Adheris Health, an inVentiv Health company and a provider of medication adherence programs, has announced the start of the next phase of an ethnographic study into how Americans make healthcare decisions and the role of American culture in influencing health behaviors.
The insights derived from the research are designed to help life science companies more successfully develop products and services to influence American patients toward better health.
Ethnographic research takes a holistic, in-person and qualitative approach to the study of human behavior and interactions in natural settings. It provides information and insights that cannot be gleaned from surveys, data analysis or self-reporting and is a tactical tool in today's highly competitive business environment.
The first phase of fieldwork, led by Adheris Health, Behavioral Insights Group, included 30 families in Boston, Portland, Shreveport and Kansas City. Families were selected to represent a wide range of ages, socioeconomic levels, experiences and health backgrounds. The sample included retirees, families with small children and others with adult children, single-parent families, and those caring for elderly family members. Fieldwork included in-home interviews and direct observation.
In addition, participants in the study collected and submitted video diaries documenting their interactions with the healthcare system, their everyday decision-making and behaviors between in-person visits with field researchers. Nearly 600 hours of video data was collected over a year.
"This kind of ethnographic research is indispensable for companies hoping to facilitate positive behavior change, such as adherence to medication or lifestyle changes," said Kathleen Starr, Ph.D., a behavioral psychologist and Adheris Health's senior vice president of behavioral insights and strategies.
Among the people in the study were those with allergies and asthma, arthritis, back pain, diabetes, infertility allergies, heart disease, high blood pressure, mental illness, osteoporosis and pediatric cancer—diseases and medical conditions influenced by behaviors.
"Our American cultural context explains a lot about the 'negative' health behaviors that are so widespread," Starr said. "What we found should cause healthcare companies, such as hospitals, health plans and pharmaceutical companies, to rethink how they are marketing to Americans. If we want to facilitate behavior change, we need to understand the day-to-day reality of modern life and how people manage their health—not what they say, but what they actually do."
The initial research produced a broad range of insights useful to healthcare marketers. One such insight from the observational research concerned the way Americans organize their families. Children are at the center, significantly influencing health behaviors of the entire family. Decisions are made based on the children's activities, schedules and desires, such as what and when they want to eat. And such decisions are all about making the children happy, with ramifications on the health of the entire family.
"In many cases, kids hold the power," Starr said. "If they want to eat fast food for dinner, for example, then the whole family eats fast food. And health decisions for individuals are made not by the individual, but by the family unit."
Starr noted that social scientists see the role of the child as a significant shift in American culture over the past few decades. Understanding the impact of this shift on health allows marketers to work more effectively within a culture they cannot change.
Healthcare companies wishing to encourage positive health behavior change should be thinking about the entire family unit and understand the focus on keeping the kids happy. A company providing medication and dietary support to a person with diabetes, for example, may be most successful working with dieticians to devise recipes that are not just better for diabetics, but also attractive to kids.
The research showed that American families, particularly those with children, are unstructured, on-the-fly, rushed and driven by the desires of the youngest family members. Daily health decisions often are dictated by events impacting the family system as a whole. Families with a finite amount of time and emotional resources must overcome obstacles daily and health gets put on the back burner. This means marketers must strip down messages and objectives to those that are the most essential because today's families have no time or energy for more.
The research also produced insights and recommendations into how to leverage family systems, why the perception of American individuality matters to health, why focusing on improving resilience is better than just trying to drive adherence and when to focus on the change process rather than the end goal.
The first phase of research, finalized earlier this year, resumes this month following 25 of the original 30 families. The next phase of work—continuing to study people where and when the health actions occur—will examine discrepancies between objective health status as measured by their lab results and how people perceive their own health. The study will examine the patient experience from a systems level, learning how social, familial and bureaucratic influences—including the Affordable Care Act—shape health practices.