Gaining a fuller picture

Ever more companies are discovering that ethnography, where researchers observe people doing things, is making a significant impact on new product development and marketing.

Ethnography differs from traditional market research because it is conducted in the setting where the activities and behaviours actually happen. As a result, it uncovers what people actually do, as opposed to what they say they do. It highlights activities and behaviours of which the subject may be unaware. Plus, there is no formal question and answer format.

This method can be particularly useful when investigating current care processes, including patient flow. It can probe barriers to product adoption and point to the behaviours, tools and materials that could be used to overcome them.

How does this relate to the pharmaceutical industry? Could observational studies improve marketing?

What is it?
Ethnography originates from anthropology, where anthropologists spend significant periods of time with people in a community, making detailed observations of their practices and culture.

Today's ethnographers study more familiar groups and cultures, such as teenagers, retail shoppers, patients and mobile phone users. Ethnography is recognised as a valuable form of consumer research for identifying emerging and unmet customer needs. Although it is not a new scientific technique, its application to the new product development (NPD) process is relatively recent.

It draws on a range of methods, including observations, interviews and the documentation of 'traces' left by people as they go about their lives.

It can be used throughout NPD, but it is probably most useful in the earliest stages as it can explore emerging or unmet needs for a particular target group. This in-depth and open-ended approach can help reveal what is really important to people. Such understanding can help reduce the risk involved when entering a new market or bringing to market a totally new product or, in the case of medicines, a new treatment method.

In ethnographic fieldwork, there are many ways to observe and document what people do and use, ranging from direct observation with note taking to the use of photography or video recording and even self-documentation.

With ethnography, observation is introduced, which means watching behaviour and behavioural traces. Notes are made mapping patterns of behaviour, enabling the production of a sketch or diagram showing the relationships between people and the ways that they use the product.

Mixed media
Photography, including time-lapsed photography and shots to capture product use, can also be employed. Videotape can record daily living activities and digital technology can maximise the use of web cameras. In all, ethnography produces a more multi-dimensional/holistic view of the study subjects than more traditional forms of data collection.

Applied ethnography has been found to be superior to other techniques, such as focus groups, in the new development process. Traditional focus groups rely primarily on what people say, but this data can be restricting. There are many reasons why people say what they say and why they don't say other things. There are also many other thoughts and feelings that people are unable to put into words.

As with any approach, there are limitations in that findings are qualitative in nature and may need further validation through additional methods. There may be some selection bias. For example, those physicians agreeing to participate may practice differently from those who have not agreed to take part. Plus, there is no direct dialogue with patients, so the ethnographer cannot interrogate them to obtain their perspectives.

The findings from observational research are synthesised into a CareMap, which can be used to guide marketing strategy and tactical implementation. This records the activities seen during the ethnographic research, capturing the essence of these observations. Generally, it looks like a patient flow or patient algorithm.

It can include the drivers and barriers to product adoption and the conversations between clinicians and patients. The findings presented may lead to refinement or enhancement of the current marketing message, the introduction of sales training initiatives, or the development of peer-to-peer programmes to transfer the knowledge and practices of the higher users to the lower users. For example, it could result in a certain tool or technique to manage side effects.

Listening and learning
Xerox was one of the first companies to use applied ethnography globally. Ethnographic fieldwork was conducted in the workplace and summarised in a film showing office workers struggling to complete a copying job on a Xerox machine. After viewing the film, Xerox engineers began to think about designing the machines differently. The work led to the incorporation of the large green button seen on most copiers today that enables users to walk up to the machine and make a copy easily.

In the early 1980s, several of the larger industrial design firms hired anthropologists or psychologists to bring the human perspective to their new development process. Today, there are a number of social science-related research consultancies and many individuals who offer a psychological and/or anthropological angle to product development teams.

Now, many large consumer-based organisations, such as Microsoft, Motorola and Intel, have anthropologists on their staff.

A group of researchers helped Intel expand its involvement in the US healthcare field. These in-house researchers conducted a large, ethnographical study of healthcare producers that uncovered the fact that many doctors had time constraints, which prevented them from accessing the people, information and/or resources they needed to provide patients with quality healthcare. The result of this knowledge was the development of Allscripts Healthcare Solutions, which are wireless Intel devices that automate physician tasks such as prescribing medication and capturing billing information.

Benefits
To understand the value that ethnography can bring to pharmaceutical marketing, and why it can offer incremental benefits over traditional techniques, it is essential to compare and contrast both approaches.

The ethnographical approach is in almost direct contrast to traditional pharmaceutical marketing research which takes people from the context of their daily lives and places them in sterile research facilities for individual interviews or focus groups. In these cases, as with market research interviews conducted via telephone or internet-based questionnaires, the researchers depend entirely on what the respondent says in response to a list of questions that they believe encompass the important issues for the project in question. While much can be learned from this data, the researchers' powers of visual observation are underused. Participants' responses are necessarily limited by the questions asked.

Clearly, these methods provide valuable information, but the researchers risk getting inaccurate data, as they are limited to what the respondents want to tell them, what the respondents believe to be true, what the respondents think the researchers want to hear and feel is important and what the respondents remember to mention.

An early example of the use of video to corroborate written records investigated subjects who kept food diaries for weight control studies. A commonly observed discrepancy was the subjects' 'finishing up' of food left on plates, which was not recorded in the diaries.

In contrast, ethnographic research goes a step further and is useful for those pharmaceutical marketers who want to go deeper in the pursuit of marketing questions by exploring the gaps between what people say and what they are observed actually to do. For example, it could reveal subtle differences in practice between geographically dispersed parts of the same organisation, such as clinics.

As with the academic anthropological approach, the use of ethnography in pharmaceutical marketing has the same underlying principle as 'living with the natives'. Whether studying patients in their homes to help the research sponsor better understand what 'really' happens with compliance and adherence among asthma sufferers, or investigating what 'really' happens with pharmaceutical samples in private practice offices, the fundamental approach means the ethnographer spends days, and sometimes weeks, in and around the setting where the behaviours occur.

Another example could be where a market entrant needs a detailed understanding of the current operating environment into which it plans to introduce an improved treatment regime. The value of such studies is compounded when an international dimension is added, for example when an American company needs to understand the variations in local practice among clinicians across Europe in developing a market entry strategy.

On-site ethnographic research can be less threatening for respondents; the research is happening on their territory and, as they get to know the researchers over time, they can relax and respond more naturally. Also, being surrounded by objects, routines and other people in these familiar environments often triggers ideas that may not occur in more sterile facility settings.

As with all research methods, ethnography will not provide a solution to all marketing problems encountered by the pharma industry. Traditional, facility-based interviews and focus groups are attractive to pharma marketers because they are fast, efficient and cost-effective. Ethnographic projects, meanwhile, can take time and money to design, carry out and analyse. However, they can reap huge and unexpected rewards.

The Author
Karen Lenoir is client services director at ParagonRx International LLC and wrote this article in conjunction with Harten Group

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