FIRST IMPRESSIONS: “WHAT DO YOU THINK OF WHEN YOU HEAR THE WORDS SIDE EFFECT?”

Purpose: Side effects can prompt patients to forego otherwise-beneficial therapies. Although much research examines how patients deliberately weigh a specific medication’s risks and benefits, little is known about whether automatic beliefs about side effects generally might predispose people to perceive medications as exceptionally risky. To begin to address this gap, we examined spontaneous mental associations with the term “side effect.”

Method: Women (n=144) aged 40-74 years were recruited from a participant registry for an online survey about side effect perceptions. We examined responses from the open-ended question “What are the first three things you think of when you hear the words ‘side effect?’”  Data were analyzed using content analysis, chi-squares, and t-tests.

Result: 17 codes were identified.  In decreasing frequency they were: Evaluating Risks (36%), Health Problems-Specific Symptoms (35%), Health Problems-General Terms (33%), Affect/Emotions-Strong (19%), Severity (18%), Affect/Emotions-Mild (16%), Health Problems-Worsening Health (12%), Inability to Take Medication (11%), Health Problems-Permanent Effects (10%), Side Effects are Rare (9%), Responsive Actions (8%), Want More Information (7%), Doubt Medication Efficacy (5%), Legal/Marketing Considerations (4%), Side Effects are Expected (4%), and Considering Alternative Options (2%).  Responses unrelated to these codes were categorized as Other (7%).

The contents of responses were relatively similar across demographic characteristics (ps>.05), with a few exceptions. Responses from older (vs. younger) participants more frequently mentioned Severity (p=.01), Health Problems-Specific (p=.01), and Health Problems-General (p=.05). Non-Hispanic white (vs. non-white) participants gave responses more frequently coded with Affect/Emotions-Mild (p=.004). Responses categorized as Other were more common among participants without any college education than those with at least some college experience (p=.03). Among participants who reported ever experiencing a side effect (n=117), those whose first thoughts were coded as Specific Symptoms reported experiencing more serious side effects than those without a Specific Symptoms response (p=.01).  However, no other codes were related to differences in the seriousness of side effects participants reported experiencing (ps>.05).

Conclusion: Spontaneous mental associations with the term “side effect” focused primarily on evaluating risks vs. benefits, identifying health problems caused by the medication, and expressing affective/emotional reactions.  Reactions seldom varied by demographic characteristics, which may facilitate patient-provider treatment discussions. Closer examination of side effect perceptions among individuals with less formal education is warranted, as is research that examines whether spontaneous associations predict treatment decisions.