?

Positive Effects Strongly

Disagree


Agree

A Patients are informed and

empowered

B Diagnosis of under-diagnosed

condition

C Gives psychological confidence

D Makes patients more likely to

follow treatment instructions

E Encourages patient to disclose

health concerns

F Improves doctor-patient

relationship

283

G More and cheaper therapeutic

options leads to consumer

satisfaction

H Knowledge about side effects


I Removes the stigma associated

with certain diseases

J Helps patients develop a positive

attitude towards health issues

14. Which of the following do you think are negative effects of social media

DTCA?

Negative Effects Strongly

Disagree


Agree

A Fear of side effects hampers

decision making

B Damages doctor-patient

relationship

C Influences prescription

D Leads to confusion and inaccurate

perceptions of a drug‘s


E Encourages drug over-utilization

F Leads to over use of prescription

284

drugs

G Discourages use of generic

medicines

H Exposure to potentially risky

drugs

I Affects patient goals, divert time

away from disease screening or

examinations

YOUTH BEHAVIOUR

15. Which of the following did you do after seeing the advertisement of

prescription drug on social media?

Effect on behaviour Strongly

agree


agree

A 1. Carefully read the advertisement

B 2. Ask the doctor for more

information as a result of a

DTCA

C Keep the advertisement for later

reference

D Call toll-free number given in the

advertisement for more

information

E Discuss with friends and family

285

F Try to seek information from

virtual communities on social

media

G Buy the advertised medicine

Thank You Date:

286

ANNEXURE II

287

ANNEXURE II

DETAILS OF CITIES SELECTED FOR THE STUDY

PUNE

Source: punediary.com and punemunicipalcorporation.gov.in

Second largest metropolis in Maharashtra and seventh largest in India, Pune is the

administrative headquarter of Pune district. It is known for Manufacturing,

Automobile, Government & Private Sector Research Institutes, Information

Technology (IT) and Educational, Management, Training institutes that attract

migrants, students and professionals from India and abroad. The 1961, flood

destroyed the older sections of the city, leading to the introduction of modern town

planning concepts. This also led to a boom in construction and manufacturing sectors.

In 1990 Pune began to attract foreign capital, particularly in the information

technology and engineering industries; new businesses like floriculture, food

processing and wineries were started in the city. In 2008 the Commonwealth Youth

Games took place in Pune, which encouraged additional development in the city.

Pune has proportionately large no. of students and young professional populations

than Metros or any other city in India. The population of working youth (18-35 yrs)

using internet is 0.972 million in Pune. Because of the large number of colleges and

universities, Pune is emerging as a prominent location for IT and manufacturing

companies. Pune boasts to have the sixth highest per capita income in the country.

Called India‘s "Motor City" the automotive sector is prominent in Pune. Tata Motors

started operations in 1961, which gave a huge boost to the automobile sector. It is

home to the Automotive Research Association of India, which is responsible for the

homologation of all vehicles available in India.

288

All sectors of the automotive industry are represented - two-wheelers, autorickshaws,

cars, tractors and trucks. Big automobile companies like Tata Motors, Mahindra &

Mahindra, Mercedes Benz, and Kinetic Motors have set ups in Pune. Some of the

automobile companies with their Greenfield set ups near Pune are General Motors,

Volkswagen, Jaguar, and Fiat. While others like TATA, Saint-Gobain, Robert Bosch

and Visteon are having their automotive component manufacturing base. The IT

sector employs more than 70,000 people. Software giant Microsoft intends to set up a

Rs. 7 billion (US$120 million) project in Hinjewadi. Pune Food Cluster development

project an initiative funded by the World Bank, is being implemented with the help of

SIDBI Cluster Craft to facilitate the development of the fruit and vegetable processing

industries in and around Pune.

The emergence of industrial Pune began in the early 1960s, with mechanical

engineering industries arriving. Pune's proximity to Mumbai, good climate and

availability of talent made it a destination for large firms like Kirloskar Group, KSB

Pumps, Hindustan Antibiotics and several others. Pune also has many IT companies

and is the largest hub in India for German companies. Pune is one of the premier

industrial centres of India. A large number of engineering, electronic and electrical

industries have set up base in the large, medium and small scale sectors. The

industrial township of Pimpri Chinchwad, adjacent to the main city, is dotted with

over 4,000 manufacturing units.

This huge industrial base has imbibed the city with a 'professional' ethos and work

culture. Some of the big companies with their headquarters in Pune are Atlas Copco,

Bajaj Auto, Bajaj Allianz, Bajaj Tempo, Deepak Fertilizers and Petrochemicals,

Kirloskar Oil Engines, Kinetic Engineering, Mercedes Benz India, Cummins India,

Sandvik Asia, Tetrapak India and Thermax. Bajaj Electricals Ltd, Cummins

289

Generator Technologies India Ltd., Cummins India Ltd, Haier Appliances India Pvt.

Ltd., LG Electronics India P Ltd, Valeo India Pvt. Ltd., Whirlpool of India Ltd, Dow

Corning India Pvt. Ltd., Foseco India Ltd., Fresenius Kabi India Pvt. Ltd., are also

located in Pune region. Pune has several educational institutes and nine universities,

students from across the world are studying at Pune.

Some of the well-known institutes based at Pune are College of Engineering Pune,

Symbiosis International University, National Chemical Laboratory, ILS Law College,

Research institutes. Pune is also well connected by road and air to different parts of

India. The Mumbai-Pune Expressway, India's first six-lane high-speed expressway,

was built in 2002, and has reduced travel time between Pune and Mumbai to almost

two hours. A ring road is being planned for the convenience of heavy traffic.Pune is

served by two intra-city highways: Old Pune-Mumbai Highway and Katraj-Dehu

Road Bypass, a part of National Highway 4. The Nashik City-Pune Highway NH 50

will be part of the golden triangle (Nashik-Pune-Mumbai).

AURANGABAD

Source: aurangabad.nic.in

Aurangabad is one of the twelve districts in Maharashtra currently receiving funds

from the Backward Regions Grant Fund Programme (BRGF). Some of the companies

with their manufacturing base in Aurangabad are Bajaj Auto Limited, Skoda, Audi

Assembly, Videocon Industries Ltd., Ceat Goodyear, Siemens, Perkins, Hindalco,

Garware Polyester, Orchid, Lupin, Ajanta Pharma, Sabmiller, Fosters, Cosmo Films

Ltd., Grindmaster, Greaves, Forbes Gokak, Forbes Marshall and Lombardini. It also

has a Software Technology Park in Chikalthana MIDC. Aurangabad has a population

of 0.932 million working youth (18-35 yrs) using the internet. This huge figure shows

that Aurangabad is comparable to the small metros interms of internet connectivity.

http://en.wikipedia.org/wiki/National_Chemical_Laboratory

http://en.wikipedia.org/wiki/Mumbai-Pune_Expressway

http://en.wikipedia.org/wiki/Ring_road

http://en.wikipedia.org/wiki/Old_Pune-Mumbai_Highway

http://en.wikipedia.org/wiki/Katraj-Dehu_Road_Bypass

http://en.wikipedia.org/wiki/Katraj-Dehu_Road_Bypass

http://en.wikipedia.org/wiki/NH_50

http://en.wikipedia.org/wiki/Aurangabad,_Maharashtra

290

Aurangabad is one the fastest developing cities in Asia. It tops the chart among the

developing cities. It lies on a major trade route that used to connect north-west India's

sea and land ports to the Deccan region. Offlate Aurangabad was in news for placing

single largest order for Mercedes Benz cars in a single transaction in India- 150

Mercedes Benz cars worth Rs 65 crore. In the absence of a local dealer a group of

people pooled their orders and negotiated with the firm. Soon after that, bulk purchase

order of 101 BMW cars was also placed.

Aurangabad is a classic example of government‘s efforts towards industrialisation of

a state. Major Industrial areas of Aurangabad are Chikhalthana MIDC, Shendra

MIDC and Waluj MIDC. A new industrial belt namely Shendra - Bidkin Industrial

Park is being developed under DMIC. The Maharashtra Centre for Entrepreneurship

Development has its head office located in Aurangabad. Many large Indian and

multinational companies have their base in the Industrial Estates of Aurangabad.

Recently Aurangabad became the third city in Maharashtra (after Pune & Nashik) to

host an auto cluster namely Marathwada Auto Cluster (MAC).

Electrical goods major Siemens has set up a plant for manufacturing superior quality

bogies for locomotives, electric multiple units and metro coaches at Aurangabad.

Modern Retail Industry is sprawling in the form of Malls. Prozone Mall spread over 1

million square feet is the biggest in the region. Prozone the biggest mall in

Aurangabad has created direct employment opportunities for 4000 people. This

industry is a big employment generator. In the first decade of the twenty-first century,

Aurangabad has seen a spurt in financial activities, almost all public sector and private

banks have opened up branches including the State Bank of India, Union Bank of

India, State Bank of Hyderabad, Bank of Maharashtra, Citibank India, Deutsche

291

Bank, ICICI Bank, Bank of India, HDFC Bank, etc. Also Regional Rural Banks like

Maharashtra Gramin Bank has its regional head office in Aurangabad.

SURAT

Source: suratmunicipalcorporation.gov.in

Surat, also called city of flyovers is the second largest city in the state of Gujarat. It is

the administrative capital of the Surat district. It is the eighth largest city and ninth

largest metropolitan area of India. Population of working youth (18-35 yrs) using

internet is 0.293 million in Surat. The City Mayors Foundation, an international think

tank on urban affairs ranked Surat as the 4th

largest globally in a study of fastest

developing cities. Surat was awarded the Best City Award in 2013 by Annual Survey

of India's City-Systems (ASICS). Ranked 8th

in India, Surat is estimated to have a

GDP of $57 billion in 2020 as per City Mayors Foundation. Surat registered a GDP of

11.5% for the seven fiscal years 2001-2008, the fastest growing GDP in India.

Surat is known as a Diamond Hub of the World. In 1970s, Surat-based diamond

cutters began exporting stones to the US for the first time. It is the heart of the world's

diamond-polishing industry, which in 2005 cut 92% of world's diamonds and earned

India $15 billion in exports. Surat is also known for producing textiles, including silk.

Rightly called the textile hub of India or Silk City of India, it is the largest

manufacturer of clothes in India.

Surat city is home to some of the corporate giants like ONGC, GAIL, ABG Shipyard,

Narmada Cement, Ambuja Cement, Ultratech Cement,NTPC-KGPP Power Plant,

ESSAR Group of Industries (Steel/Power/Chemical/Oil/Shipping), L&T, Reliance

PVC, Reliance Petroleum, Kribhco-Feartilizer Mammoth, GSPC, Gujarat Gas, Shell,

LNG, Naiko Gas, Rama Paper Mill etc are some of them.There are many SME

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Domestic IT Companies present in Surat. MNC IT companies like IBM, TCS, HCL,

Wipro are having satellite or virtual Branch in Surat. On 14-Feb-2014 Govt of Gujarat

DST handed over STPI Surat at Bhestan-Jiav Road, Bhestan Near Udhana-Sachin

BRTS Route. STPI Surat is good option for SME IT Entrepreneurs of South Gujarat

and MNCs to expand business in Surat/South Gujarat at cheaper rate compared to

Metros or IT Hubs. Software Technology Park in Surat could grow in near future.

Surat has a computerised water distribution system and a computerised drainage

system with a sewage treatment plant to transform waste into energy. It has one of the

best water treatment plants in India. Every part of Surat has underground drainage and

street lights. PNG (Pipelined Natural Gas) entered Surat in the early '90s and most of

the areas are covered under PNG. CNG entered Surat in the early '90s, and as of the

end of 2005 more than 95% of auto rickshaws and public buses ran on CNG as an

efficient and less polluting fuel. The authority has stressed e-Governance to bring

speed to the overall administration efforts. Except for Sardar Vallabhbhai National

Institute of Technology (SVNIT), which is an institute of national importance most of

the colleges are affiliated to Veer Narmad South Gujarat University (VNSGU)

(named after the Great Kavi Veer Narmad). Apart from that colleges are also

affiliated to SNDT, Gujarat Technical University (GTU) and other universities. The

Indian Diamond Institute (IDI) was established in 1978. It is the most coveted

institute in the field of diamonds, gems and jewellery in India and is a state-of-art

school of learning. The IDI is ISO 9001:2008 certified for Design Development and

provision of Training, Consultancy and Certification services related to diamonds,

colored stones and jewellery. With the presence of broadband service providers like

BSNL, TATA Indicom, Reliance Communication, YOU Broadband and Hathway

Communications, connectivity to the internet is also good.

http://en.wikipedia.org/wiki/Veer_Narmad

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VADODARA

Source: barodaonline.com

Vadodara is the third largest city in the Indian State of Gujarat, after Ahmedabad and

Surat. It is the administrative headquarter of Vadodara District. Both the railway line

and national highway connecting Delhi and Mumbai pass through Vadodara. It is also

the home to the Maharaja Sayajirao University of Baroda, the largest university in

Gujarat. Major industries include petrochemicals, engineering, chemicals,

pharmaceuticals, plastics and Forex.Vadodara enjoys a special place in the state of

Gujarat. With a population of 0.579 million of working youth (18-35 yrs) who are

internet savvy, Vadodadarstands out amongst tier II and III cities in India

The first modern factory (Alembic Pharmaceuticals) was established in Vadodara in

1907 and subsequently companies such as Sarabhai Chemicals, and Jyoti came up in

the 1940s. By 1962 there were 288 factories employing 27,510 workers. At that time,

the dominant industrial groups were chemicals and pharmaceuticals, cotton textiles

and machine tools. The establishment of Bank of Baroda by Sayajirao III in 1908 also

helped industrial growth.

In 1962, Vadodara witnessed a sudden spurt in industrial activity with the

establishment of Gujarat Refinery and Indian Oil Corporation Limited at the nearby

village of Koyali. Several factors like raw material availability, product demand,

skillful mobilisation of human, financial and material resources by the government

and private entrepreneurs have contributed to Baroda becoming one of India‘s

foremost industrial centres.

The discovery of oil and gas in Ankleshwar led to the industrial development of

Gujarat in a big way. The Vadodara region is the largest beneficiary in the process of

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this industrialisation. Gujarat Refinery went into the first phase of production in 1965.

The refinery being a basic industry made vital contributions on several fronts at the

regional and national levels.

In Vadodara various large-scale industries such as Gujarat State Fertilizers &

Chemicals (GSFC), Indian Petrochemicals Corporation Limited (IPCL, now owned

by Reliance Industries Limited) and Gujarat Alkalies and Chemicals Limited (GACL)

have come up in the vicinity of Gujarat Refinery and all of them are dependent on it

for their fuel and feedstock. Other large-scale public sector units are Heavy Water

Project, Gujarat Industries Power Company Limited (GIPCL), Oil and Natural Gas

Corporation (ONGC) & Gas Authority of India Limited (GAIL).

In addition to these public sector enterprises, a number of other large-scale enterprises

have come up in the private sector such as Bombardier Transportation, a Canadian

company manufacturing the Delhi Metro from its site in Savli. Baroda also has quite a

few established manufacturing units such as; General Motors, Siemens, ALSTOM,

ABB Group, Philips, Panasonic, FAG, Sterling Biotech, Sun Pharmaceuticals, L&T,

Schneider and Alstom Grid, Bombardier, and GAGL (Gujarat Automotive Gears

Limited). There are also a number of glass manufacturing companies in and around

Vadodara, including Haldyn Glass, HNG Float Glass and Piramal Glass. The

establishment of large industrial units in a region automatically brings into existence a

number of smaller enterprises.

Vadodara is no exception and the city and the surrounding areas are today humming

with industrial activity. The industrialisation of Vadodara has attracted entrepreneurs

not only from Vadodara but also from all over Gujarat and the rest of India. In line

with the 'Knowledge City'vision of the Confederation of Indian Industry, Vadodara is

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gradually becoming a hub in Gujarat for IT and other development projects. Vadodara

is also home to the Vadodara Stock Exchange (VSE). Vadodara is one of India‘s most

cosmopolitan cities.

Thanks to the vision and broadmindedness of the Gaekwads, the subsequent

industrialisation, the proliferation of academic activities and a strategically important

geographical location, Baroda has welcomed a wide variety of people from all over

India and also from all over the world. In all of this, the sprawling and cosmopolitan

Maharaja Sayajirao (MS) University campus and the large number of local, national

and foreign industries act as a catalysing and unifying force.

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