There are myriad reasons why patients may bypass CHD marketers' messages. Some older patients may feel frustrated by the number of pills they need to take and the degree to which medications disrupt their lifestyles. Other CHD patients may not realize that their cholesterol levels are out of the normal range and could be a contributing factor to CHD. And while overcoming that obstacle is a core challenge for pharma marketers, it is, of course, possible. Just look at the grassroots "Know Your Numbers" health-education campaign: It urges consumers to learn their blood pressure, cholesterol, and blood glucose levels, and it has effectively increased awareness and treatment of hypertension, dyslipidemia, and diabetes in communities supporting the campaign. Key to the campaign's success is close adherence to health-literacy guidelines—using clear, common language and plainly identifying the action to take, why it's important, and specific next steps (testing and follow-up discussions with healthcare providers).

Today, many companies are making headway by creating personalized disease-management programs—what some in the industry are calling "a pill and a plan"—to help patients better navigate the range of factors that affect their health behaviors. Personalized health communication enables marketers to vary the messages they deliver to patients with different needs and abilities, and it increases their ability to motivate different patients to act.

"It's getting harder and harder to justify using only a DTC/broadcast-promotion approach," says Tom Snow, EMD Serono's director of marketing, reproductive health. "Many disease states require more nuanced, complicated relationship-marketing initiatives."

Other companies are attempting to tackle the emotional barriers to engagement. For example, Lilly includes an interactive video module that explores specific attitudes and beliefs about depression on its http://cymbalta.com/ Web site. Unlike typical pharmaceutical Web sites, the language used on the navigational tabs and in the videos reflects the real words that people use to describe their feelings about depression. By avoiding medical jargon and "sanitized" terms, the content is more approachable and more easily understood by people with low health-literacy skills.

Certainly, these tools can be used for health-information seekers. But for brand teams, their return on investment really comes in terms of providing individualized support after a patient sees the physician, so that the tool helps the patient better interpret the physician's care.

Baby Steps

The NAAL findings confirm what many marketers already knew: A much-needed innovation in marketing and patient care will come, in part, from more focused, understandable, and relevant disease information. However, Snow warns that developing these communications can be very resource intensive and, therefore, cost prohibitive. In those cases, pharma companies may decide to reassess current executions rather than reworking entire marketing campaigns.

Some companies have started to personalize their patient brochures and other programs for certain audiences by changing the images and including messages relevant to the target group. Others are tackling health literacy by ramping up the number of delivery platforms (like podcasts, blogs, and text messages) used to disseminate health information, in an effort to bring these messages to a wider audience. But the NAAL study results show a simple truth: Despite innovation in the delivery of these messages, too much drug advertising and healthcare information is not understood.

Instead, the industry must take a critical examination of the content, style, tone, reading level, and layout of its communication. As a first step, companies should ensure their brand messages are understood and actionable by consumers at even very low levels of health literacy. "It's important to take what can be very complex and boil it down to the simplest-possible description," says Anne Myers, patient marketing manager for Lilly's neuroscience portfolio. "Communicate with people at their level."