By Jackson Salter, Anne Mette Worsøe Lottrup and Charlotte Vangsgaard

Society’s shared memories of the fight against HIV/AIDS in the 80s, the grim prognosis of cancers, and the debilitating effects of haemophilia continue to shape how doctors, nurses, and patients think about disease and the promise of treatments. Without an understanding of these shared memories, companies risk pushing messages that don’t speak to the underlying emotional drivers for prescription and adherence.

The hearing aid has exponentially improved  over the last half-century, evolving from a cumbersome, heavy, and hardly capable device to a sleek, comfortable, self-calibrating gadget. Even still, many people with hearing loss refuse to adopt hearing aids.

This hesitancy can largely be explained by collective memory. In his 1950 book, La mémoire collective, French philosopher and sociologist Maurice Halbwachs describes how societies have a collective group consciousness shaped by history – a ‘collective memory’ that influences  how individuals think and act. When it comes to hearing loss, a history of people struggling with hearing aids, losing command of social situations, and becoming psychologically isolated still remains in our collective memory, despite how much hearing aids have advanced.

This is just one example. From hearing loss to ostomomies to HIV to hemophilia, ReD’s research has shown how histories of ineffective treatment can continue to impact how people think, speak about, and act – or fail to act – on different medical conditions. Healthcare companies that don’t understand collective memory are prone to a ‘collective memory blindspot’ which leads to three common pitfalls. 

Three common pitfalls

#1 We misinterpret what patients and HCPs want by focusing on what they say 

#2 We use blanket messaging that alienates a target community that has a unique collective memory 

#3 We blindly accept today’s standard of care

#1

We misinterpret what patients and HCPs want by focusing on what they say. In reality, desires and aspirations can be hampered by collective memory. Companies can help lift the psychological barriers that limit what people strive for.

We are often mistaken when we take patients’ satisfaction at face value. Take ostomy care: in a study for Coloplast, ReD found that people with an ostomy are likely to report satisfaction with their lives when asked, but in fact, they significantly underestimate and underreport their own suffering. This tendency to downplay struggle stems from a collective memory of fighting and surviving cancer. A sense of gratitude for surviving can then colour conversations about treatment, meaning quality of life is less likely to be questioned or brought up. Moreover, a history of inadequate treatment has contributed to seeing leaking as normal and acceptable, resulting in a “this is just how it is” mentality. As a result, patients underreport to HCPs who in turn may conclude patients are doing well and simply rewrite the same prescriptions.

The insights from the study were translated into an original value proposition to drive all future innovations at Coloplast. This new direction redirected focus away from second-order issues like discretion and convenience, and towards solving the most pressing issue – that of leakage.

For healthcare companies to consider:

Is collective memory hampering what patients want and what doctors think they know? Are patients underreporting or underestimating their own suffering due to a “this is just how it is” mentality?

#2

We use blanket messaging that alienates a target community that has a unique collective memory. In reality, one-size-fits-all messaging can alienate certain groups of people or entire markets that have their own distinct history. Companies can reach target communities by understanding their collective memories.

In a study on HIV in America, ReD found that sub-communities related to the condition and its treatment in different ways, for historical reasons. In the 80s, the AIDS epidemic primarily affected gay men in big urban environments, and the mainstream narrative around the disease was shaped by a resolution to be ‘out and proud’. For many Black MSM, those campaigns didn’t feel relevant and rather represented a treatment paradigm shaped for another lifestyle than theirs, leading to a strained relationship with the healthcare system.

To help break this dynamic, ReD translated the study’s insights into a patient-facing value proposition that would increase HIV-related healthcare seeking behaviours amongst Black MSM.

For healthcare companies to consider:

Is a mainstream discourse potentially alienating any groups or markets? Does it make sense to have a ‘one-size-fits-all’ value proposition or different ones for different communities?

#3

We blindly accept today’s standard of care. In reality, current standards of care metrics may have their roots in obsolete circumstances. Companies can play active roles in updating outdated standards.

Following significant advancements in care, doctors and companies may proclaim that a disease area is “mostly solved”. As a consequence, the healthcare system rests on its laurels and turns a blind eye to persisting needs and challenges.

ReD’s research on the haemophilia community uncovered a pervasive sense of ‘comparative gratefulness’ that haemophilia was no longer socially taboo and medically untreatable as it was in the time of  so-called “bleeders” such as Alexei Nikolaevich, the last heir to the throne of the Russian Empire. Major persisting problems, therefore, like an inability to walk more than 500 meters a day, were accepted and considered normal by patients and HCPs.

The insights from the study were translated into a strategy on how to drive a new standard of care within haemophilia, with carefully selected metrics that could break away from historically defined ones.

For healthcare companies to consider:

Is there a tendency of patients, doctors, and the industry to rest on their laurels due to historical comparisons? Could there be an opportunity to elevate the standard of care and define new metrics for what care should look like and achieve in the future?

Conclusion

To drive prescription and adherence, healthcare companies have the opportunity to critically engage with collective memory. Mixed methods research can uncover how collective memory is restraining patients’ opportunities for a good life and limiting HCPs’ role in providing better care. By understanding and tapping into the underlying emotional drivers for prescription and adherence, companies can gain a major competitive edge and ultimately provide better care.