Social Science Behavior Change Models: The Key to More Targeted Messages

Pharmaceutical executives responsible for sales and marketing success have long grappled with the problems of providing the appropriate selling message to their different physician targets. Whether through representative detailing, email marketing or a myriad of other sales and marketing strategies, key decision makers know that the physicians’ time is very precious usually with a small window to get “face time” and make an impression. Delivering messages that do not coincide with the physician needs will very quickly lead to physicians’ loss of interest and along with the possibility of losing a mutually beneficial relationship and most likely loss of sales.

Behavioral social scientists whose job it is to understand human behavior and find ways to make people accept and adapt new behaviors have long grappled with this problem. Making people change behaviors and stick with a new behavior is one of the most difficult things do in any walk of life. Pharmaceutical sales and marketing is no different – especially with the launch of a new product. Essentially the job of the sales representative is to present a compelling message to the physician with the ultimate goal to “sell” the physicians to start and/or continue prescribing the new drug or to switch for an existing drug he/she is already prescribing to the new drug being “detailed”. Essentially the goal is to change physician behavior ethically and within the various guideline that govern the pharmaceutical industry.

I spent over 15 years in the pharmaceutical industry selling for top 10 companies and though we successfully deployed several selling methods and probably used parts of the model I describe in this article, we rarely tapped into the vast field of social science and behavior change. It was during my doctoral program in Health and Behavior Studies (Health Education) at Teachers College, Columbia University in New York that I was able to see selling to physicians from a scientific perspective. It is that perspective – the application of behavior change theories and/or models to physician sales (detailing)  that I share in this article. This article focuses on the use of one behavior change model – the Transtheoretical Stage of Change model

Using Behavior Change theories/models

Several theories and models on how to effect behavior change have been researched and studied for decades by behavioral and social scientists. These theories have proven to be effective in several fields including areas such as public health and psychology. Adapting some of these theories and/or models to pharmaceutical sales could make the job of proper messaging much more effective. Understanding physician readiness to adopt a new behavior (prescribing a new drug), recognizing barriers that may prevent the physicians from prescribing the promoted drug can make the adoption process much more effective.

An example of a behavior change theory that could work in pharmaceutical sales is the Transtheoretical Model also known as the “Stage of Change” model (Prochaska & DiClemente, 1983). The Stage of Change models posits the individual move through several changes before ultimately accepting or adopting a new behavior. Each stage demands its own sales and marketing message, quickly  determining  the physician stage and delivering a message appropriate for that particular stage  is key. The stages and potential messages are as follows:

Stage 1: Precontemplation. This is the stage when an individual (such as physician) is not thinking about adopting a new behavior for at least six months. In pharmaceutical sales, this would be the target physician who has never heard about a new drug or has not entertained the thought about prescribing the drug. A physician in this stage would likely need a sales and marketing message to be totally educational and informational to at least provide some basic knowledge about the drug before the “selling” can begin. Putting forth a message about the features and benefits of your drug or how your drug stacks up against the competition to this physician probably will not be effective. Only after explaining the drugs pharmacology and what it does are clearly explained to the physician, can the selling of features and benefits can begin. This physician is not yet ready to be sold.

Stage 2: Contemplation. This is when a physician is open to new drug, maybe searching few a new product or an alternative to his/her current drug use, and open to making a change within the next six months. This is a physician who has probably heard about a new drug or has a favorable opinion of new drugs and just needs the impetus to begin prescribing something new or different. This physician is ready to listen and open to being “sold”. This physician does not need the type of novice introduction one would use with the physician in the pre-contemplation stage. A sales representative will be wasting valuable time if he/she starts with basic knowledge about what the drug. This physician is ready to be “sold”.

Stage 3: Preparation. This is when a physician is not only open to change, but is actively considering making the change within one month. This is the proverbial “low hanging fruit”. Physician is ready to make the change, he/she understands how the drug works, understands the benefits, knows how to dose the drug. The physician is in mode of “self-efficacy”, meaning that he/she has the confidence to prescribe the new/alternate drug. The sales representative job at this point is to paint a picture of the appropriate patients that would benefit from the drug. So when a patient walks in and describes their symptoms, the doctor’s mind immediately goes to this new or different drug that the srep has been detailing.

Stage 3: Action. This stage is when a physician has made a meaningful change in the past six months, i.e. he/she has prescribed the new or alternative medication for at least three, but less than six months. This process can be facilitated by a detail that lets the doctor verbally explain their use of the new drug, the type of patient, and the positive and negative results. This is described as “self-liberation”; the physician has the belief that he or she has adopted a new drug and are committed to using it for the appropriate patients. The sales rep's job is to provide positive re-enforcement to the physician to strengthen the physician’s commitment to the new drug.

Step 4: Maintenance. Evidence that the physician has been prescribing new drug for at least six months. The physician is less tempted or cannot easily be “sold’ to go back to the old drug. This stage usually lasts from six months to five years unless something drastic happens to change physician’s belief and commitment to the drug. Here is where you want to be. It is more of a “service” than selling call. You check regularly to make sure physician is still on board with drug and prescribing and provide more reinforcement information regularly.

Dr. Charles Daramola is a faculty member and program director in Marieb College of Health and Human Services at Florida Gulf Coast University I Fort Meyers, Florida.