What to Consider When Conducting Patient Research in Saudi Arabia

The need to understand the patient as a key stakeholder is now recognized by pharma across the globe.



Conducting market research with patients in any market can be a challenge, requiring sensitivity and consideration for language, culture, religion, as well as for other emotional, behavioral and environmental factors that might impact patients’ behavior.

In The Kingdom of Saudi Arabia (KSA), where religion and culture are central to society and there are strict laws governing behavior, patient research can be uniquely challenging. However, as the fastest growing pharma market in the Middle East, it is critical that those who want to leverage opportunities in this Arab state understand patient needs and behavior. In this article, we will outline the factors to consider when designing a patient research program, based on our experience and knowledge of the region.

Culture, religion and family

Cultural and religious factors must be considered when conducting patient research in Saudi Arabia, where Islam is a way of life. Illness and suffering can be seen as a test from Allah, and praying is a key source of support for patients. Religion and culture have considerable influence on the patient’s view of disease management, creating a unique context for the pharmaceutical industry.  

The family plays a key role in patient care and the opinion of senior family members, such as the father or the eldest person in the family, is highly valued. It is considered the obligation of the family to enquire about the patient’s health and family members may act as intermediaries during the patient-doctor interaction. They will often participate in decisions regarding treatment options. Physicians may even discuss major decisions with the family without the patient’s involvement. For example, a patient may be in pain, but if the patient’s family have a religious belief about the endurance of pain, they might ask the physician not to give the patient strong pain medication. The family may demand more procedures than the physician considers appropriate for critically-ill patients, which can create tension and anxiety. Therefore, physician communication with caregivers is regarded as important as with the patient in Saudi Arabia.

Patient behaviors in Saudi Arabia should be observed through the lens of Islamic culture and religion, in which family and gender play important roles.

One also needs to be sensitive to the part that gender roles play in healthcare decision-making in Saudi Arabia, which are highly influenced by Islamic culture. Although nowadays women in Saudi Arabia are granted full rights in making healthcare decisions, many women and even doctors will still seek permission from males who act as the female’s legal guardian (father, husband or son) before initiating certain surgical procedures. This situation may lead to compliance issues and delay in treatment. However, these healthcare decisions cannot be dismissed as being due to a lack of awareness or education.  Patient behaviors in Saudi Arabia should be observed through the lens of Islamic culture and religion, in which family and gender play important roles.

Patient/caregiver-HCP interaction

Communication issues between patients and doctors are universal, but they can be amplified in Saudi Arabia where a large proportion of HCPs originate from another country. Seventy percent of the nurses in Saudi Arabia are expatriates from all over the world, and some of them do not speak fluent Arabic. Nurses may speak English with different accents, and interact with patients who speak Arabic in different accents (Egyptian, Lebanese, Moroccan, etc.). Language barriers can often cause tension between nurses and their patients, as both sides experience frustration during communication. For example, nurses may find it difficult to convey doctor’s instructions to patients on how to take a certain medication, while patients and caregivers may complain that nurses are not being responsive to their questions. Pharma companies need to be aware of the language barrier in the patient-HCP interaction. Training HCPs can result in better care and better compliance, especially for chronic conditions. 

Cultural and religious diversity can also impact the overall quality of communication and overall care. For example, expatriate nurses or doctors who are non-Muslim might underestimate the discomfort a female Muslim patient is likely to experience during physical examinations. Patients might behave in a way that is alien to an expatriate, such as pronouncing the name of God during labour and birth to keep them from harm. Without intending to, HCPs may not pick up on subtle communication cues and consequently provide inadequate moral support. In certain circumstances, HCPs may even unintentionally offend the patient. For example, doctors and nurses may attempt to comfort patients by touching them, without realizing that touching the opposite sex is considered offensive. The ability of the healthcare workforce to deliver culturally sensitive care can affect patients’ satisfaction of the treatment (which can include certain drugs/medical devices). Ensuring that products can be used in a culturally sensitive way is an important consideration for pharmaceutical companies marketing in Saudi Arabia, as important as conventional factors such as efficacy and safety.

Furthermore, pharmaceutical companies need to ensure that their communication speaks to the correct audience. For example, although it might be usual in other markets for a female health product to speak just to a female audience, in Saudi Arabia, it might also be appropriate to include messaging for the male guardian as well.

Effective communication between patients and healthcare providers is key to ensuring safe and high quality healthcare. Good communication can lead to improved patient satisfaction, adherence to medical recommendations, and better healthcare outcomes. Despite the government providing programs for expatriate healthcare workers, there is a need to further improve educational and orientation programs regarding the culture and language in Saudi Arabia.

Conclusion

Saudi Arabia, as the biggest market of the six Gulf Co-operation Council Countries, offers considerable opportunities to pharma. However, the strong influence of religion on culture and the way healthcare provision is perceived in Saudi Arabia, can be challenging. Understanding the patient is critical. We recommend pharmaceutical clients work with trusted and experienced market research partners who have a deep understanding of the country’s cultural, religious and social context, in order to harness the opportunity.


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