Patient centricity is a central philosophy and strategy for virtually all of the top 40 global pharmaceutical companies. What this means and how to achieve it, however, varies considerably.

As a strategy it intuitively makes sense: increasing patients’ knowledge and skills around their health should lead to improved clinical and patient outcomes. But the articulation of this strategy, how we can increase patients’ ‘activation’ with their health and encourage positive behavioural change, has many challenges. There are a number of beliefs that hold back the development of successful patient engagement programmes which, once understood, in our experience can lead to much more successful interventions:

Education Can Change Behaviour

It’s common sense that increasing people’s knowledge about their health and the implications of their choices, from lifestyle decisions to taking their medicine as prescribed, should increase positive behaviours and therefore improve health outcomes. Unfortunately common sense is one of, if not the, key enemy of effective behavioural change and patient engagement. Essentially this is the idea that understanding human behaviour is so obvious that there requires little or no serious thought.

Providing ‘factual’ and ‘accurate’ information to patients or ‘shocking’ people into different choices with a powerful messaging campaign has consistently failed to improve people’s engagement with their health (with two of many perfect examples in public health being smoking cessation and diabetes management). However, education is still the ‘go-to’ strategy for many pharmaceutical companies and agencies offering patient-focussed services.

Adding to this problem is the explosion of channels that enable communication between pharmaceutical companies, health providers and patients. Although providing a veneer of innovation, this has led in many cases to the same type of non-evidence-based communication simply being distributed in a greater number of ways.

What Can We Do Differently?

Never before have we had access to such a depth of real-time information, but this doesn’t necessarily translate into understanding and certainly doesn’t predict a change in behaviour. We know that in 2018 people engage with content to either pass the time and entertain or to solve a problem. Patient engagement should focus on understanding the cause of an issue and providing a solution to the problem, rather than education or increasing health literacy. For example, with our award-winning application MyAsthma, in partnership with GSK we understood the problems that contribute to a lack of asthma control and provided contextual tools that helped someone overcome these issues. Launched in October 2016, early data suggests that 80% of people are still active on the app a year after launch and we have improved asthma control by 10% for these active users.

People Act Rationally

In many ways the misapprehension that people act rationally, making sensible and rational decisions after a rigorous appraisal of the evidence, follows on from the ‘common sense’ belief that education improves health behaviours. This myth is also based on the long-standing theory that human beings seek to maximise pleasure and gains and minimise pain, losses and costs. This subjective expected utility model has been utilised in healthcare to emphasise the threat of a particular behaviour in order to change habits and still forms the backbone of many patient support initiatives in pharma.

When someone diagnosed with COPD refuses to stop smoking, it’s easy to believe they either don’t understand the information they have been given or that they are foolish and disengaged from managing their health. But it’s far more complex than that. People have their own reasons for behaving the way that they do. The life of a person living with COPD can very quickly become very limited, living from day to day with less and less interaction with other human beings and stimuli from external activity. Having a smoke may be the one opportunity to do something indulgent for them that briefly lifts their mood. This may not be a rational response to the evidence, but it isn’t irrational to the individual and is the reason quality of life scores are often higher in COPD patients who do not give up smoking on diagnosis.

What Can We Do Differently?

I believe we cannot over emphasise the importance of personalisation. By this I mean a true and deep understanding of an individual’s motivations and the capacity for a programme to cater for these emotional drivers. A practical example of this comes from another award-winning programme in rare disease, pulmonary arterial hypertension. The programme uses an application and HCP portal to enable the tracking of key vital signs and clinical indicators such as nutrition and activity. However the real driver is a bespoke quality of life questionnaire that uses artificial intelligence to build contextual information based on the daily needs and concerns of the individual, such as feeling a burden on their family. Currently being piloted by Hammersmith and Royal Brompton Hospitals with hundreds of patients, 70% utilise this function and of these nearly 60% have demonstrated improved quality of life measures.

It is Possible to Predict People’s Response

A great deal of academic work has been done to identify the key factors that shape behaviour, but it’s still very difficult to predict how individuals behave in any given situation. At a population level it’s possible to observe patterns of common behaviour and relate these to consequent outcomes, such as the impact of social deprivation on health inequalities and the resulting negative impact on health outcomes. While these patterns and trends can be described in great detail, tools that can actually tackle these inequalities are thin on the ground and don’t tackle the problems on an individual basis.

What's Next ?

The key learning for The EarthWorks over the last five years is not to make assumptions and not to work on assumptions made by our clients. The average age of the patients in our pulmonary arterial hypertension programme is well over 50, but they are extremely engaged in a technology-led programme, whereas there are numerous tech-based programmes focussed on younger demographics that fail spectacularly. The need to build solutions in collaboration with users, rigorously test and be prepared to continually iterate is also key. Perhaps the greatest insight, however, is to be aware of people selling solutions based on academic theory without a proven record of practical application.