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Test of strength

Diffusion of Innovation is one of the fundamental theories that underpin the practice of global marketing, but how well can it be applied to pharma?

Some management theories are better known for their argot than their substance. Many pharmaceutical marketers, for instance, bandy around terms like innovator, early adopter and, pejoratively, laggard. Yet, many people have no more than a passing understanding of the model that first introduced these terms.

Rogersí Diffusion of Innovation theory (see box 1, here) is not only one of the fundamental theories of strategic marketing, it is the theory that led to the idea of product life cycle and then portfolio management. If any theory can claim to pervade current pharmaceutical marketing thinking, this is it.

Of course, there is much more to Rogersí work than this. His research identified a number of factors that drive or constrain the speed at which innovations diffuse in a market. These include:

Relative advantage of the new idea over the old

  • Compatibility or conflict with current practice
  • Ease or difficulty of use
  • Ease or difficulty of trial use
  • Ease or difficulty of observing other peopleís use of the idea
  • Strength of recommendation by other users.

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Rogersí work has spawned many other interesting ideas, of which one, in Geoffrey Mooreís 1999 book, was that innovations failed when innovators adopted an idea but it failed to ëcross the chasmí into mainstream custom. When innovators moved on to the next idea, the innovation then failed.

It is ironic, therefore, that a theory that underpins a great deal of the strategic management in our industry is, in practice, so poorly understood by many practising marketers. Even more ironic is that, despite its pervasive, but hidden, hand in guiding our strategies, there is little empirical evidence to support the validity of the Diffusion of Innovation theory in the pharmaceutical market.

What little evidence there is comes from other sectors, mostly consumer markets, which may behave very differently from the regulated, technically complex context of the pharmaceutical market. These ironies were the starting point for our research. We wanted to examine whether innovation really did diffuse through a population of prescribers and use our observations to make the practice of pharmaceutical marketing more effective.

Realising Theory
Rigour is as important in marketing as it is in drug development or medical affairs, so we sought a quantitative, data-founded way of testing Rogersí theory, the underpinnings of much of our present-day thinking. There were two fundamental questions to ask:

Do prescribersí attitudes to innovation vary in the way the model says they do?

  • Does their prescribing behaviour follow their attitudes?

Much management research uses small samples of a couple of hundred people, but for this project we were given the invaluable help of a leading global provider of pharma market intelligence; using IMS data, and with the help of their expert analysis, we were able to look at doctor-level responses of 18,000 UK physicians. In short, we asked the doctors first about their attitudes to new products and whether they were likely to be the first to prescribe, the last, or somewhere in between. Then we looked at their prescribing behaviour across a number of disease areas.

The theory says that their attitudes should follow the sort of curve shown in box 1 (here) and that what they prescribe should reflect their attitudes. Our results provided remarkably robust and interesting findings.

Space does not allow for a detailed discussion of our methodology, suffice to note that it involved the use of data from two of IMSí key data sources, Prescriber Focus, the largest quantitative data set in the UK containing the attitudes and behaviour of General Practitioners (GPs), and Xponent, a doctor-level database covering the prescribing behaviour of 90 per cent of UK GPs.

When synthesised together, these data sources provided a deep, multi-dimensional view of these important prescribers, a key audience for pharma marketers. The sample represented approximately half of the community-based physicians in the country, so was much more representative than most sample-based research.

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Essentially, the methodology involved testing the correlation between prescribing behaviour with GPsí perception of various aspects of their work, including their attitudes towards new ideas and products.

Our initial finding is captured in figure 1 (here). Prescribers certainly vary in their attitudes towards innovation and, although it is not a perfect match, the correlation to Rogersí archetypal distribution of attitudes is very strong. It seems that prescribers, who care a great deal about patient outcomes, are a little more conservative than typical consumers, but not significantly so.

Despite this clear result, we wanted to test the theory yet more rigorously, so we sliced the data to consider prescriber attitudes across different therapy areas. We sought to discover whether prescribers are more or less cautious depending on the patient they are addressing. In fact, the data continues to support the theory, with patterns of attitudes that were both similar to each other and to the basic theory (see figure 2, here). There was some detailed variation between therapy areas, which suggested that prescribersí attitudes were shaped by a combination of two factors: an innate attitude to risk, and their comfort zone with a particular therapy area. In short, prescribers are slightly more innovative when they feel that their knowledge of a particular area is good, and slightly more conservative when they do not.

Does the Theory Matter?
So this work has proved that Rogersí 1962 theory does apply in modern-day pharmaceutical markets. In other words, prescribersí basic attitudes do not change during the short walk from the shops to the surgery. However, experimental proof is insufficient to make a theory useful. We needed to see this theory reflected in prescribing behaviour.

When examining this area, the data revealed something we had not been looking for. The more innovative a prescriber is, the more prescriptions they are likely to write, as shown in figure 3 (here). When individual prescribing level is added to the influence that innovators have over their colleagues, it reinforces the importance of this small, but key, group of people to pharma marketers.

Yet, the key test of the usefulness of Rogersí theory was very simple; it is one thing for prescribers to say that they believe themselves to be innovative or conservative, but actions speak louder than words. We needed to see whether those who claimed to be positive towards new drugs prescribed them earlier and, conversely, if conservative doctors clung on to old drugs for longer.

The results of this analysis are shown in figure 4 (here), which reveals strikingly clear evidence that what prescribers say about their attitude to new products is indeed reflected in what they choose to prescribe. They do as they say and so, taken together with the earlier data, the Diffusion of Innovation theory stands up well to rigorous empirical testing.

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Practical Implications
However, an idea that is proven in theory and practice is useful only in that it has practical implications for real life. What, then, does this imply for the way in which marketers should work?

There are seven key lessons that emerge from this work (see below) which, taken together, imply that marketers should use the theory of innovation diffusion when creating and implementing marketing strategies. The customer universe is not a homogeneous mass and comprises people with very different attitudes to risk and innovation. We should adapt both the targeting and the message to ensure that the right things are being said to the right people; the ëwhatí and ëwhoí will of course vary in accordance with the product being managed.

Only the most naÔve brand manager will copy best practice from an established brand for a product launch. They should always carefully tailor call activity, promotional messages, educational activity, etc to suit the life cycle stage of the product.

This research holds an important second point too. Most of us, under pressure of time and results, consider ourselves to be pragmatists and would hate to be labelled as ëtheoreticiansí. Yet, this research shows that a piece of theory, if tested and applied rigorously, can have real, practical benefits for pharmaceutical marketers. These findings tell us that it is a false dichotomy to separate theory and practice; understanding the first leads to success in the second, and to work in an innovation-based industry without understanding how innovations spread in the market will only invite failure.

Innovation Diffusion ñ 7 key Points
1. Prescribers can be categorised by their attitude to innovation
2. The size of category fits with theory and empirical evidence
3. Prescribersí attitude varies by therapy area, but not greatly
4. The importance of each category differs according to the product life cycle stage
5. The impact of early adopters goes beyond prescribing, serving also to influence others
6. Different categories of prescribers respond in different ways  to different messages
7. It is not enough to target innovators solely. Pharmaceutical marketing campaigns must ëcross the chasmí.

The authors
Dr Brian Smith (brian.smith@pragmedic.com)is a research fellow at Cranfield and runs PragMedic; Baba Awopetu (btawopetu@yahoo.co.uk) is brand manager, EMEA, Stryker, and visiting lecturer at The Marketerís Forum; Kevin Piper is new product development manager, IMS Health (www.imshealth.com). Dr Smith welcomes comments on this article

2nd September 2008

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