Helen W. Sullivan

When planning is needed: Implementation intentions and attainment of approach versus avoidance health goals.

OBJECTIVE This study tested whether forming implementation intentions is an effective strategy for attaining health goals focused on trying to avoid a negative state. DESIGN Participants chose to either eat more healthy snacks (i.e., an approach goal) or eat fewer unhealthy snacks (i.e., an avoidance goal) over two weeks and were randomly assigned to create an implementation intention to do this or not. MAIN OUTCOME MEASURES The authors measured fat and calorie intake after one week and after two weeks. RESULTS After two weeks, the participants who ate most unhealthily were those who pursued an avoidance goal and did not form an implementation intention. CONCLUSION These results suggest that forming implementation intentions for avoidance goal pursuit can help people attain important health goals.

What Is My Cancer Risk? How Internet-Based Cancer Risk Assessment Tools Communicate Individualized Risk Estimates to the Public: Content Analysis

Background Internet-based cancer risk assessment tools have the potential to inform the public about cancer risk and promote risk-reducing behaviors. However, poorly communicated information on these websites may result in unintended adverse health outcomes. Objective This study examined whether: (1) Internet-based cancer risk assessment tools use risk communication formats that facilitate comprehension and reduce bias (as identified by the empirical literature); (2) the use of these formats varies by website affiliation; and (3) the websites provided information necessary to evaluate the quality of the risk estimate. Methods A content analysis of Internet-based cancer risk assessment tools was conducted. The terms calculate cancer risk, cancer risk calculator, estimate cancer risk, assess cancer risk, and cancer risk assessment were searched using three search engines. We identified 47 risk assessment tools and coded each according to standardized criteria. We calculated simple frequencies on all coding categories and performed crosstabulations but did not conduct formal statistical analysis due to small cell sizes. Results Use of risk communication formats that facilitate comprehension and reduce bias varied widely (eg, 30% of websites [14/47] provided absolute and comparative risk information but 83% [39/47] provided safety messages). Use of formats that facilitate comprehension varied by website affiliation and communication strategy (eg, only 8.3% [1/12] websites affiliated with the health care industry provided absolute and comparative risk information, but 83% [5/6] of websites affiliated with a governmental organization did so). Only 53% (25/47) of websites provided information about the statistical model or the peer-reviewed literature that was used to calculate the risk estimate. Conclusion Internet-based cancer risk assessment tools varied in their use of risk communication formats that facilitate comprehension and reduce bias. Formats that are difficult to understand may cause people to misperceive their cancer risk and consequently take inappropriate action.

Randomized Trial of Risk Information Formats in Direct-to-Consumer Prescription Drug Advertisements

Background. Federal regulations specify that print advertisements for prescription drugs and biological products must provide a true statement of information “in brief summary” about each advertised product’s “side effects, contraindications, and effectiveness.” Some of the current approaches to fulfilling the brief summary requirement, although adequate from a regulatory perspective, result in ads that may be difficult to read and understand when used in consumer-directed promotion. Objective. To explore ways in which the brief summary might be improved. Design. The authors conducted an experimental study that examined 300 consumers’ (mall visitors ever told that they were overweight) understanding of and preference for 4 different brief summary formats: traditional (a plain-language version of the risk sections from professional labeling), question and answer (Q&A; with headings framed in the form of questions), highlights (a summary section from revised professional labeling), and prescription drug facts box (similar to the current over-the-counter drug facts label). Results. The format had several effects. For instance, participants who viewed the drug facts format were better able to recall risks (P < .01) and reported greater confidence to perform the tasks (P < .01) than those who saw the traditional format. Differences in preference were noted; for example, the drug facts format was ranked highest, followed by the Q&A format, the traditional format, and finally the highlights format, P < 0.001. Conclusions. Taken together, these data suggest that the traditional method of conveying information in the brief summary is neither the most comprehensible nor the most preferred by consumers. These data provide policy makers and researchers with important information regarding the role of format in consumers’ understanding of the brief summary.

Communicating quantitative risks and benefits in promotional prescription drug labeling or print advertising

Under the Food, Drug, and Cosmetic Act, all promotional materials for prescription drugs must strike a fair balance in presentation of risks and benefits. How to best present this information is not clear. We sought to determine if the presentation of quantitative risk and benefit information in drug advertising and labeling influences consumers’, patients’, and clinicians’ information processing, knowledge, and behavior by assessing available empirical evidence.

Presenting efficacy information in direct-to-consumer prescription drug advertisements

OBJECTIVE We evaluated whether presenting prescription drug efficacy information in direct-to-consumer (DTC) advertising helps individuals accurately report a drugs benefits and, if so, which numerical format is most helpful. METHODS We conducted a randomized, controlled study of individuals diagnosed with high cholesterol (n=2807) who viewed fictitious prescription drug print or television ads containing either no drug efficacy information or efficacy information in one of five numerical formats. We measured drug efficacy recall, drug perceptions and attitudes, behavioral intentions, and drug risk recall. RESULTS Individuals who viewed absolute frequency and/or percentage information more accurately reported drug efficacy than participants who viewed no efficacy information. Participants who viewed relative frequency information generally reported drug efficacy less accurately than participants who viewed other numerical formats. CONCLUSION Adding efficacy information to DTC ads-both in print and on television-may potentially increase an individuals knowledge of a drugs efficacy, which may improve patient-provider communication and promote more informed decisions. PRACTICE IMPLICATIONS Providing quantitative efficacy information in a combination of formats (e.g., absolute frequency and percent) may help patients remember information and make decisions about prescription drugs.

Cancer Prevention Information-Seeking among Hispanic and Non-Hispanic Users of the National Cancer Institute’s Cancer Information Service: Trends in Telephone and LiveHelp Use

Evidence-based strategies to enable, encourage, and support cancer prevention information seeking among Hispanic populations are needed. We examined cancer prevention information requests to the Cancer Information Service (CIS) via telephone (1-800-4-CANCER toll-free telephone information service) and LiveHelp (an instant messaging service provided in English only) from 2003 to 2006. We summarized differences in the communication channel utilized by ethnicity (Hispanic vs. non-Hispanic) and, among Hispanic information seekers, the language used during the contact (English vs. Spanish). Utilization of LiveHelp was higher among non-Hispanic than Hispanic seekers of cancer prevention information. LiveHelp use for seeking cancer prevention information increased between 2003 and 2006 for both groups, but the increase was greater among non-Hispanics than Hispanics. Nearly half of Hispanics who sought cancer prevention information did so in Spanish. Because LiveHelp is not available in Spanish, the number of Spanish-only speakers who preferred to contact CIS via LiveHelp instead of telephone is unknown. When communicating cancer prevention information via multiple channels, it is important to consider differences in access to communication technologies and preferred communication channels among ethnic minority groups.

Cancer Prevention Information Seeking: A Signal Detection Analysis of Data From the Cancer Information Service

Communication and health information seeking play a significant role in the promotion of cancer prevention behaviors, including screening. Data from a sample of information seekers who contacted the National Cancer Institutes (NCIs) Cancer Information Service (CIS; N = 20,412) were split randomly into an exploratory and validation sample to conduct signal detection analysis predicting cancer prevention information seeking. Important predictors of seeking prevention information in the exploratory sample were type of information seeker, communication channel, age, and gender; these findings generally were confirmed in the validation sample. Our findings also reveal important information about the demographic characteristics and communication channel preferences of cancer prevention information seekers.

Communicating Benefit and Risk Information in Direct-to-Consumer Print Advertisements A Randomized Study

Background: Previous research demonstrated that providing qualitative and quantitative information in a “drug facts box” may help individuals understand prescription drug information in print-based direct-to-consumer advertisements. The authors sought to determine whether qualitative, quantitative, or a combination thereof best communicates benefit and risk information. Methods: To replicate and extend previous research, the authors used simple quantitative drug information. A randomized controlled study was conducted with 5067 Internet panelists with heartburn. Participants viewed a drug facts box with benefit and risk information that varied the presence or absence of qualitative summaries and absolute frequencies, percentages, and absolute differences. Measures included knowledge of drug benefits and risks, perceptions, and intentions. Results: Providing absolute frequencies and percentages most improved participants’ drug knowledge and affected perceptions and intentions. Conclusions: The study findings suggest that, for simple drug information, adding absolute frequencies and percentages to direct-to-consumer advertisements may benefit consumers. Absolute differences and qualitative labels may not be needed.

Randomized Study of Placebo and Framing Information in Direct-to-Consumer Print Advertisements for Prescription Drugs

BackgroundResearch suggests that quantitative information in direct-to-consumer (DTC) prescription drug ads may be helpful for consumers.PurposeThe objective was to examine the effect of adding placebo rates and framing to DTC ads.MethodsIn study 1, 2,000 Internet panel members with chronic pain participated in a randomized controlled experiment of DTC ads varying in placebo rate and framing. In study 2, 596 physicians ranked DTC ads varying in placebo rate and framing by how well they conveyed scientific information and their usefulness for patients.ResultsIn study 1, participants who viewed placebo rates were able to recall them and use them to form certain perceptions. A mixed frame led to lower placebo rate recall and perceived efficacy. In study 2, overall, physicians preferred a placebo/single frame ad.ConclusionsAdding placebo rates to DTC ads may be useful for consumers. The evidence does not support using a mixed frame.

Visual presentations of efficacy data in direct-to-consumer prescription drug print and television advertisements: A randomized study

OBJECTIVE To determine whether visual aids help people recall quantitative efficacy information in direct-to-consumer (DTC) prescription drug advertisements, and if so, which types of visual aids are most helpful. METHODS Individuals diagnosed with high cholesterol (n=2504) were randomized to view a fictional DTC print or television advertisement with no visual aid or one of four visual aids (pie chart, bar chart, table, or pictograph) depicting drug efficacy. We measured drug efficacy and risk recall, drug perceptions and attitudes, and behavioral intentions. RESULTS For print advertisements, a bar chart or table, compared with no visual aid, elicited more accurate drug efficacy recall. The bar chart was better at this than the pictograph and the table was better than the pie chart. For television advertisements, any visual aid, compared with no visual aid, elicited more accurate drug efficacy recall. The bar chart was better at this than the pictograph or the table. CONCLUSION Visual aids depicting quantitative efficacy information in DTC print and television advertisements increased drug efficacy recall, which may help people make informed decisions about prescription drugs. PRACTICE IMPLICATIONS Adding visual aids to DTC advertising may increase the publics knowledge of how well prescription drugs work.