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How does repetition work?

As we have mentioned in a previous chapter, we tend to react initially with mild discomfort to anything or to anyone new. But, with repeated exposure we become desensitized and our anxiety decreases. After frequent contacts with a new stimulus, the stimulus becomes more familiar and less threatening, which in turn leads to habituation, and eventually to a gradually more positive evaluation of the stimulus.

Similarly, the more times an opinion is heard, the more comfortable the recipient will become with it. In a vacuum, where no or few competing opinions are present, familiarity also seems like popularity. In some instances, that can give recipients a misplaced sense that the opinion is more widespread than it actually is.

Although not always a panacea, repetition can act as a very powerful persuasive tool when used properly. Certain conditions enhance the effect of repetition on liking and persuasion, while others act to limit its usefulness [4]. Here are some of the points and nuances to consider about repetition and the mere exposure theory:

  • The mere exposure effect is enhanced when the stimuli are presented for shorter periods of time. Also, repetition works better when the message is presented in a heterogeneous, rather than a homogeneous, exposure context. For example, when a word like ‘afworbu’ appears with different types of words, it is evaluated more favorably than when it repetitively and monotonously follows itself.
     
  • Repeated exposure is more suited for stimuli or messages that are complex. According to psychologists, complex stimuli gain in ‘hedonic valence’ or perceived attractiveness over the course of a number of exposures. By contrast, simple stimuli begin to bore people after fewer exposures. Similarly, increasing the frequency of exposure to an already familiar stimulus is unlikely to increase the likeability for the stimulus much further. For example, citizens are usually quite familiar with their country’s flag and (in most instances) have positive attitudes toward it. Showing them the flag a few more times would probably do little to enhance their positive evaluations of it. Similarly, if a doctor is already prescribing a drug and is happy with its performance, exposing him to repetitive messages about the drug will unlikely cause him to rate the drug any higher.
     
  • TV ads seem to best incorporate the principles of the exposure-affect relationship listed above: they are typically fairly complex and interesting (albeit with relatively simple messages), fairly brief (15 to 30 seconds), and presented in a heterogeneous exposure context (i.e., broadcast in various TV programs and episodes, and interspersed with other advertisements and announcements).
     
  • Mere exposure exerts particularly strong effects when the stimuli are neutral or unfamiliar, rather than intrinsically pleasant or unpleasant. This principle holds true, for instance, in U.S. election campaigns where political newcomers and individuals holding low-visibility states offices (e.g., lieutenant governor, secretary of state) competed and where candidates who spent the most money on advertising were most likely to win the election [5].
     
  • When the objective of a promotional campaign is to create short-term maximum awareness (e.g., for a seasonal product or a limited-time offer), a burst of closely-timed exposures would be appropriate. On the other hand, if the goal is to create long-term awareness and enduring likeability, spread-out exposures will usually yield better results.
     
  • The effects of repetition vary according to the recipient’s level of involvement in the search for information. Learning and information search under a situation of ‘low involvement’ occur when the individual has little or no motivation to learn about a given product (e.g., the doctor has little interest in or use for a given drug, the product’s use and indications fall outside the doctor’s specialty or expertise, or the product carries very little risk). In ‘high involvement’ learning, the consumer, or the doctor in our case, is very motivated to carefully search for and assess relevant information (e.g., the doctor has many patients who are resistant to existing drugs, or the drug has serious potential risks).
     
  • Under conditions of low involvement, repetition alone is unlikely to produce strong retention of learned material. Conversely, in high-involvement situations, two or three exposures to a stimulus (like an ad or a sales message) may be sufficient for later recall. Among children, a single exposure to a commercial can produce a full effort in the direction of obtaining the advertised toy.
     
  • According to the May 2007 issue of the Journal of Personality and Social Psychology, repeated exposure to one person’s viewpoint (e.g., a single rep) can have almost as much influence as exposure to the same viewpoint but coming from several people (or different reps).
     
  • Repetition creates familiarity. However, familiarity might at times breed contempt. In fact, repeated exposure to a stimulus enhances positive feelings up to a point, but after a certain number of exposures, ratings of the stimulus will begin to decline [6]. This is the classic inverted U curve. Social psychologists call it tedium, advertising researchers call it wear-out, and physicians simply call it boredom and overkill. As evidenced by the following physician verbatim comments, the excessive and indiscriminate repetition of pharmaceutical sales messages is a major source of physician complaints, aggravation, and sometimes dislike of or even hostility toward reps:
    • “ I Just get bored when some of the reps come in so often telling me the same thing.”
    • “Rep goes over the same studies over and over again; excessive repetition of the same information and great waste of time.”
    • “I don’t appreciate a rep detailing me on a familiar medication when there were no new indications or studies about its effectiveness.”
    • “I am tired of spending time with reps who have nothing new to say. Often they keep talking when you already know the product (and are informed as such).”
    • “Drug X and drug Y reps are broken records. It seems their knowledge is limited to the product monograph. I can read that myself.”
    • “Company X reps are very aggressive; barge into office; visits too frequent with nothing new to say. I now refuse to see them.”

More often than not, the indiscriminate and excessive repetition of the sales message and the quest for a larger share of voice will translate into a higher noise volume and restricted rep access. Furthermore, the literal repetition of the same message erases the perception that the message is personal and tailor-made to the individual physician. The challenge facing pharmaceutical reps (and their managers and trainers) is how to properly calibrate the rate of message repetition and how to keep that message fresh…

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