Patient non-adherence is a serious public health concern. Three patient-side factors—motivation, recall, and comprehension—are key determinants of whether or not someone will adhere to prescribed treatments. To leverage the power of these key influencers, brands should consider utilizing narrative communication methods. Specifically: Strategic, regulatory-compliant, patient-driven and patient-centric storytelling.
It’s striking how centuries-old healthcare topics have been around for that long and remain current and highly relevant. Think of the Hippocratic Oath and how it encouraged patient centricity millennia ahead of our time. Or think of Molière’s classic 17th century comedy Le Malade Imaginaire. It highlights the responsibility of care partners and the balancing act between a patient’s and an HCP’s authority. Of course, revolutions in the medical field do not simply recycle old ideas but are genuinely new: Science and evidence-based medicine; the institution of regulatory bodies to oversee the pharmaceutical industry; and public health policies, as well as private health insurances, also play their part in shaping healthcare into what it is today. Yet a lot of things that preoccupy our industry have in some form been around for a long time.
One current trend that made me think about that is the shift in who’s sitting in the driver seat on treatment decision-making. The web and social media make it possible for patients to form their own opinions before they meet with an HCP. With patients demanding a bigger say in how they want to be treated, they enter into a delicate balancing act of competing authority with their doctors reminiscent of the one described by Molière, although there is no comparison between the expertise and ethics of real-world 21st century doctors and the ones caricatured in the 17th century play.
The Double-edged Sword of Emotions
Patients and care partners respond strongly to personal experiences and emotionally charged anecdotes. The bad news: Emotions can undermine medical best practice. Consider parents who choose to expose their children to risk of serious infections rather than provide them the protection of a vaccine. The good news: Emotions can just as well be a powerful driver of medically sound decisions.
Many HCPs in everyday practice share specific anecdotes to illustrate how their proposed prescription has, in concrete cases, helped others with the same condition. We are all storytellers and instinctively prefer to receive information in this approachable way rather than analyzing intellectually challenging piles of data. Research indicates how narrative communication can be a tool for health behavior change.1,2 It’s a call for the life science industry to support adherence and other positive behaviors through storytelling to blunt emotionally charged disinformation with emotionally charged information.
The Cost of Non-Adherence
No matter how captivating these stories are though, if they lack authenticity they are easily dismissed and can even backfire. You cannot just tell stories and expect them to have the desired effect. Stories must be true, believable, relatable, and vetted for the right messaging. They should come from people living with the condition who, at some point in their journey, made good decisions. Even people who made past poor health choices can demonstrate to others like them that anybody can eventually find a more positive approach to life.
Improving medical treatment adherence is of major interest to our industry: $188 billion of lost revenue is attributed to patients not taking their medication as prescribed. That’s just the industry side—but what about all those avoidable hospital readmissions? What about the public and private resources for treatment and prevention going to waste? The man-hours lost from people who can’t work because their disease has the upper hand? The material loss to the whole of society through non-adherence is estimated to be $300 billion in the U.S., which doesn’t even count the human suffering from preventable pain and death.
Motivation, Recall, and Comprehension
It’s often presumed that non-adherent patients willingly reject their prescriptions. That’s why we still hear the expression “non-compliant” in this context, even though in the UK the terminology has shifted to “non-concordant,” and internationally to “non-adherent,” to stop implying disobedience on the patient’s part.3 The perception of willful non-adherence focuses on patient motivation alone and overlooks all the other factors at play. Patients may also simply forget to follow their treatment (patient recall). Or they may misunderstand their physician’s instructions (patient comprehension). Or, it could be external factors—like medication access, that cause patients to go without the right treatment. To address external factors, some companies have co-pay assistance programs, or join advocacy groups lobbying for improved access.
For patient factors including motivation, recall, and comprehension, narrative communication is the strategy that yields the best results. Specifically: Strategic, regulatory-compliant, patient-driven storytelling. As University of Princeton fMRI studies show, storytelling can lead to neural coupling, in which the brains of listeners essentially mirror activities in the brain of the storyteller.4 This means if the storyteller shares an authentic, subjective perspective on why he or she adheres to treatment, the audience will likely feel the same way about it. Through neural coupling, a storyteller who shares a personal account will get the audience to almost experience the same thing and go through the same emotions and rational thoughts. The increased levels of attention and alertness that come with following a story improve intellectual processing of the content. The audience better understands, and also better remembers.
Engaging the Disengaged
People diagnosed with a life-changing condition, and those caring for someone newly diagnosed, long for nothing more than to speak to someone just like them. They want to exchange ideas on how to best cope with their own situation, but they also really want to get hope and inspiration from strong peers who can act as role models—they want to know they’re not alone with the disease.
This doesn’t mean that the value of a personal story is lost on audiences not directly affected. In fact, compared to other outreach efforts, stories are the most likely way to get through to previously unengaged audiences. In other words, if we need to reach, say, at risk populations who should get tested for a disease, it is imperative to give a voice to those who have a personal perspective to share that illustrates the need to be proactive. Policymakers, HCPs, and various other stakeholders can also benefit greatly from patient stories to make decisions informed from all angles.
Stories have been our way of teaching and learning since the beginning of humankind. And they’re not foreign to healthcare either. Patients and care partners who share their stories are as universal as Hippocratic patient centricity. What’s new? We are now aware of the power of stories, which helps us influence the narrative to improve health outcomes to the benefit of all. It’s worth tapping into this great potential—something truly patient-centric companies do every day.
1. T.K. Houston, J.J. Allison, M. Sussman, W. Horn, C.L. Holt, J. Trobaugh, M. Salas, M. Pisu, Y.L. Cuffee, D. Larkin, S.D. Person, B. Barton, C.I. Kiefe, S. Hullett (2011) “Culturally Appropriate Storytelling to Improve Blood Pressure: A Randomized Trial.” Annals of Internal Medicine, 154, 77-84.
2. L.J. Hinyard, M.W. Kreuter (2007) “Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview.” Health Education & Behavior, 34, 777-792.
3. E. Vermeire, H. Hearnshaw, P. Van Royen, J. Denekens (2001) “Patient Adherence to Treatment: Three Decades of Research. A Comprehensive Review.” Journal of Clinical Pharmacy and Therapeutics, 26, 331-342.
4. G.J. Stephens, L.J. Silbert, U. Hasson (2010) “Speaker-listener Neural Coupling Underlies Successful Communication.” Proceedings of the National Academy of Sciences of the United States of America, 107 (32), 14425-14430.