How affiliation disclosure and control over user-generated comments affects consumer health knowledge and behavior: A randomized controlled experiment of pharmaceutical direct-to-consumer advertising on social media

Background: more people are seeking health information online than ever before and pharmaceutical companies are increasingly marketing their drugs through social media. objective: the aim was to examine two major concerns related to online direct-to-consumer pharmaceutical advertising: (1) how disclosing an affiliation with a pharmaceutical company affects how people respond to drug information produced by both health organizations and online commenters,and (2) how knowledge that health organizations control the display of user-generated comments affects consumer health knowledge and behavior. methods: we conducted a 2×2×2 between-subjects experiment (n=674). all participants viewed an infographic posted to facebook by a health organization about a prescription allergy drug. across conditions,the infographic varied in the degree to which the health organization and commenters appeared to be affiliated with a drug manufacturer,and the display of user-generated comments appeared to be controlled. results: affiliation disclosure statements on a health organization's facebook post increased perceptions of an organization-drug manufacturer connection,which reduced trust in the organization (point estimate -0.45,95% ci -0.69 to -0.24) and other users who posted comments about the drug (point estimate -0.44,95% ci -0.68 to -0.22). furthermore,increased perceptions of an organization-manufacturer connection reduced the likelihood that people would recommend the drug to important others (point estimate -0.35,95% ci -0.59 to -0.15),and share the drug post with others on facebook (point estimate -0.37,95% ci -0.64 to -0.16). an affiliation cue next to the commenters' names increased perceptions that the commenters were affiliated with the drug manufacturer,which reduced trust in the comments (point estimate -0.81,95% ci -1.04 to -0.59),the organization that made the post (point estimate -0.68,95% ci -0.90 to -0.49),the likelihood of participants recommending the drug (point estimate -0.61,95% ci -0.82 to -0.43),and sharing the post with others on facebook (point estimate -0.63,95% ci -0.87 to -0.43). cues indicating that a health organization removed user-generated comments from a post increased perceptions that the drug manufacturer influenced the display of the comments,which negatively affected trust in the comments (point estimate -0.35,95% ci -0.53 to -0.20),the organization (point estimate -0.31,95% ci -0.47 to -0.17),the likelihood of recommending the drug (point estimate -0.26,95% ci -0.41 to -0.14),and the likelihood of sharing the post with others on facebook (point estimate -0.28,95% ci -0.45 to -0.15). (all estimates are unstandardized indirect effects and 95% bias-corrected bootstrap confidence intervals.) conclusions: concern over pharmaceutical companies hiding their affiliations and strategically controlling user-generated comments is well founded; these practices can greatly affect not only how viewers evaluate drug information online,but also how likely they are to propagate the information throughout their online and offline social networks.