The Role of Motivation in Patient Engagement

As Dave Chase @chasedave recently stated The most important medical instrument is communication, and Patient Engagement is the Blockbuster ‘drug’ of the century. The idea is that by engaging patients to become more proactively involved in the management of their own health, better outcomes can be achieved, and generally at a lower cost to the healthcare system (compared to expensive tests, procedures and medicines).

New technologies make it easier to engage patients – for example via online portals, health apps, personal electronic health records, portable monitoring devices or a clever combination of these tools within a new care model. Clearly, when the generation of texting, tweeting, vining, instagraming twenty-year olds turns fifty and start their decent into chronic illness, resistance to digital, mobile, sharable health tracking and communications technology will no longer be an issue.

Remains the issue of motivation. The people who continue to supersize their burgers and fries, do they lack awareness of the health impacts of excess weight? The schizophrenic who skips her pill because it makes her head feel fuzzy, has she not been educated on the dangers of messing with her medication regimen? Will improved communication with a healthcare provider convince my uncle to stop smoking?

Yes, there are those who suffer from inertia, who are uncertain about the right way forward or who find it hard to fit taking care of themselves into their busy days. These patients will find it helpful to be supplied with tools and supportive healthcare providers who make it easier for them to look after their own health. These patients are the low-hanging fruit for the new care models.

And then there are other people. People who will not download the app. Who will not sign up for the e-newsletter. Who do not want to be called by their pharmacy to remind them to refill their prescription. Some people will continue to do dangerous, unhealthy things because they want to. It makes them feel good, at least momentarily. Some do not want to face the realities of getting older, of their failing bodies, loss of beauty and loss of agility. Some are comfortable with the thought that this is all inevitable, and do not feel inclined to take action. Some are looking to their doctor for the quick fix, just make it go away, I don’t want to bother with it.

PtEngageUSED

Motivating people is a tricky business and tech tools are only going to do part of the work. What motivates patients to take care of themselves? Pain? The desire to live longer? A feeling of obligation? Because your mom told you to? Peer pressure? Because it is cool? Fun? Because it makes you look better?

Also, doesn’t motivation change over the course of one’s life? What motivates a twenty-five year old to track his weight loss with a health app and what motivates a seventy-year old to continue his androgen deprivation therapy would likely be very different things. Capturing the Show Me The Way segment of patients with new patient engagement tools will be easy and rewarding. Addressing the Maybe Later and the No Way segments will be much tougher, and cracking the motivation nut will be essential to make it work.

Our online and offline worlds

I am a student of human behaviour. When the Internet first became a thing, we used to compare online and offline behaviour. As if we were one person while we sit at our computer and another person in real life. Maybe it was like that in those days. I am talking ten, fifteen years ago.

The world of communication was segmented into different channels: television, radio, print etc. Talking like that does not even make sense any more. Today a typical user experience includes interacting with content and with people across a number of platforms, in a more or less fluid fashion.

Vinu George, Market Intelligence and Customer Insight Manager at Microsoft, recently described this in an article in VUE magazine as follows: We are now moving to a five- screen world…large-screen TVs, gaming consoles, laptops/PCs, tablets and smartphones. Content is now consumed and created across these screens. We are moving from one screen to the next to the next, reading, watching, posting, commenting, sharing online, sharing online offline (Look, mom, have you seen this video?).

Up until recently, I have not been a technology junky at all. But with four out of the five interfaces at my disposal, and discovering the infinite possibilities of social media, I find it more and more difficult to differentiate between online and real life, it is all just life.

Having school-aged children also gives me a privileged view into the future of online immersion. Many parenting experts advise parents on limiting screen time for their kids. Which I agree with. The trouble is, there is not just brain-dead consumption of junk going on, there are lives lived, and they are lived in part through electronic platforms.

As a market researcher, I wonder if our methodologies really address this level of immersion in the online world and the fluidity with which online and offline experiences are intertwined. Rather than focusing on one interviewing medium and throwing in a bit of social media analysis or a few ethnographic observations for good measure, how much richer and more insightful could a truly integrated multi-media exploration of behaviours and attitudes be?

Mom and baby

Sea Change in Market Research

The art and skill of market research lies in asking the right questions and drawing the right conclusions from the answers. I know how to ask questions.

I know how to ask them online, on the phone, in person, in a fashion that makes responses quantifiable, in a fashion that allow us to publish the results, in a fashion that elicits emotions, in a fashion that minimizes bias, in a fashion that entertains my clients. I know how to ask questions to old people, to young people, to people with illnesses, to people with children, to CEOs, to large donors, to physicians, to nurses, etc. etc.

In a house, with a mouse, in a box, with a fox, here and there, I can ask questions anywhere…

What if market research is no longer about asking direct questions to real, live people? Why are we asking questions anyway? Our clients want to know what people think and feel, and what they will do, based on their thoughts and feelings. How they will vote, who they will support, what they will buy.

Much of this can be elicited from data that is produced without asking questions. I recently read an article on how you can predict someone’s age, gender, sexual orientation, level of education and the emotional state he or she is in relatively accurately from the pattern of likes they leave across the Internet. Predictive modelling is the name of the game. How can you link likes, content of posts, tweets and comments to action, online and offline? The best people who develop these algorithms sit no longer in traditional market research companies.

They sit in large IT companies. Or they sit in smaller digital shops, where they specialize in a particular thing. And probably in some large financial institutions. And government think tanks.

What do they understand about people? What do they not understand about people? What do my clients need me for? Sure, I know my clients business. I consult. I interpret. I put things in context. At the end of the day, it is still all about making the right connections. So you know what pattern of online behaviour precedes a purchase. Now what? What information do you really need, and how do you use this information to your advantage? That is where the consultant comes in.

To do the job right, however, the consultant needs to understand what kind of information is out there, what is technically possible, what is practical and what is economically feasible in terms of analysis. And to stay on top of that is becoming more and more time consuming with the data explosion in which we are currently caught up…

The difference between recharging and goofing off

Taking breaks from your regular activity supposedly enhances your ability to concentrate. Consequently, the clever employer should encourage those who spend their day in front of the computer screen to interrupt their activity from time to time to relax and recharge.

I have a small beach ball in my office, a promotional item left over from some conference. What if I’d throw it up into the air? Today I tried it out: very relaxing – beats walking to the washroom or getting another cup of coffee. But I felt odd.  What would my co-workers think about me? Sure looks like I’m goofing off.

In an office environment, some forms of de-stressing are more accepted that others. Getting coffee is the top accepted de-stresser, I would say. Smoking also features high on the list – need a break, have a smoke. Going for a walk – good, but may take too long in the eyes of the boss.

Many also deal with stress by talking to their fellow employees. Probably better for your health than smoking, but can cause significant disruption of the workflow, particularly if many employees go through a stressful time at once.

Spending five minutes with a beach ball (or a skipping rope? or a mini-putt?) seems like a worthwhile alternative that should be an acceptable form of recharging – and easier to monitor than other common forms of in-office relaxation, such as constantly checking your Twitter feed or Facebook updates. Then, I think, you are basically just goofing off…

Innovation, the new normal?

Companies in many sectors are facing rapid change. Following Clayton Christensen’s terminology, established businesses are being disrupted by new technology, and new business models are developed around these technologies.

Whether it is 3D printing of medical implants, crowd sourcing of clinical trial data analysis, software that supports pre-clinical studies and identifies the most promising drug candidates, ‘big data’ capturing patients’ genomic profile or personalized health records that patients can carry from physician to physician, fundamental transformations are afoot in the healthcare industry.

Consultants to the healthcare sector struggle to stay on top of all the different angles that are emerging. How much reading can you do in a day? Should you rather update your skills in data mining (i.e. working with ‘big data’) or become an expert in social media platforms and the many ways they are being used by patients and physicians or study government initiatives to incorporate new technologies in reorganizing the way healthcare is delivered to the patient?

The state of confusion is pretty typical for market changes. Initially, there is a whirlwind of new ideas and approaches. Are electric cars going to be the way of the future or ceramic fuel cells? Or will biking emerge as ‘disruptive technology’ in a reorganized urban neighbourhood? Will patients carry their own health records around on a USB stick or will they become universally accessible through a (password protected) cloud? Will pharmaceutical companies find ways to make drug development cheaper or will fewer drugs be approved or will best supportive care with the bells and whistles of comfortable retirement living ‘disrupt’ the oncology pipeline? Will iOS, android or Windows 8 emerge as the dominant ecosystem for computer / tablet / phone or do we need to learn all three to know what works how in which environment? Etc, etc.

Should we wait until the dust settles before we decide how to focus our efforts?

I am not sure that the dust will ever settle. The pace of change is accelerating, with no sign of stopping or settling down. Then where should we pitch our tent? What should we hold on to? I believe that companies and individuals will succeed who develop mechanisms, routines, practices that allow them to deal with change. Not just once, but on an ongoing basis. Those who effectively survey what is going on in the whirlwind, who systematically capture their own ideas on how to ride the storm and who devise an easy process that allows them to test, develop and implement these ideas will have a chance.

Is big data transforming healthcare marketing research?

Yesterday (June 27, 2013), SAS and GSK announced a collaboration which puts clinical trial data ‘in the cloud’ in a secure way, respecting the privacy of trial subjects, and makes it accessible to other researchers. It is believed that other big pharma companies may follow suit and create an unprecedented shared data base that could potentially speed up the analysis process, make analysis more transparent and produce significant advances in medical discovery.

While this particular example of ‘big data’ pertains to clinical trials, many other big data sets exist (or are being created) in the healthcare space, awaiting data integration and analysis. One wonders to what extent this trend will impact the need for primary healthcare marketing research. Secondary data analysis is not new – it has been part of business intelligence for a long time. What’s new is the amount of data that is being collected, the multitude of platforms and interfaces through which it is collected and the ease with which the data can be accessed and analyzed.

Traditionally, primary marketing research has been faster than secondary data sources at delivering behavioural data such as prescribing of certain drugs. This is now changing. Mobile health apps, EMR, data warehouses for adverse event reporting, point-of sales data at the pharmacy level and many more points of data collection are becoming more readily accessible. Secondary data is going ‘real time’, well almost. On the other hand, primary data collection methods can also harness the power of ‘real time’, thinking of mobile surveys etc. Who will come out on top, or rather, which mix of primary and secondary sources will deliver the best insights?

Also, primary marketing research has been practically the only way to capture attitudes and beliefs and to explore how they relate to behaviour. Arguably, communicating with your target audience is still the best way to understand their motivations. However, social listening, drawing on tens of thousands of online conversations and powerful tools for text analysis, has made some inroads into this area as well. In addition, to what extent do stated opinions really drive behaviour, and how good is primary market research, even with creative methods and advanced analytics, at uncovering these drivers?

Big data is certainly transforming the primary marketing research industry, in healthcare as well as in other sectors. The question remains which solutions will bring the most value to clients and will become the new standard for companies who survive the transformation.

Banking on our fear of death

Pharmaceutical companies have reoriented their businesses over the past several years to focus on discovery of molecules that target narrow markets, usually in oncology or in rare, but serious diseases. It is well known that revenues for ‘mass market’ products for diseases that are highly prevalent and not immediately life-threatening have been declining and few truly breakthrough discoveries have been made to replace revenue drivers that have become generic.

But why the rush into oncology and other small-but-serious markets? I believe that this has to do largely with our attitude towards death. Inevitably, we will all die of something. Before the advent of penicillin, people died of infections. As medical care has improved dramatically in the past 100 years, at least in some parts of the world, we live longer and are more likely to experience diseases which are basically a function of our body breaking down i.e. cancer.

Oncology drugs present an attempt to prevent the inevitable. In some tumour types, enormous advances have been made – breast cancer, for example, can now be regarded more as a chronic disease than as a terminal illness. For many other tumour types, however, scientific progress has been underwhelming. New agents are being trialed and approved that offer three or four more months of progression-free survival or a few months of overall survival vs. the incumbent standard of care. …and regulatory bodies such as the FDA find it difficult to turn those agents down, because they allow patients to live longer. Enormous costs to the healthcare system are perceived as justified, because they allow patients to live longer.

How much value do four extra months have when you are very sick and 80 years old? I don’t know, as I have not yet been in this situation. Who drives decisions to try another therapy, complete with side effects, at that point? Is it the physician, feeling compelled to offer a treatment when one is available? Is it the patient, clinging to life? Or is it the patient’s family, not wanting to let go?

One thing seems certain – no politician in his or her right mind will advocate spending healthcare dollars elsewhere, when there is time to be gained in the battle with death. Can you imagine the headlines? But the societal discourse may be shifting, looking at more humane ways of dealing with end-of-life, and re-evaluating our overall priorities in what kind of healthcare is being offered and funded.

Personalized, patient-centric medicine

Much has been published lately about personalized medicine. The other, similar buzzword is patient-centric.

It seems to me that in these terms, consultants and trend-spotters mesh together two very different ideas, each with associated with different strategic implications.

Personalized medicine in the sense of using biomarkers and genetic information to target therapies more specifically to patients who are more likely to respond to them is an approach that many pharmaceutical companies are embracing.

However, in this context the patient as a person has very little relevance for the R&D process and the commercialization of new products. What he or she feels, thinks, believes or does is unrelated to the peculiar genetic mutation that makes him or her a good candidate for a specific drug.

The second trend, namely focusing on the patient as a person, does not usually play a role in drug discovery. Pharmaceutical companies commonly find themselves in the situation that their compound is the third or fourth me-too agent to market with little incremental benefit. Identifying and targeting a specific patient with distinctive attitudes, behaviours and needs can be a successful marketing strategy in an undifferentiated market.

And while some companies may strive to bring both approaches closer together – understanding the patient as a person and developing new molecules that meet the patient’s specific needs – this is far more difficult to achieve in pharmaceutical product development than in the area of consumer goods.

Psychological benefits of exercising

Getting more exercise has undisputed health benefits. It is what many of us need. Experts also say that it makes you feel better. Why don’t more people get into the habit then?

In my experience, exercise does have a positive effect on mood – but not immediately. While exercising, anxiety, stress and frustration are felt even more acutely. That’s why, in my opinion, many people stay away from exercise. We don’t want to be brought face-to-face with unpleasant feelings.

However, to reap the benefits of a more relaxed mind, that’s exactly what we need to do. No pain, no gain. Good luck with the struggle!