In a scene duplicated hundreds of times a day throughout the US, a physician in a busy practice participates in a marketing research study. A moderator is working his way through a schedule of back-to-back, in-person interviews to determine the role of digital drug information sources in physicians’ practices. In response to the moderator’s question on this topic, a physician replies, “Each of us has a computer on his desk and we use these for literature searches and to check for dosing, side effects and possible drug interactions before writing a prescription.”

Later that day, the same physician is rushing between exam rooms in his office, ducks into a cul-de-sac and reaches on top of a tall cabinet where a dog-eared copy of “Drug Facts and Comparisons” is stored and checks the dosage and drug-drug interaction information for a prescription he is about to write before jogging to the next exam room and patient. The previously mentioned computer remains untouched on the physician’s desk.

In another city, an emergency room physician is interviewed on the topic of IV antibiotic use in his hospital and, in response to the moderator’s specific question, describes the range of products available on the formulary at his hospital, and the interactions required with the pharmacy and infectious disease departments before restricted agents are dispensed from the central pharmacy.
Later, a nurse who works in the same ER points out to a visitor the drug cabinet where a small subset of the hospital’s antibiotic inventory is stored, noting, “On a weekend night when a gunshot victim with an abdominal wound is wheeled in, we don’t have time for prior authorization—they get one of these.”

These seemingly contradictory anecdotes reveal the disconnects that can occur between what physicians say they do, in a formal marketing research interview setting, and the reality of what they actually do when observed in a more natural setting. These examples are drawn from real projects conducted by GfK V2 researchers who have used “ethnographic” research methods to provide pharmaceutical industry clients with more detailed and comprehensive insights about their customers than can typically be obtained from “traditional” marketing research methods.

The ethnographic approach
What exactly is ethnography? It’s the research approach used by anthropologists that, at its core, uses a range of data collection techniques that hinge on “participant observation,” that is talking with and observing respondents in the context of where they typically work and live. Here it is important to note that while ethnographic research can be conducted by marketing research generalists, it is strongly recommended to involve or consult with an anthropologist, who is a social scientist highly trained in the study of how differences in environment and culture—across societies and organizations—affect human behavior.

Ethnographic research has been used for years by consumer products companies and other industries to gain deeper insights about their markets and the beliefs, motivations and behaviors that characterize their customers. The ethnographic data collection and analytic techniques that are being applied to marketing research studies are the same as those that anthropologists use in graduate level fieldwork. Whether studying the rice production in isolated Indonesian villages, working on the shop floor of a Volvo automotive plant in Sweden, or studying a physician group practice in the US, the research techniques that anthropologists employ in both academic and marketing research settings are largely the same.

Ethnographic value
To understand the value that ethnographic methods can bring to pharmaceutical marketing research, and when and why this approach can offer incremental benefits over the traditional marketing research techniques, it is helpful to compare and contrast the strengths and weaknesses of both types of approaches.

The ethnographic approach is one that is in almost direct contrast to traditional pharma marketing research approaches whereby people are removed from the context of their daily (work) lives and invited to more sterile research facilities for individual interviews and/or focus groups. In these cases, as well with marketing research interviews conducted via telephone or Internet-based questionnaires, the researcher is entirely dependent on what the respondent tells him in response to an a priori list of questions/topics that we, the researchers, believe will encompass the important issues for the project in question. While we doubtless learn many useful facts as a result of this verbal data stream, our powers of visual observation are underutilized.

Clearly, these tried-and-true traditional marketing research techniques provide needed information, are beneficial in that they are cost- and time-efficient, convenient for all involved and fairly black-and-white in terms of getting concrete answers to concrete questions. However, there can be downsides to relying solely on these research methods. For example, researchers risk getting superficial and/or inaccurate data; specifically there is the chance of getting answers based on:
■ What respondents want to tell the researcher
■  What respondents perceive to be true
■  What respondents think the researcher wants to hear
■  What respondents think the researcher will think is important
■  What respondents remember to mention

Ethnographic research, in contrast, represents a way to go beyond the limits of traditional research techniques and is useful for those pharmaceutical marketers who want to go deeper in the pursuit of their marketing questions by exploring the gaps between what people say and what they are observed to actually do, a common challenge for the researcher as typified by the anecdotes noted in the beginning of this article.

At one with the natives
Just as is true with academic anthropological fieldwork, the application of ethnographic data collection and analysis to pharmaceutical marketing research has, at its core, the same principle of “living with the natives.” Whether studying patients in their homes to help a client better understand what “really” happens with compliance and adherence among asthma sufferers, or studying what “really” happens with pharmaceutical samples in private practice offices, the fundamental approach rests on spending days and sometimes weeks in and around the setting (a household, an office practice, a hospital, etc.) where the behavior(s) of interest actually occur.

Interestingly, this notion of conducting research in the respondent’s natural environment is not necessarily a new concept, as it was standard practice decades ago when no other options existed.
Reflecting on the early days of his 35-year career, GfK V2’s founder and chief executive officer, Richard B. Vanderveer, PhD, reminds us that in the “old days” of pharmaceutical marketing research, before the advent of nationwide chains of mirrored research facilities, conference call-enabled phone interviews and Internet-based quantitative surveys, it was common for researchers to travel to physicians’ offices to conduct one-on-one interviews with respondents and to learn both by listening and through direct observation.

The nuance of observing, studying and interviewing people in the natural environment where they typically live and work (“their world”) through ethnographic research is essential.

Act natural
Importantly, on-site ethnographic research is inherently non-threatening for respondents—the research is happening on their turf not ours and, by getting to know one another over time, a trained ethnographer can help a respondent relax, buy into the research objectives and respond in a more forthcoming manner and with increasingly greater detail and insights regarding the topics of interest.

Additionally, objects, routines and other people in these familiar environments surround the respondent with clues that often trigger ideas that are procedural in orientation—ideas that don’t occur to them in more sterile facility based settings. Furthermore, being on site enables the researcher to listen to the stories people tell about their daily lives and what they do in everyday routines, since by telling stories, people naturally reveal both their explicit (open) and implicit (hidden) needs and motivations.

In short, seeing and hearing what occurs in these natural environments greatly adds to the total understanding of the structure and dynamics of the customers’ world.

Time is of the essence
From a data collection standpoint, a key benefit of spending intensive amounts of time in a research setting is the opportunity to meet with and conduct multiple interviews and engage in ad hoc conversations with important players in a “community” (e.g., a multi-specialty group practice).

Having the luxury of time to identify and arrange repeat visits with the decision makers and influencers in a community leads to much greater richness and validity of information than can ever be obtained through the classic, one-of-10 back-to-back facility interviews that has become the cornerstone of the bulk of qualitative pharmaceutical marketing research these days.

One size doesn’t fit all
In addition to a different quality of interview, the on-site approach that characterizes ethnographic research also facilitates the use of a range of other methodological exercises (see the sidebar on enhancing the ethnographic experience at left).

As is true with all research methods, ethnographic research is not a one-size-fits-all solution to the range of marketing problems encountered by the pharmaceutical industry. First and foremost, the very qualities that make traditional facility-based interviews and focus groups so attractive to pharmaceutical marketers—speed, efficiency and cost-effectiveness—are nowhere to be found in ethnographic research projects. By their very nature, ethnographic projects take time and money to design, field and analyze. Indeed, for many of the bread-and-butter market research projects that involve assessments of promotional materials or reactions to new product concepts, ethnographic research has nothing to add. The time to consider ethnographic research is when there is a desire to go beyond what can reasonably be expected from the traditional marketing research toolkit.

Barry J. Cerf, PhD, is an anthropologist and executive vice president at GfK V2 in Blue Bell, PA

From the March 01, 2007 Issue of MM+M - Medical Marketing and Media