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Harnessing the power of ethnography in healthcare

Locating the elusive, yet vital, insights into how people manage and live with their medical conditions

The power of ethnography

While ethnography as a research technique has been around for a long time, only recently has it been applied within the healthcare marketing environment. It could now be a pivotal tool for gathering patient insights and guiding pharmaceutical marketing and support programmes - but is it really being used to best effect?

What is ethnography?
Ethnography is a term that originated in anthropology and refers to the systematic study of people and cultures by spending time living with them. By capturing detailed observations to understand how participants see their world, ethnography provides rich, holistic insights into their lives.

  • Ethno - derived from the Greek ethnos meaning people, race or culture
  • Graphy - derived from the Greek graphia meaning the process of writing or recording

The concept of ethnography was apparently first developed by Professor Gerhard Friedrich Müllero while participating in an expedition to Siberia in the 1700s. Whatever the true origin, it is clear that ethnography has been used to great effect in both academic and commercial spheres over the years.

Ethnography in marketing contexts
Ethnography is common practice in the fast-moving consumer goods sector. Just think about accompanied shopping trips where a researcher observes and interviews a consumer with the aim of understanding his/her purchasing decisions. This is a form of ethnography. At a more technical level the use of observational research via CCTV cameras in shops reveals valuable information about shopper flow and interactions with displays. Digital billboards can incorporate eye-tracking software which, when combined with interviews, can measure visual effect and product recall.

The German manufacturer Miele made effective use of ethnography by observing persistent cleaning behaviour in homes where people were suffering from allergies. This led to the design of a vacuum cleaner with a traffic light indicator to show when a surface is dust-free.

Ethnography's transition to healthcare marketing
I first became aware of ethnography being applied in a healthcare setting a few years ago at a time when the importance of patient compliance with medication was beginning to be recognised. A research agency filmed a diabetic patient at home over the course of a few days, and reported back to its client. The findings revealed a notable cognitive dissonance between the patient's belief and behaviour. Put simply, the patient believed the diet had been stuck to and the medication taken correctly. The footage revealed a different story - with deviations from the diet and occasions when the medication regimen was not adhered to.

The value of ethnography in healthcare today
When applied to present day healthcare marketing research, a robust ethnographic methodology goes further and deeper than other research approaches have been capable of going. It adds another dimension: it is contextual and dynamic; it reveals previously unknown perceptions, behaviours and true patient insights.

Being based on observation, ethnography allows participants to express themselves within their own environment at different times of the day or night, as and when thoughts occur to them. It therefore delivers real-life insights and offers a unique opportunity to see how patients live with their disease and/or therapy. In a nutshell: ethnography can reveal what people actually do or think, rather than what they report they do or think for example, when in an interview situation.

The process and outputs of ethnography are very different from conventional research. A traditional telephone interview does not allow the researcher to see or react to the participant's non-verbal communication. While this limitation may be overcome by face-to-face interviews or focus groups, these situations are inherently false - it is clearly a pre-planned interview or discussion, rarely eliciting real, spontaneous, honest insight.

In addition, research participants may have an innate wish to 'please' the researcher and say what they think the researcher wants to hear. This phenomenon is well recognised in the context of patient-HCP consultations. How much more likely is it for a patient to say “yes I'm fine and I'm getting on ok with the medicine” rather than what they are really thinking, such as “I'm confused and nervous about taking this medicine, so I skip doses”? Patients simply are not in an environment that makes them comfortable to share their true perceptions and behaviours.

Ethnography allows patients to reveal the impact of their condition on their life over an extended period

Why and how pharma can harness ethnography
Quality insights into how people manage and live with their medical conditions remain both vitally important to inform medical communications, and yet elusive. Ethnography addresses this need.

Ethnography can and should:

  • Combine clinical collaboration, individual patient perspectives and expert interpretation to provide unmatched immersion and insight into the lives of patients, their journeys and their disease management experiences
  • Allow immersion into patients' lives without working to pre-held assumptions and hypotheses, while still offering the facility to address 'known' key issues where required.

Healthcare is obviously very different from the FMCG environment that first utilised ethnography. Healthcare is highly personal to the patients involved, and discussing their condition can be difficult, embarrassing and fraught with emotional issues. That's why ethnography is particularly applicable to healthcare, helping to overcome patients' barriers and reservations to elicit deep and honest emotional insights.

Ethnography allows patients to reveal the impact of their condition on their life over an extended period giving 'in the moment' reflections rather than considered and retrospective answers to pre-set questions.

Furthermore, ethnography offers the opportunity to involve family members to give a comprehensive understanding of the impact of patients' conditions, not only on themselves but also on those they live with.

Ethnography in practice: outputs and outcomes
Recent ethnographic studies that I have been involved with have generated around 2,000 minutes of video footage (depending on the sample size). The footage is much more than a simple patient diary or filmed interview: participants are provided with novel stimulus to enliven the experience. Video outputs are systematically analysed to produce a detailed, themed assessment, which forms the basis of the 'patient story'.

Conducted correctly, ethnography not only furnishes effective, strategic decision-making, it also provides a wealth of materials that can be used for internal and external communication programmes which are evidence-based, and have real value in improving health outcomes for the target audience.

Is ethnography being used to best effect?
I believe that ethnography represents a huge opportunity to inform how pharma companies interact with and support healthcare professionals and patients. We work in an industry where evidence should underpin everything we do, from product development to marketing and support programmes.

At the beginning of this article I posed the question 'is ethnography being used to best effect'? I think the jury is out on this one. Some marketing teams are already ahead of the curve in harnessing the full power of ethnography by using novel approaches. Some are still making do with traditional interviews, focus groups and patient diaries. As more pharma companies recognise the value of ethnography, the pharma industry will be much better able to meet the real needs of healthcare professionals and importantly in this patient-centric world, the patients themselves.

Article by
Pip Keys

is head of insights at Bedrock Healthcare Communications. To find out more, please contact: or call +44 (0)1252 240218

21st March 2016

Article by
Pip Keys

is head of insights at Bedrock Healthcare Communications. To find out more, please contact: or call +44 (0)1252 240218

21st March 2016

From: Research



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