Factors Affecting Adherence to Governmental Health Warnings and the Case of Over-the- Counter Cough and Cold Medications (OTCCCM) in Children Under Two - Innovation and Marketing in the Pharmaceutical Industry - page 346

This has been examined in the context of people's regulatory focus (whether
preventive or promotional) and their appraisal of response effi cacy (i.e., will the
behavior result in the desired outcome) or self-effi cacy (i.e., can I undertake the
behavior). It has been shown that a preventive regulatory focus fi ts better with
response effi cacy and a promotion regulatory focus fi ts better with self-effi cacy, and
that regulatory focus may determine the weights for response and self-effi cacy
(Keller 2006 ). Critically, regulatory focus-effi cacy fi t has been shown to increase
the desired behavior. Thus health messages phrased in the “loss” frame and appeal-
ing to response effi cacy may lead to higher intentions to comply in individuals with
a prevention regulatory focus, and those phrased in the “gain” frame and appealing
to self-effi cacy lead to better compliance individuals with a promotion regulatory
focus (Keller 2006 ). In support, Zhao and Pechmann ( 2007 ) found that antismoking
advertisements were most persuasive when the viewer's regulatory focus, the mes-
sage's regulatory focus, and the message frame were compatible. As expected, for
promotion-focused adolescents, a promotion-focused positively (“gain”) framed
message was most effective at persuading them not to smoke, but for prevention-
focused adolescents a prevention-focused negatively (“loss”) framed message was
most effective. As previous research demonstrated that adolescents do not respond
well to disease-related consequences (Hastings and MacFadyen 2002 ; Pechman
et al. 2003 ), both prevention and promotion messages in the Zhao and Pechmann
( 2007 ) study focused exclusively on social consequences.
For examples of promotion-focused positively (“gain”) framed messages, see
Sample Warnings A and D. For examples of prevention-focused negatively (“loss”)
framed messages, see Sample Warnings B and C.

12.1.7 “Nudging” vs. Coercing

Thus far we have dealt with how warnings and alerts should be constructed to opti-
mize receptiveness and effi cacy. Ratner et al. ( 2008 ) raise the important issue of the
legitimacy of limiting consumer freedom by disseminating messages that encourage
specifi c actions (e.g., smoking cessation). They remind us that once health mes-
sages intended to increase personal and public welfare are released to the public, the
consumer is free to choose adherence or non-adherence. Thus an intervention that
guides consumers to be better off without restricting their choices may be necessary
to assist them in making better, unbiased decisions (Thaler and Sunstein 2003 ).
Indeed in their topic entitled Nudge: Improving decisions about health, wealth, and
happiness , Thaler and Sunstein ( 2009 ) elaborate on this “libertarian paternalistic”
approach—creating a choice architecture that gently “nudges” citizens, patients, or
consumers in the desired direction. This approach has been applied in a variety of
contexts, including organ donation (Johnson and Goldstein 2003 ), where a default
policy of organ donation (with an opt-out option) enhances personal and societal
welfare by increasing prevalence of organ donation, relative to a default policy of no
organ donation (with an opt-in option). Thus increased adherence to a health