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DTC in FocusGuest Columnist

It Takes a Village: Inciting Call to Action with Disease Prevention Outreach Programs Through Theoretical Foundation

May 20, 2015

In her 1996 book It Takes a Village, current presidential candidate and former United States Senator, First Lady, and Secretary of State Hillary Rodham Clinton detailed her view that multiple determinants, such as community involvement, cultural/environmental influences and social interactions, contribute to how a child is raised. Similarly, inciting a consumer call to action with disease prevention outreach programs takes an amalgamation of different social and behavioral theories which rely on the same factors as the village concept. Studies assert that outreach programs based on more than one theoretical foundation, including Million Hearts which was established by combining the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB), are more likely to produce a desired positive outcome than those that lack theory or are based on only one theory.

The Health Belief Model

The first social behavioral theoretical foundation, Health Belief Model (HBM), emphasizes that the willingness to take action and prevent risk depends upon the beliefs about the susceptibility and severity of disease; the perceptions about the benefits and barriers; cues to action and self-efficacy.

In a hypertension prevention study, Hispanic respondents not only misperceived that certain behaviors are barriers that would increase their risk factors, but also expressed a lack of confidence in their ability to perform such behaviors as having their BP checked regularly, limiting their salt intake, eating five or more servings of fruit and vegetables daily, exercising at least 30 minutes four or more days of the week, and controlling their weight. The general perception that hypertension was not a severe disease and the susceptibility misunderstanding resulted in 68.6% of the respondents being at increased risk for developing hypertension.

The Theory of Planned Behavior

The second social behavioral theoretical foundation, Theory of Planned Behavior (TPB), assumes that attitude, subjective norms, and perceived behavioral control predict actual behavior. Attitude refers to beliefs merged with the value placed on the behavioral performance outcome. Subjective norm signifies the perception of the social expectations to adopt a specific behavior. Perceived behavioral control reflects the beliefs about the level of ease or difficulty of performance behavior.

A circle of culture surfaced in a hypertension prevention study concerning poor eating patterns passed from generation to generation; physician distrust and questioning reasons doctors would want to lower BP because of the belief that physicians would not have a job if they addressed this health issue; and an unwelcome move that changes consumers from insiders to outsiders when they act differently by engaging in healthy behaviors. Severing cultural traditions and adopting preventive behaviors suggested by health care professionals resulted in social pressures.

Combining HBM & TPB: The Million Hearts™ Program

The Million Hearts™ national outreach program engages Community Health Workers (CHWs) to help achieve the goal of preventing one million heart attacks and strokes in the United States by 2017. The CHWs educate consumers about the importance of fit lifestyles and specifically promote these tenets for maintaining a healthy BP:

1)     Having routine screenings for high BP;

2)     Understanding BP numbers and the significance of lowering BP while searching for economical ways to increase lower sodium and whole grain foods and still keep their weight within BMI;

3)     Comprehending the ramifications of uncontrolled BP that include damage to eyes, kidneys, heart blood vessels, and brain; high risk of heart attack and stroke; and chronic kidney failure requiring dialysis.

CHWs encourage consumers to interact with other members of the community including their physicians about clearly defined health goals and keep a daily record of BP readings to track progress. CHWs also introduce consumers to social workers and others who can teach them how to apply for programs and insurance that help pay for health care. Many Hispanic consumers prefer to learn information with plain language fotonovelas, similar to comic books, which are common in the culture. Personal interaction is carried out by “promotoras” from the same ethnic background who honor the tradition of reading a fotonovela with consumers.

In summary, creating a consumer call to action with disease prevention outreach programs such as a Million Hearts™ takes a village of community involvement, cultural/environmental influences and social interactions supported by different theories including HBM and TPB. The underlying premise is that a combination of theories informs the message. Theories determine why, what, and how a health issue should be addressed and assist in developing successful program strategies that reach targeted priority populations to affect a positive impact.

References:

Del Pilar Rocha-Goldberg, María et al. “Hypertension Improvement Project (HIP) Latino: Results of a Pilot Study of Lifestyle Intervention for Lowering Blood Pressure in Latino Adults.” Ethnicity & Health 15.3 (2010): 269–282. PMC. Web. 19 May 2015.

Glanz, Karen, Rimer, Barbara K., andViswanath, K. Health Behavior and Health Education: Theory, Research, and Practice (4th ed). San Francisco: Jossey-Bass. 2008.

Noar, Seth M., Chabot, Melissa, and Zimmerman, Richard S. “Applying Health Behavior Theory to Multiple Behavior Change: Considerations and Approaches.” Prevention Medicine. Volume 46. March 2008.

Peters, Rosalind M., and Thomas N. Templin. “Theory of Planned Behavior, Self-Care Motivation, and Blood Pressure Self-Care.” Research and Theory for Nursing Practice 24.3 (2010): 172–186.

Peters, Rosalind M., Karen J. Aroian, and John M. Flack. “African American Culture and Hypertension Prevention.” Western Journal of Nursing Research 28.7 (2006): 831–863. PMC. Web. 19 May 2015.

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DTC in FocusGuest Columnist

What’s the Role of Disease Awareness in Search?

May 20, 2015

Most pharmaceutical marketers understand the importance of including search marketing in their media plans. Often the champion of the final click, a good paid search campaign contributes to the overall success of any advertising effort and connects your brand to active seekers within the marketplace. Unfortunately, advertisers often focus the majority of their attention on the brand.com site and, at times, overlook the importance role disease awareness (DA) sites play within search strategy through enabling the option of executing a multiple listing strategy.

Let’s take a step back and look at how a good DA site provides marketers with the opportunity to better capitalize search results.

But… what if I’m not first-to-market?

I know what you’re thinking – unless you’re at the helm of a first-to-market treatment, you’re probably thinking that a DA site just doesn’t fit your strategy. Certainly first-to-market competitors have a great opportunity to educate and grow interest in a category for patients and HCPs with an awareness site. However, the opportunity to influence this audience on a condition or disease state exists for more than just the first-to-market competitor. Unbranded education content generally resonates strongly with audiences wary of an overtly branded message and provides marketers with a forum to set the stage for a branded message to follow at a later point in time.

What’s more, a proper DA site need not be overly complex or represent the pinnacle in site design to be effective. Instead, focus investment on good, quality content that stands out from the crowd and strikes a new position on the condition. Savvy digital marketers can take this opportunity to set the table and influence what patients and HCPs should expect or demand from the category. Following on-brand messages can then reinforce differentiation to maximize this added perception. Examples of differentiation can include cost, safety, or even dosage and delivery (e.g., why take an injection when treatment is available via pill).

Finally, DA sites generally resonate better than brand.com sites for unbranded search campaigns. Diagnostic indicators of post-click success – including bounce rate, page views per visit, and even time on site – generally return stronger numbers when an unbranded searcher consumes DA content. With the right site design and layout, the engaged audience can be converted to the brand.com site and ultimately shaped to take the action the advertiser desires.

Once advertisers commit to adding a DA site to the portfolio, a multiple listings approach can be pursued within search. Below, I’ve broken out what makes this tactic so powerful for search advertisers.

Competitive blocking

This additional listing provides added flexibility to advertisers looking to provide active seekers with as many opportunities as possible to connect with their brand and their message. You may already be following this strategy without knowing it – having a separate website for HCPs and patients enables a second listing to populate the search results with a message unique to each audience. The DA site furthers this approach and provides the opportunity to reach both audiences who may be higher up the funnel.

Some advertisers truly embrace the multiple listing approach and create separate DA sites for patients and HCPs, creating yet another additional search listing. The possibilities are endless!

Added coverage and efficiency

Employing a multiple listing strategy provides a great way to even the playing field against competitors with deep pockets determined to remain in the top position. Added listings provide added impression share and SOV opportunities at greater efficiency than an all-or-nothing approach to search positioning (which is why I always advocate employing a separate domain for your patient and HCP brand sites).

If each of your site properties achieves even a 15% impression share, you can quickly begin accruing over half of the available search opportunity without spending the same cost per visitor that you would with fewer listings forced to remain at the top to ensure traffic volume forecasts are achieved.

Flexible messaging opportunities

Multiple listings provide advertisers with greater opportunities to determine the optimal investment levels within search. What’s more, using a test-and-learn approach often reveals which unbranded categories make sense to drive directly to brand.com and which respond better to the unbranded table setting of your DA site – and of course, which terms should have the opportunity to drive to both!

Know thy funnel

Many brand managers regard the branded site as the best chance to engage patients and HCPs. Unfortunately, speaking to a brand naïve audience searching on general condition terms via a branded site usually leads to poor engagement and a questionable user experience. Since we know that qualified patients and HCPs tend to search using basic, single-phrase keywords, it remains difficult to assume what level of brand awareness a searcher has based on the keyword they input.

Disease awareness websites play a critical role in successfully engaging patients and HCPs who may remain higher up in the conversion funnel. Multiple listings provide the opportunity to not only engage in message testing but also audience A/B testing. Which site property makes the most sense for these keywords and ad groups?

Creating a DA site provides brand managers with added flexibility in how they create and execute their paid search campaigns. Having the advantage of added listings in the search results allows advertisers the opportunity to customize their messaging and audience alignment approach at a much more granular level, all while returning greater efficiency and engagement.

Oliver J. Nelson

DTC in FocusGuest Columnist

Driving Disease Awareness, 1 Month at a Time

May 20, 2015

It’s pretty much impossible to count how many people in the world are afflicted with disease; there are simply too many diseases and too many people to count. And if you count the loved ones of those with diseases, then it’s safe to say that virtually everyone is affected by disease.

Our global population of roughly 7 billion people is afflicted with all kinds of diseases, from infectious to non-communicable. Yet education and action are sorely lacking in developing countries and even powerhouse nations like the United States.

It isn’t till one is burdened with illness that one can actually be aware of the severity and implications of it. Unfortunately, by then we must act in a reactive mode, rather than a proactive, preventative, and healthier one.

Activating: a year of disease awareness

Disease awareness months have been around since at least 1985, when the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries (now part of AstraZeneca) formed National Breast Cancer Awareness Month. Since then, every month has been claimed as an awareness month for many diseases. For example, May is Mental Health Month, Stroke Month, Lyme Disease Awareness Month, Celiac Awareness Month, Healthy Vision Month, and Arthritis Awareness Month, to name a few. The monthly “real estate” is totally crowded and the months have less impact when they are sharing with other groups who are also trying to build awareness.

The goal of awareness months is to educate and drive screening. They promote action by driving checkups, and get the larger communities involved in many different initiatives, from walks and runs to health fairs.

The abundance of disease awareness days, weeks, and months provides an opportunity to take a holistic educational view on disease states at large. Even if you’re living with and being treated for only one particular disease, it’s necessary to understand that there’s a whole universe of diseases out there. Get screened and try to prevent illness. The more you’re aware and understand what you need to do, the better chance you have of avoiding disease. And helping others avoid it, too.

Social platforms: spread disease awareness

HealthWellNext, a thought leadership publication, has created a social platform called HealthAwareNext to spotlight and educate around disease months throughout the year. They refer to it as “A Year of Disease Awareness.”

The goal of HealthAwareNext is to educate and drive awareness about disease states. Each month will feature impactful call-to-action content showcasing unique graphics that not only grab attention but educate as well, with real-world information on screening and testing for that month’s condition. The content will be spread via healthawarenext.com as well as through the social media platforms Facebook, Pinterest, Twitter, Tumblr, and Instagram. The hashtags #HealthAwareNext and #YearofDiseaseAwareness, as well as disease-specific hashtags, will drive to relevant content.

HealthAwareNext started in January by focusing on cervical health, followed by heart health in February. March was dedicated to vision health and colon cancer awareness. April put a spotlight on sexually transmitted infections (STIs), and May highlights mental health and stroke. When 2015 ends, it will be with a collection of disease month assets that are as informative as they are visually arresting, and that provide always welcome attention for these diseases. The ultimate goal is to get people to take charge of their health – and make prevention a year-round activity.

Elizabeth Elfenbein

DTC in FocusGuest Columnist

Our Mission: Breaking the Cycle

May 20, 2015

Diabetes. Heart Disease. Obesity. These are three preventable conditions that millions of Americans are living with today. Is misinformation or lack of information the cause? Are they educated but lack motivation to take necessary precautions? Each day people make numerous decisions that have a tremendous impact on their overall health. As health industry marketers, our job is to give them the right information, support, and inspiration to help them make judicious decisions to live healthy lives and prevent chronic conditions, when possible.

According to the CDC, diabetes, heart disease, and obesity are among the top diseases that are the most preventable. “Diabetes is the leading cause of kidney failure, lower limb amputations (other than those caused by injury), and new cases of blindness among adults.” One would think these consequences could provide enough motivation to make healthy choices, yet millions of Americans continue to be diagnosed because they fail to take action. Unfortunately, the number of cases keeps rising year-after-year. Fortunately, we can break the cycle and reverse the trend.

Knowing the facts & their future

The American Academy of Family Physicians stated that patient education and filling prescriptions have about the same impact on health outcomes. Our responsibility is to provide the necessary information patients need to understand the impact of these conditions, steps to prevent them and the difficult future they may experience living with these conditions if precautions are not taken. Empowering patients to act now, by taking steps to wellness, starts with education. Pharmaceutical brand marketers, health content developers, and healthcare providers must work together to create expert disease prevention content. But what is the right time and method to make an impact? The encounter must be highly engaging personal experiences filled with emotion, and distributed through key platforms for easy access by patients.

Support through connections
After educating patients and instilling motivation, the next step is ensuring prolonged commitment to health. This can be accomplished by creating connections between people through online communities and social groups. In a recent Remedy Heath Media study, 7 in 10 people said they were motivated by others to take an action such as eating healthier, exercising regularly, and getting a routine physical. It’s pretty amazing how contagious good health decisions become when surrounded by other like-minded individuals. Plus, there is the opportunity to make new friends who will push you when you need it most.

Through online outlets, health experts such as Amy Hendel (The Health Gal) – physician assistant, nutritionist, and health coach – provide connections for people needing support with their weight-loss, nutrition and fitness goals. These experts give people a sense of belonging and that they are not alone – they have somebody to turn to for trustworthy insights, advice, and guidance – keeping them focused and on track.

Other connections can be made through health and wellness social groups, like the one my wife started last year by connecting with neighbors, exercising together and sharing healthy family eating habits, grocery shopping, fitness tips, and more. Not only did it build a community focused on health and wellness, it created a support system sustaining their commitment. When a member of our wellness group cannot attend meetings the group reaches out and rallies together to ensure they remain engaged. Yes, peer pressure is still alive and well… but for good reason.

Remarkable health heroes spark inspiration

We have found that people become empowered through emotional storytelling. Remedy’s research indicates that among respondents who were highly motivated by emotional storytelling, 90% felt inspired after hearing an emotionally charged personal story.

To spark motivation, sites such as BerkeleyWellness.com are developing emotional marketing programs including Be Well, Be Brave™, which captures the spirit of being brave by challenging themselves to lead a healthy life. Be Well, Be Brave™ presents emotional personal stories of everyday health heroes, who, despite huge hurdles, made important choices needed to live well. These stories depict the real-life transformations of people taking charge of their health. In turn, they inspire others to take action. The health hero’s story are chronicled in a long-form multi-media experience with video and text infused with expert supporting content – buying guides, diet and fitness plans – providing support, inspiration, and engagement for others to go above and beyond what they thought possible.

Whether it’s connecting online, through a social group, or via emotional storytelling, people need to spark their motivation to live healthier. That motivation comes from being educated, not just about where they are today, but what their future holds if changes aren’t made. Motivation will drive action and ultimately lead to a more healthy life, without the worry of preventable conditions. Remember, today the number of people being diagnosed with diabetes, heart disease, and obesity is climbing year-after-year; but by working together, our mission is to break this cycle, stop the trend, and reverse these growing numbers.

Ryan LeMonier

DTC in FocusGuest Columnist

Multitasking Their Lives: How to Support and Educate Patients Who Are Managing Multiple Diseases

May 20, 2015

Pharma marketers spend much time and effort developing and improving ways to support patients in their specific disease areas. This is important work. An estimated 150 million people are living with at least one chronic condition in 2015, and by 2030 the number is estimated to grow to 171 million.[1]

However, this effort does not take into account an important reality: many patients are dealing with more than one condition at the same time. This means that current efforts may be too narrow to offer the full breadth of support that your consumers need every day. Almost one in three Americans has multiple chronic conditions (MCCs).[2] Specifically, about 27.9% of adults aged 45 to 64 and more than half (51.6%) of adults 65 and over suffer from two or more chronic conditions, with the major burden of MCCs on older Americans aged 65 and over.[3] As the baby boomer generation continues to age, the problem is expected to increase.

The CDC reports that the most prevalent combination of two chronic conditions in the United States is hypertension and arthritis, and for people who have the most common combination of three diseases, they add diabetes to that duo. Other common chronic conditions include high cholesterol, heart disease, cancer, depression, substance use disorders, asthma, HIV/AIDS, and dementia. But what makes this challenge so pervasive is that even though these diseases are most common, there are many others. Each person is unique, and so are the health challenges they face every day.

The price of living with MCCs is steep: 71 cents of every dollar of US healthcare spending goes to treating people with MCCs, according to the US Department of Health and Human Services Agency for Healthcare Research and Quality[4] (see the details in a great infographic here). And these are definitely your customers. People with three chronic conditions fill an average of 23 prescriptions per year, and that number jumps to 50 prescriptions per year for people with five chronic conditions.

What can we do to provide information and support for people with multiple conditions? It is a conceptual, logistical, and IT challenge to be sure, and one that pharma does not face alone: government, nonprofit groups, and other health organizations are also structured to provide support that is segmented:

  • The CDC provides a wealth of information and resources for patients on its website, but all are segmented by disease: http://www.cdc.gov/features/diseasesconditions.html
  • The nonprofit National Council on Patient Information and Education (NCPIE) recently launched a 10-step adherence program called Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda as part of its campaign platform at www.bemedicinesmart.org.  Though the resource gallery includes links and resources for the most common, costly, and preventable of all health problems in the US, there is not one place where patients can turn to address all of their conditions and symptoms.
  • Data aggregators, sites you probably know that are set up for patients to log their health data to be combined with others and inform clinical research, are set up for patients to track their diagnosis and treatment for one disease/condition at a time.

How can pharma marketers face this challenge to help their patient consumers? It’s a multi-faceted problem, but here are some starting points to open the discussion:

  1. Stop focusing on just disease and focus instead on the tools of coping, juggling and living. Not only do most people have more than one medical condition, but everyone is trying to get through each day successfully managing their health along with their relationships, their jobs, and more.
  2. Engage with patients the way patients want to engage (not the way pharma prefers). It’s not about controlling the message – instead, put yourselves in your customer’s shoes, work to deeply understand their journey, and see how you can help.
  3. Provide peer-to-peer support. When it comes to their health, patients want to hear from people that they feel are like them. Because it is likely that others are dealing with multiple conditions, peer support that connects patients with real people who have volunteered to share their experiences and provide support can make a significant impact on disease management. Helping to connect people so they can share what has worked for them in their journey means they can learn from and help each other.

The takeaway here is that the convergence of social media, empowered patients, and The Internet of Things has brought us to a point where consumers expect the tools they rely on to blend seamlessly into their lives, providing the information and support they need, the way they need it. Pharma needs to help patients navigate the complexities of their own health in all aspects, not just around one drug.

References:

[1]Wu, S. Green, A. “A Projection of Chronic Illness and cost inflation 2000”

[2] U.S Department of Health and Human Services Agency for Healthcare Research and Quality, “The Importance of Investing in Care for People with Multiple Chronic Conditions,” http://www.ahrq.gov/professionals/prevention-chronic-care/decision/mcc/mcc_infographic.pdf

[3] National Council on Patient Information and Education, “Chronic Conditions 101,” http://www.bemedicinesmart.org/chronic.html

[4] U.S Department of Health and Human Services Agency for Healthcare Research and Quality, “The Importance of Investing in Care for People with Multiple Chronic Conditions,” http://www.ahrq.gov/professionals/prevention-chronic-care/decision/mcc/mcc_infographic.pdf

Cheryl Lubbert

DTC in FocusGuest Columnist

Why Pharma Patient Adherence Programs Fail

April 15, 2015

In last month’s edition of the DTC Perspectives’ DTC in Focus newsletter, we discussed patient engagement and provided prescriptive thoughts on maintaining and even increasing patient commitment. This month, we take that thought one-step further (as well as, adhere to this month’s theme) and focus on patient adherence. The discussion includes whether the emphasis of such programs should be on both long and short-term medication adherence particularly in how they are resourced and measured.

A situational review

  • Current support programs typically devote a large amount of time and money ensuring patients initiate therapy. However, these programs never allocate time or funding to safeguard that the patient maintains adherence after that time period.
    • Studies indicate that patients with chronic diseases may not either grasp the severity of their condition; understand the literature they receive about their condition; or require multifaceted efforts to achieve adherence.[1]
    • Current support programs operate in silos. While these programs are typically mapped out strategically, they are not executed in a coordinated fashion.
      • These silos execute patient adherence programs:
        • Ad agency
        • PAP vendor
        • Co-pay card company
        • Reimbursement and benefits investigation vendor
        • Specialty pharmacy
        • Technology companies
        • Consumers, patients, and caregivers often are not satisfied with the content and creative contained in patient adherence programs
          • These targets at some point in the treatment process stop at Brand.com. All find the information initially helpful, but tend to look somewhere else for information because the information they want or need is not in the adherence program.
          • Patient adherence programs today are like an inverted hourglass. The strategy is thin at the top, disparate and expansive in the middle due to the silo construct, and then the program strategy attempts to narrow again. Yet, often this does not occur.
          • While all pharma brands say they have patient adherence programs, the reality is – and I am basing this information on my 20 years of experience – very few deeply engage and build a relationship with the patient; maybe 10% to 15% really execute this well. These programs work because senior leadership is committed to them for the long term, both in human and financial capital. (See last month’s column re: Biogen Idec.)

Operational issues still exist today

Along with the barriers already mentioned to pharma’s delivering quality adherence programs, there are two more barriers, and they are formidable.

First, product managers are no longer brand champions. Their roles now resemble those of purchasing procurement agents who buy a single program; their sole hope is to get noticed by senior leaders.

The second, arguably more significant complication is the FDA, namely its regulations. Companies have allowed their legal and regulatory teams to make business decisions regarding programs that minimize risk in terms of providing the evidence and content that patients and healthcare professionals want. The pejorative natures of today’s drug marketing regulations are designed to educate, not inform. Grant Corbett, a psychologist we have worked with says pharma produces content from the perspective that patients and others affected by disease are not competent to understand the information so brand programs need to “educate them.”[2] He asserts companies should make the opposite assumption and assume the patient, caregiver and consumer understand their condition and work to provide information that fills in the knowledge gaps. This is where great programs in the marketplace are focusing their efforts today.

Answers exist today

The short-term lead generation and conversion marketing strategies of patient adherence programs are no longer viable. The key to winning at the ground level is to have the program’s patient advocate be part of the solution that has been prescribed. It is paramount to ground a multi-channeled adherence program in a scientifically validated model to instill confidence in patient and caregiver. Patients and their care team need to believe they have the complete and long-term support needed to overcome their disease. Moreover, to accomplish this, the program needs resource and execution in a coordinated fashion. These are the factors creating a real competitive advantage in adherence programs today!

While industry spends $10s of millions on various aspects of the entire effort, that resource is cut up into smaller chunks or pools of money. This causes all parties to fight for their chunk of the pie and to lose interest with the whole strategy. Senior leaders, in this age of consolidation of resources, must consider these programs at a total cost level and ensure they all are driving value. That is why we advocate bringing back the role of a Brand Champion, an individual or set of individuals who commit to a longer-term career path with the brand, who can oversee the convergence and collapse of the silos – and decide how to spend the money.

Finally, we are big proponents of the net promoter score construct. Two or three simple questions added to any program to assess the patient’s willingness to recommend a product to a family member or friend. This simple measure helps leadership teams stay focused on the end goal of customer satisfaction, regardless of the program’s timeframe.

References:

  1. http://www.uspharmacist.com/content/s/200/c/33457/; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/; http://www.ncbi.nlm.nih.gov/pubmed/12472330
  2. Grant Corbett, Behavior Change Solutions.

Robert Nauman

DTC in FocusGuest Columnist

Get Hooked – Making Engagement a Habit

April 15, 2015

We know that the formation of healthy lifestyle habits is critical to overall health. However, adherence to exercise programs, medication regimens, or dietary changes can be challenging. So how do we help patients develop habits to improve their overall health?

Habits are defined actions employed without conscious thought.1 Habit forming potential of any behavior is often driven by two factors: frequency and perceived utility. The more frequently a new behavior occurs, especially within a short period of time, the stronger the habit becomes. Likewise, the more rewarding the behavior is perceived to be (its utility), the greater the chance for habit formation. The “Hook Model” is one method that we use at Health Union to build value and encourage habit-forming behaviors within our communities. Four key components converge in the hook model – a trigger, an action, a reward, and an investment2 – to create ecosystems that cultivate engagement habits and motivate people to live better with their health conditions.

Triggers

Health Union communities use both internal and external triggers to encourage patient engagement. External triggers may include advertisements or comments from doctors, family, and friends; while internal triggers are leveraged when an action becomes strongly tied to a thought, emotion or preexisting routine, like checking email every morning. While we utilize some paid external triggers, like Facebook advertising, we’ve found that relationship triggers (social media sharing/word of mouth) and owned triggers (opting into a weekly newsletter) are most effective for long-term engagement. Owned triggers are most likely to prompt repeat engagement until a habit is formed, and relationship triggers support continuous community growth.

Action

The more people interact with your product, the more likely they are to keep doing it. Our community engagement strategy creates a “funnel” approach to increase the level of participation over time, knowing that simple actions can lead to big changes in future behavior.3 For instance, our members may start as site visitors, then progress to following us on social media and engage in passive activities like anonymous polls. Passive participation may lead to newsletter registration and eventually active engagement by posting comments or personal stories. It’s important to make it easy for even the most passive patients to engage while still providing outlets for the most active members.

Reward

Provide a real benefit to action – with variability – and do it quickly! Show people that taking action results in a clear benefit. Of course, keep in mind that the preferred benefits vary from one person to the next. Make sure to clearly communicate what the reward is – whether that is answers to basic questions, immediate poll results upon voting, published results from surveys, or community support. Don’t assume the reward is obvious and communicate the benefit gained by others as well as that of the individual. Variability can multiply the natural effects of a reward and keep people coming back for more. All Health Union communities provide daily content that is relevant and useful, but the type of content, topics, and authors are varied to create novelty.

Investment

Encourage people to make an investment, beyond just lurking or passively clicking. This may be an emotional investment, an investment of time, or a contribution of personal information. Investment implies action that will improve the service for the next visit. And, the greater the investment, the more likely they are to continue engaging over time, thereby increasing the value of the product. For example, the simplest investment is to follow one of our social media accounts. However, we also invite members to “own” part of the site by participating in surveys and publishing personal stories.

What else can we do?

In addition to the four elements of the Hook Model, don’t forget to …

  • Remove barriers and provide support. Be aware of both perceived and actual barriers. For example, in response to a perceived barrier that weight loss is dependent on foregoing all desserts, provide recipes for healthier dessert options.
  • Strengthen self-efficacy, the belief in one’s own ability to complete tasks and reach goals. Since many people are uncomfortable asking their doctors questions, provide discussion guides to encourage dialogue focusing on areas where the patient is the expert – like how a condition affects day-to-day life.
  • Find what people are doing already, and make it easier for them by linking habits to daily routines.4 Our content strategy focuses heavily on giving people the information we know they are seeking, where they are already seeking it (with social media and search).

The ultimate goal is to create a cycle of interaction where the investment itself becomes an internal trigger. Members seek responses to topics discussed within the community – that desire for shared experience is the trigger to continue engaging. And then, they’re hooked!

References:

  1. E. Morsella, J.A. Bargh, P.M. Gollwitzer, eds., Oxford Handbook of Human Action (New York: Oxford University Press, 2008).
  2. Eyal, Nir. Hooked: How to Build Habit-Forming Products.
  3. J.L. Freedman and S.C. Fraser, “Compliance Without Pressure: The Foot-in-the-door Technique.” Journal of Personality and Social Psychology 4, no. 2 (1966) 196-202.
  4. Bas Verplanken and Wendy Wood, “Interventions to Break and Create Consumer Habits, Journal of Public Policy & Marketing 25, no. 1 (March 2006): 90-103, doi: 10.1509/jppm.25.1.90.

 

Amrita Bhowmick

DTC in FocusGuest Columnist

Adherence and the Authentic Truth

April 15, 2015

After a patient initiates treatment, the real selling-process begins. More than ever, patients are approaching Rx-trialing with a heavy dose of skepticism. It’s understandable. Oftentimes, long-term treatment is thrust upon patients without time to get comfortable. And sometimes, those patients have healthy fears over side effects. On the other side of the coin, many patients expect treatment to fix everything fast or they diminish the value of Rx treatment altogether (before giving it a real chance).

This net skepticism has fueled – no, skyrocketed – a behavior patients hold dear when trialing treatment. And that is finding the authentic truth – conducting their own in-depth exploratory research into Rx treatment expectations, outside of brand communications. Outside of the brand context is where patients perceive to find this authentic truth and the optimal basis for their own opinions and behaviors toward Rx treatment.

Here, I’ll explore this rising phenomenon a bit more and then present an opportunity for brand adherence communications. Essentially, I’ll show you how to guide patients toward external content, in order to help them find their own, preferred version of the truth. In the end, they want to put the “authentic” puzzle pieces together. If we can help them do that, we can help them feel more comfortable with treatment early on and more receptive to the rewarding possibilities of long-term treatment.

Origins of the truth

A year or so ago, I spent time reflecting on the success of online services such as Angie’s List, Yelp, and others, with large investments into customer review networks. I came to one conclusion: in the digital age, the truth comes from strangers.

My hope is that this speaks to you, as both logically flawed and intuitively accurate. Let me explain. Logically speaking, we put our trust in people/entities we know, or in some cases, those we think we know. In this case, the ol’ saying “never trust a stranger” holds true. But today, we live in a hyper-consumerized world where we have many “long-term relationships” with an array of organizations and companies we really “know” little about (e.g., mobile phone, streaming, cable, grocery delivery, etc.). We expect those companies to meet our expectations or, in other words, be trustworthy.

In many cases, the results have been less than stellar. However, there are exceptions. Brands like Zappos and Wayfair have elevated the benchmark of customer service to a religion – but again, these are exceptions. And, the fault cannot be placed entirely on either side – it’s a combination of consumers and companies. Consumers can exaggerate or even create the problems, yet companies (or brands) aren’t exactly model citizens, when the almighty dollar rules the day.

Regardless of who’s right and who’s wrong, the net result has been a heightened mistrust among consumers. You could even say it’s already hit the boiling point with persistent steam ahead. Who can we trust these days?

The person/entity we often trust is the person/entity with no vested interest in us: the stranger. They don’t want our money, our commitment, or a relationship. They do have opinions, though – invaluable ones about the subjects that matter most to us. And they like to voice these opinions. It’s these anonymous voices we seek in order to find the authentic truth and, as a result, make better decisions.

The patient “truth-seeking” journey

This is the kind of approach patients take when trialing Rx treatment. They get the doctor’s version of the story, they get the brand version (e.g., brochure, site), and then they go looking for the outsider context: the anonymous opinion, the unknown academic perspective, the clinical trial data, the virtuous community site, and even sponsored content, but on a trusted site.

Now, let’s bring these learnings back to the question at hand: how can Rx brands become an integral part of the content system patients tap into when finding their authentic truth?

First, I have to acknowledge that this is not a one-stop shopping experience for patients. They will leverage this behavior at multiple points during treatment. In my experience, the best way to manage this is to glean the most important barriers to short-term, intermediate, and long-term adherence. Typically, short-term issues surround potential side effects, whereas intermediate and long-term issues usually surround side effect experiences, efficacy, and cost.

On the subject of cost, we often think of cost-saving programs benefitting patients just starting treatment. What I’ve learned is that most patients wrestle with treatment value relative to cost, once they’ve come to the conclusion that they’ve experienced said treatment’s full potential. For the commercially insured, if their treatment co-pay is negligible (through a branded support program), they will likely accept average efficacy, for example, and stay on treatment longer.

So, how do we use branded content to encourage adherence, while embracing a patient’s journey to find the authentic truth? Below are five recommendations to help you, and your patients, succeed:

  1. Use a trustworthy environment to evolve your brand marketing into brand truth.
  2. Market clinical studies without feeling like your marketing clinical studies.
  3. Gain their trust by setting them free.
  4. Let patients – even help them – find the good and bad about your brand.
  5. Lastly, recognize how search can unearth issues patients were never searching for.

Patients hold all the power these days. Let’s help them realize that dream… and get rewarded for it.

EDITOR’S NOTE: This is a condensed version of John’s article. To read the full-length feature and learn more about the five recommendations for the authentic truth, check out his upcoming article in the 2015 annual issue of DTC Perspectives Magazine out next month.

About the Author:
John Nelson has spent over 13 years in advertising, working with some of the most iconic health brands of our time. In his role as VP, Strategic Planning at Evoke Health New York, John is responsible for inspiring strategy that creates big ideas and big connections between brands and people – connections that drive behavior change and deliver tangible results for clients. He can be reached at john.nelson@evokehealth.com.

John Nelson

DTC in FocusGuest Columnist

How Contact Centers Leverage Live Patient Interactions to Drive Adherence

April 15, 2015

As the new model of healthcare delivery takes shape, the spending burden for care continues to shift to the patient, giving them more control over their care. As a result, patients are more informed and have access to more healthcare decision-making tools than ever before.

However, it needs to be relevant to them. Recent research commissioned by McKesson shows that patients are less interested in general information about their condition and more interested in personal communications and support in the form of missed prescription reminders (89%), refill reminders (87%), live phone support (86%), and pharmacist coaching (83%).

Evolution of relationship marketing

In the past, one size-fits-all-messaging followed by content delivered through traditional communication channels such as e-mail or print, enabled brands to deliver consistent and controlled messages to the patient. However, this model did not enable dynamic two-way communication, where questions can be asked of the patient, responses captured, and then messaging and actions tailored accordingly. As a result, the ability to create lasting behavioral changes was limited.

Driven, in part, by more engaged and empowered patients, new technologies now enable brands to perform more targeted outreach to patients with specific medical conditions, on particular medications, who have opted in to receive information. While this improves patient targeting and personalization of the message, this evolution of relationship marketing in healthcare is not just about pushing a brand message, but about creating greater patient engagement and opening the door for two-way conversations designed to improve adherence and outcomes. Ultimately, this support helps to differentiate the brand from its competition, driving adoption and adherence.

Delivering personalized support

There is no silver bullet for impacting adherence as every patient is diverse and every patient situation is different. Complexities that can impact a patient’s likelihood to remain adherent include the length of time since diagnosis, brand challenges and attributes, cost barriers often outside the patient’s control, and the nature of the diagnosis itself.

The ability to uncover what behavioral barriers can be modified and to recognize what factors cannot be changed (e.g., doctor’s choice to discontinue the medication), is one of the benefits of dynamic live patient interactions. While each patient’s individual situation may be unique, our experience in behavioral coaching reveals that there are similarities across therapeutic conditions which can be used to infer best practices in addressing patient challenges across brands and patient populations. For example, sensitive conditions (HIV, Hepatitis C) have social implications that require more empathetic messaging than more mainstream chronic conditions, such as Diabetes or Hypertension. Patients with a visible dermatological condition (psoriasis, onychomycosis) often face quality of life issues that physicians may not fully embrace and will need significantly different support.

Recognizing that adherence barriers change over time, as well as patients’ information and education needs, brands can integrate out-bound support and multi-channel communications to maintain that personalized support for patients throughout their brand journey. In this scenario, delivering smarter dynamic communications can help connect patients to support driving brand loyalty and program success.

Consider a program that helps patients navigate their own healthcare decisions, supporting adherence, sharing information, addressing barriers along the way and deploying proven behavioral-based techniques. One example is McKesson’s Behavioral Call Campaigns (BCCs), which use live agent support to identify adherence barriers and provide targeted messaging to help overcome those barriers, connecting with patients using proven health behavior change tools and techniques to build programs that allow patients to opt in to allow them to be more engaged in their healthcare decision-making, while aligning personalized messaging with a patient’s intended utilization activity. These campaigns can be used as stand-alone solutions or integrated into broader marketing campaigns by pairing them with financial assistance or educational support programs.

Engaging live interactions

Successfully tackling adherence requires a comprehensive strategy that includes multiple communication channels to support patients towards positive behavioral outcomes. Coupling in-bound and out-bound support, live patient conversations can transform static traditional relationship marketing programs and allow live agents to uncover patient needs over time and use behavioral coaching techniques to address those needs. Pharma brands are increasingly leveraging live support, the insightful data provided through their co-pay programs, and segmentation tools to help predict a patient’s level of engagement or likelihood of being non-adherent, then allocating the investment accordingly.

Brands using these tools at enrollment can segment patients in order to provide additional support only to patient segments which need it. The interesting brand question then becomes which segment should you invest in: the group that you predict will be adherent and most engaged; the group you predict will not be adherent; or the group in the middle that could go either way?

This is a great conversation to have with your contact center strategist.

Amanda Rhodes

DTC in FocusGuest Columnist

Adherence: It Takes a Village

April 14, 2015

How do we keep patients adherent? It’s the billion-dollar question in the healthcare industry. And the truth of the matter is there isn’t one simple answer.

In the past year alone, nearly 75% of adults age 40 and older with a chronic condition admit to not adhering to their prescription medication treatment. As healthcare marketers, we focus our efforts on getting patients to the doctor. We’re hoping to motivate them to make an appointment. We provide tools and information to talk to their doctor about medication. We encourage them to ask for a particular brand by name. We push the HCPs to prescribe it. And finally, we hope that patients fill it and actually take the medications as prescribed. It’s a significant investment – time and money. Yet, after all of these efforts, only 25% of these patients are taking that medication as directed. It’s apparent; we have some work to do.

So, what do we do? Often I hear healthcare marketers telling me they are focused on driving adherence through a particular tactic. “We’re

going to invest in our CRM database” or “We’re using text message reminders” or “We’re utilizing SEO to keep our brand top of mind”. Good! These are great tactics. But by merely implementing a tactic, you’re checking a box to say you’re driving adherence. Is that enough?

We need to be better and smarter about how we are keeping patients adherent (remember only 25% of patients are adherent). We cannot only be thinking tactics. The reality is, keeping a patient adherent requires much, much more. To keep a patient adherent to their treatment, we need to be their partner and support them, and also look at the key motivators in a patient’s life: spouse, parent, child, sibling, boss, friend, HCP, and many more. And who is their biggest personal motivator? It is their spouse or partner as shown a recent study conducted by Remedy Health Media with Princeton Survey Research Associates International (PSRAI). (See related pie chart.) When it comes to healthcare, we rely on the people we are closest to, our support systems, and the people we trust. It truly takes a village to motivate a patient to stay adherent and committed to their health.

My personal story
10 years ago my husband complained that he had terrible heartburn. It was a daily battle. He attributed it to too much eating and too much drinking (at 25 years old, I’m sure that was the case). But then I explained, although it felt like a daily discomfort, heartburn/GERD can have long lasting and damaging effects. I urged him to see a doctor. After he reluctantly made an appointment, to be supportive, I printed out 10 questions for him to ask his doctor, along with a medication to request. At the time, I’m sure he thought I was slightly annoying with my persistence and I am certain there was some eye rolling when I handed him the printouts… but he took them. Then after a productive and successful doctor visit, he was given a prescription, and he’s been taking the same medication ever since. Even today, to keep him adherent, I ask, “Did you take your pill today?” Although it’s his health, I’m a part of it, I’m connected, I’m supportive. I feel responsible.

We are responsible for our own health, and we also feel responsible for somebody else. It’s what connects us. It relates us. We rely on each other. Health is incredibly emotional. It’s happy, it’s sad, it’s scary, it’s confused, and it’s triumphant. It is real. We’re an industry dedicated to helping people live better, healthier lives – yet we get bogged down in the tactical solutions rather than the big idea of how we can create change and embrace patients. I challenge you to put down your excel spreadsheet. Look beyond the media spheres of TV, print, digital, mobile/tablet, etc. Stop for a minute. Take a step back. Be human and put a relatable, personal approach to adherence. Challenge yourself to inspire millions of people. It takes a village. But we will get there.

Alison Sheerin

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