Cultural narratives reveal the subliminal impact on illness

We overlook the influence of cultural forces in our research design and our quest to understand why people do what they do in relation to their health.
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Cultural Narratives Reveal the Subliminal Impact on Illness
Jeanette Hodgson

Global Head of Qualitative Strategy, United Kingdom

All around the world, people form beliefs and adopt behaviors relating to health and illness that are shaped by the cultural forces prevalent in their communities.

The importance of perceptions of others and the social codes by which we live have been demonstrated as important by behavioral psychologists and recognized for many years. Yet despite the significance of the role of our social and cultural context in forming our beliefs and driving our behaviors in the healthcare world, we largely overlook this influence in our research design and our quest to understand why people do what they do in relation to their health.

Shifting Focus from Individual to Social

If our goal is to understand behavior, and it so often is, we need to understand all the influences on it. Much of the work we do in pharma focuses on the individual and the internal drivers of behavior, and we have become much better at that over the years. The notion of "patient centricity" has sprung from this goal of putting the "patient" at the heart of what we seek to achieve. However, in understanding what it is that drives the patient, we still design our research around the individual. Yet we know from behavioral psychologists that not only is behavior context dependent but we are heavily influenced by how we perceive ourselves relative to others and what others around us do.

In our research design, we need to embrace the notion that, as individuals, we do not function in a vacuum, and we can only understand those broader influences by thinking more laterally when designing our work to understand social and contextual influences on how people relate to their health. Perhaps now, the time has come for another shift in our compass from "individual" to "social".

The Impact of Cultural Beliefs on Patients with IBS

In our Patient Ecosystem study designed to build a comprehensive picture of sufferers’ experiences of Irritable Bowel Syndrome (IBS), which combined a variety of methodologies -- IDIs amongst sufferers and patient advocates, online blogs, social media listening, contextual prevalence data and cultural narrative exploration -- we discovered an intricate web of factors influencing how people relate to, discuss and behave in the context of their IBS.

There is no doubting the significant emotional, social and practical impact of the condition on day to day living. From contextual data, it's also clear to see the economic impact too in terms of lower work productivity and cost of treatment. Yet despite this undoubted impact, sufferers go to lengths to keep their condition hidden.

The cultural exploration we conducted confirmed that if we want to change the narrative of IBS and encourage people to come forward for the support and help they need to minimize this huge impact on life, it would not be sufficient to target sufferers alone. The cultural climate would have to change, much the same as is occurring with mental illness, where awareness campaigns have focused on promoting understanding and empathy.

Research Implications

In understanding the cultural narrative and therefore the broader, more subliminal influences on health behavior, we need to improve the way we:

  • Identify the influencer network and the roles adopted by the different players.
  • Understand the role of family. Who are the health decision makers? E.g. the family matriarch or male head of house?
  • Understand the role of the healthcare professional. What role do they assume in this context?
  • Understand the way people relate to health in any given culture. Are there scientific, natural, spiritual, fatalistic or other drivers which could impact how people behave?
  • Identify and understand the signs and symbols which surround the condition and which may carry diverse cultural meaning dependent upon context, as well as analyzing the language itself which is chosen to describe the condition.

Step Out from Behind Closed Doors

As an industry, we have worked hard to get closer to the patient and immediate caregivers. The time has come to widen our lens on patient centricity by incorporating a cultural view of conditions to reveal their hidden meaning and the subliminal impact this undisclosed narrative has on the way people relate to and behave in the context of the condition itself. The cultural narrative can be changed when that is desirable. Let’s help those patients who hide behind closed doors step out into the open and seek the support they need.

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