Health Marketing Quarterly

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Message Strategies in Direct-to-Consumer

Pharmaceutical Advertising: A Content Analysis
Using Taylor's Six-Segment Message Strategy
Wheel

Wan-Hsiu (Sunny) Tsai & Alyse R. Lancaster

To cite this article: Wan-Hsiu (Sunny) Tsai & Alyse R. Lancaster (2012) Message Strategies
in Direct-to-Consumer Pharmaceutical Advertising: A Content Analysis Using Taylor's
Six-Segment Message Strategy Wheel, Health Marketing Quarterly, 29:3, 239-255, DOI:
10.1080/07359683.2012.705708

To link to this article: https://doi.org/10.1080/07359683.2012.705708

Published online: 20 Aug 2012.

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Health Marketing Quarterly, 29:239–255, 2012
Copyright # Taylor & Francis Group, LLC
ISSN: 0735-9683 print=1545-0864 online
DOI: 10.1080/07359683.2012.705708

Message Strategies in Direct-to-Consumer

Pharmaceutical Advertising: A Content
Analysis Using Taylor’s Six-Segment
Message Strategy Wheel

WAN-HSIU (SUNNY) TSAI and ALYSE R. LANCASTER

School of Communication, University of Miami, Coral Gables, Florida

This exploratory study applies Taylor’s (1999) six-segment message

strategy wheel to direct-to-consumer (DTC) pharmaceutical
television commercials to understand message strategies adopted
by pharmaceutical advertisers to persuade consumers. A con-
venience sample of 96 DTC commercial campaigns was analyzed.
The results suggest that most DTC drug ads used a combination
approach, providing consumers with medical and drug infor-
mation while simultaneously appealing to the viewer’s ego-related
needs and desires. In contrast to ration and ego strategies, other
approaches including routine, acute need, and social are relatively
uncommon while sensory was the least common message
strategy. Findings thus recognized the educational value of DTC
commercials.

KEYWORDS creative strategy, content analysis, direct-to-

consumer, prescription drug advertising, message strategy

INTRODUCTION

Since the Food and Drug Administration (FDA) released a draft of guidelines
in 1997 that made broadcast advertising for prescription medicine a viable
option for pharmaceutical advertisers, spending for direct-to-consumer
(DTC) drug advertising increased from an estimated $47 million in 1990 to
nearly $2.5 billion in 2000 (Frank et al., 2002). In 2009, the pharmaceutical
industry was the second largest product category by ad spending with

Address correspondence to Wan-Hsiu (Sunny) Tsai, PhD, School of Communication, Uni-

versity of Miami, P.O. Box 248127, Coral Gables, FL 33124-2105. E-mail: wanhsiu@miami.edu

239
240 W.-H. Tsai and A. R. Lancaster

approximately $4.5 billion in advertising expenditure, second only to the

automotive industry (Nielsen, 2010). In his book, Overdosed America,
Abramson (2004) also noted that the ‘‘1997 change [in DTC advertising laws]
unleashed an unprecedented onslaught of commercials. By 1999, the average
American was exposed to nine prescription drug advertisements on tele-
vision every day. The number of television ads increased 40-fold between
1994 and 2000’’ (p. 152).
Empirical evidence to date suggests that DTC advertising is in effect
valuable in raising brand awareness and effective in generating sales. Not only
brands with high DTC spending are typically among the best-selling drugs,
but also a closer look at the sales data of prescription medicine reveals that,
among the 50 most heavily advertised drugs, the number of prescriptions
dispensed rose 25% between 1999 and 2000, compared to a mere 4% increase
for other drugs (U.S. General Accounting Office, 2002). In addition, 92% of
physicians in a 2002 FDA survey reported having had a discussion about an
advertised drug initiated by a patient (Aikin, 2003). Studies further suggest that
about one-third of consumers who remember seeing a DTC advertisement
indeed ask their physicians for a specific prescription (U.S. General
Accounting Office, 2002).
There are three categories of DTC advertising: (a) health-seeking adver-
tising that solely provides information about a specific condition or illness but
does not mention a specific branded product; (b) reminder advertising that
state the brand name but does not indicate any product claims or the uses
of the drug, based on the assumption that the viewer is already familiar with
the brand; and (c) product-specific advertising that mentions a drug’s name
and the condition it is intended to treat. Advertisers realize that the first two
types of DTC advertising tend to confuse consumers and are not effective
for sales (Sheehan, 2003). Consequently, most DTC commercials are designed
to explicitly promote a particular brand. However, to ensure that sufficient
drug information is provided in the product-specific DTC television commer-
cials, these ads are required by FDA to provide a ‘‘fair balance’’ of product
benefits and key adverse effects, contradictions, warnings, and precautions
for a drug, known as ‘‘major statement.’’ It is also mandatory for product-
specific DTC commercials to provide alternative sources of obtaining
complete product information, such as Web site, a toll-free number, and from
health-care professionals, known as the ‘‘adequate provisions.’’ However, the
‘‘fair balance’’ guideline presents a grey area where many DTC commercials
may be questioned for omitting or downplaying certain critical side effects
while exaggerating drug benefits and efficacy.
With the growing influence of DTC advertising, we have also witnessed
heated debates about the positive and detrimental effects of promoting pre-
scription medicine directly at consumers. Different from traditional consumer
goods, pharmaceutical products are part of a complicated web of medical
care system that involve not only the consumers, retailers and manufactures,
 Message Strategies of DTC Commercials 241

but also physicians and health insurance companies. On the one hand,
supporters argue that DTC advertising can educate consumers about medical
conditions and health care choices, raise awareness of a variety of diseases,
particularly underdiagnosed conditions, and enhance treatment compliance
(Bradley & Zito, 1997; Holmer, 1999; Masson & Rubin 1985; Terzian, 1999).
One the other hand, DTC advertising has been criticized as prone to contain
incomplete, inaccurate, and misrepresented drug information, specifically
overemphasizing drug efficacy while downplaying risks and other negative
product information. Other criticisms include overwhelming consumers with
information overload, interfering with doctor-patient relationship, increasing
unnecessary or inappropriate prescription, and encouraging consumption of
expensive new branded drugs over other more affordable, albeit older, treat-
ments (Bradley & Zito, 1997; Cohen, 1988; Hoffman & Wilkes, 1999; Lexchin,
1997; Terzian, 1999; Wilkes, Bell, & Kravitz, 2000).
Despite the significance of pharmaceutical spending to the advertising
industry and the numerous controversies surrounding the growing trend,
advertising literature has not adequately analyzed DTC pharmaceutical adver-
tising. Prior studies have predominantly focused on examining the degree of
informativeness or educational value of the ads and whether the information
presented is in compliance with FDA guidelines. These critical observations
have found an imbalance of risk and benefit information (Kaphingst &
DeJong, 2004; Main, Argo, & Huhmann, 2004; Sumpradit, Ascione, & Bagozzi,
2004) and cautioned the public that the presented information about the
health conditions that the drug is intended to treat is often ambiguous or insuf-
ficient (Frosch et al., 2007). Yet, most content analysis research on DTC adver-
tisements primarily focus on print media only (i.e., Bell et al., 2000; Main et al.,
2004), despite the fact that television commercials promoting prescription
medicine has been the center of controversy. Some recent exceptions that
look at DTC commercials include Sumpardit et al.’s (2004) investigation of
the use of prevention and promotion-oriented motivational themes in both
magazine and television advertisements for prescription drug, Kaphingst
et al.’s (2004) study that examined aspects of DTC commercials that could
interfere with consumers’ comprehension of critical information, and Ball
et al.’s (2009) assessment of African American models in DTC pharmaceutical
commercials. To address this void in the advertising literature, the primary
objective of this exploratory study is to conduct a descriptive content analysis
of DTC television commercials to understand the types of message strategies
that are frequently used in DTC advertising. Such knowledge will advance our
understanding of the very nature of the important advertising trend for a
unique product category as well as its implications for policy making. This
analysis applies Taylor’s (1999) six-segment strategy wheel as a theoretical
framework for analyzing DTC commercials, a tool that has proven to be useful
for examining conventional consumer products and services across different
marketing communication platforms.
242 W.-H. Tsai and A. R. Lancaster

Taylor’s Six-Segment Message Strategy Wheel

In an effort to help advertising professionals devise effective message strategies
for consumer-product advertising, Taylor (1999) proposed the six-segment
message strategy wheel. His model is built upon previous theorizations of
creative strategies, including Carey’s (1975) transmission and ritual models,
Kotler’s (1965) buying and Veblenian models, and Laskey, Day, and Crask’s
(1989) dichotomy of transformational and informational message strategies,
and Vaughn’s (1980, 1986) widely cited FCB model. Taylor’s model, however,
has extended the conventional binary analysis of advertising by incorporating
three subcategories within each of the two dimensions, hereby allowing a
more sophisticated, analytical approach towards understanding advertising
strategy. Specifically, the transmission view is composed of three segments:
ration, acute need, and routine, while the ritual view is composed of the
ego, social, and sensory segments. Furthermore, Taylor distinguished between
message strategy—what to say—and creative strategy—how to say it by
incorporating prior typologies of creative strategies into his model.

THE RITUAL VIEW

According to Taylor’s model, the first segment located on the ritual side of the
strategy wheel, the ego segment, proposes that consumers purchase and use
products to reflect or enhance their self-image. Such purchase decisions are
related to one’s ego, and consumers may have strong emotional attachments
to the image-oriented products. The objective of advertisements in this
segment, then, is to show how the product matches the consumers’ self-image
or persuade the consumer through the use of emotional appeals. Typical
executions would include advertisements that appeal to vanity, one’s image,
one’s personal feelings, and self-actualization.
In contrast to the self-oriented ego segment, the second segment on the
ritual side focuses on the collective. In the social segment, consumers use the
product to win the attention, approval, respect, and affection of others or to
signal their membership belonging to a social group. This message strategy
thus involves the consideration of others in the purchase decision while
resonance is a typical appeal for this segment.
Within the sensory segment, advertisements appeal to any of the five
senses: taste, smell, touch, sight, or hearing. Products are depicted as life’s
treats and advertisements aim to showcase how the use of products would
allow consumers to enjoy ‘‘moments of pleasure’’ (Taylor, 1999, p. 13), such
as food, beverage, music CDs, and perfume.

THE TRANSMISSION VIEW

Located on the transmission side of the wheel, the routine segment focuses on
the repetitive, habitual aspect of consumer behavior. Common products for
 Message Strategies of DTC Commercials 243

this category include household goods and laundry products that consumers
purchase out of habit. Advertisements in this segment thus focus on providing
cues to consumer needs, as well as reminding the consumers to continue
purchase in order to develop and maintain the desired consumption habit.
Common appeals include convenience, ease of use, and satisfaction from
product usage.
The acute need segment refers to the purchase situation when consu-
mers’ need for products arises abruptly. Although consumers may desire
product information, they are limited with time for research and thus, choose
on the basis of availability. Advertising thus focuses on ensuring the product
as being part of the consumer’s evoked set, establishing brand familiarity,
consumer trust, and brand recognition.
The last segment, the ration segment, describes the buying occasion
where consumers desire and actively seek product information such as
product attributes, quality, warranties, and price and take time deliberating
options available to form a rational purchase decision. Advertisements in this
category thus use hard facts and informative appeal to persuade consumers.
Creative strategies contained within this segment include comparative,
unique selling point (USP), pre-emptive, generic, and positioning strategies.
Taylor’s strategy wheel is valuable for the current investigation because
his model is developed upon the foundation of previous theoretical formula-
tions from the interdisciplinary fields of communication, consumer behavior,
and advertising and is both comprehensive and sophisticated for analyzing a
broader range of strategic communications. Studies that apply Taylor’s strat-
egy wheel have reported that this model effectively captures a comprehensive
view of diverse consumer-buying decisions and across different advertising
platforms. Morrison and White (2000) used Taylor’s model to analyze Super
Bowl advertisements of dot.com companies and found that the majority of
such commercials used the ration and ego strategies. Another content analysis
of Super Bowl commercials and related Web sites conducted by Kim,
McMillan, and Hwang (2005) looked at message strategies used in the inte-
gration of the Web in Super Bowl commercials. They report that the Super
Bowl commercials were more likely to take a transformational approach
while corresponding Web sites tended to more informational in nature. In
their study of analyzing corporate Web sites as a form of corporate advertis-
ing, Hwang, McMillan, and Lee (2003) suggest that Taylor’s strategy wheel
presented a useful model for identifying message strategy of nontraditional
forms of strategic communications such as Web sites and they found that
high-revenue companies are more likely to use ego and social strategies than
are low-revenue companies while the routine strategy was the most common
tactic used for this marketing communication medium. A similar application
of the strategy wheel to another novel development of advertising is conduc-
ted by Golan and Zaidnor (2008). They applied the model to analyze message
strategies in viral advertising and found that 51% of video videos used
244 W.-H. Tsai and A. R. Lancaster

ego-based message strategies, while 24% used ration-based strategies.

These recent studies not only demonstrated that Taylor’s strategy wheel
can be applied across different media, but also the findings indicate that
the model is a flexible tool for analyzing a variety of advertising formats
and practices.
The current study applies Taylor’s six-segment strategy wheel in a
content analysis of DTC drug commercials to understand message strategies
adopted by pharmaceutical advertisers to persuade and influence consumers.
This study also attempts to update and extend the scholarship on Taylor’s
model through the analysis of television commercials of prescription medi-
cine, a unique product category that is heavily regulated by FDA and presents
a unique challenge of appealing to consumers while informing them of
adverse side effects and major risks. In addition, in order to better identify
dominant product claims and attributes highlighted in DTC commercials, a
taxonomy of drug-specific claims based on Bell et al.’s (2000) study and has
been extensively used for understanding drug-specific selling points (i.e.,
Macias & Lewis, 2003) is also incorporated. The current study strives to answer
the following research questions:

RQ1: Do DTC commercials base their message strategies on the trans-

mission strategy more than they do on the ritual side?
RQ2: What message strategies (Ego, social, sensory, routine, acute need,
and ration) are used most prevalently in DTC drug commercials?
RQ3: What drug-specific product claims and attributes are most com-
monly used in DTC commercials?

METHOD

In order to answer these questions, this study employed an exploratory con-

tent analysis of DTC commercials. Three weeks of primetime programming
(8 p.m. to 11 p.m.) of the five major networks (ABC, CBS, NBC, FOX, and
CW) from late June to mid-July was recorded. However, only few DTC com-
mercials were found. Additional DTC drug commercials thus were searched
using the brand names of the world’s best selling prescription medicines
identified in trade publications and collected from Adforum’s online commer-
cial archive and YouTube.com. The ads thus represent a convenience sample
with 96 DTC drug commercials, total. A convenience sample is appropriate for
the discovery-oriented nature of the current inquiry and acceptable due to
the lack of a comprehensive database for DTC drug commercial, although
inherent limitations are acknowledged. Each of the 96 DTC commercials
was coded for variables including the brand name, ad name, use of testimo-
nials, presence of doctor, and doctor as lecturer. Six message strategies—
ration, acute need, routine, ego, sensory, and social—based on Taylor’s
strategy wheel were coded in a dichotomous format to indicate whether a
 Message Strategies of DTC Commercials 245

strategy was used or not used in the ad. Specifically, the commercials were
coded as follows:

. Ego: The commercial appeals to the viewer’s need of self-actualization and

encourages the viewer to improve oneself, such as improve one’s health
condition or keep the symptoms under control. In this strategy, consumers
use the product to make a statement to themselves, and=or uses an
emotional appeal (e.g., fear, hope, sadness) to persuade the viewer to act.
. Social: Based on this message strategy, consumers use the product to make
a statement to others or take the action for the sake of others, such as fam-
ily and friends.
. Sensory: The campaign appeals to one or more of the viewer’s five senses,
suggesting that the use of the product can allow the viewer to enjoy plea-
sure in relation to one’s five senses.
. Routine: The ad encourages the viewer to develop regular, good habits
such as regular excise and=or states the positive effects when the product
is consumed regularly.
. Acute need: The ad urges the viewer to get familiar with an illness that may
affect them or with a product that can solve the problem, and=or take
immediate actions to address a health problem that she or he might not
otherwise take time to consider.
. Ration: The ad provides information about an illness or health condition as
well as the effects and uniqueness of a medicine. However, it is important
to note that drug advertisers are required by the FDA to state the most
important risks and side effects as well as alternative methods of acquiring
information in their television commercials. Therefore, an ad is coded as
using the ration-based strategy only when the non-mandatory information,
such as additional research statistics, explanations of the medical condition,
or the drug’s competitive advantage, is also provided.

In order to ensure intercoder reliability, both coders first coded 35%

of the commercials. Disagreement in coding was resolved by discussion
between the two coders. The intercoder reliability coefficient calculation
formula proposed by Perreault and Leigh (1989) was used as a rigorous test.
The intercoder reliability for the overlapping commercials averaged 89.8%,
exceeding the acceptable level suggested by Perrault and Leigh. Upon estab-
lishing acceptable intercoder reliability, the coders then coded the remaining
samples independently.

RESULTS

The sample contained 96 DTC commercials that promote a specific branded

drug. The DTC commercials in the sample varied in length: 10 (10.4%) were
246 W.-H. Tsai and A. R. Lancaster

30 seconds, 80 (80.3%) were 60 seconds, and 6 (6.3%) were longer than 60

seconds. Because most commercials collected in this sample were searched
using the brand names of the top-100 selling, no health-seeking ads were
included. There were only 4 (4.2%) reminder ads that mentioned the brand
name but did not include product claims.
Findings suggest that testimonial is commonly used by DTC advertising
that up to 38.5% of the commercial analyzed featured either an average
consumer or celebrity endorser as a satisfied user who explain the drug uses
and its efficacy. Not many DTC commercials feature doctors in their content.
Only 14 spots (14.6%) featured a doctor, and among these commercials, only
half of them depicted the doctor as the lecturer to address the audience about
product effects and risk information. Each of the 96 commercials was
analyzed on the basis of the message strategy used as per Taylor’s strategy
wheel. Table 1 summarizes campaigns that used transmission versus ritual
views and Table 2 provides a summary of the frequency of each message
strategy used.
Since reminder ads do not present product-specific information, it made
sense that all of the reminder ads adopt a message strategy that is located on
the ritual dimension. Without featuring drug claims, these reminder ads were
intended to appeal to the view’s private fantasy world through emotional or
sensory appeals. To be specific, two used an ego strategy, one social, and
one sensory. For instance, in a Celebrex reminder commercial, the voiceover
praised the spring time for enjoying outdoor picnic, leisurely stroll, while the
ad showing a middle-aged couple savoring the delights of spring in a pictur-
esque setting, appealing to sensory pleasures. The ad ends by wishing
viewers a happy season and reminding viewers to talk to your doctors about
Celebrex. Another reminder ad showed a grandpa helping his grandson ride a
children’s bicycle for the first time without the training wheels. The voiceover
indicated ‘‘Aren’t there enough reasons in your life to ask your doctor about
Zocor?’’ as the audience see the grandpa proudly watching the little boy cruis-
ing away, revealing a social-based message strategy.
For commercials that feature explicit product claims, the majority of the
commercials adopted a combination strategy (77.2%). A typical combination
is providing consumers with medical and drug information using the ration
approach while appealing to the viewer’s ego-related needs and desires

TABLE 1 Ritual Versus Transmission Views

Ritual view Transmission view Combination

Message Total
strategy Frequency % Frequency % Frequency % commercials

Reminder 4 100.0 0 0 0 0 4
Product claim 4 4.3 17 18.5 71 77.2 92
Totals 8 8.3 17 17.7 71 74.0 96
 Message Strategies of DTC Commercials 247

TABLE 2 Percent of Message Strategies Used by Campaign Type

Message strategy Reminder (n ¼ 4) Product claim (n ¼ 92) Total (n ¼ 96)

Ego 50.0 (n ¼ 2) 77.2 (n ¼ 71) 76.0 (n ¼ 73)

Social 25.0 (n ¼ 1) 15.2 (n ¼ 14) 15.6 (n ¼ 15)
Sensory 25.0 (n ¼ 1) 11 (n ¼ 12) 13.5 (n ¼ 13)
Routine 0 26.1 (n ¼ 24) 25.0 (n ¼ 24)
Acute need 0 20.7 (n ¼ 19) 19.8 (n ¼ 19)
Ration 0 92.4 (n ¼ 85) 88.5 (n ¼ 85)

(i.e., pursuing personal goals without worrying about or being hindered by a

medical condition) through the ad narratives and imagery. Only four
commercials (4.3%) used a ritual-only strategy while 17 ads (18.5%) utilized
a transmission-only strategy.
In terms of specific message strategies, the most widely used approach
was ration-based (92.4%). These commercials were intended to persuade the
audiences through logic and reasoning. It is important to note that, in
addition to the required ‘‘major statement’’ summarizing the key warnings
and side effects, most DTC commercials in this sample indeed provided
key pieces of medical and drug information, such as the cause of certain
medical conditions, precursors, symptoms, and prevalence. Overall, the pur-
pose of most DTC commercials appears to be about educating consumers
about the medical condition and the brand being advertised.
Another frequently employed strategy is ego-based (77.2%). These
campaigns stressed how taking the drug would make the viewer feel better
about him=herself, improving their life quality, or allowing the consumers
to actualize their lifestyle goals. For instance, in a commercial for a heartburn
relief medicine, a father addresses to the camera as he disciplines his children
to finish up eating vegetables and doing homework. He then described his
acid reflux problem that he thought was under complete control using a prior
drug until his doctor told him about the advertised brand. The character was
then seen proudly standing with his children as his voice announced, ‘‘I told
them that you should not do anything halfway,’’ suggesting that the drug
allows him to effectively cure his medical problem and making a clear state-
ment about his self-image as the ‘‘finisher.’’ Another example is a prescription
medicine commercial for treating an enlarged prostate. The ad features a
group of middle-age men on a mountain-biking trip, enjoying the great
outdoor as the voiceover assertively announced: ‘‘Here’s to men. To guys
who want to spend more time having fun and less time in the men’s room,’’
attempting to appeal to male viewer’s self-image as a masculine, active,
adventurous ‘‘real men.’’ These commercials stresses how taking the medicine
would make the viewer feel better about him=herself and often used emotion-
al appeals to persuade the viewer to take action.
In contrast to ration and ego strategies, other approaches including rou-
tine (26.1%), acute need (20.7%), and social (15.2%) are relatively uncommon.
248 W.-H. Tsai and A. R. Lancaster

Commercials that incorporated the routine strategy reminded consumers of

the importance of exercising regularly and eating healthy, as well as taking
the advertised medicine regularly to improve health. The acute need strategy
assumes that although consumers would like to have more product infor-
mation before they make a purchase, the pressing need to solve a problem
overrides their information demand. Yet, given the critical, and in some cases,
lethal implications of taking or not taking the drug, prescription medicine is
clearly a high-involvement product that consumers are less likely to make a
purchase decision based on availability or familiarity. Also, consumers’ abrupt
need for a prescription drug is relatively rare. Therefore, it is not surprising that
acute need strategy was adopted by only 20.7% of the commercials. A relevant
example is a drug commercial for Alzheimer’s disease. In the ad story, a
middle-aged woman visits her mom with her husband and children and says,
‘‘Every Sunday, lasagna at Mom’s was a family tradition.’’ Yet when they walk
into the living room, she found her mother complete forgetting about the
Sunday tradition, looking frail and confused. The daughter was alarmed by
the early signs of dementia, as we hear her comments on her moment of epi-
phany: ‘‘That’s when I knew I couldn’t wait.’’ Combing strategies of ration and
acute need, the ad goes on stating the uses and effectiveness of the advertised
drug, and ends by highlighting the urgency of the medical problem: ‘‘Don’t
wait, Alzheimer isn’t waiting.’’
The social strategy is used by only 15.2% of ads. Such commercials
typically remind the viewers that they should take care of their health for their
family members (i.e., ‘‘Now I have Advair, I can enjoy the zoo with my grand-
son’’). Ads using this strategy also reminded audiences that their illness
impacts many others around them. A good example is a commercial for
Cymbalta that treat major depressive disorder. The ad, known for its slogan
‘‘depression hurts,’’ shows a sepia-toned video montage of sorrowful faces
whose lives are impacted by individuals who suffer from depression, includ-
ing a little girl being neglected by her ill mother, a husband being ignored at a
lonely dinner table, and a dog waiting for his owner with a longing look. After
explaining how the drug is designed to treat the disorder, the second part of
the commercial then shows the mother taking her children out to a park
eating ice cream, the now active dog owner leaves the house to walk his
dog, and various individuals happily socializing with friends. The commercial
is thus is designed to remind the viewers of what impact their illness has on
others around them. Additionally, ads using a social strategy can demonstrate
how using the advertised drug can help the viewer make a positive statement
to others, which can be illustrated by a Detrol commercial. The ad features a
beautiful middle-age woman who is attending her spouse’s company annual
BBQ party and feels anxious with her constant worry that her bladder control
problem can be noticeable to others. The ad later shows the woman confi-
dently engaging in conversations in a black-tie event, finally feeling comfort-
able with how she is seen by others.
 Message Strategies of DTC Commercials 249

The least common message strategy was sensory, which was used in only
11 (12%) of the commercials. These commercials emphasized that taking the
advertised drug can allow the user to enjoy pleasures in relation to the five
senses, such tasting food one loves. For instance, in an Advair commercial
(a drug that prevents asthma), a woman talks about her frustration of having
to avoid parks on her way to work because of her asthma. Later in the ad story,
she is shown inhaling fresh air as she walks through a beautiful park. Her
voice then announces: ‘‘Since I started using Advair, I have fewer days with
asthma symptoms and more time to stop to smell the roses.’’ Other examples
include a series of allergy medicine commercials that present animated, stimu-
lating visual effects, such as spinning colorful daisies, when the voiceover
explains the drug benefits and common side effects.
Although two thirds of the product-specific commercials adopted a com-
bination approach, mostly pairing ration with other strategies, a few commer-
cials did not include informative content other than the required statement of
major risks. Such examples include a series of ‘‘Viva Viagra’’ commercials that
depict a group of musicians singing and saluting the blue pill, and a Seroquel
(a drug for bipolar depression) commercial that present highly vague state-
ments like ‘‘when you are living with bipolar depression, it is easy to feel that
you are fading into the background. That’s because bipolar depression
doesn’t just affect you. It can consume you,’’ with no other information in
relation how the drug can help get the symptoms under control.
Among the four types of DTC-specific product attributes, effectiveness is
clearly the most widely stated claim (87.5%, n ¼ 84), followed by appeals of
social-psychological enhancements (56.3%, n ¼ 54). Attributes of safety and
ease of use are relatively uncommon, stated by 16.7% and 8.3% of commer-
cials, respectively. To be more specific, the frequencies for the effectiveness-
related drug attributes were: ‘‘effective’’ (63.5%), ‘‘cure’’ (43.8%), ‘‘symptom
control’’ (31.3%), ‘‘prevention’’ (27.1%), ‘‘innovative’’ (20.8%), ‘‘dependable’’
(13.5%), ‘‘powerful’’ (11.5%), and ‘‘reduced mortality’’ (7.3%). The percentage
of commercials using each of the social-psychological benefit claims was:
‘‘lifestyle enhancement’’ (51.0%), ‘‘psychological enhancement’’ (41.7%),
and ‘‘social enhancement’’ (4.2%). The percentages of ease of use attributes
were: ‘‘convenience’’ (7.3%), ‘‘quick acting’’ (6.3%), ‘‘economical’’ (2.1%),
and ‘‘easy on system’’ (1.0%). The percentages for safety-related claimed attri-
butes were: ‘‘natural’’ (4.2%), ‘‘safe’’ (3.15%), ‘‘nonmedicated’’ (1.0%), and
‘‘nonaddictive’’ (1.0%). Overall, DTC commercials focus on the product
attributes that are the most beneficial to the consumer, such as effectiveness,
lifestyle (i.e., allowing a more active, normal life) and psychological
enhancements (i.e., increasing feelings of confidence, happiness, and relief
of fears).
In order to gauge whether certain drug attributes tend to be associated
with specific message strategies, Table 3 illustrates the relationship between
the taxonomy of drug-specific product claims and Taylor’s six-segment
250 W.-H. Tsai and A. R. Lancaster

TABLE 3 Relationship Between Types of DTC-Specific Attributes and Message Strategies

Ritual view Transmission view

Sensory Routine Acute

Attributes Ego (%) Social (%) (%) (%) need (%) Ration (%)

Effectiveness 65 (89.0) 13 (86.7) 7 (58.3) 24 (100) 19 (100) 81 (95.3)

Social-Psych 46 (67.0) 12 (80.0) 5 (41.7) 11 (45.8) 13 (68.4) 50 (58.8)
Enhancements
Ease of Use 12 (16.4) 1 (6.7) 2 (16.7) 8 (33.3) 0 16 (18.8)
Safety 7 (9.6) 1 (6.7) 1 (8.3) 3 (12.5) 1 (5.3) 6 (7.1)
Note. Percentage reflects the column (within each message strategy). Totals for each column are greater
than 100% because many ads contained more than one product attributes.

strategy wheel. Findings indicate that commercials based on strategies

located on the transmission side are most likely to contain effectiveness-
related product claims, although 50% or higher of the commercials using stra-
tegies of the ritual side also present effectiveness attributes, probably because
strategies of ego and social are commonly combined with the ration-based
strategy. It is particularly true for routine and acute need strategies that all
of the ads that adopt these two approaches promoted the drug as ‘‘cure,’’
‘‘proven to work,’’ or being able to ‘‘control or prevent symptoms,’’ while
95.3% of ration-based commercials also include drug claims of efficacy. As
expected, in order to inform and persuade consumers through reasoning,
advertisers strategically provide consumers with product information that
highlight the effectiveness of the advertised drug. In addition, the routine
strategy assumes that purchase decisions are made on the basis of rational
motives but consumers’ purchase behavior is largely based on habit without
much deliberation and thus advertising appeals in this segment emphasize
convenience, ease of use, and product efficacy (Hwang 2003). Findings
confirmed this theorization that all of the ads using the routine strategy incor-
porated claims of product effectiveness, and 33.3% highlighted the ease of
use (i.e., convenience or economical), while many of them also contained
lifestyle and psychological appeals.
Some associations between attributes of social-psychological enhance-
ments and Ritual-based strategies were found. In particular, 64.3% of ads
using the ego message strategy presented drug claims of allowing for a
more active, normal, or free life (i.e., ‘‘Because of Enbrel, I am enjoying
things again’’), and 70.3% of them include stories and imagery that suggest
the benefits of increasing feelings of confidence, happiness, and relief of
fears (data not shown). Similarly, 80% of ads using the social message strat-
egy contained benefit claims for enhancing an active, regular lifestyle that
allows the users to take care of their family or have an active social life
(data not shown).
 Message Strategies of DTC Commercials 251

CONCLUSIONS

The purpose of this study was to understand the message strategies used in
DTC pharmaceutical commercials by applying Taylor’s (1999) six-segment
message strategy wheel. Different from advertisements promoting typical
consumer goods, DTC commercials are required to provide negative product
information including risks and contradictions, resulting in lengthy commer-
cials that consumers tend to avoid. As one of the first research attempts to
understand the message strategies employed by DTC commercials, findings
presented here shed insights on the nature of DTC advertising and advance
our understanding of an important advertising phenomenon.
The results suggest that reminder ads which were used by advertisers to
avoid the requirement of providing negative information about drug risks
and adverse effects (Bunis, 2000) can be confusing and even meaningless to
consumers who are not familiar with the advertised brand since no direct refer-
ences to the drug uses are provided. Therefore, unless the advertised medicine
has been a well-known market leader, reminder ads should be avoided.
In term of product-specific DTC commercials, the majority of them used
a combination approach incorporating strategies from both the transmission
and ritual views, with the pairing of ration and ego strategies being most
dominant. This indicates that the integration of factual information with
emotional connections to the health concern is a common tactic used in
DTC commercials. Given that the length of most DTC commercials is sixty
seconds long, advertisers can influence consumers by both providing per-
suasive information and persuading them through emotional and psycho-
logical appeals. The combination approach of ration and ego can be the
most effective strategy as prior research suggests that an integrated approach
often works well in health promotion (Benady, 2006).
Even with the mandatory information required by the major statement
guideline that can easily take half of the commercial time, the ration strategy
was adopted by more than 90% of the commercials. Most ads included
additional information such as source and prevalence of the medical problem,
common symptoms, and how the treatment works. Therefore, the educational
value of DTC commercials should be recognized. Besides ration, the most
common message from the transmission side is routine, which is used by
roughly a quarter of the ads analyzed. These ads advocated regular use of
the drug to cure the medical condition or control the symptoms. The least used
transmission strategy is acute need, which is again often paired with ration to
urge the viewer to take immediate actions to take care of the health problem.
The most widely used strategy from the ritual side is the ego strategy. As
an individual’s health condition has a direct and critical impact on his=her life
and self-image, about two quarters of commercials demonstrated how the
advertised drug can help consumers to realize their self-perception of who
252 W.-H. Tsai and A. R. Lancaster

they are (i.e., a dedicated runner who is not intimidated by outdoor

allergens) or who they want to be.
However, although commercials using strategies solely on the ritual side
were relatively rare, these DTC commercials attempted to appeal to consu-
mers using abstract, intangible psychological benefits and emotional appeals
without educating consumers about the medical conditions and their treat-
ments. Such commercials are alarming signs of the potential misleading
effects that DTC commercial can cause. A particular case is Cymbalta’s
‘‘Depression Hurts’’ commercial that was heavy with its emotional appeal.
Although the drug is intended for treating major depressive disorder and
the associated physical pain, the ad narratives focus on how many other
people are impacted by the individual who suffer from depression, thus
may confuse consumers as to what it actually treats. Yet, according to
Nielson, this spot was the second most-recalled pharmaceutical ad of 2008
(Brand Week 2009). Future research investigating the effects of ritual-based
message strategies on consumer’s information comprehension and brand
recall thus is imperative.
Only a few DTC commercials were found to use a sensory strategy
but these were coupled with the ration approach. Given the nature of pre-
scription medicine being a high-involvement product, health issues do not
naturally lend themselves to stimulation of the five senses, but rather on
ration-based messages in order to meet consumers’ need of information as
well as ego-based messages of improving one’s health and lifestyle. Different
from traditional consumer goods such as ice cream or perfume that can be
promoted as ‘‘life’s little treats,’’ pharmaceutical products are not consumed
for sensory pleasures per se, but instead, ads using the sensory strategy
stressed how taking the medicine would allow consumers to enjoy pleasures
in relation to one’s five senses.
Research question three asked what kinds of drug-specific claims are
most common in DTC television commercials. In general, drug claims of
efficacy, cure, prevention, and symptom control were found to be prevalent
while claims of assisting the viewer to live a active normal life and boosting
feelings of confidence and happiness were also dominant.
Overall, the findings presented in this study suggest that Taylor’s model
provides a very useful model for an in-depth understanding of how pharma-
ceutical advertisers designed their messages in the attempts to persuade con-
sumers. Despite the unique nature of prescription drugs and the distinctive
content requirement of DTC commercials, the results illustrates the flexibility
and utility of this model for identifying message strategies for an unconven-
tional product category—prescription drugs. The coding scheme may offer
other researchers helpful guidelines in how to apply the strategy wheel to
an analysis of health-related marketing communications. Findings also indi-
cate that advertisers of pharmaceutical products can benefit from using this
model as a foundation for crafting DTC commercials.
 Message Strategies of DTC Commercials 253

This study provides one of the first empirical investigations to systemati-

cally analyze message strategies used in DTC drug commercials. The strengths
and limitations of this study should be considered in interpreting the research
findings. This study used a descriptive content analysis, and hence did not
examine which message strategy is more effective in inducing positive brand
attitude or enhancing information comprehension and retention. In addition,
rather than using a random sample, this study analyzed a convenience sample
drawn from both prime-time broadcasts on major networks, online commer-
cial archive, and video sharing Web site. Therefore, the generalizability of the
study is clearly limited. It is imperative for future studies to collect sample
from an extended period of time and beyond primetime broadcasts on
network television, especially when many DTC commercials may target elder
consumers who may prefer certain cable channels. Future studies should also
go beyond the descriptive scope of this study to examine the relationship
between message strategy and different drug types, such as drugs for
emotional disorder versus physical conditions. Prescription drug commercials
directed to consumers, as it appears on television today, has only been
made possible since 1997. As a relatively new advertising phenomenon, it
is possible that the message strategies used may change over time. Longitudi-
nal studies to detect changes and trends thus are necessary.

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