Research repeatedly shows the link between a strong social support network and the likelihood that a person will experience an improved health outcome such as a better controlled condition or a healthier lifestyle.  Often, people think of their social network as solely those who are around them all the time – immediate family, friends and co-workers.  However don’t discount the influence of those in your virtual social network.  Senator Claire McCaskill documented her journey to lose weight over the last 6 months on her twitter feed.  She credits her 50 pound weight loss in part to her twitter followers, saying that they kept her accountable to her goals.

As the internet becomes a more integral part of our every day lives, it follows that people will increasingly turn to online sources of support, hoping for a success story like Senator McCaskill’s.  Pharma companies need to prepare to respond to this demand by offering opportunities to link their patients with support they need to manage their conditions.  Doing so will provide value beyond the brand alone, letting patients know that their health and well-being is of highest priority.  Success is possible for both patients and brands with support offerings that are relevant and engaging.

I am a tech geek, but I was surprised by the notion of using a virtual nurse in a hospital setting. And I was really surprised that some patients preferred one over a real nurse. However, after reading the whole story, I like the idea.

Meet Elizabeth, a creation of researchers at Northeastern University. She is programmed to be more than an information exchange towards a social exchange who expresses empathy. The results from a clinical trial (still under review) in a discharge setting found that Elizabeth appears to have a beneficial effect on care. A month after discharge, those who interacted with her were more likely to know their diagnosis and to make a follow-up appointment with their primary-care physician.

The reason for this is that patients feel less rushed or talked down too with Elizabeth than a real doctor or nurse. The basis for Elizabeth was through emulation of recorded interactions between patients and nurses. Then some “small talk” (i.e., simple touches of humanity) was added in between healthcare-related interactions. In a pilot study, people seemed to feel less lonely interacting with the virtual nurse. On average they interacted 17 times a day with the virtual nurse!

The researchers also created Karen, a virtual home-based exercise coach. They found the over twelve weeks, the people who interacted with Karen were significantly more active than those who did not. Karen has a backstory and tells her stories in the first person, which seems to increase engagement.

The researchers are now working on an in-room version where patients can “talk” to the virtual nurse about their experience, report pain levels and ask questions.

What a great opportunity for a mobile app!

See Elizabeth in action…

As marketers, every day we are tasked with solving client’s problems. Usually these problems involve shifting a mindset or a behavior.

At MicroMass, we use behavioral science as a tool to dig below the surface, beyond the obvious, and examine what is driving a particular attitude or behavior.

Take this scenario for example – forgetting is one of the most common reasons cited for medication nonadherence, especially in chronic diseases.  Ok – you say. I could see that.  Most days I am lucky if I remember to have matching socks on when I leave the house. I certainly couldn’t remember to take a medication every single day, especially if it’s for a condition where I’m not having active symptoms.

And as marketers, in an attempt to be swift and results-driven, we have a tendency to take shortcuts and focus on those solutions that are more tangible and accessible. We create nice functional reminders for our patient customers – email pushes, text messages – whatever it takes to remind them not to forget.

“Forgetting” may indeed be the label for the nonadherent behavior in this situation. But “forgetting” isn’t the full story.

Cognitive neuroscientists have demonstrated that in our brains, there is a complex interplay between emotions and cognition. And when we make a decision to act, there is an unconscious negotiation between our rational cognitions and our emotions. These processes in our brain are interconnected – emotions and cognitions are always influencing one another. So, in a sense, much of what drives our thinking and behavior happens below the surface, in our unconscious. Columnist David Brooks conveyed this concept more eloquently – “We are players in a game we don’t understand. Most of our own thinking is below awareness.”

So back to the “forgetting” medication example – this could at least partially explain why someone taking a daily medication to prevent breast cancer recurrence cites forgetting as a reason they don’t take their medication as prescribed.

You might think – how could someone forget to take a medication for cancer?

Imagine this. A 52-year old woman is 2 years out from completing surgical and chemotherapy treatments for breast cancer.  She is supposed to take a daily medication to prevent recurrence. She often finds herself forgetting her medication, sometimes days at a time. I just get so busy that it slips my mind – she says.

If her brain could talk to us, if her unconscious processes at work could verbalize their activity, it might sound something like this…

I am not the woman with breast cancer anymore. I am past that now. I am acclimating back to my old life now – to being a mom, a devoted wife and a high school math teacher.  Seeing that bottle on the counter, really thinking about, evokes fear…it makes me think that that part of my life will never be over. I want to look forward not back.

So, while a functional reminder can work some of the time, it can also push patients further away. That’s not something you will necessarily uncover in focus groups or in-depth interviews, unless you have a direct line to participants’ subconscious brain activity.

On the other hand, behavioral science can provide a roadmap. It serves as a tool so we can skillfully unravel some of these unconscious processes at work, and get to creative communication strategies that go beyond a band-aid approach to drive meaningful, lasting change.

We all have stress. Let’s face it – whether you are a working mom juggling a family and a job, a stay at home parent, or just a person fully dedicated to every endeavor you take on – you have stress! It’s inevitable. But, it’s how you face that stress that matters.

Having studied behavioral theory for years, I’m constantly reading articles and reports on the interrelationship between one’s environment and health behaviors and outcomes. Theorists have studied the relationship between stress and how people in turn cope with these stressors. But rarely do I think about what I study in the context of my own life. 

Recently, however, I got to thinking…how do I cope with stressful events?

When faced with a challenge, a subconscious, automatic process is often set in motion. Most people do not choose to be in denial over a grave diagnosis. Rather, a person diagnosed with a serious illness may automatically enter a state of denial. This is a coping mechanism that helps this person deal with the bad news. In the world of behavioral science, this is a kind of emotion focused coping.

Emotion focused coping helps a person deal with and ameliorate the negative emotions associated with the stressor, as opposed to actually taking steps to deal with and solve the problem at hand. This is not to say that all emotion focused coping is negative. Other examples include humor, venting, and crying, all of which can help a person feel better and more able to face their problems. The key is employing a combination of coping strategies that also includes more positive, problem focused techniques, such as goal setting, information seeking, and problem solving, to take steps to actually reduce the stressor.

Like I’ve said, for most of us, the way we cope is automatic. We deal with challenges by employing techniques that work for us and using those we’re comfortable with. However, many of us could probably benefit from adding some more positive techniques to our coping toolbox. The only way this can truly happen is to make coping a more conscious, active event.

Positive coping is often an acquired skill, and is not something that usually happens without the help of others, which is where MMC’s team of behaviorists comes in. Patients who are dealing with lots of difficult treatment decisions and changes in quality of life probably don’t feel they have time, or have the interest, to learn new ways to cope. The key is helping patients integrate new ways of thinking and behaving into their lives without making it an arduous, and obvious, task. At MMC, we employ techniques that help those we touch become more skilled at tackling obstacles to help them attain the health outcomes that we know they desire – even if they are in denial.

Pharmas are always talking about putting patients first. 

But who is doing it? And who is doing it well?

Alyson Connor’s recent article in MM&M explores the issue.  Read it here.

Last week, I attended the PH Professional Network Symposium in Crystal City, Virginia. It was a gathering of approximately 400 PH-treating allied health professionals and others working to make a difference in the field of pulmonary hypertension. I looked forward to learning from the experiences of those in the field, how they overcome obstacles with patients, and future research in PH. I was also excited to present our research poster on the Psychosocial Aspects of Living with Pulmonary Arterial Hypertension. So much focus is often put on the clinical aspects of treating a disease, and it’s just as important to understand the psychosocial components, as these can great affect medication taking patterns, mental health, and overall well being.

The Symposium was fantastic. I came back with a renewed hope for the future of this disease, in addition to learning a lot about the day-to-day of those treating it (like complex cases and medication decisions). Not surprisingly, the keynote speaker was an inspiration. It was given by Jessica Lazar, a PA at Allegheny General Hospital in Pittsburgh, Pennsylvania. She spoke about her experience climbing Mount Kilimanjaro, likening the climb and the altitude effects to what it’s like for people living with PH. Her blog describes her climb for a cure. Below is an excerpt.

“Pulmonary arterial hypertension is a curable disease. No, we don’t have the cure yet, but to me it is something I am quite hopeful will happen within my career, which has about 15 years to go. We just have to push hard enough, be dedicated enough, climb over every obstacle, and keep pushing just when we feel like sitting down. Kind of like climbing a mountain. And kind of like living with PAH. Our climb of Kilimanjaro honors all those who courageously live with PAH every day, those who courageously have died with PAH, the caregivers who are there every step of the way, the caregivers left behind when a loved one with PAH reaches the end of their struggle.”

The Symposium closed with an inspirational presentation by three clinicians, Mae Centeno, Heather Langlois and Peggy Kirkwood, treating PAH and how they’ve created and sustained a multidisciplinary, patient-centered approach to caring for their PAH patients. The time, energy, organization, and drive of these individuals really does give hope for the future of those living with this disease.

An intriguing new skin cancer prevention campaign from the UK-based non-profit Skcin had 14,000 sun worshippers logging onto their site to receive messages about skin cancer.   How did they do it?  By telling them there is a way to make the effects of the sun even stronger. 

Starting with a teaser campaign in magazines and social media, potential “customers” are directed to a website claiming to sell a new product that makes the sun work three times as hard while tanning.  The visitor is asked to input their contact information to receive a free sample of this miracle cream.  Instead of receiving a confirmation that their order is on the way, a pop-up message reveals that there is no such product and, in fact, sun exposure is linked to skin cancer which is a leading cause of death in the UK.  These statements are followed by jarring close-up images of skin cancer lesions and an invitation to visit a website that promotes self-protection from the sun and skin cancer. 

An interesting approach for sure, but how many of these tanners will spend their next beach trip under an umbrella, slathered in SPF 50+?  Behavioral science would suggest that it won’t be very many.

There are a few reasons for this. 

First, the campaign targets those who are unlikely to be ready to change their current behavior, and does so in a way that is deceptive.  By focusing on an audience that’s not apt to be interested in engaging in preventative behaviors (i.e. people who are actually looking to make the sun’s effects STRONGER, not trying to protect themselves from it), they probably won’t consider the message to be relevant or applicable to them, and therefore, won’t absorb it.  Also, the credibility of the source of information is undermined by using a bait and switch tactic that tricks people coming to the website.  These two factors combined make it almost certain that the message will be dismissed.  As anyone who has been a teenager knows, having an unrespected voice of authority telling you not to do something is the surest way to get you to do just that thing. 

Second, the campaign employs a fear appeal approach.  This method of persuasion has been used in many campaigns, often intending to scare teenagers away from drugs and sex.  But the track record for this tactic is spotty.  Fear appeals don’t tend to work when the targeted audience is already entrenched in that behavior and doesn’t consider themselves at risk, like this group of extreme tanners. 

Finally, the messages focus primarily on providing information about the dangers of overexposure to UV rays.  The problem with this approach is that, as with most health issues, a lack of knowledge is probably not the barrier to taking action.   In order to enact true behavior change, it is imperative to go deeper than providing information and actually speak to the motivations of the target audience.  I’d venture to guess that the average heavy sunbather has likely heard all of the warnings about skin cancer but feels that “it won’t happen to me.”  That same person may also be very concerned about their appearance.  Focusing on the more immediate and tangible adverse effects of tanning such as leathery skin or pre-mature wrinkles may resonate more with this audience and inspire them to take steps to adopt healthier behaviors. 

That said, it is clear that with so much competition for the attention of your target audience, innovation is the key to breaking through.  The challenge now is to develop ground-breaking campaigns while using behavioral science to light the path.  Non-UV light of course.

Dear Pharma, you’ve underestimated this whole mobile phone thing.

A recent TeleNav survey of US mobile users reveals that one third would rather forgo sex for a week than their cell phones. They’d also be willing to give up chocolate (63%), alcohol (70%), caffeine (55%), and even (yikes!) toothbrushes (22%) for a week than be without their cell phones.

That’s not like. That’s love. Or at least deep and abiding dependence.

You’d think Pharma would be paying attention.

Here at MicroMass we’re just wrapping up an in-depth assessment of the patient support programs for top brands and we were surprised to find that only one of the 25 brands we analyzed uses mobile technology.

As we’ve said here before, getting people to change how they act is pretty hard. But it can be done if you know how to push the right buttons.

Knowing which messages will motivate people is crucial. But if you’ve got the right message but aren’t delivering in the right medium and at the moment when your consumers are most receptive, you’re missing the boat.

A few days ago I noticed articles in The New York Times and The Wall Street Journal that described a substance that could both help prevent obesity in children and save children from dying of malnutrition.

What is this versatile and magical substance? Breast milk.

Back in 2004, the Ad Council commissioned a national breastfeeding campaign (full disclosure, I worked on this campaign) to increase breastfeeding rates.

What we learned in research was that although everyone knows “Breast is Best,” it’s not a sufficiently compelling message.

What does change people’s behavior is the idea that by not breastfeeding you are increasing your child’s risk of respiratory illnesses, ear infections, obesity, etc. The behaviorists I work with call this loss-framing.

While the resulting breastfeeding ads were ultimately stripped of some of their hard-hitting statistical data (a full list is available here), loss-framing is still a compelling way to tell that story.

Go here to see TV and radio spots or to download print ads.

Using frightening images that depict the consequences of this habit to encourage quitting is probably not enough in all cases. After all, these images aren’t revealing new information. I do agree that one piece of influencing behavior change is to heighten individuals’ perceived susceptibility of developing complications from smoking, and also increase the perceived severityof these consequences. But, like I said before, most people know the consequences. They’ve seen the images before, they’ve been told by their peers that smoking can ultimately kill, yet they still choose to light up. In this case, influencing behavior change isn’t as simple as just using these warning labels, although it’s definitely an important piece.

Behavioral science tells us that information alone isn’t enough to influence behavior change. People need to be motivated to master the behavioral skills needed to change. While these labels all provide the 1-800-QUIT-NOW contact information, many won’t take advantage of this service if they lack motivation. Officials need to uncover the insights that will help them successfully motivate smokers to want to quit. Using exercise as a comparison, most people know that exercise helps maintain good health and helps to stave off certain diseases. But many people still don’t exercise. They often lack motivation to work out. In addition, they need tangible steps to help them not only get into a good routine, but also the confidence and skills to maintain this healthy behavior. It’s no different with smoking.

These images are a great step in helping to reinforce the negative consequences of smoking and making them more apparent and top of mind, but just as much effort needs to be put toward helping people want to build the skills they need to quit.

One of the 9 warning labels selected for use.

For more information, or to see the new images, visit the FDA’s website at: http://www.fda.gov/TobaccoProducts/Labeling/CigaretteWarningLabels/default.htm.