Spotlight On... Patient Insights

1Patient insights |www.wearecouch.com
SPOTLIGHT ON...
PATIENT INSIGHTS
Inspiring audiences. Motivating change. Thinking beyond.
ISSUE 2

first awareness of a condition, through diagnosis and treatment decisions, to ongoing
management, including adherence to medications.
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.
This eZine will discuss the role of patient insights and what impact it has on
improving patient outcomes.
As always, I would love to get your feedback and hear your thoughts on this eZine. You
can email me at ash@wearecouch.com or tweet me at @ash_rishi.
Till next time.
Ash Rishi
Managing Director
COUCH Medical Communications
Nowadays, there is a lot of noise with terms such as
patient engagement, patient empowerment and patient
centricity. These efforts have entered our lexicon, and
should generally focus on the patient and understanding
that patients are no longer a passive player in their own
healthcare. People are becoming better educated about their
own health conditions, and are playing an ever-increasing
role in their own healthcare management. With this in mind,
marketing interactions need to be developed with a thorough
understanding of the patient 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 BEHAVIOR
CHANGE
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 BRAND
If 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 trigger
patients 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 were
listened 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.
1
2
3
4
5

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 FOR
PATIENT 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, around
112 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 online
in 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 to
recruit patients for clinical trials and improve
retention rates.
Insight gained from monitoring social media can in
turn inform patient engagement activity by
providing 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 then
it 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

© COUCH 2016.
At COUCH, we create content that responds to the known
needs and preferences of your target audience, and elicits
the desired response from them.
www.wearecouch.com
l if i

Spotlight On... Patient Insights

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