The brand team for Genentech’s Nutropin injectable human growth hormone was mystified. One-third of all prescriptions was for Hispanic children but non-Hispanic children had better, more consistent outcomes.
It turned out Hispanic parents were not sticking to the precise injection regimen required for consistent growth prompting the brand team to rethink the Hispanic marketing strategy.
These parents who hailed from Mexico and Central America were typically shorter than Americans, thanks to their indigenous heritage. They wanted their children to grow taller than them, believing it would provide better opportunities for success in the U.S.
For a variety of reasons, they weren’t adhering to the dosing regimen but didn’t recognize that irregularity hampers the efficacy of growth hormones. So, the team developed the Stepping Stones program, a CRM-like compliance and persistence program.
This bilingual marketing program integrated proven interventions like outbound text reminders, monthly kits with premiums, and other components. It was enormously successful, partly because of constant repetition of critical information about the drug, and why it must be injected precisely to doctor’s orders.
Linguistic and cultural obstacles force health care practitioners to continually repeat instructions and other information to Hispanic patients and caregivers. Examples include:
As the architects of the marketing strategies that activate, educate, and drive patients into care, marketers’ key objective is to directly support the efforts of clinicians, and everyone else in the care continuum. This is especially true when the clinicians don’t speak Spanish and translators must convert exactly what the doctor is saying. Clinical accuracy and precise translations of terms can enhance the patient’s and caregiver’s ability to understand what they are supposed to do.
What happens when Spanish-dependent patients or caregivers don’t fully comprehend the doctor’s instructions?
Unfortunately, they don’t say so. In keeping with the impact of respeto — the cultural norm of deference to authority — they don’t ask questions for fear of appearing disrespectful of the medical professional, and thus go home with a questionable understanding of what to do.
To quote Glenn Flores of Boston Medical Center from his seminal paper, “Culture and the Patient-Physician Relationship: Achieving Cultural Competency in Health Care,” “demonstrating appropriate respeto may include a hesitancy to ask questions, because posing a question to an authority figure can be construed as disrespectful. The ‘nod of the head’ in response to a physician’s instructions or comments may therefore represent a socially required gesture of respect, rather than understanding or agreement.”
Care coordinators and navigators can help reinforce regimens, but they are only able to do so sporadically along the patient journey. The day-to-day interactions with those mothers administering medications are frequently driven by the marketing and communications tactics.
This leads to three key lessons for marketers:
1. Work with physicians and other clinical personnel to capture the precise wording for patient-facing dosing and treatment-related instructions. Patients, caregivers and the providers who treat them benefit from a second or third opportunity to comprehend the core message within marketing materials.
2. All consumer-facing messaging and content strategies should integrate exactly the same language across all messaging for dosing and treatment instructions — from blogs to social media to websites and brochures.
3. Content development should repeat dosing information and other treatment-specific educational copy at least two times within the same communication.
It is presumptuous to think marketing strategy will vastly improve the life of a child being treated with human growth hormones. But we can ensure a better chance the medication will work, and support hopes for the better life a few more inches may bring.