It is a verb and a noun and one of the hardest states to achieve by persuasion or even force. A lesson in syntax is not the most obvious route to understanding one of healthcare’s greatest challenges, but language is important when we talk about this particular topic – behaviour change.
It’s a loaded phrase, freighted with aspiration and hope yet burdened with misunderstanding and mistrust. Human nature responds far more erratically than human physiology.
But, for healthcare, changing behaviour is the highway to improved interactions within the complex relationship matrix of patients, healthcare professionals (HCPs), industry and regulators. It is also the great hope for solutions to rising global ill health. A Lancet report estimated that by 2060 more than 48 million people will die with serious health-related suffering – 22 million more people compared with 2016.
Many souls and ambitions, along with eye- watering budgets, have been lost trying to steer the turbulent seas of behaviour change in healthcare, but it can be transformative when it connects deeply with patients and physicians.
The looming global health issues are huge, but healthcare is at an ideal moment for change thanks to accelerating digital capabilities, rapidly advancing medical science, easier identification and associations with patient groups, along with a halo effect from industry’s pandemic performance.
How these positives are deployed will be hugely influential in realising a beneficial impact on individuals and healthcare systems.
“It is clear that medicine cannot solve everything and that people will have better lives if they make better choices. That’s where credible, accessible and relatable information comes in – influencing behaviour change is a large part of why we are all in this industry,” said Marie Little,
Group Commercial Head at Resonant Healthcare Communications, which includes the agencies Anthem, Bedrock and Origins.
“Look at adherence; it is something that pharma has never really cracked and that is partly because it is down to human interaction and human choice, which have a raft of psychological elements. The benefits of adherence are obvious. Unpacking why people don’t adhere is less so.
“How we communicate the value of adherence to an individual, or group, is critical. We have to help people see the benefit to themselves so they can make up their own minds and change.”
The recent Doctor’s Orders report by the International Longevity Centre UK highlighted that non-adherence costs €125bn across Europe, emblazoning the behaviour change dilemma, and opportunity, across a giant light-flooded billboard.
“It is important to recognise that there are several target audiences that view things through different lenses. They experience their conditions in many different ways and being able to understand those nuances before you communicate to them is absolutely key,” observed Little.
“Patient Advisory Groups are fantastic and the more you can listen to actual patients and understand their lived experience – not just the disease or treatment pathway – and how that affects the rest of their lives through the psychological impact, the rational and emotional, the more you can connect.
“You have got to be willing to hear all of it, then act on it.”
Be bold and authentic
Patient-centricity has been a core industry commitment for more than a decade, with impressive projects revealing the drivers of both patient and HCP behaviour and influencing market strategies, but Little believes the positive glow from vaccine success has presented a moment for industry to push further.
“Everyone talks about patient-centricity as being their credo, their mission, and I believe organisations have the power to really live up to that,” she said. “It’s time to rip up the rule book, not something pharma is always that comfortable with, but if you are bold and authentic, the rewards are there.
“We create solutions that are relevant and bespoke based on what we’ve heard, rather than what we assumed or what we would like to think. Our understanding comes directly from patients and those insights can define the strategy you should take.”
Resonant Group, whose agencies cover healthcare communications, public relations and patient-focused activities, scored a significant success with an award-winning feature film project (Millefeuille), driven by behavioural science and patient insights, that shone a light on those living with psoriasis and psoriatic arthritis. It drove awareness and conversations between HCPs and patients, ultimately supporting better understanding and outcomes.
“Millefeuille created significant discussion focused on optimising patient care and outcomes, demonstrating that even on first viewing this vital conversation had been stimulated and perceptions were changed,” added Little.
“I am optimistic that there are more successes out there, but they will only come if we can understand the authentic experience and communicate with patients and HCPs in a targeted way, rather than trying to talk to millions of people with the same message and language.”
Connecting with HCPs, who have been liberated from time-worn engagement tracks since the pandemic, is a vital element of shifting behaviours onto better pathways. Matt Pugh, VP, Medical and Scientific Services at Ashfield MedComms, believes language and tone are prime factors in empowering commercial teams and providing internal education.
“We are working in a highly regulated environment so using the correct language and terminology is vital,” he said. “Treatment inertia can be problematic – why are HCPs struggling to adapt to new treatment guidelines? To encourage different behaviours, we often think carefully about how they are reacting to the latest medical evidence. This could lead to support for Medical Science Liaisons (MSLs) in how they frame conversations with HCPs or, alternatively, we might concentrate on how educational materials are designed and made available to HCPS.”
Ingredients of change
Pugh views the recipe for behaviour change as containing ingredients that blend together, and added: “We start by identifying what the ideal behaviour should be, such as an HCP following treatment guidelines and making appropriate decisions in the eyes of the patients and then, crucially, we rewind to find out why this isn’t happening and which barriers are in the way.
“It is important to understand which barriers are most influential and then align them with appropriate interventions. These are the ingredients of change.”
Ashfield MedComms, which is an Inizio company, creates medical communications to inform, educate and motivate using the power of data and analytics for both industry growth and improved patient outcomes.
While commercial teams in pharma companies are perhaps more accustomed to applying principles of change, Medical Affairs should also consider how best to invest in this area, especially as HCPs continue to finesse the frequency and channels they use to engage with industry.
“We have seen the Medical Affairs function become a far more strategic force within pharma companies, with greater influence on the overall direction of the business,” added Pugh. “They have a challenge in utilising the evidence (data) to support wider strategic communications for a multitude of stakeholders, at different times. Therefore, we need to understand, from a behavioural point of view, how they approach their day-to-day work, how they interact with key audiences and what devices they use, so we can develop appropriate content.
“Ultimately, we are becoming more accustomed to translating insights into actions and appreciating how our target audience might like to receive information. By understanding our audience from a behavioural perspective, we build a picture of their preferences, how they work. Whereas five to ten years ago it likely meant communicating with HCPs via every available channel, it is now much more tailored.
“It is about constructing an engagement journey for our target audience. For an MSL, this might start with an initial in-person interaction with an HCP, continue with follow-up emails and invitations to attend congresses or symposia, or engage with online content – every communication encourages the next action. The key factor with this approach is that it allows us to measure interactions both quantitively and qualitatively so we can make communications as efficient and productive as they can be.”
Pugh added that grappling with behaviour change is compelling, challenging and rewarding. “We design communication programmes so that outcomes are measurable. Many of the therapy areas we support are rare diseases, and we are privileged to interact directly with patients, their families and advocacy groups,” he said. “This means we often see first-hand how our work plays a small part in improving their situation – this makes everything worthwhile.”
Making health more human
Efforts to nudge people to stop developing preventable disease and reduce the harm from chronic conditions are stepping up, with initiatives such as the European Commission’s healthy lifestyle promotion and the World Health Organization’s AI digital health worker, Florence 2.0, providing tips on reducing stress and leading a more active lifestyle.
European countries have also committed to applying behavioural and cultural insights when developing health policies and services for its 900 million population. The five-year programme, running till 2027, is researching the barriers and drivers to healthy lifestyles to help design future policy and services.
Sam Hughes, senior strategist at Evoke Mind+Matter, sees huge potential from putting behaviour change at the heart of healthcare, but cautioned that it needs an alchemy of research, discipline and creativity to break through.
“You only have to look at stop smoking campaigns to see how tough it can be,” he said.“The risks of smoking became very clear but it didn’t stop many people – it took systemic interventions and restrictions on top of the advice from doctors.
“Behaviour change is multifaceted with lots of triggers and you really need to understand your audience, to know their biases, their daily habits and the barriers they are facing. From there, you can create an intervention strategy. Behaviour change theory allows you to develop a targeted approach with evidence-based interventions so you don’t end up with scattergun tactics and wasted messages. Basically, it makes health more human.
“Using behaviour change helps gets better results and is more cost-effective for healthcare systems.”
Hughes added: “If you ask people about their risk of getting cancer then, due to ‘optimism bias’, most people will underestimate their own chance of getting it. People will always minimise their own risks and that is at the core of a lot of what we are trying to change.
“Early intervention saves lives across all aspects of health and getting people to that point is the massive challenge to overcome in almost every healthcare brief we get.”
Change skills growth
Evoke Mind+Matter, an Inizio company, deploys its planning model CHANGE, a behavioural science-led strategic methodology, to frame its approach across a breadth of campaigns.
Its award-winning campaign, The Smear Word, helped dismantle taboos surrounding cervical screening, which had resulted in 25% of young women missing appointments. It attacked the issue with humour and candour across familiar channels that resonated with a young audience.
“It used relatable humour that helped combat some of the fear that was a big barrier and 44% of women said they were more likely to get a smear test after seeing the campaign,” added Hughes.
Another successful behaviour change campaign saw the use of geo-targeted advertising and ambient media to improve safety at rail stations that had witnessed an increase of accidents from people distracted by their smartphones and social media. It massively reduced accident levels and stands as a powerful behavioural change example.
Change is never easy and attempts to influence behaviour have to wrestle through the swamp of healthcare misinformation and disinformation that festers around social media and can taint even the most elegant of strategies. But the tactics and tools of behaviour change are growing and communications skills sets are elevating to meet the challenge.
“Moving forward, we are facing multiple health challenges that have complex relationships with each other so we will have to understand the triggers and drivers specific to each patient population,” commented Hughes.
“Behaviour change interventions are going to need to be both individual and systemic, helping people make better choices and supporting healthcare infrastructures cope with the stresses on resources.
“It is a fascinating discipline from a theoretical and practical viewpoint and, when you see the interventions working and campaigns making a difference, it is very satisfying.”
References are available on request.