Consumer Health Products Survey

Contract # HT372-152592/001/CY (POR 043-15)
Produced by TNS Canada
Contract Award Date: March 8, 2016
Report Date: July 18, 2016
Ce rapport est aussi disponible en français sur demande:
communications@hc-sc.gc.ca

Table of Contents

• 1. Executive Summary
  • 1.1. Research Purpose and Objectives
  • 1.2. Summary of Findings
  • 1.3. Methodology
  • 1.4. Contract Value
  • 1.5. Statement of Political Neutrality
• 2. Foreword
  • 2.1. Background
  • 2.2. Research Objectives
  • 2.3. Methodological Overview
• 3. Detailed Findings
  • 3.1. Canadians’ Knowledge and Understanding of Consumer Health Products
    • 3.1.1. Perceived Knowledge of Safety of Consumer Health Products
    • 3.1.2. Perceived Knowledge of Effectiveness of Consumer Health Products
    • 3.1.3. Categorizing Consumer Health Products
    • 3.1.4. How Informed are Canadians when Purchasing Consumer Health Products?
    • 3.1.5. Perceived Meaning of Homeopathic Medicine
    • 3.1.6. Understanding of Ayurveda
    • 3.1.7. Understanding of SPF
    • 3.1.8. Awareness of Product Identifiers
    • 3.1.9. Perceived Health Canada Responsibilities
  • 3.2. Canadians’ Attitudes towards Consumer Health Products
    • 3.2.1. Perceptions of Product Safety
    • 3.2.2. Attitudes towards Safety
    • 3.2.3. Trust in Claims
    • 3.2.4. Attitudes towards Claims
    • 3.2.5. Product Identifier Perceptions
  • 3.3. Selection and Use of Consumer Health Products
    • 3.3.1. Frequency of Use
    • 3.3.2. Incidence and Frequency of Label Reading
      • 3.3.2.1. Natural Health Products
      • 3.3.2.2. Non-Prescription Drugs
      • 3.3.2.3. Cosmetics
    • 3.3.3. Desired Product Information to Make Purchase Decision
    • 3.3.4. Determining Safety of Products
    • 3.3.5. Determining Effectiveness of Products
    • 3.3.6. Where Canadians Look for Product Information
    • 3.3.7. Product Preference
    • 3.3.8. Reasons for Product Preference
• 4. Survey Methodology
  • 4.1. Methodological Overview
• 5. Appendix A: Survey Instrument

1. Executive Summary

1.1. Research Purpose and Objectives

The overall objective of this research is to better understand Canadian consumers’ knowledge, attitudes awareness and behaviours as they relate to consumer health products.

More specifically, this research seeks:

• To determine attitudes of Canadians with regard to consumer health products;
• To understand how Canadians select and use consumer health products;
• To understand what information Canadians want to see on consumer health products to assist them in their decision making;
• To assess how and from where Canadians seek information about consumer health products; and,
• To gauge the public’s knowledge and understanding of the various categories of consumer health products and how they are regulated.

The findings will be used by Health Canada:

• To gain more insight into the Canadian public’s views on consumer health products;
• To help ensure that the approach to consumer health products reflects the consumer’s needs.

Health Canada will continue to engage with Canadians as the approach moves forward and evolves.

1.2. Summary of Findings

Canadians’ Knowledge and Understanding of Consumer Health Products

Canadians have low perceived knowledge of the safety and effectiveness of consumer health products.  Canadians generally consider themselves more knowledgeable about non-prescription drugs (35%) than cosmetics (25%) or natural health products (19%). They consistently rate their knowledge of the safety and effectiveness of consumer health products higher for non-prescription drugs than natural health products or cosmetics.  Canadians also generally feel uninformed when purchasing consumer health products (33-58%).  Again, to a lesser extent with non-prescription drugs (33%) than natural health products (58%) or cosmetics (45%).

Women, older Canadians (55+), those with at least a college education and those who use consumer health products more frequently all report higher levels of knowledge regarding the safety and effectiveness of consumer health products in all categories and generally feel more well informed about these products.

Canadians do not categorize consumer health products in the same way Health Canada does. For the most part, Canadians tend to categorize products based on their use rather than the particular ingredients in a product.  As such, Canadians tend to categorize products like dandruff shampoo and lip balm with sunscreen into cosmetics rather than non-prescription drugs.   Interestingly, perceived level of knowledge and frequency of use do not change the way in which Canadians categorize products.  They continue to categorize them based on use rather than ingredients like Health Canada currently classifies and regulates these products.

Awareness and knowledge of homeopathic medicine, Ayurveda and SPF varies substantially.  Unprompted, most Canadians (95%) are unable to correctly or even partially define homeopathic medicine.  When prompted with a variety of responses, less than half of Canadians (42%) were able to correctly define Ayurveda.  Canadians were unable to provide a consistent unprompted definition for SPF 15 however, most (75%) could associate it with “sun protection factor 15”.

Awareness of product identifiers also varies with more than half of Canadians being aware of DINs but much fewer aware of NPNs (15%) or DIN-HMs (10%).

Canadians have a general understanding of Health Canada’s responsibilities but a large portion do not understand the details of exactly what these responsibilities entail.  More specifically, around two thirds of Canadians understand Health Canada is responsible for many tasks when it comes to product safety of consumer health products such as making sure products are safe before they hit the shelf, setting safety standards for companies to follow, making sure products contain the ingredients they claim to, etc.  There is however, some confusion on what this specifically means. For example, half or more of Canadians believe Health Canada reviews and approves all types of product labels before they hit the shelves and/or test products in the laboratory for all consumer health products. Generally speaking Canadians that perceive themselves to be better informed and have higher perceptions of safety and trust are more likely to believe that Health Canada is responsible for most/all of the tasks presented related to non-prescription drugs and cosmetics.  This is not the case for natural health products where only increased trust (not safety) is associated with increased perceptions of Health Canada’s responsibilities.

Attitudes and Perceptions towards Consumer Health Products

Canadians’ attitudes and perceptions about consumer health products are in line with their perceived knowledge and understanding.  For the most part, Canadians believe non-prescription drugs are safe (70%), but as seen throughout the research, they are less confident in the safety of cosmetics (60%) and even less so with natural health products (51%).  This reflects the finding that Canadians believe more strongly that Health Canada is responsible for ensuring the safety of non-prescription drugs(74%) and less so for cosmetics (65%) and natural health products (67%).  More Canadians believe that the government (Health Canada) is primarily responsible for ensuring safety rather than the manufacturers of consumer health products (78% vs 61%).

Attitudes toward claims on labels are another point of interest. Canadians do not trust the claims made on the labels of consumer health products (only 18-36% trusts them).  However, even though Canadians claim to be wary of these claims, they also believe these claims are supported by science (66%) and proof from manufacturers (66%).  Clearly there is a disconnect with these findings and it is unclear why Canadians lack trust in claims when they also feel they are supported by science and proof from manufacturers.

Perceptions about product identification numbers (DIN, DIN-HM and NPN) tend to be in line with Canadians’ attitudes towards the product categories.  These numbers are most associated with product safety and to a lesser extent, being without contamination (there is little association with effectiveness of a product).

Again we see that women, older Canadians (55+), those who use consumer health products and those who feel they are more informed display similar attitudes towards consumer health products.  For instance, they are all more likely to believe all consumer health products are safe, more likely to trust the claims on all consumer health product labels and more likely to believe it is Health Canada’s responsibility to ensure a product is safe and claims are supported by science.

Selection and Use of Consumer Health Products

Consumer health product usage varies greatly by category and type of product.  Cosmetics are the most frequently used consumer health products, particularly products for hair (79% uses at least once per week) and skin (70% use at least once per week).  Natural health products such as vitamins and minerals are also frequently used by a majority (56% uses at least once a week) of Canadians. Seasonal products and specific types of medicines are used by the majority of Canadians (88-92%), however on a less frequent basis.  The same is true for sunscreen, antacids and allergy relievers – all used by most Canadians (58-89%), but infrequently.  The majority of Canadians never use traditional natural health products (70%) (such as traditional Chinese medicines, or Ayurveda) or homeopathic products (66%).

Incidence and frequency of reading product labels is fairly consistent between the three categories of products. Consistently for each category, dosage and directions are two of the most frequently read portions of the label, while the least commonly read elements are where the product was made and endorsements.  The most noticeable difference between categories is that frequency of reading labels is universally higher for non-prescription drugs (23-67%) – all elements are more likely to be viewed at every purchase or at every use, compared to natural health products (23-58%) and particularly cosmetics (20-49%).  Brand name is the only product element viewed more frequently on cosmetics than the other two categories.

With regard to information desired to make a purchase decision, directions, ingredients and product warnings are the most important to Canadians.  For all three product categories, a strong majority of Canadians want to have directions on how to use the product (70-77%), ingredients (66-72%), warnings (66-75%) and dosage (71-78%) (with the exception of cosmetics) directly on the product to help them to decide what to buy.  Brand name is more important to have on non-prescription drugs and cosmetics than it is on natural health products, while the origin of the product is of higher importance on natural health products.  Package inserts and endorsements are the least important package features in the product purchase decision, regardless of category.

Product use plays a role in how much information Canadians’ want for purchase decisions. Frequent users of natural health products such as homeopathic products want more information than infrequent or non-users while frequent users of traditional natural health products want less information than infrequent or non-users.  With regard to non-prescription drugs, generally speaking frequent users tend to require less information than infrequent or non-users. Cosmetics users such as hair and skincare products tend to want more information to support their purchase decisions.  Furthermore, Canadians who consider themselves informed about non-prescription drugs and Cosmetics also require more information to make purchase decisions.

When it comes to determining the safety and effectiveness of consumer health products, Canadians look to several sources.  For natural health products, there are clearly three top sources of information that Canadians look to – asking a health professional or practitioner, researching the product online and reading labels or product inserts.  That being said, none of these sources are used by a majority (44-48%).  Non-prescription drugs have two sources of information that stand out above the rest – asking a health professional or practitioner and reading labels or product inserts, though only a very slight majority(53-57%) use these sources.  For cosmetics, relying on brand name (44-45%) and reading labels or product inserts (43%) are the main sources of information.  It is also worth noting that a sizeable portion of the population simply doesn’t think about safety or effectiveness (10-20% and 10-9% respectively); however more think about it for non-prescription drugs (89-90%) than natural health products (86-88%) and cosmetics (79-80%).

Canadians also use a variety of sources to look for product-specific information in each category.  While there are no information sources that are used by a strong majority of Canadians, search engines (41-43%) and product labels (43-51%) are two of the most commonly used sources for all three categories.  Health care professionals (such as a doctor or a nurse) (53%) are an important source for looking up information on non-prescription drugs.  While general internet searches using a search engine are common, specific health-related websites (such as manufacturers’ website, Health Canada’s website, consumer group websites, etc.) are not commonly used by Canadians to look up product information.

As seen with knowledge and attitudes towards consumer health products, selection and usage of these products is predominantly affected by gender and age.  Again, women and older Canadians (55+) both display similar tendencies: they are more likely to frequently use most types of products, search for product information about both safety and effectiveness and read several different parts of the labels on product packaging.

1.3. Methodology

An online panel survey was conducted among 2,502 Canadians age 18 years and older.  A pre-test consisting of 10 completed English interviews and 10 completed French interviews, was completed before fielding the survey on April 15^th, 2016.  The survey was in field from April 18^th to April 26^th, 2016. Respondents for this survey were selected from among those who have registered to participate in the TNS online surveys. The results of such surveys cannot be described as statistically projectable to the target population. The data have been weighted to reflect the demographic composition of the Canadian population 18 years and older. As this was a panel survey, margin of error does not apply.  Surveying was conducted in the respondent’s official language of choice and took an average of 21 minutes to complete.   A detailed methodology can be found in Chapter 4.

1.4. Contract Value

The total contract value for this project was $44,547.82 including HST.

1.5. Statement of Political Neutrality

I hereby certify as Vice President, Ottawa Regional Office & Public Sector Practice Lead of TNS Canada Ltd. that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences and standings with the electorate or ratings of the performance of a political party or its leaders.

David Ang
TNS Canada Ltd.
Vice President, Ottawa Regional Office & Public Sector Practice Lead

2. Foreword

2.1. Background

Canadians play an active role in managing their own health and using consumer health products responsibly. It is relatively easy for Canadians to do so since they have access to an unlimited amount of health resources and products, many without a prescription or involvement of a health care practitioner. Self-care plays a key role in disease prevention and maintaining public health, as it helps to make the Canadian health care system more sustainable.

Consumer health products can be categorized into three main groups – non-prescription drugs, natural health products and cosmetics. They can range from sunscreens to pain medications, vitamins to homeopathic remedies and toothpastes to skin moisturizing cosmetics. Canadians can easily access these health products in places such as grocery, convenience and department stores, pharmacies, natural health food stores and online.

It is important that Health Canada understand Canadians’ views on consumer health products since it is the federal department responsible for helping Canadians maintain and improve their health.  Additionally, it is not always obvious to consumers which category the consumer health product belongs to which can cause consumers to think products are in one category but in fact are in another.

2.2. Research Objectives

The overall objective of this research is to better understand Canadian consumers’ knowledge, awareness, attitudes and behaviours as they relate to consumer health products.  This information will be used to support the development of policies relating to these products.

More specifically, this research seeks:

• To determine attitudes of Canadians with regard to consumer health products;
• To understand how Canadians select and use consumer health products;
• To understand what information Canadians want to see on consumer health products to assist them in their decision making;
• To assess how and from where Canadians seek information about consumer health products; and,
• To gauge the public’s knowledge and understanding of the various categories of consumer health products and how they are regulated.

The findings will be used by Health Canada:

• To gain more insight into the Canadian public’s views on consumer health products;
• To help ensure that the approach to consumer health products reflects the consumer’s needs.

2.3. Methodological Overview

An online panel survey was conducted among 2,502 Canadians age 18 years and older.  A pre-test consisting of 10 completed English interviews and 10 completed French interviews, was completed before fielding the survey on April 15^th, 2016.  The survey was in field from April 18^th to April 26^th, 2016. Respondents for this survey were selected from the TNS online panel. The results of panel surveys cannot be described as statistically projectable to the Canadian population. The data have been weighted to reflect the demographic composition of the Canadian population 18 years and older using age, gender and region. As this was a panel survey, margin of error does not apply.  Surveying was conducted in the respondent’s official language of choice and took an average of 21 minutes to complete.   A detailed methodology can be found in Chapter 4.

Please note: Analysis was undertaken to establish the extent of the relationship among variables such as age, region, level of education attained, income, differences among caregivers of children and seniors, pregnant and breastfeeding women and those with severe allergies or chronic conditions.  Only differences significant at the 95% confidence level are presented in this report.  Any differences that are statistically significant between subgroups are highlighted in green in tables throughout the report.  As this was a non-probability sample, conclusions from these tests cannot be generalized to any population.

The numbers presented throughout this report are rounded to the closest full number. Due to this rounding, in some cases it may appear that ratings collapsed together are different by a percentage point from when they are presented individually and totals may not add up to 100%. As well, respondents were required to respond to all questions in the survey.  Many of the charts in this report present only the top three and bottom three responses on a scale of 7. In instances where the charts do not add to 100% the remaining responses belong to the neutral category or don’t know.

3. Detailed Findings

3.1. Canadians’ Knowledge and Understanding of Consumer Health Products

3.1.1. Perceived Knowledge of Safety of Consumer Health Products

Canadians have low perceived knowledge of the safety of consumer health products.

Before being given any additional information, respondents from across Canada who were recruited from TNS’s online panel (hereinafter referred to as “Canadians”) were asked to rate themselves on their knowledge of consumer health products.  Only one third of Canadians (or less) rated themselves as ‘knowledgeable’ (score of 5, 6, or 7 on a 7-point scale) about the safety of the three categories of consumer health products.  Canadians are slightly more confident in their knowledge of non-prescription drugs safety (33%), compared to the safety of cosmetics (25%) and natural health products (19%).  In fact, at least half of Canadians consider themselves to have poor knowledge (a score of 1, 2, or 3 on a 7-point scale) about the safety of cosmetics (50%) and natural health products (56%).

Exhibit 3.1.1.a: Perceived Knowledge of Safety

Q3. In general, how would you rate your knowledge about the safety of:  
On a scale of 1 to 7, where 1 is no knowledge at all and 7 is extremely knowledgeable. 
Base: Total Respondents (n=2502)

Frequency of product use plays a role in Canadians’ self-rated knowledge about the safety of consumer health products.  More specifically, frequent users of natural health products such as traditional natural health products, natural health products and homeopathic products are more confident in their knowledge about the safety of natural health products than infrequent or non-users.  This is also the case for frequent users of non-prescription drugs such as allergy relievers and decongestants, antacids, sunscreens and pain relievers and for cosmetics such as skincare products.  Complete details can be found in the table below.

Gender, region and education also play a role in Canadians’ self-rated knowledge about the safety of consumer health products.  To this point, women are more confident than men in their knowledge about safety of natural health products (22% vs. 17%), non-prescription drugs (35% vs. 30%) and cosmetics (34% vs. 16%).

Regionally speaking, those residing in British Columbia are significantly more likely than the rest of Canada to rate themselves as ‘knowledgeable’ about the safety of natural health products (24% vs. 16%-20%), while Quebecers are more likely to rate their knowledge higher for non-prescription drugs (36% vs. 29%-34%) and cosmetics (28% vs. 23%-25%).

With regard to education, Canadians with at least a university degree are significantly more likely than those with a high school or less to consider themselves ‘knowledgeable’ about the safety of natural health products (20% vs. 15%), non-prescription drugs (34% vs. 29%) and cosmetics (27% vs. 21%).

3.1.2. Perceived Knowledge of Effectiveness of Consumer Health Products

Canadians have low perceived knowledge of consumer health product effectiveness.

While slightly higher than perceived knowledge of safety, Canadians perceived knowledge of effectiveness is also low.  Less than two in five Canadians consider themselves ‘knowledgeable’ (a score of 5, 6, or 7 on a 7-point scale) about the effectiveness of consumer health products.  Again, Canadians are slightly more confident about their knowledge of the effectiveness of non-prescription drugs (39%), compared to cosmetics (27%) and natural health products (21%).  Around half of Canadians rated themselves as having ‘poor knowledge’ (a score of 1, 2, or 3 on a 7-point scale) about the effectiveness of cosmetics (46%) and natural health products (54%).

Exhibit 3.1.2.a: Perceived Knowledge of Effectiveness

Q4. In general, how would you rate your knowledge about the effectiveness(how well they work) of: On a scale of 1 to 7, where 1 is no knowledge at all and 7 is extremely knowledgeable. 
Base: Total Respondents (n=2502)

Similar to perceived knowledge, frequency of product use plays a role in Canadians’ self-rated knowledge about the effectiveness of consumer health products.  More specifically, frequent users of natural health products such as traditional natural health products, natural health products and homeopathic products report higher levels of  knowledge about the effectiveness of natural health products than infrequent or non-users.  This is also the case for frequent users of non-prescription drugs such as allergy relievers and decongestants, antacids, sunscreen and pain relievers and for cosmetics such as skin and hair care products.  Complete details can be found in the table below.

Similar to perceived knowledge about safety, women are significantly more likely than men to consider themselves ‘knowledgeable’ about the effectiveness of natural health products (23% vs. 19%), non-prescription drugs (41% vs. 37%) and especially cosmetics (36% vs. 18%).

3.1.3. Categorizing Consumer Health Products

Canadians do not categorize consumer health products in the same way Health Canada does.

Participants were shown images of ten products chosen based on availability in French and English that represent a range of product types and categories of natural health products, non-prescription drugs and cosmetics.

These included:

• Black Radish Ayurvedic product indicated to promote digestion (NPN 80037361)
• Centrum Select® 50+ Multivitamin/Mineral supplement (NPN 80005153)
• Sedatil Homeopathic medicine indicated for Nervousness hypersensitivity- irritability due to stress (DIN-HM 80017593)
• Extra Strength Non-Drowsy Reactine Allergy 24-hour relief (DIN 02223554)
• Nivea Sun SPF 30 lip balm (DIN 02416972)
• Neutrogena Ultra Sheer Dry-touch sunscreen SPF 30 (DIN 02377403)
• Pepto Bismol cherry flavour (DIN 02097079)
• Tylenol Extra Strength (DIN 00559407)
• Head & Shoulders dandruff shampoo for Men Old Spice (DIN 02387476)
• Pantene PRO-V Clean Rinse Shampoo

Nearly all Canadians (94%-98%) were able to identify that Tylenol, Reactine and Pepto-Bismol are non-prescription drugs.  A strong majority were also able to identify Pantene Pro-V Shampoo as a cosmetic (91%) and Black Radish as a natural health product (85%).  These are the products that fit most with Canadians’ definitions of these categories.

That being said, Canadians did not categorize several other products presented in the same fashion as Health Canada.  The products that Canadians categorized differently tend to be products that are used in a particular way but based on particular ingredients, do not actually belong to the category as defined by Health Canada. For example, dandruff shampoo is used for cleaning one’s hair and is identified as a cosmetic by most Canadians however due to particular ingredients; Health Canada defines it as a non-prescription drug.

Nivea Lip Balm and Neutrogena Sun Screen were also identified as cosmetics by nearly all Canadians (87%-88%).  Only a very small proportion correctly categorized them in the same fashion as Health Canada - as a non-prescription drug (6% each), while a similar proportion were equally likely to think they were natural health product (6%-7%).

Natural health products such as Centrum Select and Sedatil were only categorized as an natural health product by one third of Canadians (30%-39%), while the majority (61-68%) identified them as non-prescription drugs.  These findings suggest that Canadians do not always categorize products in the same way that Health Canada does.

Exhibit 3.1.3.a: Perceived Product Category

Q1. Please drag each product into the category box you think they most belong.
Base: Total Respondents (n=2502)

Interestingly, Canadians’ perceived level of knowledge (how informed they consider themselves to be) and frequency of product use generally do not improve their ability to correctly categorize consumer health products.  The exception being Centrum Select, those who considered themselves more informed and those who use traditional natural health products, natural health products and homeopathic products were more likely to identify Centrum Select as a natural health product.

3.1.4. How Informed are Canadians when Purchasing Consumer Health Products?

Canadians do not feel well informed when purchasing consumer health products.

Canadians do not consider themselves ‘well informed’ when purchasing consumer health products.  This is not surprising given how poorly Canadians rated their knowledge of consumer health product safety and effectiveness of these same products.  To this point, Canadians rated themselves very poorly in terms of how ‘well informed’ (a score of 5, 6, or 7 on a 7-point scale) they feel when purchasing non-prescription drugs (37% consider themselves ‘informed’), cosmetics (29%) and even less so when purchasing natural health products (19%).

These results, coupled with the low levels of perceived knowledge on safety and effectiveness suggest that Canadians are not well informed consumers.

Exhibit 3.1.4.a: How Informed when Purchasing Products

Q8. In general, how informed do you feel when you buy products in the following categories?  On a scale of 1 to 7, where 1 is not well informed at all and 7 is extremely well informed. 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.1.4.a: How Informed when Purchasing Products

Frequency of product use plays a role in Canadians’ perceived level of knowledge about consumer health products.  Specifically, frequent users of natural health products such as traditional natural health products, natural health products and homeopathic products report feeling more well informed than infrequent or non-users.  This is also the case for frequent users of non-prescription drug such as allergy relievers and decongestants, cough cold and flu, antacids, sunscreen and pain relievers and for cosmetics such as skin and hair care products and sunscreen.  Complete details can be found in the table below.

Gender and education play the biggest role in whether Canadians feel informed when purchasing consumer health products.  A consistent theme throughout this research is that women are significantly more likely than men to consider themselves ‘well informed’ when purchasing natural health products (21% vs. 17%), non-prescription drugs (40% vs. 35%) and particularly cosmetics (37% vs. 20%).

With regard to education, Canadians with at least a university degree are significantly more likely than those with a high school diploma to consider themselves ‘well informed’ when purchasing natural health products (20% vs. 15%), non-prescription drugs (39% vs. 34%) and cosmetics (30% vs. 24%).

3.1.5. Perceived Meaning of Homeopathic Medicine

Few Canadians understand what homeopathic medicine is.

A mere five per cent of Canadians have even a partial understanding of what homeopathic medicine is and/or the tenants (or origin) behind it.  Specifically, the concept of enabling the body to heal itself (1%), like curing (1%), diluted solutions (1%) or low doses(1%) were identified by a very small proportion of Canadians.

Many Canadians (46%) confuse homeopathic medicine for herbal products indicating that it was a natural, plant based or herbal medicine. While others (10%) simply consider it an alternative to traditional medicine such as non-traditional treatment, unconventional medicine or home remedies.

Some Canadians (14%) define it as a medicine that is unproven or does not work while others (12%) consider it unregulated medicine (10%).

Exhibit 3.1.5.a: Meaning of Homeopathic Medicine (Unaided)

Q5. When you come across a product that says “homeopathic medicine” on the label, what does that mean to you? (OPEN ENDED RESPONSE)
Base: Total Respondents (n=2502)

Some groups are more likely to have at least a partial understanding of what homeopathic medicine is.  In particular:

• Those with more than a high school education are more likely to have at least a partial understanding of homeopathic medicine (5-7% vs 1%).
• Users of natural health products such as traditional natural health products (8-9% vs 4%) or frequent users of natural health products (6% vs 3-4%) are more likely to have at least a partial understanding of homeopathic medicine than non-users of traditional natural health products and infrequent or non-users of natural health products.  Interestingly, results were similar among users and non-users of homeopathic products.

3.1.6. Understanding of Ayurveda

Most Canadians don't understand what Ayurveda is.

When asked which description(s) Canadians would associate with a “product traditionally used in Ayurveda to aid digestion” the majority (58%) answered incorrectly (a drug that aids digestion or a digestive aid made in a place called Ayurveda) or don’t know.  Nearly four in ten Canadians were able to correctly associate it with either an herbal digestive aid (31%) and/or with a folk medicine from South Asia to aid digestion (17%)¹.

It would appear that Canadians do not have a full understanding of Ayurveda.

Exhibit 3.1.6.a: Associated Ayurveda Terms

Q6. Which of the following descriptions would you associate with a “product traditionally used in Ayurveda to aid digestion”? Select all that you think apply.
Base: Total Respondents (n=2502)

Frequent users of traditional natural health products were more likely to choose an incorrect answer compared to infrequent or non-users (drug: 26% vs 10-15%; place: 18% vs 10-13%).

However, frequent users of natural health products are more likely to understand what Ayurveda is compared to infrequent or non-users (digestive aid: 36% vs 30-19%; folk medicine: 19% vs 10-13%) as are those who consider themselves to be more well-informed about natural health products (digestive aid: 24% vs 14%; folk medicine: 41% vs 26%).

Demographically speaking, women, Canadians under the age of 55 and those with at least a college education are all more likely to understand what Ayurveda is – though still at relatively low levels.

3.1.7. Understanding of SPF

Canadians associate the term “SPF 15” with sunscreen or protection from the sun.

While Canadian consumers did not come up with a consistent definition to the term “SPF 15”, a large majority (75%) correctly associate it with sunscreen or protection from the sun.  The terms “sun protection at lower dosage”, “sun protection factor 15” and “protects from the sun/UV rays” were the most common definitions.

Exhibit 3.1.7.a: Perceived Meaning of "SPF 15"

Q7. When you come across a product that says “SPF 15” on the label, what does that mean to you? (OPEN ENDED RESPONSE)
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.1.7.a: Perceived Meaning of "SPF 15"

3.1.8. Awareness of Product Identifiers

A small majority of Canadians have heard of a Drug Identification Number.

Just over half (57%) of Canadians have heard of a Drug Identification Number (DIN). However, very few Canadians are aware of Natural Product Number (NPN) (15%) or Homeopathic Medicine Number (DIN-HM).

Exhibit 3.1.8.a: Awareness of Product Identifiers

Q18. Have you ever heard of a:
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.1.8.a: Awareness of Product Identifiers

Not unexpectedly, those who use these types of consumer health products are more likely to be aware of the identification numbers. Users of natural health products such as traditional natural health products and natural health products are more likely to be aware of NPNs (17-20% vs. 6%  and 11-12% vs 4% respectively) while users of homeopathic products are more likely to be aware of DIN-HMs (16-24% vs 6%).  Users of non-prescription drug such as allergy relievers and decongestants (59-61% vs. 52%), antacids (56-60% vs 52%), sunscreen (60-61% vs 51%) and pain relievers (57-62% vs 42%) are also more likely to be aware of DINs.

Furthermore, Canadians who consider themselves more well informed about natural health products have increased awareness of NPNs (28% vs 11%) and DIN-HMs(22% vs 5%) and those who consider themselves more well informed about non-prescription drugs have increased awareness about DINs(66% vs 47%).

Some demographic groups are more likely than others to have heard about DIN.  In particular:

• Women are significantly more likely than men to have heard of a DIN (61% vs. 53%).
• Older Canadians (35 and older) are significantly more likely than those under 35 years old to have heard of a DIN (58%-68% vs. 42%).
• Canadians residing in Ontario and the Prairies are significantly more likely than the rest of Canada to have heard of a DIN (60% and 64%, respectively vs. 47%-55%).
• Those with at least a university education are significantly more likely than those with only a high school education to have heard of a DIN (58%-59% vs. 52%).

Awareness of NPN and DIN-HM are not significantly affected by demographic differences.

3.1.9. Perceived Health Canada Responsibilities

Canadians have a general understanding of Health Canada’s responsibilities but a large portion does not understand the details of exactly what these responsibilities entail.

Regardless of category, Canadians understand Health Canada is responsible for many tasks when it comes to product safety.  In particular, at least two thirds of Canadians feel Health Canada is responsible for making sure products are safe before they hit the shelf and setting safety standards for companies to follow.

Even more so than with natural health products and cosmetics, Canadians feel Health Canada is responsible to ensure the safety of non-prescription drug products.  This category consistently rates higher on all tasks than the other two, suggesting that Canadians believe Health Canada is more involved with products in the non-prescription drug category as a whole.

While most Canadians believe Health Canada is responsible for a variety of tasks related to safety of consumer health products, more than half do not understand the exact nature of this responsibility.  For example, half or more believe Health Canada reviews and approves all types of product labels and/or tests products in laboratories for each category of consumer health product.

Exhibit 3.1.9.a: Perceived Tasks Health Canada is Responsible For

Q17. For each of the following categories, which tasks, if any, do you believe Health Canada is responsible for?
Base: Total Respondents (n=2502)

Generally speaking Canadians that perceive themselves as better informed and have higher perceptions of safety and higher trust in claims are more likely to believe that Health Canada is responsible for most/all of the tasks presented related to non-prescription drugs and cosmetics.  This is not the case for natural health products where only increased trust is associated with increased perceptions of Health Canada’s responsibilities.

Gender and age also play a role with regard to perceived Health Canada responsibilities.   Women are more likely to believe Health Canada is responsible for all of the tasks related to natural health products, non-prescription drugs and cosmetics identified in the tables below.  The same is true of Canadians who are 55 year or older compared to their younger counterparts where they believe Health Canada is responsible for most tasks.

3.2. Canadians’ Attitudes towards Consumer Health Products

3.2.1. Perceptions of Product Safety

For the most part Canadians believe non-prescription drugs are safe, but are not as confident in the safety of cosmetics and natural health products.

The majority of Canadians (70%) feel non-prescription drugs are ‘safe’ (a score of 5, 6, or 7 on a 7-point scale), however, there is less confidence in the safety of cosmetics (60%) and even less with natural health products (51%).  These scores reflect Canadians’ perceptions that Health Canada is responsible for ensuring the safety of non-prescription drugs and less so for cosmetics and natural health products.

Exhibit 3.2.1.a: Perceptions of Product Safety

Q9. How safe do you believe the following products sold in Canada are?
On a scale of 1 to 7, where 1 is not safe at all and 7 is extremely safe. 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.2.1.a: Perceptions of Product Safety

Product use plays a role in Canadians’ perceptions of safety. Users of natural health products such as traditional natural health products, natural health products and homeopathic products are more likely to think natural health products are safer.  Users of non-prescription drugs such as cough and cold, antacids, sunscreen and pain relievers are more likely to consider non-prescription drugs safer and users of cosmetics such as hair and skincare products are more likely to consider cosmetics safer.  Furthermore, Canadians who consider themselves informed are also more likely to consider consumer health products safe.  Complete details can be found in the table below.

A couple of demographic differences exist in relation to perceived levels of safety for natural health products and cosmetics.  Canadians under 55 years old are significantly more likely to feel natural health products are ‘safe’ compared to older Canadians (55+). With regard to cosmetics, women are significantly more likely than men to feel they are ‘safe’ (64% vs. 56%).

3.2.2. Attitudes towards Safety

Canadians are more likely to believe that responsibility for consumer health product safety lies with government than the manufacturer.

Consistent with findings throughout this report, a solid majority of Canadians (78%) believe (a score of 5, 6, or 7 on a 7-point scale) that Health Canada is responsible for ensuring safety of a consumer products.  While not as strongly, most Canadians (61%) also believe it is the responsibility of the manufacturer to ensure the safety of products.

Less than one quarter of Canadians (23%) believe that natural products are safer because they are made of natural ingredients.  In fact, more than half (54%) ‘do not believe’ (a score of 1, 2, or 3 on a 7-point scale) this notion.  This is consistent with the finding that Canadians have the least amount of trust in natural health products and are least likely to feel Health Canada is responsible for ensuring safety of natural health products.

Exhibit 3.2.2.a: Attitudes Towards Safety

Q11. How much do you agree or disagree with the following statements?
On a scale of 1 to 7, where 1 is completely disagree and 7 is completely agree. 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.2.2.a: Attitudes Towards Safety

Gender and age play a role in Canadians’ attitudes towards the perception of safety of consumer health products:

• Women are more likely than men to think that it is Health Canada’s responsibility to ensure product safety (81% vs. 75%).
• Canadians over 55 years old are significantly more likely to believe it is Health Canada’s responsibility to ensure product safety (85% vs. 74%-76%).
• Canadians over 55 years old are also more likely to not believe that natural products are safer because they’re made of natural ingredients (60% vs. 49%-51%).

3.2.3. Trust in Claims

Canadians are generally sceptical about the claims made on the labels of consumer health products.

The claims that are made on labels of consumer health products are not considered to be trustworthy by the majority of Canadians (64-82% do not explicitly trust them).  Only about one third of Canadians (36%) say they ‘trust’ (a score of 5, 6, or 7 on a 7-point scale) the claims made on the labels of non-prescription drugs, while even fewer trust the claims made on cosmetic (22%) and natural health products labels (18%).

These results are in line with the perceived levels of knowledge about effectiveness associated with the same consumer health products (see section 3.1.2).

Exhibit 3.2.3.a: Trust in Claims on Labels

Q10. How much do you trust the claims made on the labels of?
On a scale of 1 to 7, where 1 is do not trust at all and 7 is trust completely. 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.2.3.a: Trust in Claims on Labels

Product use plays a role in how much Canadians’ trust claims on labels. Users of natural health products such as traditional natural health products, natural health products and homeopathic products are more likely to trust claims on labels of natural health products.  Users of non-prescription drugs such as cough and cold, antacids, and pain relievers are more likely to trust the claims made on the labels of non-prescription drugs while users of cosmetics such as hair and skincare products are more likely to trust the claims made on the labels of cosmetics.  Complete details can be found in the table below. Furthermore, Canadians who consider themselves informed about natural health products, non-prescription drugs and Cosmetics are also more likely to trust the claims on their respective labels (48% vs 6%, 61% vs 12%, 47% vs 6% respectively), as are Canadians that consider consumer health products safe: natural health products and Cosmetics (32%vs 2%) and non-prescription drugs (48% vs 4%).

Gender and age affect Canadians’ level of trust in claims made on the labels of consumer health products.  As such, women and younger Canadians are more trusting of label claims on natural health products and cosmetics.  No demographic differences exist for non-prescription drugs.

3.2.4. Attitudes towards Claims

Canadians believe that scientific support and proof from manufacturers back up the claims on labels.

Two thirds (66%) of Canadians believe (a score of 5, 6, or 7 on a 7-point scale) that claims made on the labels of products must be supported by science, as well as all products claiming to do the same thing need the same level of proof from the manufacturer to support their claim.  A small majority (52%) also believe that product claims must be true if they are written on the label.  On the contrary, nearly half (54%) of Canadians ‘do not believe’ (a score of 1, 2, or 3 on a 7-point scale) that products with similar claims will do the same thing.

Exhibit 3.2.4.a: Attitudes Towards Claims

Q11. How much do you agree or disagree with the following statements?
On a scale of 1 to 7, where 1 is completely disagree and 7 is completely agree. 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.2.4.a: Attitudes Towards Claims

Canadians’ attitudes towards claims are influenced by their perceived level of knowledge (how informed), perceptions of safety and trust in claims.  Those who consider themselves more knowledgeable, have higher perceptions of product safety and more trust in label claims are more likely to believe claims are supported by science, manufacturers require similar levels of supporting evidence, product claims must be true and that similar claims will do similar things.

Canadians’ attitudes towards claims are significantly affected by age.  Canadians over 55 years old are significantly more likely than younger Canadians to believe the following:

• Claims on the labels of products must be supported by science (70% vs. 63%-65%).
• All products claiming to do the same thing must have the same level of proof provided by the manufacturer to support their claim (71% vs. 63%).

These same Canadians (55+) are significantly more likely than younger Canadians to not believe the following:

• Product claims must be true if they are written on the label (41% vs. 27%-35%).
• Products with similar claims will do the same thing (59% vs. 46%-54%).

3.2.5. Product Identifier Perceptions

Product identification numbers are most associated with safety.

After being provided a description for each, the majority of Canadians (52-70%) would consider products with identification numbers to be safe and without contamination, particularly products with a DIN.  A small majority of Canadians (55%) would also consider products with a DIN to be effective.  That being said, less than half would consider products with a DIN-HM (42%) or NPN (39%) to be effective.

Consistent with other responses, there appears to be increased confidence in non-prescription drugs for safety and effectiveness.

Exhibit 3.2.5.a: Product Perceptions

Q19. If a product has a (DIN, DIN-HM or NPN) would you consider it to be:
Base: Total Respondents (n=2502)

Gender and age play a role in whether Canadians think products with DIN, DIN-HM or NPN are “safe”, “without contamination”, or “effective”.  To this point, women and Canadians over 55 years old are significantly more likely than men and Canadians under 55, respectively, to consider products with DIN, DIN-HM and NPN as safe and without contamination.

3.3. Selection and Use of Consumer Health Products

3.3.1. Frequency of Use

Cosmetics are the most frequently used consumer health products.

Most Canadians frequently (at least once per week) use cosmetic products for their hair (79%) and for their skin (70%).  Natural health products such as vitamins and minerals are frequently used by over half of Canadians (56%), while about one fifth of Canadians are infrequent users (a few times per month or less) or non-users (never use them).

Seasonal products and specific types of medicines are used by majority of Canadians (68-92%), however, on a less frequent basis.  Specific medicines such as cough, cold and flu medicine, as well as pain relievers are used by nearly all Canadians, although presumably on an “as needed” basis, so it is not surprising that they are used infrequently.  The same is true for sunscreen, antacids and allergy relievers – all used by most Canadians, but infrequently.

Finally, the majority of Canadians do not use either traditional natural health products (70%) (such as traditional Chinese medicines, or Ayurveda) or homeopathic products (66%).

Exhibit 3.3.1.a: Frequency of Product Use

Q2. On average, how frequently do you use each of the following products? 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.3.1.a: Frequency of Product Use

Gender, age and education all play a role in the frequency of consumer health product use:

• Women are significantly more likely than men to frequently use hair care products (83% vs. 75%), skin care products (88% vs. 53%), natural health products such as vitamins (61% vs. 50%), sunscreen (42% vs. 22%) and pain relievers (28% vs. 22%).
• Canadians 55 year or older are significantly more likely than younger Canadians to frequently use natural health products such as vitamins (64% vs. 47%-54%) and pain relievers (30% vs. 19%-26%).
• Canadians under 55 years old more likely than those 55 years or older to frequently use skin care products (72%-73% vs. 68%), traditional natural health products (9%-12% vs. 6%), homeopathic products (9%-10% vs. 7%) and cold and cough medicine (4% vs. 2%).
• Canadians with a university degree are more likely than those with a high school education to frequently use skin care products (72% vs. 66%), sunscreen (35% vs. 27%), traditional natural health products (11% vs. 7%) and homeopathic products (10% vs. 7%)

3.3.2. Incidence and Frequency of Label Reading

3.3.2.1. Natural Health Products

Dosage and directions are the most frequently looked at elements of natural health product labels and packaging.

Dosage and directions on how to use the product are the packaging elements that Canadians are most likely to read every time they use or purchase a natural health product.   While still read by most Canadians at some point, elements such as, warnings, brand name, ingredients and package inserts are more commonly read at point of purchase, rather than every use.  

The least commonly looked at packaging elements are where the product was made and endorsements.  Over one third of Canadians never or are unsure if they read these parts of the labels.

Exhibit 3.3.2.1.a: Incidence and Frequency of Reading Labelling or Packaging – Natural Health Products

Q12. Thinking about ( insert product category ) , which part(s) of the labelling or packaging do you read and how frequently do you read them? 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.3.2.1.a: Incidence and Frequency of Reading Labelling or Packaging – Natural Health Products

3.3.2.2. Non-Prescription Drugs

Dosage and directions are the most frequently looked at parts of non-prescription drug packaging.

Roughly two thirds of Canadians read the dosage and directions on how to use the product every time they use or purchase a non-prescription drug, highest among the three categories.   Brand name is the element most commonly viewed during every purchase, with about half of Canadians doing so.  Elements such as warnings about the product, ingredients and package inserts are viewed less frequently and are more commonly looked at during purchase, rather than every use.

As with natural health products and cosmetics, the least commonly looked at packaging elements are where the product was made and endorsements.  Over one third of Canadians never or are unsure if they read these parts of labels.

Exhibit 3.3.2.2.a: Incidence and Frequency of Reading Labelling or Packaging – Non-Prescription Drugs

Q12. Thinking about ( insert product category ) , which part(s) of the labelling or packaging do you read and how frequently do you read them? 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.3.2.2.a: Incidence and Frequency of Reading Labelling or Packaging – Non-Prescription Drugs

3.3.2.3. Cosmetics

Canadians look at the brand name of cosmetics most frequently.

The brand of cosmetics is most commonly looked at every purchase occasion, however only a small majority (54%) look at this at every purchase or every time they use the product.   Dosage, directions on how to use the product and product warnings are the next most frequently looked at packaging elements on cosmetics. However, only a minority of Canadians (39-49%) do so at every purchase or during every use.

Elements such as where the product was made, package inserts or leaflets, ingredients and endorsements are not frequently viewed on cosmetics packaging.  Roughly one quarter or less of Canadians looks at these parts of the package at every use or every purchase.

Exhibit 3.3.2.3.a: Incidence and Frequency of Reading Labelling or Packaging – Cosmetics

Q12. Thinking about ( insert product category ) , which part(s) of the labelling or packaging do you read and how frequently do you read them? 
Base: Total Respondents (n=2502)

Text Description - Exhibit 3.3.2.3.a: Incidence and Frequency of Reading Labelling or Packaging – Cosmetics

3.3.3. Desired Product Information to Make Purchase Decision

Directions, ingredients and product warnings are the most desired product information to make a purchase decision.

For all three categories, a strong majority of Canadians(66-77%) want to have directions on how to use the product, ingredients, warnings about the product and dosage (with the exception of cosmetics) directly on the product to help them to decide what to buy.  Slightly less important, six-in-ten Canadians would also like to see product features on natural health products, non-prescription drugs and cosmetics.

According to Canadians, brand name is more important to have on non-prescription drugs and cosmetics than it is on natural health products, while the origin of the product is of higher importance on natural health products.  Package inserts and endorsements are the least important features in the product purchase decision: less than half of Canadians want to have package inserts or leaflets and only about one quarter wants endorsements on the product to help them make a purchase decision, regardless of category.

Exhibit 3.3.3.a: Product Information Needed to Make Purchase Decision

Q13. Which of the following pieces of information do you want to have on a product to help decide what to buy?
Base: Total Respondents (n=2502)

Product use plays a role in how much information Canadians’ need for purchase decisions of various consumer health products.  Generally speaking the type and rank of information remains the same regardless of use.  For example, directions and ingredients remain the top two pieces of information desired by Canadians regardless of use.  However, the degree to which Canadians want such information tends to vary based on use.  Frequent users of natural health products such as and homeopathic products want more information than infrequent or non-users while frequent users of traditional natural health products want less information than infrequent or non-users.  With regard to non-prescription drugs, generally speaking frequent users tend to require less information than infrequent or non-users. Cosmetics users such as hair and skincare products tend to want more information to support their purchase decisions.  Complete details can be found in the table below.

Furthermore, Canadians who consider themselves informed about non-prescription drugs and cosmetics also require more information to make purchase decisions however the type and rank remain the same.  The level of information required to make purchase decisions about natural health products however is similar regardless of the level of perceived knowledge Canadians consider themselves to have in this area. Details can also be found in the table below.

Gender and age both play a role with regard to desired product information in making a purchase decision.   Women consistently rate significantly higher than men a desire for all types of information (with the exception of endorsements) on all three categories.  This is likely tied to women’s higher perceived knowledge on these categories.  The same is true of Canadians who are 55 year or older, who also rate their desire for each type of information significantly higher on all three categories than their younger Canadian counterparts (again, with the exception of endorsements).

3.3.4. Determining Safety of Products

Canadians look to many different sources to determine the safety of a product.

For natural health products, there are clearly three top sources of safety information that Canadians look to: asking a health professional or practitioner (48%), researching the product online (47%) and reading labels or product inserts (46%).  That being said, none of these sources are used by a majority, suggesting Canadians use multiple sources to determine product safety.  About one third of Canadians look for Health Canada’s approval number for both natural health products and non-prescription drugs, dropping to one-quarter for cosmetics.

Non-prescription drugs have two sources of safety information that stand out above the rest – asking a health professional or practitioner (56%) and reading labels or product inserts (53%), though only a very slight majority use these sources.

For cosmetics, relying on brand name (45%) and reading labels or product inserts (43%) are the main sources of information.  Canadians are also more likely to “not really think about” the safety of cosmetics compared to natural health products and non-prescription drugs (20% vs. 10%-12%).

Exhibit 3.3.3.a: Determining Safety of Products

Q14. How do you determine if the products in these categories are safe?  Select all that apply.
Base: Total Respondents (n=2502)

Canadians who consider themselves knowledgeable about the safety of consumer health products, those who consider themselves well informed in general about consumer health products and those who have higher perceptions about the safety of consumer health products in Canada are more likely than their counterparts to use a variety of sources to help them determine if products are safe.

Gender and age both play a role in how Canadians determine safety of products.   Women and older Canadians (55+) are both more likely to search for safety information from various sources.  For each of natural health products, non-prescription drugs and cosmetics, women are significantly more likely than men to rely on name brand/reputation of a product, reading product labels or inserts and researching online.

For all three categories, Canadians who are 55 year or older are significantly more likely than their younger counterparts to ask a health professional or practitioner, read product labels or inserts, search advisory, warning or recall information and look for the Health Canada approval number on the product.

3.3.5. Determining Effectiveness of Products

Canadians use similar sources to determine the effectiveness of a product as with safety.

Similar to when Canadians look for safety information, there are a few sources on effectiveness that stand out for each category.   For natural health products Canadians prefer to research the product on the internet (48%) or ask a health professional or practitioner (44%).  For non-prescription drugs, the majority of Canadians ask a health professional or practitioner (57%), while others rely on brand name or reputation (43%) or internet research (42%).  For cosmetics, relying on brand name (44%) and conducting internet research (41%) are the main sources of information.  As seen with determining safety of a product, a sizeable portion of the population does not think about effectiveness; however, more think of it for non-prescription drugs compared to natural health products and particularly cosmetics.

Exhibit 3.3.5.a: Determining Effectiveness of Products

Q15. How do you determine if the products in these categories do what they say they will do? Select all that apply.
Base: Total Respondents (n=2502)

Canadians who consider themselves knowledgeable about the effectiveness of consumer health products, those who consider themselves well informed in general about consumer health products and those who have more trust in label claims are more likely than their counterparts to use a variety of sources to help them determine the effectiveness of the various health products.

Gender, age and education all impact how Canadians determine the effectiveness of products.  For all three categories, women are significantly more likely than men to research online or to ask friends and family.  Men are significantly more likely to not really think about it or assume that all products for sale in Canada must do what they say they do.

Canadians who are 55 year or older are significantly more likely than those under 55 years old to ask a health professional or practitioner, rely on the brand name, search advisory, warning or recall information and look for the Health Canada approval number on the product.  Canadians 18-34 years old are significantly more likely to ask family or friends, research online, or to not really think about it.

Finally, with respect to education, Canadians with a university degree are significantly more likely than those with only a high school education to ask family or friends, as well as research the product on the internet.  Canadians with a high school education or less are significantly more likely than those with higher education to believe that all products for sale in Canada must do what they say they do.

Where Canadians Look for Product Information

3.3.6. Canadians use a variety of sources to look for product information.

While there are no information sources that are used by a strong majority of Canadians, search engines and product labels are two of the most commonly used sources for all three categories.  Healthcare professionals (such as a doctor or a nurse) are the number one information source for Canadians when looking up information on non-prescription drugs (53%). Far fewer (21-39%) consult a healthcare professional when looking for information on natural health products or cosmetics.

While general internet searches using a search engine are common, specific health-related websites (such as manufacturers’ website, Health Canada’s website, consumer group websites, etc.) are not commonly used by Canadians to look up product information, as only one quarter of Canadians or fewer use any of these types of websites for any of the three categories.

Social media and blogs are not popular information sources and are only used by less than one-in-ten Canadians for all categories.

Exhibit 3.3.6.a: Product Information Sources

Q16. Where do you look for information about products in each of the following categories?  Select all that apply.
Base: Total Respondents (n=2502)

Gender, age and education all play a role in what sources Canadians use to look up product information.  For each category, women are significantly more likely than men to read the product label, ask family or friends, consult the manufacturer’s website and/or use a health magazine or journal.

Canadians who are 55 years or older are significantly more likely than those under 55 to read the product label and ask a health professional.  Younger Canadians (18-34 years) are significantly more likely to use internet based research using a search engine, government websites, social media and blogs. They are also significantly more likely to talk to family or friends than older Canadians.

Canadians with a university degree are significantly more likely than those with high school or less to use nearly all of the various sources of information.

3.3.7. Product Preference

There is no strong preference for homeopathic or non-prescription drug for cough and cold products.

Participants were shown images of two products chosen based on availability in French and English that represent a non-prescription product and a homeopathic product indicated as “cough & cold”.  The homeopathic product was Real Relief cough & cold daytime formula (DIN-HM 8002246). The non-prescription product was Balminil Syrup indicated to relieve dry cough due to colds, antitussive (DIN 00436895).

When asked which product they would be more likely to use, Canadians did not display a strong preference for the homeopathic or non-prescription drug to relieve cough and cold.  To this point, roughly half (47%) claimed they would be equally likely to use either product, while about one quarter preferred product A (“Real Relief”, a homeopathic product) (25%) and another quarter preferred product B (“Balminil”, a non-prescription drug) (28%).

Exhibit 3.3.7.a: Product Preference

Q5A. Both of these products have been reviewed and approved by Health Canada. Would you be:
Base: Total Respondents (n=2502)

Frequent users of natural health products such as traditional natural health products (37% vs 31-22%), natural health products (29% vs 22-17%) and homeopathic products (29% vs 17-22%) were more likely to choose Real Relief.

There are a couple demographic differences when it comes to selecting these products:

• Real Relief was significantly more likely to be chosen by women, Canadians residing in any province other than Quebec and by those with less than a university education.
• Balminil was significantly more likely to be chosen by Canadians under the age of 55, Canadians living in Quebec and by those with at least college education or higher.
• Equal likelihood of choosing Real Relief or Balminil was significantly more likely to be Canadians 55 years of age or older and those with a high school education or less.

3.3.8. Reasons for Product Preference

There are many reasons for product preference.

The reasons why Canadians preferred Balminil (a non-prescription drug) or Real Relief (a homeopathic product) vary greatly.

Reasons Canadians selected Real Relief included the details or information on the package (16%), the natural ingredients (15%) and that it relieves or covers more symptoms (15%).

Canadians chose Balminil because it contains medical ingredients (10%), or because they are familiar with the product (10%).

For those who were equally likely to choose either product, the most common response was that they felt that the products were similar to each other (26%). The frequency of use of homeopathic products did not affect the responses on this question, which could mean that consumers are not able to easily identify homeopathic products from non-prescription drugs.

Based on these findings, it would seem Canadians are most likely to choose a brand based on packaging or which has more information on the ingredients or effectiveness of the product.

Exhibit 3.3.8.a: Unaided Reasons for Product Preference – Real Relief

Q5B. Why would you be ( insert response from Q5A)? (OPEN ENDED RESPONSE)
Base: Respondent prefers Real Relief (n=635)
*Only responses with 5% or higher are included

Text Description - Exhibit 3.3.8.a: Unaided Reasons for Product Preference – Real Relief

Exhibit 3.3.8.b: Unaided Reasons for Product Preference – Balminil

Q5B. Why would you be ( insert response from Q5A)? (OPEN ENDED RESPONSE)
Base: Respondent prefers Real Relief (n=635)
*Only responses with 5% or higher are included

Text Description - Exhibit 3.3.8.b: Unaided Reasons for Product Preference – Balminil

Exhibit 3.3.8.c: Unaided Reasons for Product Preference – Equally Likely to Use Real Relief or Balminil

Q5B. Why would you be ( insert response from Q5A)? (OPEN ENDED RESPONSE)
Base: Respondent prefers Real Relief (n=635)
*Only responses with 5% or higher are included

Text Description - Exhibit 3.3.8.c: Unaided Reasons for Product Preference – Equally Likely to Use Real Relief or Balminil

4. Survey Methodology

4.1. Methodological Overview

Questionnaire

Based on the objectives of the research and discussion with the Project Authority, TNS drafted the questionnaire.  The resulting survey was 28 questions that were primarily closed-ended.  TNS translated the survey into French.

Survey Pretest

A pre-test was undertaken on April 15^th obtaining 10 English and 10 French completions, including probing questions.  The results were reviewed to ensure the survey was working as expected and that the questions were being interpreted as expected.  Based on the results of the pre-test, no changes were required for the survey and as such the results of the 20 completes were included in the final data set.

Sample Design and Selection

A regionally disproportionate sample of Canadians from the general population aged 18 years and older was drawn to achieve 2,500 completions.  The sample was regionally stratified to ensure regional quotas were met.

All sample was obtained from TNS’s proprietary online panel.

Survey Administration

An online survey was conducted using computer assisted web interviewing (CAWI) technology.  CAWI ensures the interview flows as it should with pre-programmed skip patterns.  It also controls responses to ensure appropriate ranges and data validity.  Sample is imported directly into the survey to ensure accurate recording of sample variables such as region.

Surveys were conducted in English or French as chosen by the respondent.  The survey was conducted from April 18^th to April 26^th, 2016.  In total 2,502 surveys were completed.  The average survey length was 21 minutes with the shortest being 5 minutes and the longest being 118 minutes (outliers removed).

All participants were informed of the general purpose of the research.  They were also informed of the sponsor and the supplier and that all of their responses would be confidential.  As well, the survey was registered with the Survey Registration System.

Margin of Errors

As mentioned previously, panel sample was used for this study and as such margin of error does not apply.

Weighting

Weighting adjustments were applied to the final edited, clean data to ensure that the data were representative of the 18+ population of Canada based on the 2011 Census.  The data were weighted by age within gender and within region to match the Canadian population using 2011 Census Data.   The following is the breakdown of actual and weighted completions.

Completion Rate

A total of 18,500 invitations were sent, of which n=2,502 completed the survey.  The overall completion rate achieved for the online study was 13.5%. The following table outlines the sample disposition and response rate as per the MRIA guidelines.

Non-response Bias

To address the issue of response bias, data were weighted to be representative of the Canadian population.

5. Appendix A: Survey Instrument

Introduction

Thank you for coming to our site to complete this survey. Today we are conducting a study on behalf of the Government of Canada about the opinions and behaviours of Canadians. This survey will take approximately 15 minutes to complete and is registered with the National Survey Registration System. This survey is anonymous and confidential.

Screener

Do you or anyone in your household work in any of the following fields? (Select all that apply)

• Market research company
• Local, provincial/territorial, federal government health agency (for example: Health Canada)
• Health care professional (for example: medical doctor/physician, naturopathic doctor, pharmacist, nurse)
• Clinical or academic research on non-prescription drugs, natural health products or cosmetics
• Consumer advocacy groups in the area of non-prescription drugs, natural health products or cosmetics
• Non-prescription drug, natural health product or cosmetic industry/trade associations (including members, executives,  associates or other staff)
• Manufacturing, packaging, labelling, testing, importing, distributing, marketing, advertising of non-prescription drugs, natural health products or cosmetics
• None of the above <exclusive>

PN: Terminate if response is not none of the above

Consumer Use and Perceptions of Consumer Health Products

PN:  Assign random order for product category for each unique respondent but keep consistent throughout the survey.

1. Please drag each product into the category box you think they most belong.

Images: 10 images

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

2. On average, how frequently do you use each of the following products?

Randomize list

• Traditional natural health products such as traditional Chinese medicine or Ayurvedic medicines
• Natural health products such as vitamins, minerals, fish oils, probiotics
• Homeopathic products
• Allergy relievers and decongestants
• Cough, cold and flu medicines
• Sunscreen products
• Antacids and laxatives
• Pain relievers
• Skin care products (for example: moisturizers, cleansers)
• Hair care products (for example: anti-dandruff shampoo, conditioners)

Scale:

• Daily
• A few times a week
• Once a week
• A few times per month
• Once a month
• Every few months
• A few times per year
• Never

3. In general, how would you rate your knowledge about the safety of:

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Scale:

• 1 No knowledge at all
• 2
• 3
• 4
• 5
• 6
• 7 Extremely knowledgeable

4. In general, how would you rate your knowledge about the effectiveness (how well they work) of products in these categories:

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Scale

• 1 No knowledge at all
• 2
• 3
• 4
• 5
• 6
• 7 Extremely knowledgeable

5. When you come across a product that says “homeopathic medicine” on the label, what does that mean to you?

OPEN

5A. Both of these products have been reviewed and approved by Health Canada. Would you be:

[Two images – to be labelled Product A and Product B]

• (a) More likely to use Product A to relieve your cough and cold
• (b) More likely to use Product B to relieve your cough and cold
• (c) Equally likely to use Product A or Product B to relieve your cough and cold

5B. Why would you be < insert response from Q5A>?

OPEN

6. Which of the following descriptions would you associate with a “product traditionally used in Ayurveda to aid digestion”? Select all that you think apply.

Randomize list

• A folk medicine from South Asia to aid digestion
• An herbal digestive aid
• A medicine (drug) that aids digestion
• A digestive aid made in a place called Ayurveda
• Don’t know

7. When you come across a product that says “SPF 15” on the label, what does that mean to you?

Free-text box (50 words maximum)

DISPLAY:

PN:  Use same order as random display selected at the beginning of the survey.

The following survey is about < natural health products, non-prescription drugs and cosmetics>.

Natural health products contain ingredients that originate in nature and include a variety of products such as vitamins and minerals, herbal remedies, homeopathic products, traditional products (such as traditional Chinese medicines), probiotics, and other products like amino acids and essential fatty acids.

Non-prescription drugs are everyday medicines and first-aid products that are available without a prescription, such as allergy and sinus/nasal congestion relievers; cough, cold and flu medicines; fever and pain relievers; eye and ear care drops; antacids and laxatives; children’s medicines; and antiseptic and wound cleansers.

Cosmetics are products used for cleansing, improving or altering the complexion, skin, hair or teeth, such as body wash, facial moisturizer, hair shampoo and conditioner, make-up, deodorant and perfume.

8. In general, how informed do you feel when you buy products in the following categories?

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Scale

• 1 Not well informed at all
• 2
• 3
• 4
• 5
• 6
• 7 Extremely well informed

9. How safe do you believe the following products sold in Canada are?

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Scale

• 1 Not safe at all
• 2
• 3
• 4
• 5
• 6
• 7 Extremely safe
• Don’t Know

DISPLAY:  A product claim is something that a manufacturer says their product will do.  The following are a few examples of product claims:

• A stain-removing toothpaste may say “whitens teeth”.
• A weight loss product may say “helps you lose weight”.
• A cold medicine may say “reduces coughing”.
• A body moisturizer may say “helps relieve dry skin”.

10. How much do you trust the claims made on the labels of?

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Scale

• 1 Do not trust at all
• 2
• 3
• 4
• 5
• 6
• 7 Trust completely
• Don’t Know

11. How much do you agree or disagree with the following statements?

Scale

• 1 Completely disagree
• 2
• 3
• 4
• 5
• 6
• 7 Completely agree

• A natural product is safer because it is made of natural ingredients
• Products with similar claims will do the same thing
• It is the product manufacturer’s responsibility to ensure a product is safe
• It is Health Canada’s responsibility to ensure a product is safe
• Claims (for example: help you lose weight) made on the labels of products must be supported by science
• All products claiming they do the same thing (for example: relieves sore throat) must have the same level of proof provided by the manufacturer to support their claim
• Product claims (for example: reduces signs of aging) must be true if they are written on the label

Consumer Behaviours

12. Thinking about < insert product category>, which part(s) of the labelling or packaging do you read and how frequently do you read them?

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Randomize list

• Brand or product name
• Directions on how to use the product (that is, how to take it or apply it)
• Warnings about the product (for example: do not use if pregnant, may cause skin irritation, may have come into contact with allergens)
• Ingredients in the product
• Dosage (that is, how much of the product  to use – for example: take 1 tablet every 4 hours)
• Endorsements (as approved by a professional groups or associations, for example: “#1 toothpaste recommended by dentists”)
• Where the product was made (country of origin)
• Package insert or leaflet (found attached to or inside the product package)

Scale

• Never
• Only the first time I buy it
• About half of the time
• Every time I buy it
• Every time I use it
• Don’t know

13. Which of the following pieces of information do you want to have on a product to help decide what to buy?

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

PN: Anchor other to bottom of list

Randomize list

• Brand or product name
• Directions on how to use the product (that is, how to take it or apply it)
• Warnings about the product (for example: do not use if pregnant, may cause skin irritation, may have come into contact with allergens)
• Ingredients in the product
• Dosage (that is, how much of the product much to use – for example: take 1 tablet every 4 hours)
• Endorsements (as approved by a professional groups or associations, for example: “#1 toothpaste recommended by dentists”)
• Where the product was made (country of origin)
• Package insert or leaflet (found attached to or inside the product package)
• Product features
• Other

14. How do you determine if the products in these categories are safe?  Select all that apply.

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Randomize statements, anchor other

• Assume all products for sale in Canada are safe
• Don’t really think about it
• Ask family or friends
• Ask health professional or practitioner
• Read labels or product inserts
• Rely on brand name/reputation
• News media
• Search advisory, warning or recall information
• Research product on the Internet
• Look for Health Canada approval number on the product
• Other (please specify)

15. How do you determine if the products in these categories do what they say they will do? Select all that apply.

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Randomize statements, anchor other

• Assume all products for sale in Canada must do what they say they will do
• Don’t really think about it
• Ask family or friends
• Ask health professional or practitioner
• Rely on brand name/reputation
• News media
• Search advisory, warning or recall information
• Research product on the Internet
• Look for Health Canada approval number on the product
• Other (please specify)

16. Where do you look for information about products in each of the following categories?  Select all that apply.

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Randomize

• Internet (drop down menu)
  • Search Engine (Google, Yahoo, etc.)
  • Health Canada website
  • Government of Canada website
  • Other government website
  • Consumer group website
  • Health professional website
  • Manufacturers’ website
  • Blogs
  • Social media (Facebook, Twitter, Instagram)
  • Other
• Health magazine, journal, book
• Health care professional (Doctor, Nurse, Pharmacist)
• Health care practitioner (Homeopath, traditional healer)
• Family or friends
• Product label
• Other (please specify)

Role of Health Canada

17. For each of the following categories, which tasks, if any, do you believe Health Canada is responsible for?

Categories:

• Natural health products
• Non-prescription drugs
• Cosmetics

Randomize statements

• Reviewing (evaluating) the product before it hits the shelves
• Making sure a product is safe before it hits the shelves
• Making sure a product does what it says it will before it hits the shelves
• Testing products in a laboratory
• Ensuring products are manufactured without contamination
• Making sure products contain the ingredients they say they do
• Approving labels before they hit the shelves
• Pulling products that are not safe from the shelves
• Setting safety standards for companies to follow
• None of these

Product Identifiers

18. Have you ever heard of a:

• Drug Identification Number (DIN)
• Natural Product Number (NPN)
• Homeopathic Medicine Number (DIN-HM)

• Yes
• No
• Don’t know

DISPLAY

A Drug Identification Number (DIN) is an eight digit number assigned by Health Canada to non-prescription and prescription drugs prior to being sold in Canada. This number tells you that Health Canada has evaluated a product and authorized it for sale in Canada.

A Natural Product Number (NPN) or Homeopathic Medicine Number (DIN-HM) is an eight digit number assigned by Health Canada to natural health products or homeopathic medicines prior to the products being sold in Canada. This number tells you that Health Canada has evaluated a product and authorized it for sale in Canada.

PN: Ask for each item and randomize DIN, DIN-HM and NPN.  Leave discriptions displayed at all times.

19. If a product has a (DIN, DIN-HM or NPN) would you consider it to be:

Scale

• Yes
• No
• Don’t know

Randomize statements

• Safe
• Effective (does what it claims to do)
• Without contamination

Demographics

Now, we just have a few questions to help us classify your answers.  Your responses to these and all other questions will be kept completely confidential.

20. In what year were you born?

21. What is your gender?

• Male
• Female
• Other

22. In which province or territory do you reside?

• Alberta
• British Columbia
• Manitoba
• Newfoundland and Labrador
• New Brunswick
• Nova Scotia
• Ontario
• Prince Edward Island
• Quebec
• Saskatchewan
• Nunavut
• Northwest Territories
• Yukon

23. What is the highest level of formal education that you have completed?

• Grade 8 or less
• Some high school
• High school diploma or equivalent
• Registered aApprenticeship or other trades certificate or diploma
• College, CEGEP or other non-university certificate or diploma
• University certificate or diploma below bachelor's level
• Bachelor's degree
• Post graduate degree above bachelor's level
• Prefer not to answer

24. Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes?

• Under $20,000
• $20,000 to just under $40,000
• $40,000 to just under $60,000
• $60,000 to just under $80,000
• $80,000 to just under $100,000
• $100,000 to just under $150,000
• $150,000 and above
• Prefer not to answer

25. Are you a parent or caregiver for anyone that is? Select all that apply.

• Under the age of 13
• 13-17 years old
• 65 years or older

PN: ONLY ASK TO WOMEN

26. Are you currently?

Answer List:  Yes, No

• Pregnant
• Breastfeeding

27. Do you or anyone in your household have:

• A severe chronic medical condition
• A severe or life threatening allergy

Should you wish to learn more about consumer health products, please visit the following websites.

• Natural and Non-prescription Health Products - Drugs and Health Products
• Cosmetics - Consumer Product Safety
• Health

1

Note: multiple response so numbers will not add to 100%.