Presentation
Applying the Communication-Human Information Processing Model to Understand Older Adult Cognitive Processing of Direct-to-Consumer Advertisements
DescriptionThe average adult in the United States views up to nine direct-to-consumer pharmaceutical advertisements (DTCA) per day totaling about 16 hours of exposure per year. This makes televised DTCAs the most common form of medical exposure for the general public, far exceeding the time an average adult spends receiving medical education from their primary care provider. DTCAs present a unique opportunity to educate older adults, an age group who may have difficulty managing and advocating for their changing medical needs, on medication treatments outside of traditional medical settings. However, there is a significant gap in understanding how older adults comprehend and use information from DTCAs in their healthcare decision-making process.
Pharmaceutical DTCAs were originally developed to increase awareness of underdiagnosed conditions and treatment options for populations where there were small percentages of patients receiving care. While they have slightly deviated from this initial priority, DTCAs have increasing prevalence on television and maintain the capacity to educate and promote health engagement. Currently, only 43% of patients who initiate medication conversations with their providers reference DTCA information in appointments and feel the DTCAs contributed to better discussions with their providers. This is considerably low compared to other health education materials, such as brochures, that are useful for 68% of adults. Similarly, in the marketing space where an average television advertisement is expected to increase brand familiarity by 72%, pharmaceutical DTCAs are highly ineffective in comparison.
With pharmaceutical companies spending just over $8 billion in advertising in 2022, and their financial investments increasing annually, it is essential for advertisements to be tailored to their intended patient for optimal comprehension.
Objective
To meet this need, it is essential to explore how salient elements of DTCAs and older adult personal and social factors influence how they process medical information. This study aimed to synthesize human factors with marketing and communication principles to map DTCA processing from initial exposure to behavioral outcomes by applying the Communication-Human Information Processing Model (C-HIP) to identify older adult DTCA viewing personas that can aid in tailoring future DTCAs.
Conceptual Framework
C-HIP has been widely applied to understand how users receive and act upon warning signs, primarily in the context of avoiding hazardous work conditions. The C-HIP model synthesizes constructs from the human factor’s human information processing (HIP) model with the interactive communication model to provide a structure for tracking a message through the recipient's cognitive processing, C-HIP stages include: Source, Channel, Delivery, Attention Switch and Maintenance, Comprehension and Memory, Beliefs and Attitudes, Motivation, and Resulting Behavior. In the human factors field, there are various working definitions of what a warning is, but most agree an effective warning captures recipient's attention and changes their behavior in a way that reduces potential negative consequences. C-HIP is grounded in assuming pre-existing beliefs and environmental elements facilitate how the recipient processes a warning. Motivations behind the recipient’s response to the warning can be understood through assessing contextual and cognitive factors.
DTCA comprehension can be tracked through the C-HIP model because they are received in a parallel manner to warnings. An effective DTCA must be more salient than other environmental factors to capture recipient's attention, include understandable language and relevant content, communicate important information in a short period of time, and resonate with the recipient to motivate a desired behavior.
Methods
To assess how older adults comprehend DTCAs and how the messaging influenced their medication behaviors, twenty-five older adult participants were recruited to participate in this study from a midwestern senior center. The twenty-five older adults watched a one minute DTCA for a prescription medication Eliquis while wearing Tobii Pro eye tracking glasses then participated in a semi-structured interview about their reactions to the DTCA and experience with healthcare. Eye tracking glasses recorded which elements of the commercial, such as textual components and background visuals, participants focused on. The Tobii Eye Tracking software tracks when participants' gaze was stagnant on one area of stimulus long enough for their vision system to take in detailed visual information. This data was coded using researcher identifed areas of interest in the analysis software to quantify the amount of time participants spent looking at various commercial elements.
Marketing and human factors principles emphasize the use of personas as valuable strategies for identifying priorities of an intended audience and ensuring the message fits into their belief system for optimal message retention. To construct older adult DTCA viewing personas, qualitative interviews were transcribed verbatim and coded deductively using C-HIP model constructs (e.g., Source, Comprehension and Memory, Beliefs and Attitudes) then older adults were classified into personas based on similar attributes and beliefs about medications.
Results
Analysis of interview transcripts showed three main personas of older adults for medication information seeking and decision making. These include: (1) medication averse older adults who are opposed to taking medications, (2) medication adherent older adults who prefer their provider to control medication decisions, and (3) information seeking older adults who independently find health information so they can participate in medication decisions with their health team. When assessing content recall from the commercial, information seekers tended to be older adults who would ask their provider about the advertised medication and tended to remember details about the medication specifically. In contrast, participants who would not ask their provider or were resistant to medications recalled more details about scenery in the commercial.
When synthesizing eye tracking data with persona analysis, the differences in DTCA engagement can be understood by mapping persona cognitive processing along the C-HIP model. A primary distinction between older adult’s approach to DTCA comprehension lies in their pre-existing beliefs and attitudes towards medications. The medication averse and medication adherent older adults both had barriers to behavior in the ‘beliefs and attitudes’ stage of C-HIP as the information being communicated did not align with their pre-existing beliefs of how medication decisions should be carried out. In contrast, the information seeking older adults were more open to researching new medications and engaging in collaborative decisions about medications, including discussing the medication with their provider, so information could be more easily encoded into their memory and the desired behavior aligned with their pre-existing beliefs and attitudes.
Using the C-HIP model when constructing personas helped identify the heterogeneity amongst older adult approaches to consuming information presented in DTCAs. Each persona illustrates how personal beliefs and health experiences influence how they prioritize health information viewing advertisements, thus presenting a need for tailored patient-centered messaging in commercials. To achieve effective education and support patient engagement, health communicators have to pay attention to and emphasize elements that support older adult cognitive processes and commercial viewing behaviors. Exploring patient reception of health information at the intersection of health communication and human factors engineering provides a unique perspective and approach to emphasizing patient-centered messaging in medication advertisements. Integrating human-centered communication in DTCA content is the next step in enhancing their educational value and empowering patients to take ownership of their health.
Pharmaceutical DTCAs were originally developed to increase awareness of underdiagnosed conditions and treatment options for populations where there were small percentages of patients receiving care. While they have slightly deviated from this initial priority, DTCAs have increasing prevalence on television and maintain the capacity to educate and promote health engagement. Currently, only 43% of patients who initiate medication conversations with their providers reference DTCA information in appointments and feel the DTCAs contributed to better discussions with their providers. This is considerably low compared to other health education materials, such as brochures, that are useful for 68% of adults. Similarly, in the marketing space where an average television advertisement is expected to increase brand familiarity by 72%, pharmaceutical DTCAs are highly ineffective in comparison.
With pharmaceutical companies spending just over $8 billion in advertising in 2022, and their financial investments increasing annually, it is essential for advertisements to be tailored to their intended patient for optimal comprehension.
Objective
To meet this need, it is essential to explore how salient elements of DTCAs and older adult personal and social factors influence how they process medical information. This study aimed to synthesize human factors with marketing and communication principles to map DTCA processing from initial exposure to behavioral outcomes by applying the Communication-Human Information Processing Model (C-HIP) to identify older adult DTCA viewing personas that can aid in tailoring future DTCAs.
Conceptual Framework
C-HIP has been widely applied to understand how users receive and act upon warning signs, primarily in the context of avoiding hazardous work conditions. The C-HIP model synthesizes constructs from the human factor’s human information processing (HIP) model with the interactive communication model to provide a structure for tracking a message through the recipient's cognitive processing, C-HIP stages include: Source, Channel, Delivery, Attention Switch and Maintenance, Comprehension and Memory, Beliefs and Attitudes, Motivation, and Resulting Behavior. In the human factors field, there are various working definitions of what a warning is, but most agree an effective warning captures recipient's attention and changes their behavior in a way that reduces potential negative consequences. C-HIP is grounded in assuming pre-existing beliefs and environmental elements facilitate how the recipient processes a warning. Motivations behind the recipient’s response to the warning can be understood through assessing contextual and cognitive factors.
DTCA comprehension can be tracked through the C-HIP model because they are received in a parallel manner to warnings. An effective DTCA must be more salient than other environmental factors to capture recipient's attention, include understandable language and relevant content, communicate important information in a short period of time, and resonate with the recipient to motivate a desired behavior.
Methods
To assess how older adults comprehend DTCAs and how the messaging influenced their medication behaviors, twenty-five older adult participants were recruited to participate in this study from a midwestern senior center. The twenty-five older adults watched a one minute DTCA for a prescription medication Eliquis while wearing Tobii Pro eye tracking glasses then participated in a semi-structured interview about their reactions to the DTCA and experience with healthcare. Eye tracking glasses recorded which elements of the commercial, such as textual components and background visuals, participants focused on. The Tobii Eye Tracking software tracks when participants' gaze was stagnant on one area of stimulus long enough for their vision system to take in detailed visual information. This data was coded using researcher identifed areas of interest in the analysis software to quantify the amount of time participants spent looking at various commercial elements.
Marketing and human factors principles emphasize the use of personas as valuable strategies for identifying priorities of an intended audience and ensuring the message fits into their belief system for optimal message retention. To construct older adult DTCA viewing personas, qualitative interviews were transcribed verbatim and coded deductively using C-HIP model constructs (e.g., Source, Comprehension and Memory, Beliefs and Attitudes) then older adults were classified into personas based on similar attributes and beliefs about medications.
Results
Analysis of interview transcripts showed three main personas of older adults for medication information seeking and decision making. These include: (1) medication averse older adults who are opposed to taking medications, (2) medication adherent older adults who prefer their provider to control medication decisions, and (3) information seeking older adults who independently find health information so they can participate in medication decisions with their health team. When assessing content recall from the commercial, information seekers tended to be older adults who would ask their provider about the advertised medication and tended to remember details about the medication specifically. In contrast, participants who would not ask their provider or were resistant to medications recalled more details about scenery in the commercial.
When synthesizing eye tracking data with persona analysis, the differences in DTCA engagement can be understood by mapping persona cognitive processing along the C-HIP model. A primary distinction between older adult’s approach to DTCA comprehension lies in their pre-existing beliefs and attitudes towards medications. The medication averse and medication adherent older adults both had barriers to behavior in the ‘beliefs and attitudes’ stage of C-HIP as the information being communicated did not align with their pre-existing beliefs of how medication decisions should be carried out. In contrast, the information seeking older adults were more open to researching new medications and engaging in collaborative decisions about medications, including discussing the medication with their provider, so information could be more easily encoded into their memory and the desired behavior aligned with their pre-existing beliefs and attitudes.
Using the C-HIP model when constructing personas helped identify the heterogeneity amongst older adult approaches to consuming information presented in DTCAs. Each persona illustrates how personal beliefs and health experiences influence how they prioritize health information viewing advertisements, thus presenting a need for tailored patient-centered messaging in commercials. To achieve effective education and support patient engagement, health communicators have to pay attention to and emphasize elements that support older adult cognitive processes and commercial viewing behaviors. Exploring patient reception of health information at the intersection of health communication and human factors engineering provides a unique perspective and approach to emphasizing patient-centered messaging in medication advertisements. Integrating human-centered communication in DTCA content is the next step in enhancing their educational value and empowering patients to take ownership of their health.
Event Type
Oral Presentations
TimeTuesday, March 269:15am - 9:37am CDT
LocationSalon A-3
Patient Safety Research and Initiatives