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As marketing researchers, we are tasked with discovering the real motivators of behavior and preference among healthcare customer stakeholders.However, this poses a challenge on multiple levels. One is that research respondents struggle to identify many of the latent or subconscious factors that influence how they think and behave.
As insightful as stated responses might be, they rarely paint a complete picture of real-world behaviors. People are often poor reporters of their own situations, and their expressed intentions can diverge significantly from their actual actions. To bridge this gap, it is important to employ a range of deeper techniques to glean more accurate insights into expected behaviors.
It is often said that there are three sides to every argument: one side, the other side, and the truth. This adage underscores a fundamental challenge when eliciting insights in pharmaceutical marketing research —understanding how doctors and patients will actually behave versus how they say they will behave.
One effective method to uncover the truth behind stated intentions is through the use of a board consisting of carefully curated images.In general, image boards present a collection of visuals designed to elicit responses that may not be as top-of-mind. Unlike traditional lines of questioning, which may rely solely on verbal responses, image boards tap into the visual and emotional aspects of decision-making.
It's important that images shared in a board are not merely a collection of pictures, but images designed to represent a wide variety of “mind states” and ones that can be interpreted in different ways by different people.The image a respondent selects is not necessarily the important part of the discussion; it’s the probing around the reasons for that selection that become central to uncovering deeper reasons behind feelings or choices.
Often overlooked when using image boards is the technique of simply asking the respondent to describe the image they see.In a recent study, asking further about an image that depicted one individual bending down to speak to another was described by one respondent as “bad news being communicated,” and another as “a new idea being taught,” and a picture of a hilly terrain described by one respondent as “an insurmountable challenge,” but another as “new, uncharted territory.”
Clearly, it’s not about the image itself, but how it represents a respondent’s underlying views, subconscious biases, and preference that might not be directly articulated.
The use of image boards can also provide insight into cultural or ethnic contexts that may not be readily apparent during a standard interview. In How CustomersThink, Gerald Zaltman recounts a case where image boards were used to explore the cultural values and preferences of Hispanic respondents. Through this approach, researchers found that Hispanic respondents exhibited nuanced reactions to different images based on their cultural background. For instance, certain images tied to cultural traditions, family values, and community resonated deeply with respondents, evoking strong emotional responses.
Zaltman emphasizes how a careful selection of images that can evoke a variety of metaphorical themes –togetherness, support, fear, rejection, embarrassment, identity – is, along with careful probing, a way to elicit responses that are grounded in personal and cultural experiences.
Another valuable approach is allowing respondents to tell their own stories. Narrative techniques, such as storytelling exercises, provide a richer, more nuanced understanding of behaviors and attitudes. When patients and doctors recount their experiences in their own words, they often reveal habitual behaviors and underlying motivations that aren’t captured through direct questioning.
Listening to these personal stories, and giving respondents the space to tell them, helps identify patterns and discrepancies between what individuals say and what they actually do. For example, a patient might claim to strictly follow prescribed treatment regimens, but their narrative may reveal instances of missed doses or alternative therapies they’ve tried. Or, a physician might state that he recommends a certain treatment for the majority of his patient population, but his “patient story”may reveal specific non-clinical characteristics that steer him in a different direction.
In a recent interview, one physician talked about changing a treatment because her patient made an offhand comment that he disliked driving. As her story unfolded, she referenced a patient she had several years ago who had missed several appointments because he relied on someone else to drive him. When this more recent patient indicated that while he was able to drive, he disliked driving, this physician immediately changed direction on a recommended therapy because of earlier experiences. These non-clinical insights can be crucial for developing strategies that align better with real-world practices.
As in the above example, it’s apparent that both clinical and non-clinical experiences can form the basis for ingrained, habitual behaviors that are often not identified in a more surface-level conversation. When research respondents are given the space to recount experiences fully and in their own words, these habitual behaviors and underlying motivations, not captured through direct questioning, are allowed to surface. Researchers must be attentive to these often subtle references to habitual behavior and probe accordingly; a respondent might say“I always,” or “I never,” but they are more likely to say something like, “This reminds me of…,” or “When I do X, then usually Y happens,” or a variety of other phrases that may hint at preferences that are actually driven by rote behavior.
Observational studies offer another pathway to bridge the gap between intention and action. By viewing and scrutinizing behaviors in real-world settings—whether through in-person visits, video recordings, or digital interactions—researchers can collect data on how decisions are made and how treatments are administered. In-depth personalized ethnography in the patient’s own environment, where the patient is surrounded by the comforts and familiarities of their daily life, will allow the patient to better tap into their deepest concerns about their treatment.
While getting to physicians’ experience with patient interaction can be more challenging, research that is designed to bridge the gap between the patient and physician in a way that allows the physician to fully understand the patient experience can lead to further insights regarding the physician’s own subconscious feelings. For example, allowing physicians to ‘listen in’ when patients discuss their personal feelings about their disease and treatment to an impartial listener (rather than their doctor), may allow the physician to better understand the patient frame of reference and be able to tap into their own subconscious thoughts about treatment options. Technology now provides us with a myriad of ways to share patient experiences with physicians to gauge whether physicians are experiencing the same level of patient engagement and dialogue in the office with their own patients and to help us understand how to bridge that gap where it exists.
Behavioral economics applies principles from psychology and economics to understand how people make decisions.
By presenting physicians with various scenarios and trade-offs related to treatment options, researchers can assess how changes to various endpoints or product attributes impact their choices. Similarly, behavioral economics can shed light on how patients prioritize different aspects of their treatment, such as convenience vs. efficacy vs. dosing. These insights can inform more targeted marketing strategies that address the real drivers of behavior.
However, in a qualitative interview, simply asking a rating or ranking question related to the above can often fall flat, as the introduction of a numerical scale often forces the focus towards the numbers rather than the individual drivers of interest. Instead there are several interesting techniques that present information in a gamified way –allowing the respondent to focus on, for instance, what kind of gas one car needs to pull ahead of another, or what feature gets thrown out of the boat so that it continues to move forward. This allows respondents to move away from a traditional ranking or rating exercise and think more broadly about what matters to them in specific situations.
In healthcare insights work, bridging the gap between stated intentions and actual behavior is crucial for developing effective strategies. Choiceful use of a variety of techniques combined with skilled moderation, real world observation, and gamification, can offer a valuable toolbox for uncovering the truth behind reported behaviors. In the end, navigating the complex terrain of behavior requires a multifaceted approach—one that goes beyond surface-level responses to uncover the deeper truths that drive behavior.
1 Zaltman, G (2003). How Customers Think: Essential Insights Into the Mind of the Market.HarvardBusiness Review Press
