Efficacy Expectations and Adherence: Evidence of Consumer Biases and Heuristics in Pharmaceutical Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 314

expectancy models (e.g., expected utility theory; Ajzen and Fishbein's ( 1980 )
theory of reasoned action; Becker's ( 1974 ) health belief model) propose that people
rationally weigh the risks and benefi ts inherent in a decision and act accordingly,
evidence from both academia and practice suggests that oftentimes this is not the
case. Specifi cally, rational decision-making models assume that consumers have the
motivation, opportunity, and ability to exert suffi cient cognitive effort to make
optimal decisions. However, given the sheer number of decisions and evaluations
made on a daily basis, consumers have inevitably formed an anecdotal toolbox of
lay theories about their environment, meshed with a variety of heuristics and biases
used to guide their decision-making (e.g., choosing a medication and judging its
effi cacy). Thus, rather than assessing the risk and benefi t information in a system-
atic manner, many consumers utilize it in ways that lead to biased information
processing, which results in inferences, both plausible and unmerited, about medi-
cation and treatments (Menon et al. 2003 ; Cox et al. 2006 ). Therefore, one of our
objectives in this chapter is to discuss the different types of heuristics consumers
utilize and show how they drive consumer effi cacy expectations of pharmaceutical
products at the awareness stage, resulting in initial (non)adherence. To achieve this
goal, we illustrate how consumer expectations of medicinal effi cacy are infl uenced
by biases and heuristics that originate from (1) the manner in which risk and benefi t
information is perceived and (2) lay theories that consumers hold about their
surroundings, such as beliefs about product attractiveness, inter-attribute correlations,
market effi ciency, and the like.
Before discussing the next stage, it is important to note that adherence during the
awareness stage may vary with whether the medication is over-the-counter (OTC) or
prescription (Rx). For OTC medications, consumers tend to make purchase decisions
themselves, whereas for prescription medication, they also rely on physicians for
guidance. Thus, in the latter case, marketers are presented with a dual task of raising
effi cacy expectations of physicians and consumers alike; indeed, a discrepancy
between product effi cacy expectations of a consumer and his/her physician may affect
consumers' adherence to physician recommendations. As such, all else being equal,
infl uencing consumers' expectations and stimulating initial adherence to OTC (vs. Rx)
medication may be easier as there is no mediating individual between the marketer and
consumer (Creyer et al. 2001 ; Hoy 1994 ). In this chapter, we focus on the factors that
affect effi cacy expectations and consequences such as non-adherence (e.g., in terms of
foregoing a benefi cial treatment) that apply to both OTC and Rx medications; readers
should note, however, that other variables, such as physician-patient relationships and
physicians' awareness of the medication remain outside the scope of this chapter but
nonetheless may additionally affect adherence.

11.1.2 Stage 2: Trial and Adoption Stage

At the second stage—trial and adoption—effi cacy perceptions infl uence whether
consumers will adhere to their medicinal regimen as they experience the positive
health effects of the medication; adherence at this stage is marked by proper usage