Published in PME Magazine
Changing someone’s mind takes persuasion, argument, evidence and patience. Changing behaviour is a twisting journey into the fog of habit, rumour and folklore that wreathes what we do and why we do it.
Clearing those mists requires a deep understanding of what makes humans tick while factoring in the growing body of research and practical models that prove behaviour can be influenced for the better of patients, healthcare systems and industry.
It is a Holy Grail of healthcare with legions crusading to lay their hands on the keys to guide populations away from poor health decisions and loose medical adherence as financial and systemic pressures heat up with the challenges of ageing populations with multiple co-morbidities.
Their weapons range across a spectrum of subtle nudges, incentives and public messaging and it is clear that better patient outcomes are driven by clear, achievable practical steps underpinned by transparent evidence.
Patients are not robots
A prime area to influence is poor medication adherence which accounts for around 200,000 premature deaths in Europe every year and has an economic burden that has been calculated at €1.25 billion annually.
The public is awash with conflicting and confusing information so the Gravitate-Health project – supported by pharmaceutical companies, research groups, public bodies and non-profit organisations – has been launched to create a digital platform guiding patients to trustworthy, up-to-date and understandable information to help them take their medication and improve their health outcomes.
Healthcare systems across Europe are deploying various levels of nudges and incentives to improve health behaviours, while pharmaceutical companies are investing heavily to connect with healthcare professionals and patients by understanding their beliefs, motivations and the barriers to change.
“What is unique and fascinating about healthcare is that every patient is different and different factors impact their decisions,” said Tim Warren, managing partner at Triducive, an agency that combines commercial healthcare experience with expertise in structured expert consensus to create impetus and advocacy around the factors that drive decisions to create change.
“There should be different approaches across conditions, ages, areas of society, different clinical disciplines and sectors of healthcare that might have varying priorities and agendas.
“You can’t just expect people to act like robots and operate in the same, uniform way. Two-way dialogue is essential because it generates inclusion and understanding and makes people feel they are being listened to. Opinions matter.
“This was evident during the pandemic where, for every piece of evidence saying this is the best way forward, another piece said virtually the opposite. You have to rely on people’s intelligence, human ability, opinion, whatever influences them to help them apply the evidence in the right way.
“Decisions are better when they are collaborative which is why we advocate for consensus to drive behaviour change. It’s always worth contextualising projects in a more humanistic approach that takes into account people’s feelings, opinions, views, hopes, dreams and frustrations to inform their behaviours, as well as using evidence, opinion and advocacy.”
Poor medication adherence accounts for around 200,000 premature deaths in Europe every year and has an annual economic burden that has been calculated at €1.25bn
The levers for change are lined up
Triducive believes that measuring the impact of opinion on creating behaviour change is crucial to develop effective strategies across healthcare, pharma and MedTech markets.
“Whether it is qualitative or quantitive or a mix, it is vital to measure progress. We need to know how much behaviour is shifting and analyse why,” added Tim, who believes the experiences of the pandemic could offer an opportunity for greater behaviour change.
“It has been a tough period all round but there has been a greater connection with the public which now has more understanding of the impact of their health choices on healthcare systems. They may have bigger appetites for healthy lives and more willingness to respond to advice from healthcare professionals but, again, this should be measured.
“The world has shifted in the last 18 months and industry has to understand the implications to better anticipate and meet their needs.”
He emphasised: “It is really important to make people feel like they can own the solution, not just the problem. In too many instances the patient feels they are not being listened to.”
For once, the main levers of behaviour change – opportunity, motivation and capability – have clicked into place across healthcare, due to the pandemic’s disruption.
“I see a lot of opportunity as we come out of the pandemic because this period of change has helped us understand more about what influences the behaviour of stakeholders, patients and doctors so we can create much more tangible interventions rather than just marketing communications,” said Dan Coffin, director at Research Partnership, the independent healthcare market research and consulting agency.
“As a company, we have experienced a huge rise of projects looking at optimising patient engagement through channels like digital health platforms and patient support programmes over the last 18 months. Trust in the pharma industry has grown over that time, as has the public’s consumption of information. There is no golden answer as the interventions will depend on the therapy area, the patient and the market, but people have never been more amenable to change.
“It is a great opportunity but we still need to understand the complex moving parts of behaviour and the biases that inhibit the adoption of healthcare regimes. If we can understand that then we can start to work out how to influence them.
“There is a lot of emphasis placed on the healthcare professional. They are the interface with the public, but doctors are not psychologists or behavioural scientists, so to enable behavioural change, you’ve got to properly investigate what is inhibiting desired behaviours. Once we do that, we can then develop suitable tools and interventions to better equip those healthcare professionals to drive that change in their patients’ behaviours.”
‘The UK government’s Behavioural Insights team heavily deployed the EAST framework – Easy, Attractive, Social and Timely – to give its COVID-19 health messages extensive reach’
Every company should be looking at behaviour change
Governments across Europe have also recognised the power of behavioural science and have established dedicated units to shape all aspects of its message. The UK government’s Behavioural Insights team heavily deployed the EAST framework – Easy, Attractive, Social and Timely – to give its COVID-19 health messages extensive reach.
Dan added that behaviour needs ‘a catalogue of elements or events to take place’ to bring about tangible change but that biases rage through our psyche, from feelings of ‘I’m not capable of change’ to ‘it will never happen to me’, making for a tangle of nuances that can neutralise broad brush campaigns.
“I believe behavioural science plays a huge part in the future,” Dan said. “An organisation’s willingness to investigate and embrace this will dictate how effective they are. Every company should be looking at changing behaviours because that is how they will get their products, their medicines, to the right people at the right time.
“There has been a significant rise in our consumption of television and social media over the last 18 months and that, for me, presents a huge opportunity for health organisations to use social influence to change the kind of culture of how we look after ourselves.
“But we still need to ensure healthcare professionals are better equipped to facilitate that patient empowerment.”
Digital initiatives can become the sinews of behaviour change and Mark Lakeram, group director head of behavioural science at healthcare communications agency 90TEN, part of the Envision Pharma Group, said: “Healthcare is at the dawn of opportunity with evolving technologies such as smartwatches enabling behaviour change through habit formation, social motivation and goal reinforcement. Technology allows you to tailor and finesse your messages.
“How we gain our insights is also changing. Mass market research can now be replaced by ethnographic research that observes behaviour as opposed to questioning, which can introduce biases. We can also capture video diaries and biometric data. In the future that will be augmented by neuro responses that measure brain activity charting which areas are getting responses to provide more accurate analyses of behaviour.”
His role is to build a behavioural science centre of excellence delivering insight-driven education and communication services across all Envision Pharma Group’s divisions based on an academic understanding of human behaviour.
Change needs creativity and innovation
The company has developed a suite of tools for different challenges: the ‘insight model’ interrogates behavioural cues, such as beliefs, risk perceptions and capabilities involved in behaviour change and filters them across emotional triggers, rational thoughts and environmental factors to inform strategies.
“We examine it from an internal and external perspective and then rank the key enablers and key barriers to change,” said Mark. “It could be a focus group or workshop with the key audience to generate a deeper understanding of what we can do with those insights, which ones are significant and are most likely to bring about change.
“If you look at a new drug, for example, that may be deemed too expensive which doctors shy away from prescribing, you have to change the external environment and influence policy and market access. Behaviour change stretches way beyond patient engagement.
“You certainly need to understand the nuances of every factor involved and a really important element is that behavioural science goes hand-in-hand with creativity and innovation. Interventions always need to be cutting edge, something our industry does really well, but behavioural science needs to have that creative aspect to be truly powerful and transformative.”
He added: “A lot of industries have recognised the importance of behavioural science and healthcare is uniquely placed to use it positively. At the same time, I think people are much more self-aware that their behaviour needs to change.
“Behavioural science has the capability to bring about real change across healthcare generally and for specific patient groups particularly.”
As campaigns become more sophisticated and their results are measured and analysed to shape campaigns across disease awareness, therapy education, adherence, healthcare professional relationships and public contact, behaviour change will become an increasingly effective weapon.