Segmentation questioned in adherence programming
Pharma is questioning the ability of segmentation models to improve patient adherence (i.e., compliance and persistence [C&P]).
By on Sep 30, 2008Pharma is questioning the ability of segmentation models to improve patient adherence (i.e., compliance and persistence [C&P]).
It is not that segment descriptors do not provide insights, my clients tell me. The problem is that they are not confident in the tactics, derived from segmentations, to resolve C&P problems. No vendor, with whom I have spoken, has had evidence that his or her model has improved adherence outcomes.
Thus, my clients ask me, What is the problem? Below are factors I believe limit the ability of segmentations to drive C&P programs. As an independent consultant, who advises pharma on evidence-based, patient-centered behavioral solutions, I would be pleased to hear from anyone in the industry, if you believe you have a resolution to these issues.
If you are a brand manager or director, know that predictors of patient C&P, derived from segmentations, are not adherence drivers (e.g., trust in the physician). What drives C&P are the program components that evoke patient commitment (e.g., Trust Signals inserted in messaging and health care provider communication).
The factors, then, impeding segmentations providing the outcomes and revenue wanted are:
1. Segmentations were not designed to evoke attitude change. Segmenting is about grouping the emotional or functional needs of your products users (e.g., some persons with erectile dysfunction want the confidence of being aroused at an intimate moment, others want other outcomes). Messaging speaks, then, to consumers with defined needs, to sell them on your brand as the best choice. Those who are committed purchase your product. In pharma marketing, this approach has been effective in motivating physicians to prescribe, and patients to purchase, treatments for the benefits they desire. However, the segmentation approach was not intended to drive reluctant patients to your brand. That is, segmentation was not conceived as means to change the attitudes of consumers who question, or who do not believe, that your brand will provide benefits. For the foregoing, cognitive and behavior-change research provides answers.
2. Knowledge doesnt improve adherence. Segment-derived messages often attempt to change patient understanding, or knowledge about their disease or treatment. More than 40 recently published studies show that there is no association between patient disease or treatment knowledge, and medication adherence. Thus, more knowledge is not the answer. A large body of research tells us that that patients need motivation, not education. The former requires a different form of evidence-based program.
3. Interventions are least effective when they assume patients are deficit. Interventions driven by segmentations may require identifying patients who are to some extent non-adherent. The assumption is that by identifying patient deficits, interventions can be created to educate or advise them on behavior change. Programs based on this logic have shown limited evidence of effectiveness. Patients who are told they are lacking in some way (i.e., deficit) do not increase their medication use.
4. Segmentations provide predictive but not prescriptive variables (e.g., trust, depression, medication beliefs). Knowing which variables predict adherence is helpful but not sufficient. You need to know how to change these factors. For example, you need to know how to evoke trust and change medication beliefs. BCS has identified, from a 10+-year review of published and industry research, four Principles of Change that are the drivers of adherence. The Principles need to be present for interventions to be effective.
5. Segments cannot specify what forms of programs will work at what critical points in the treatment cycle (i.e., at Motivational Touchpoints). However, there are published and industry studies that can tell you what to change at what points in the treatment cycle. Know that there are usually 150-200 academic studies published in the past five years to inform any brand campaign, in addition to your own proprietary research. Both can be mined in a structured way to guide your strategic and tactical selection.
6. Lack of empirical links between segment descriptors and recommended tactics. All reports that I have read "guess at" how to address segmentation differences. No theoretical or empirical evidence has been offered for proposed interventions. Again, available research, and the Principles of Change, provide the confidence you need to develop a best-practice program.
For more information on the Principles of Change, that evoke adherence at Motivational TouchPoints, or other evidence for effecting a change in patient C&P, please contact Grant Corbett at grant.corbett@behavior-change-solutions.com. Grant will be speaking about Adherence Marketing strategy at this months eyeforpharma Patient Adherence conference (October 23-24, 2008) in Boston.
Author:
Grant Corbett
Principal
Behavior Change Solutions, Inc.
North America's Foremost Experts on Patient Adherence.
52 Cherie Road
St. Catharines Ontario
CANADA L2M 6L7
Phone / Tlphone: (905) 937-1441 ; Fax / Tlcopieur: (905) 937-5858
Email / Courriel: grant.corbett@behavior-change-solutions.com