Behavioural science’s time has come in the pharma industry, as medical communications adapt to a more ambitious and diverse treatment landscape. Here, Alpharmaxim’s William Hind explains how its structured application could help overcome prescriber and even patient inertia and deliver the benefits of important new drugs where they are needed most.
In Life Sciences, behavioural science has a powerful role to play in medical communications – specifically in overcoming barriers to changing prescribing behaviour as treatments become more ambitious, complex – and expensive.
This is important so that healthcare providers (HCPs) don’t automatically default to their habitual choices of medical or treatments, but become more open to emerging options which may improve patient outcomes. If they are not, patients may be unfairly deprived of opportunities to get better or to experience a better quality of life – something most healthcare stakeholders profess a keen interest in enabling.
It is no coincidence that the UK’s Medical Research Council (MRC) is now advocating the use of behavioural science in the design of interventions such as marketing campaigns, to ensure that important new biopharma innovation fulfils its potential for patients.
This isn’t simply a case of educating the market about the new product’s benefits, however. There are other factors that keep decision-makers coming back to habitual choices. Behavioural science draws on psychological theory and the social sciences to understand why individuals follow or resist certain behaviours. Equipped with those insights, drug companies can become smarter and more strategic in applying their marketing communications resources.
Does behavioural science stand up?
In a public health or ‘responsible citizen’ context, behavioural science has been used successfully across a range of high-profile cases. These include encouraging people to follow COVID-19 guidelines[1], take up vaccines[2], and make healthier lifestyle choices.
In Life Sciences, the opportunity is to lower any identified resistance to supporting and offering novel therapies in place of entrenched drug prescription pathways. While it’s possible to make an educated guess about healthcare providers’ reasons for sticking with tried and tested treatment choices (including officially recommended first-line treatments, budget restrictions, and/or a lack of knowledge of the emerging options), the reality is usually more complex.
A knowledge gap is rarely the only issue
The established COM-B model for behavioural science sets out 93 different techniques and how they can be successfully combined to address barriers to change, based on the relative roles of Capability, Opportunity, and Motivation (M) as determinants of current behaviour.
Drug approval and associated education/data represents only one third (the Capability element) of the combined factors that may be needed to effect a change in behaviour. The other factors at play can be harder to predict. It may be that the HCPs involved don’t have access to the right resources to see through a new treatment plan, for instance. Or perhaps prescribers are not being encouraged to try something new by the system they are in.
When it comes to rare diseases, HCPs and patients may have accepted as inevitable what many people would consider a gruelling regime if it is keeping the individual alive. A new therapy might be seen to disrupt the equilibrium that had been achieved, even where there is a promise of an improved quality of life. In at least one case, further probing revealed that patients’ parents were the main source of resistance.
Confidence issues: overcoming negative perceptions
In common with other neurodegenerative diseases such as Alzheimer’s, Parkinson’s has been the subject of important novel treatments which have been heralded with great fanfare but have not delivered for patients. After a series of failed launches, it would seem that no amount of new education can substantially tackle the sense of poor motivation, where confidence has been eroded. A more involved approach will be needed.
Distilling the particular combination of ‘blockers’ to behaviour change is the first step in designing an effective medical communications campaign. Ideally this needs to be guided by a structure, framework or methodology, to ensure that campaigns are evidence rather than assumption based and have maximum impact across the target blend of channels.
Pinpointing how & when to ‘nudge’ the target
Behaviour change frameworks contain a set of instructions to guide the development of a behaviour change strategy, in this case a medical communications campaign.
Drawing on the COM-B model described above, medical communications teams can start to determine what kind of campaigns might work best to drive change. In a public health context, COVID-19 required a series of new behaviours, starting with fastidious hand-washing, face-covering and keeping a distance from others. Getting the public on board required improving their knowledge of what to do and how (Capability); ensuring they had access to soap/hand gel or face coverings (Opportunity); developing a clear plan of when they should do these things and align this with why they needed to do it or what they would get from it (Motivation – e.g. reduce the risk of negative outcomes/protect themselves and others).
At Amsterdam’s Schiphol Airport more than two decades ago, repeat issues with the cleanliness of the men’s toilets prompted alternative thinking. Putting up signs did nothing to drive ‘a better aim’, but when the creative team designed a realistic ‘fly’ into the ceramic of the urinals, suddenly customers’ ‘targeting’ became more accurate. The change was possible; it was a case of finding the right motivation. The impact was striking, too, reportedly an 80% reduction in urinal spillage and an 8% reduction in total WC cleaning costs at the airport.
How a framework can help
Behaviour change frameworks encourage those developing communication strategies to be specific about the changes in behaviour that are needed (e.g. losing weight is not a specific behaviour, whereas reducing high-calorie food intake or walking X number of steps is).
With strong, evidence-based insights into the changes that are needed, and the specific barriers that need to be overcome, it becomes easier to identify the right type of message and content, as well as the most effective combination of modes of delivery – and when these should be targeted at a population vs more individual level to maximise the omnichannel opportunity.
About the author
William Hind founded Alpharmaxim in 2001. Alpharmaxim helps cross-functional biopharma teams communicate effectively with clinicians about new medicines or alternative treatment regimes and their potential to improve the patient experience, supported by relevant scientific evidence.
References
[1] Engagement with protective behaviours in the UK during the COVID-19 pandemic: a series of cross-sectional surveys (the COVID-19 rapid survey of adherence to interventions and responses [CORSAIR] study), National Library of Medicine, March 2022 https://pubmed.ncbi.nlm.nih.gov/35272652/
[2] The London Borough of Havering: Using the COM-B framework to develop a vaccine take up strategy, Local Government Association, April 2021: https://www.local.gov.uk/case-studies/london-borough-havering-using-com-b-framework-develop-vaccine-take-strategy