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When neither attitudes nor personality drive behavior, Pharma must look to social norms to understand consumer adherence issues
In the July issue of Pharm Exec we discussed the first pitfall in problem solving: an ill-defined problem. This month we'll look at the other barrier that impedes effective problem solving: looking for the solution within a confined set of parameters when the solution actually exists outside of those limits.
Poor adherence is becoming the staple problem in the pharmaceutical industry. The problem has been clearly articulated for several years and takes a prominent position on most of Big Pharma's game plan for improved revenue. Perhaps if we keep flogging that dead horse he might just rise again!
Let's assume we appropriately specified our problem and have, indeed, identified the correct target audience—that is, those who are predicted to be non-adherent in the future. What do we do with them?
Typical adherence solutions are built around patient self-report and/or attitudinal segmentations. The fundamental problems with these two approaches are that they assume, respectively, that (A) the patient has the meta-cognition to articulate their subconscious state of mind regarding irrational behavior, and (B) attitudes cause behavior. These two assumptions will lead to the development of highly engaging, but, unfortunately, ineffective interventions. Here's why:
It is generally accepted within cognitive science that individuals are relatively poor at explaining the mechanisms behind their own behavior and thought processes. We refer to this as weak meta-cognition. Indeed, even experts in the field of cognitive science often struggle to explain behavior and thinking processes. If I were to ask you to state the top two most acceptable reasons for non-adherence, you might say side-effects and cost. Some of you might say forgetfulness. Sure, they all seem plausible. However, we know that these are not really the top reasons for non-adherence because if they were, then low-toxicity drugs would have superior adherence to the high-toxicity drugs such as chemotherapy, generics would not have an adherence problem, and reminder programs would actually work.
If, on the other hand, I were to ask you for the top two least acceptable reasons for non-adherence what would you say? That's a much trickier question. What if I asked you why you didn't let that crazy driver pull in front of you this morning, or why do you choose black shoes with a blue suit rather than brown ones? What if I asked you to explain why you didn't follow your doctor's recommendation to take a mildly toxic drug that could potentially save your life and instead opted for a bag of French fries for lunch? We shouldn't ask innocent consumers to explain what we, as pharmaceutical experts, haven't been able to explain despite years of investigation. They will give you the best answer they can think of—and nothing more.
Attitudinal segmentations are in every nook and cranny within the walls of pharma. One could argue that they are an important component of the marketer's armamentarium—when they are correctly applied, that is. When they are misapplied they are the cause of budget leaks that could fill Lake Ontario, suboptimal brand performance, and frustrated senior leadership. Correctly applied they are used to shape stylistic communications—and not to direct motivational drivers. A slight diversion should illustrate the point.
Let's say that my attitude towards house cleaning is that it is boring, tiring, and time-consuming. Nonetheless, I clean my house. Let's say my sister's attitude is that it is rewarding and makes the house look and smell better. Opposing attitudes, same behavior—not what would have been predicted if attitudes were causing the behavior.
Let's say we both have extroverted personalities that would, arguably, prefer to be doing something more fun than the solitary task of house cleaning, but yet we both clean our homes—not what we would have predicted. The conclusion is that neither attitudes nor personality are driving the behavior here.
So what is driving the behavior? A possible answer could be acceptance of a social norm. Not that we would dissuade good home cleaning, but to illustrate, suppose we wanted to change this house cleaning behavior; how would we do that? Two possible solutions come to mind: A) Challenge the acceptance of the social norm or B) challenge the social norm itself. For the former approach, you could communicate to the target audience: You don't have to do everything that people expect of you; So what if you don't clean your bathroom or your neighbor/spouse thinks it's cruddy; What do you care of their opinion? For the latter approach, you could communicate a message such as: You're a full-time working mother, people don't expect you to have a pristine home, too. The bathroom looks just fine. Either way, when you are operating against the causal drivers of the behavior, the behavior will change. It's a simple case of mathematics:
Y = MX + C
Y = cleaning bathrooms; X = social norm; C = acceptance of that norm; and M = the weighting of the social norm relative to acceptance. With a simple equation to explain your market's behavior, you know if your focus should be on X or C, what bang for your buck you will get from focusing on X compared to C, and how much you need to shift both X and C to achieve your new goal of eliminating Y or doubling Y. Now, if only pharmaceutical marketing could be so simple!
So now that we've put on the table the pitfalls of commonly accepted 'solutions' for non-adherence, where do we go from here? The answer: Where the industry has been since its inception—the sciences. In a succeeding issue of Pharm Exec we'll discuss how the scientific method and mathematics can be applied to non-adherence to finally take the bull by the horns.
Andrea LaFountain is CEO of Mind Field Solutions. She can be reached at email@example.com