Many questions, not so many answers

Editor’s note: Tara Olson and Sherrie Aycock are owners of AllPoints Research, Inc., Winston-Salem, N.C.

In June 2004, our firm, AllPoints Research, completed a study into women’s health issues. The first phase was a quantitative survey that asked women between the ages of 40 and 54 about health issues in general, and sexual health in particular. Our second phase was a qualitative study that used focus groups to raise questions and test the phase one results within ethnic populations.

We developed the study for two reasons: curiosity and methodology. Given that the vast majority of women who responded to the quantitative survey (92 percent) were Caucasian, it was clear that the opinions and attitudes of minority women over the age of 40 were not sufficiently represented in that research. The owners and staff of AllPoints (a woman-owned company) were curious to know how women of color felt about a variety of health issues, including sexual health and the marketing of pharmaceuticals, so a follow-up qualitative phase of research was conducted among ethnic women.

The final analysis brought several issues to the forefront: direct-to-consumer (DTC) marketing, sexual health, information resources, and a doctor/patient disconnect that was a common thread throughout.

Direct-to-consumer marketing

Many women who participated in the quantitative research study felt that DTC advertising conducted by drug companies is beneficial to the public. Evidence of this impression among women of color was further supported in the qualitative study. Many of the women of color interviewed appreciated DTC marketing primarily because it is a quicker, more efficient way of getting important information out, such as pharmaceutical availability, applications and possible side effects, to large numbers of consumers. Study participants also mentioned that DTC marketing provides health and drug-related information directly to consumers and allows each individual to have greater control over their personal health choices and decisions.

Discussion regarding the extent to which current DTC initiatives effectively target women of color tended to evoke a mix of perspectives. Some participants felt that, while they have observed an increasing trend of DTC advertising that effectively targets women of color, this is still an area for improvement.

For many of the women participating in the qualitative study, the degree of realism expressed in the message was more important than was the emphasis on one’s particular ethnicity. Participants said that they’d respond to marketing that showed everyday people doing everyday things, not models to which none of them can relate.

Some ethnic women may be tuning out the messages or dismissing them altogether when DTC advertising focuses on a very specific health condition (e.g., diabetes, high blood pressure, etc.) rather than more general health issues (e.g., weight, healthy diet).

A need was identified for a greater representation of minority women in clinical trials and a more concerted effort to identify potential pharmacokinetic differences as a function of ethnicity. Women of color in the study tended to express concern about how various drugs would impact women of their own ethnicity, especially when high-profile medications such as Vioxx are pulled off the market because of harmful side effects.

Women of color also stated that the DTC information frequently provides consumers with more information (e.g., about possible side effects, possible contraindications) than they are able to easily obtain from their physicians. This is an example of the doctor/patient disconnect shown again and again in the study. Focus group participants didn’t feel comfortable asking their doctors for such information and didn’t trust that their doctors would take the time to discuss options and side effects them.

Sexual health

The quantitative portion of the study carefully examined women’s feelings about their partners’ use of erectile dysfunction products, about their own sexual health, and about how they relate with their doctors on the subject.

Women whose male partners and husbands use erectile dysfunction (ED) products - such as Viagra, Levitra and Cialis - felt overwhelmingly positive about the experience. Of the 712 women surveyed, 88 percent of women whose partners are currently taking an ED product were glad that their partners had decided to use the products; 72 percent said that they played a role in the decision; and 67 percent said that the products have enhanced their romantic lives.

On the other hand, 24 percent of women whose partners are currently taking a product for erectile dysfunction didn’t feel that the use of the product was necessary and 28 percent felt that there was “more pressure to perform sexually” now that their partners were taking an ED product.

When it comes to their own personal sexual health, women in general have a tendency to avoid such a sensitive subject when speaking with their doctors and/or partners. Women of color specifically cited several factors, such as embarrassment and uncertainty about the causes of the problem. Many women participating in the qualitative research indicated that they didn’t feel that sexual health issues like vaginal dryness or decreased libido were medical problems; they are simply the result of getting older or lack of interest in their partners. However, findings from the quantitative research show that women whose partners were already under treatment for sexual dysfunction felt more comfortable discussing these sensitive subjects with their physician. These women were likely to or had already discussed their own sexual health with their doctors (see Figure 1). Also, women with a high level of education (master’s degree or higher) were more likely to look to their doctors for such information.

Hispanic women in the focus groups indicated that their cultures were strongly against the discussion of these subjects, especially with an authority figure like a doctor.

In another example of the doctor/patient disconnect, single women older than 40 surveyed in the quantitative phase tend to disregard their doctor’s warnings about safe sex. While these single women say that their doctors consistently advise them to practice safe sex, they still do not talk with their partners about their sexual histories (Figure 2) and many are not concerned about contracting a sexually-transmitted disease. Some of the women of color participating in the qualitative research attributed this to their feeling that asking questions of their partners could put their relationships in jeopardy. These women were unaware that older women are the fastest-growing group of people diagnosed with HIV in the U.S.

 

Info rmation sources

Ethnic women in the U.S.  tend not to depend on their physicians as a primary source of health information. Instead, women of color cite friends and family, the Internet, books and patient education handouts as primary information sources. Many of the women of color interviewed in the study appear to place even greater reliance on non-physician sources of information when seeking information and answers to matters pertaining to their sexual health.

Of note, several women (across different focus groups) spontaneously mentioned their use of Internet-based discussion forums when they had health-related concerns of a more sensitive nature. Descriptions of these more “structured” forums (i.e., with real-time moderation by a health care professional) that allow the individual to express her concerns and questions in a safe and anonymous environment frequently prompted reactions of interest and enthusiasm among other focus group participants. Also of note, women participating in the quantitative phase of research indicated that they rely heavily on the Internet as a source of information for health-related questions and concerns. Several women (across several of the discussion groups) also identified their insurance providers as a key resource for health information. The women who did seek out advice from medical professionals on these issues were women with other chronic health issues that required regular physician visits.

At least two women (in two different groups) expressed a need for some kind of resource (e.g., a pamphlet or brochure) that provides information regarding the health-related changes a woman should expect at different stages of her life and identifies specific health areas that warrant particular attention at different life stages. Perhaps such a resource could also help women properly “frame” a health condition they are experiencing.

Methodology

For the quantitative phase of the study, AllPoints administered a Web-based survey to 712 women. Results are subject to a maximum sampling error of + 3.67 percent at the 95 percent confidence level. Women were invited to participate and sent a link to the Web study via e-mail. All participants were over the age of 40.

The qualitative phase consisted of four focus groups, each with five African-American women and one Hispanic woman. The findings are considered to be a valuable source of additional information and anecdotal evidence - not precise data that can be extrapolated across entire populations.