spotlight on... patient insights

1Patient insights | www.wearecouch.com

SPOTLIG HT ON. . .

PATI E NT I N S IG HTS

Inspiring audiences. Motivating change. Thinking beyond.

ISSUE 2

f i rst awareness of a condit ion, through diagnosis and treatment decisions, to ongoing management , including adherence to medicat ions.

Every pat ient journey is different , and this wi l l depend on a var iety of different factors , including the pat ient ’s age, level of education, social s i tuat ion, and culture, as wel l as the pat ient ’s current condit ion, their disease type, t ime since diagnosis , and stage of disease at diagnosis . The pat ient ’s condit ion wi l l change according to the effect iveness of the treatment and the progression of the disease.

This eZine wi l l d iscuss the role of pat ient insights and what impact i t has onimproving pat ient outcomes.

As always, I would love to get your feedback and hear your thoughts on this eZine. You can emai l me at [email protected] or tweet me at @ash_rishi .

Ti l l next t ime.

Ash RishiManaging DirectorCOUCH Medical Communications

Nowadays, there is a lot of noise with terms such as pat ient engagement , pat ient empowerment and pat ient centr ic i ty. These efforts have entered our lexicon, and should general ly focus on the pat ient and understanding that pat ients are no longer a passive player in their own healthcare. People are becoming better educated about their own health condit ions, and are playing an ever- increasing role in their own healthcare management . With this in mind, market ing interact ions need to be developed with a thorough understanding of the pat ient journey at every stage, from

NOTE FROM THE EDITOR

Powering behaviour change with human insights

How can we better understand patient behaviours when it comes to adherence?

How can pharma get closer to the needs of the patient?

Generating compliant patient insights using co-design

Social listening for patient insights

Beyond data: Using insights to improve pharma marketing

IN THIS ISSUE

4 | Patient insights

Human insights should be the cornerstone of any communication strategy,

especially as we are predominantly digital first. It is very easy to continually

highlight that pharma need to continue developing products and services

that offer improved patient outcomes, however with the payers the

gatekeepers to new treatments, the idea of focusing on the emotional needs

of patients is not seen as top priority. However, as much as emotional needs

are seen as a distraction to the bigger picture (£££), it is essential.

POWERING BEHAVIOUR CHANGE WITH HUMAN INSIGHTS

Lets consider for instance ADHD diagnosis in the UK, research has found that diagnosis of ADHD in school-age children grew from less than one percent in the 1990s to about five per cent in 2014. So, lets consider why; is it that the behaviour of children has dramatically changed in the past 25 years? Could cognitive biases influence decision-making? Or is it, as Professor Conrad’s research indicates, there is an increased awareness of a range of symptoms which has created a new bias amongst healthcare professionals?

INFLUENCING BEHAVIORCHANGE

Health related decisions are far more complicated nowadays, firstly there is more choice, more information (not always accurate), more red tape, more pressure etc. This not only makes it difficult to get messages out that achieves actionable results, but it also acts as a barrier to those that make the decisions in the interest of the local health economy. We are all driven by our unconscious, sometimes irrational mind. Thus gaining an understanding of unarticulated thoughts and feelings not only drives preference for your brand, but also provides the insights that you are creating products and solutions that people want in the first place. To achieve this, your brand will need to work much much harder to be heard, understood and valued, to achieve this we will need to consider a few factors that will influence your specific audience.



The motivational factors that direct our actions are complicated and there are many ideas about how motivation operates. Many psychological theories identify motivation as an important factor in influencing behaviour.

Research suggests different factors influence motivation including: conscious and subconscious processes, internal and external drivers, different beliefs about the consequences of their current behaviour, the expected outcomes of the new behaviour, and perceptions of social norms including others attitudes and behavioural approval.

To change behaviours of patients we need to consider the self-positivity bias. We all believe that we are not going to get the illness associated with our risky behaviour, smoking would be a great example here. So, in pharma communications we need to move away from comparative references, i.e., the average person and move towards showing real people in the context of their lives and tell that story, this is more likely to motivate an individual to change.

The correlation between the mind and the body is not one-directional as one would imagine. Changes in heart rate and other physiological responses influence our perceptions of our self being, which will alter our attitude to those perceptions. This is where wearables and apps can play an important role in influencing perceptions and attitudes. Getting it right is a different issue, but firstly we must understand the person, their thought process and achieve behaviour change.

Both patients and payers/healthcare professional are not logical, data-driven decision makers; sometimes the decisions they make are not always rational. Loss aversion is possibly the most powerful bias, we as humans will do anything to avoid loss. If we put our selves in the shoes of a payer/healthcare professional. So right now we have an emergency on our hands, a serious illness is impacting our local health economy, we have 300 patients who are desperately ill and we need to treat the patients, however we have been presented with two options. The first option offers us the opportunity to save 100 patients. Whereas, the second option means that 66% of our patients will die.

Although the outcome for our patients is virtually identical, we will pick option one. Why? As humans, we have an aversion to loss, so we will focus on saving lives and not the loss of two thirds of our patients.

Context is vital in shaping thoughts and behaviours; it forms the basis of rules of what is acceptable in society. The challenge we have is to understand how these thoughts and behaviours influence audience preferences.

Here we need to ask a few questions (below is a couple for consideration) to get the required insights to understand social norms in a particular segment:

What are the values that drive prescribing behaviours?

How does the segment form their attitudes?

Understand decision-making processes1

Understand context2

Understand motivation3

Understand perception4


THE BENEFITS TO YOUR BRANDIf we look at it from a patient perspective, using behavioural insights can

lead to increased adherence. Therefore, engaging patient groups is vital to

have an understanding of the emotional realities they face and why they may

skip a dose or simply stop taking their medication. Make the patient a part

of the solution instead of the problem.

From a pharma perspective using behavioural insights can help to

understand customers and get under the skin of why they do what they do.

Understanding their motivations can help you design a meaningful brand

position and communications that addresses cognitive biases. You will

connect directly with your audience as soon as they see your messages.

Understanding the very behaviours that motivate us is one of the most

powerful ways to change perceptions and positively influence

patient outcomes.


7Patient insights | www.wearecouch.com 7Patient insights | www.wearecouch.com


UNDERSTANDING PATIENT BEHAVIOUR

Marketers should not assume that patients always take their medications according to the instructions given on the packaging or by their doctor. According to WHO, adherence to instructions hovers at only around 50 percent. This means that half of all patients are taking medications incorrectly, potentially exposing them to unwanted side effects or causing the medication to be ineffective. So if we get into the mind-set of the patient, they may be becoming disheartened with their medication for a potential variety of reasons. Is it chronic illness without any obvious symptomology? This could certainly be the case for sufferers of Type 2 Diabetes, for example. Non-adherence is where the real challenge is for pharma. Behavioural strategies seeks to understand sometimes seemingly irrational patient behaviour, and therefore find ways of working with patients

and healthcare providers to ensure medication is taken properly. Part of this responsibility involves working with patients directly, for example by providing clearer usage information along with the products. However, educating healthcare providers can achieve a potentially greater impact, so that they can instruct patients and their family on the proper use of medications.

From a personal perspective, if my Diabetic Nurse was adequately trained on how to provide support for me to take my once weekly injections, my treatment journey would be much smoother for me, my family and my CCG.

It is never too late to gain an understanding in HCP behaviours, which is

crucial. It is not enough to simply produce medications for illnesses; in order

to achieve market penetration, pharmaceutical companies must understand

both the prescribing habits of HCPs and the behaviours of patients to deliver

communications that meet the needs of both.

HOW CAN WE BETTER UNDERSTAND PATIENT BEHAVIOURS WHEN IT COMES TO ADHERENCE?



Understanding patient behaviour is important for designing an effective communications programme. In particular, brand managers must understand how patients respond to particular types of communications, we could call this the customer experience, as well as how context plays a role in their response.

A study of direct-to-consumer marketing carried out in 2002 revealed that consumers were most likely to ask their doctor about a product after they had seen an advertisement that gave them information they had not previously known. Rather than rehashing the same messages in all campaigns, advertisers need to ensure that they are providing up-to-date, useful information, as this approach seems to be most likely to trigger patients to take action and request the medication.

The study also revealed that pharmaceutical marketing fails to reach sufferers of conditions that have not yet been diagnosed. Only 15% of patients who were driven to contact their doctors after seeing an advertisement were pre- diagnosis sufferers of a condition. This is a bigger problem facing society, with the lack of social engagement and the little that pharma is doing are statistical messages that do little than scare monger. This 15% statistic represents an important opportunity for behavioural strategies in the pharmaceutical industry. Certain conditions,

particularly mental health conditions such as depression and bipolar disorder, are estimated to be as yet undiagnosed in up to three quarters of current sufferers. Some physical conditions such as osteoporosis and hypertension also go unnoticed in more than half of patients. Pharma must get better at helping patients to recognise worrying symptoms and motivating them to seek medical treatment. Not only does this approach potentially increase the number of customers taking a particular drutg, but it also has the potential to improve health by allowing conditions to be treated early.

Behavioural strategies can be applied particularly effectively in the digital sphere too. Digital allows us to use data about browsing habits to show them targeted messages. Brand managers must pay attention to the latest trends in online behavioural targeting to ensure that their messages are shown to the right users and more importantly at the right time. Brand websites can also gather data, in compliance with online privacy legislation, and use it to target consumers with more relevant marketing. For example, someone browsing a pharma website for information about a particular condition could be shown advertisements to a non-branded educational website for a condition that could help them, rather than other, less relevant websites with unreliable information.

Plan for success by gathering information about the needs and lifestyles of the target market, and using behavioural strategies to reach out to those consumers, pharmaceutical companies can deliver campaigns that are both useful for patients, and more effective at driving uptake.

DESIGNING BEHAVIOURAL STRATEGIES

Advertisers need to ensure that they are providing

up-to-date, useful information, as this approach seems to be

most likely to triggerpatients to take action and

request the medication.

HOW CAN PHARMA GET CLOSER TO THE NEEDS OF THE PATIENT?


For treatment to be successful, from the perspective of both the physician

and pharma, it needs to meet the physical and emotional needs of the

patient throughout his or her journey. This needs pharma to have a detailed

understanding of the patient’s needs and desires across a variety of different

conditions and stages of the disease. Mapping the journey is an effective

tool for highlighting these and finding potential ways to improve the care

pathway, for both patients and staff. This acknowledgment of the patient

journey from a patient-centred perspective can help pharma to develop

effective solutions. Pharma can achieve this by getting closer to the patient

and involving them, below we outline two ways pharma can engage with

patients, in a compliant manner.

Co-designing is an approach to improving patient-centric care. It is based on story-gathering with staff and carers, and focuses on providing a better understanding of the patient journey, with an aim to bring a human element to the interactions between patients and staff, and allowing staff the space and time to think about elements of care that they may not ordinarily have time to notice.

The co-design process starts with workshops that involve the stakeholders in designing the interview process, asking what questions would be the most pertinent and the resulting information could best be used and shared. By providing the opportunity to connect the human face of patient care with

CO-DESIGN

managerial and clinical priorities, co-design can help to bring about attitudinal, behavioural and cultural change, led by the needs of the patient. It also provides narrative evidence for staff who may be struggling to deal with clinical and operational data. It can also bring about practical changes in patient care, for example involving carers at an earlier stage in the treatment process, or improving the process for patient discharge arrangements that allow patients to get home quickly, but with the support they need in place.


Understanding the patient journey involves getting the patient’s perspective on their healthcare experience. This can offer great insight into gaps in service delivery, and ways in which the service can be improved. As a result, many health care organisations now have mechanisms in place for gathering patient stories, using the patients’ own words, to gain insight into the care received on a particular pathway.

Patient stories are particularly important to clarify care experiences where there is not a dynamic pathway or a recognisable journey. They can complement a shadowing process, but also can be used in isolation where shadowing may not be appropriate (such as during end-of-life care). Patient stories can also capture the opinion of family members, and help create an understanding of how care fits into the patient’s wider life – for example, what happens between episodes of care. It can highlight problems with organisation and communication, and help to uncover the impact of certain patient ‘touchpoints’.

When gathering patient stories, patients and carers should be informed that these will be used to understand and improve their experience of the health service. By inviting patients to describe their recent experience, they should be encouraged to

PATIENT STORIES

reflect on positive aspects and provide constructive criticism. Reassurance should also be given that patients’ privacy will be respected, and any safeguarding issues should be shared with the interviewee, because it may not be possible to guarantee total anonymity if they raise an issue that needs to be acted upon.

With patients more empowered than ever to take control of their own health care, it is important that pharma works collaboratively with them to understand the patient journey, in order to provide effective support. To get closer to the needs and emotions of the patient, pathway co-design can provide the ‘human’ element of care that will build a strong foundation for patient support, as well as creating an opportunity to gather new insights around health services. Patient stories can also be used to gather information around the quality of care provided on a specific care pathway, offering insight from family members and caregivers alongside the patient themselves. This can offer opinion from a number of new perspectives, allowing room for alternative viewpoints to engage in the discussion. Key themes and issues that arise can identify areas for improvement along the pathway, and allow pharma companies to engage with patients, giving both parties a voice along the way.

How long was the diagnosis and treatment process?

What information were you given?

Were your individual needs met?(This could include language or mobility needs)

Were patient services responsive?

What was the role of your family?

Was your privacy respected?

Was your care well-coordinated?

Did you feel that you werelistened to?

To truly understand each element of the patient journey, potential questions include:

12| Patient insights

GENERATING COMPLIANT PATIENT INSIGHTS USING CO-DESIGN

People are becoming better educated about their own health conditions,

and are playing an ever-increasing role in their own healthcare management.

Every patient journey is different, and this will depend on a variety of

different factors, including the patient’s age, level of education, social

situation, and culture, as well as the patient’s current condition, their disease

type, time since diagnosis, and stage of disease at diagnosis. The patient’s

condition will change according to the effectiveness of the treatment and the

progression of the disease.

With this in mind, marketing interactions need to be developed with a thorough understanding of the patient journey at every stage, from first awareness of a condition, through diagnosis and treatment decisions, to ongoing management, including adherence to medications and this is where co-design (or co-creation as it can be called) comes into play.

Co-designing is an approach to improving patient-centric care. It is based on story-gathering with patients, staff and carers, and focuses on providing a better understanding of the patient journey, with an aim to bring a human element to the interactions between patients and staff, and allowing staff the space and time to think about elements of care that they may not ordinarily have time to notice.

The co-design process starts with workshops that involve the patients in designing the interview process, asking what questions would be the most pertinent and how the resulting information could best be used and shared.

By providing the opportunity to connect the human face of patient care with managerial and clinical priorities, co-design can help to bring about attitudinal, behavioural and cultural change, led by the needs of the patient. It also provides narrative evidence for staff who may be struggling to deal with clinical and operational data. It can also bring about practical changes in patient care, for example involving carers at an earlier stage in the treatment process, or improving the process for patient discharge arrangements that allow patients to get home quickly, but with the support they need in place.

WHAT IS CO-DESIGN



The focus in co-design is very much on the interactions between patients and the stakeholders involved in patient support. The identification of tools/support/content required is solely driven by the patient, in essence they own the brief. It’s a collaboration. Its important the patient shows us how they think and feel, it is from this we get actionable insights.

Here are just a few of the benefits that pharma can have by using patient insights at a deeper level.

Real insight

Knowledge of the patient journey is important when designing interactions, however insight is a game changer. By immersing yourself into the world of the patient you well gain an understanding that will have a profound impact on your messaging and approach to patient centricity.

Create real connections

Many patients and caregivers struggle with their condition and feel lonely, isolated and sometimes helpless. Pharma can use or develop the tools to facilitate -connections patients needs. So a no-brainer really.

WHAT IS DIFFERENT TO THE USUAL “FOCUS GROUP” APPROACH?

BENEFITS OF CO-DESIGN WORK FOR PHARMA

Building trust

Co-design helps all stakeholders understand each other’s contribution to improving the patient experience. Building trust back into the industry is important, patients are calling out for support, healthcare is becoming financially burdened, so pharma have an opportunity to build trust again and to also capitalise on the patient-centricity claims.

Regulations

Did you know that co-design is compliant? Its authentic and genuine, therefore compliant. Word of advice, make sure to involve your legal and regulatory teams early, the local conclusion here is that they will see the value of including the patient voice. Continuous engagement

Co-design is not a one-time activity; it needs to be an ongoing process that drives engagement. By forming long-term relationships with patients and caregivers, pharma can use these insights to develop content and programs that continually meets the needs of patients and care givers.

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The patient journey provides a framework for shifting the focus from product

to patient, it is important for pharma and for healthcare professionals

(HCPs) alike. From the pharma perspective, gaining patient insights and

understanding the patient journey can help to create communications

strategies that center on key engagement milestones along the patient

journey and craft tailored and patient-focused activities that are of real use

to patients and HCPs. And from the perspective of the HCP, understanding

the patient journey can help create better care pathways.

SOCIAL LISTENING FORPATIENT INSIGHTS

For treatment to be successful, from the perspective of both the HCP and pharma, it needs to meet the physical and emotional needs of the patient throughout his or her journey. To achieve this, pharma need to have a detailed understanding of the patient’s needs and desires across a variety of different conditions and stages of the disease.

Mapping the patient journey is an effective tool for highlighting these and finding potential ways to improve the care pathway, for both patients and staff. This acknowledgment of the patient journey from a patient-centred perspective can help pharma to develop effective solutions.

In 2010, almost half of all US adults, around112 million, were

‘ePharma cosumers’



Pharma have traditionally had limited or no access to patients, but this has changed significantly, because of the opportunities presented by social media and other aspects of the digital age. Millions of patients are sharing their healthcare experiences of diagnosis and treatment online. This is effectively another form of ‘story’, and is providing a wealth of insights for pharma to analyse and better understand patients.

Pharma can have an opportunity to engage with patients online in a compliant manner, including through mobile phone apps and social media such as Facebook and Twitter, and interact and provide information 24 hours a day, seven days a week. This phenomenon has empowered patients to take an active role in their healthcare decisions, armed with the support and encouragement of online communities. According to Manhattan Research, in 2010, almost half of US adults, around 112 million, were ‘ePharma consumers,’ or ‘individuals online for pharma information’. This was up from 55 million in 2005. This is likely to be, at least in part, driven by the increases in older people using the internet.

THE ROLE OF SOCIAL MEDIA IN UNDERSTANDING THE PATIENT JOURNEY

Pharma can have an opportunity to engage

with patients onlinein a compliant manner... Providing information

24 hours a day, 7 days a week.

Social media can do two things for pharma:

Encourage and influence patients to better manage their condition by providing information and support

Provide information about the patient journey by monitoring patient behaviours

By encouraging patients using social networks, groups, text and instant messaging, pharma can provide reminders to improve treatment adherence, as well as giving patients support and reassurance. This is likely to reduce healthcare costs over the long- and short-term. It can also serve torecruit patients for clinical trials and improve retention rates.

Insight gained from monitoring social media can in turn inform patient engagement activity byproviding extra information about the patient journey, and help pharma to align its goals with the needs of patients, and even feed into drug development strategies along with information on the patient journey.


BEYOND DATA: USING INSIGHTS TO IMPROVE PHARMA MARKETING

Pharma marketing strategies need to include and incorporate more insight

driven programmes. Today we talk a lot of about data-driven marketing,

however, its time to start looking at insight-driven marketing differently now,

especially in our industry where everything starts and ends with the

patient experience.

INSIGHT-DRIVEN PHARMA MARKETING

Data is good, data is important, but Big Data is a challenge. There is a lot to sift through, a lot of irrelevance, such as web visits or follower count. Our role as pharma marketers is to determine what is relevant.

Getting the insights from data is less about technology but having the balance between emotional intelligence and backing that up with the data.

Insights has a strong correlation with a successful customer experience strategy. A successful and cost effective customer experience strategy has to focus resources where they will have the most impact, for example by targeting specific needs,

or concentrating on a specific set of stakeholders. To achieve this goal, pharma need to think like a healthcare professional or a patient, and create a stakeholder-centric mind set by:

Understanding the needs of the stakeholder

Measuring stakeholder behaviour

Creating experience maps for every touch point

Generating insights



Research is the best way to understand the needs of the stakeholder, and find out what they expect from the brand, for example through one-to-one interviews, and observing the healthcare professionals at work, or workshop with patients.

Once it is clear what the information and communication needs are across varying channels, the next step is to gauge how effectively the company is delivering those needs by mapping the stakeholder journey for each segment, for example:

When do primary care physicians first come into contact with the brand?

Do they have access to communications from the company, such as email?

How accessible is the brand / disease awareness website?

Have scientific statements been rigorously tested?

There may be multiple interactions with the brand across a number of devices, and across multiple channels, but by knowing more about the interaction between each of the channels, pharma can better understand how important each of them is to the brand.

UNDERSTANDING NEED AND MEASURING BEHAVIOUR

MAPPING THE JOURNEY

GENERATING INSIGHTS

The most important element of understanding the customer experience is through measurement and data analysis, to generate insights it is important that the data is analysed from a subjective perspective. Potential metrics include:

Overall thoughts about the customer experience

The ease of the process

The timing of the process

Collecting metrics around needs, pathways and experiences is vital, but if data is not harnessed and the findings acted upon thenit is worthless.

This article is a snapshot of why insight-driven strategies are important to get closer to the needs and emotions of your stakeholders. In the case of a patient, pathway co-design can provide the ‘human’ element of care that will build a strong foundation for patient support, as well as creating an opportunity to gather new insights around health services. This can offer opinion from a number of new perspectives, allowing room for alternative viewpoints to engage in the discussion.Key themes and issues that arise can identify areas for improvement along the pathway, and allow pharma companies to engage with patients and healthcare professionals, giving all parties a voice along the way.

HOW INSIGHTS DRIVE ENGAGEMENT

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At COUCH, we create content that responds to the known needs and preferences of your target audience, and elicits the desired response from them.

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