Discussion
depression, ambiguous behavior, depressed
Among the arguments frequently used by advocates of DTCA for prescription drugs, there is the claim that the devices used for this type of advertising, videos foremost, will increase consumers’ knowledge and empowerment. We tested these assumptions in a survey experiment and did not find evidence to support them.This study found mixed evidence for hypotheses 1 and 3. We found that the combination between written information and exposure to a DTCA video increases the general level of knowledge of individuals, but also that participants exposed to the DTCA-only condition showed lower depression literacy compared to that of participants exposed to the sheet-only condition. Moreover, when considering the various subdimensions of knowledge, the exposure to the video increased only the ability to correctly identify the knowledge of side effects. When knowledge about treatments and symptoms prevalence were considered, we found that written information resulted in a greater increase in individuals’ knowledge than the exposure to the DTCA video.When empowerment was considered, the three conditions of the experimental design did not influence any of the subdimensions (ie, autonomy in managing depression, autonomy in the ability to get an antidepressant, and autonomy in decision-making and asking for help to a physician). This means that hypothesis 2 could not be confirmed.The present experimental study took, as its starting point, the claim that health care consumers gain medical knowledge of their condition and, importantly, its treatment via exposure to commercials about drugs. Our study did not produce substantial evidence in favor of the claim. The capacity of DTCA videos to improve knowledge, via a single exposure, does not emerge as in any way superior to a single exposure to a traditional mode of conveying information. A single exposure to a DTCA is therefore not an effective vehicle for increasing the knowledge of consumers; rather, the combination of information presented in a video and in a text is the best solution to increase people’s knowledge. Compared to other studies in the literature [The second general result is that, in contrast to the variety of effects in depression literacy, there were no effects at all in the empowerment measure. This might be a consequence of the measure employed. Some of the items in the measure formulated self-perceptions that are very much unlike anything a depressed person might feel (eg, feeling ready to face depression or feeling confident to manage depression). Other items were worded as confirmation of the respondents’ decision to ask for help to a physician. Seeking professional help is an ambiguous behavior in relation to the concept of empowerment. It can describe a case of a person who has to overcome resistance before seeing a specialist but it can also indicate insight into the limits of one’s capacity to help oneself.This study has some limitations. First, all the measures were self-reported, and especially the empowerment scale has received little evidence of validity. Second, the experiment was conducted in Italy; therefore, the results cannot be generalized to other countries at this time and future research will be needed to extend the results to other geographical areas. Third, we assumed that baseline values of knowledge and empowerment were equal across groups due to randomization; however, without baseline measures of these variables, the claim could be fallacious. Fourth, although the content of the DTCA and the information sheet were comparable, some differences in the information presented in the commercial versus the information sheet may have influenced the results on the knowledge subscales. Another limitation includes the fact that we measured whether a Our study provides evidence that traditional written information conveys knowledge on treatments for depression, symptoms, and prevalence better than DTCA videos. The separate measure of depression literacy also declined considerably after exposure to a DTCA video. The positive effect of DTCA on the side-effects knowledge may be triggered by a special focus on side-effects information included in the video. Finally, no effects were found on empowerment.This study can serve as a starting point to create an effective and efficient strategy based on the development of health materials. The European Union voted against the liberalization of DTCA in the member countries. One can argue that lifting this ban on DTCA for prescription drugs would determine a positive influence on patients’ treatment decision-making in searching for help. However, lifting the ban would mean weakening the fundament of such decisions, since our study shows that the claimed compensation for such a weakening, increased depression literacy, will not materialize. Nevertheless, the balance remains negative.Conflicts of Interest: None declared.Description of the experimental manipulation. Factor analyses on the depression knowledge scale and the empowerment scale.Data set.