Efficacy Expectations and Adherence: Evidence of Consumer Biases and Heuristics in Pharmaceutical Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 315

of the medication. Several factors may infl uence consumer adherence to medicinal
regimen including salience/mindfulness, the cost and benefi ts associated with
adherence behavior, cues from advertising and distribution, perceived negative
effects of non-adherence, and perceptual properties of medications (Bowman et al.
2004 ; Coffi eld and Buckalew 1988 ). Importantly, when consumers misuse a
medication as a result of suboptimal product inferences, they are unlikely to reap its
full benefi t and consequently, the medication itself becomes less effective. This
experience negatively affects consumers' effi cacy judgments that, in turn, lead to
further non-adherence.
The aforementioned chain of events has signifi cant consequences; after all, only
about half of consumers who receive a prescription continue to take the medication
as directed 1 year later, and the loss in sales due to un-refi lled prescriptions is
estimated to be between $15-20 billion in the United States annually (Loden and
Schooler 2000 ). Considering that medicinal effi cacy is actually a function of how
well consumers follow the prescription (Sabate 2003 ; Wosinska 2005 ), the effi cacy-
adherence pairing constitutes a potential “vicious cycle.” In order to facilitate
adherence to the medicinal regimen, consumers must make positive effi cacy
judgments (and not only form positive effi cacy expectations). Importantly, however,
effi cacy judgments are not fully independent of effi cacy expectations. Rather,
“spillover effects,” or the biases on effi cacy judgments resulting from one's prior
expectation regarding how well a medicine should work, play an important role in
medicinal adherence.
Next, we illustrate a series of biases, heuristics, and lay theories employed at the
two aforementioned stages of the consumer evaluation process that ultimately
determine (1) how consumers choose medications, (2) how effi cacious they perceive
the treatment to be, and (3) how product effi cacy perceptions translate into adherence
behavior.

11.2 The Awareness Stage: Factors That Affect

Effi cacy Expectations

Adherence at the awareness (acquisition) stage is marked by consumers inquiring
about a specifi c medication or treatment and beginning to use the product. Such
adherence is contingent on effi cacy expectations that are often formed on the basis
of (1) how product information, such as the risks and benefi ts, is perceived by
consumers and (2) lay theories and prior knowledge. For example, a multitude of
consumer judgment biases infl uences the way consumers perceive risk and benefi t
information. These biases as well as lay theories, in turn, affect effi cacy expecta-
tions and adherence (see Fig. 11.3 ). We begin with a discussion of systematic
processing biases that infl uence effi cacy expectations and then turn our attention to
the role of lay theories and prior knowledge.