Clearing up compliance in dermatology

Achieving compliance remains a huge behavioural challenge. What new insights could we learn from a recent study in dermatology?

The behavioural challenge - Compliance

Missing doses, splitting pills, applying less topical treatment than recommended – there’s no doubt that non-compliance is a big headache for healthcare, resulting in poorer outcomes and dissatisfied patients, not to mention reduced revenue for pharmaceutical organisations and increased burden on health systems. Some estimate the cost of non-compliance to be $290bn a year in the US alone.

In dermatology, compliance is a major issue. Patients are often prescribed a complex combination of topical and systemic options, allowing plenty of scope for misunderstanding and mis-management. Some studies suggest up to 27% of patients don’t even fulfill a prescription in the first place.

Our client, a leading player in the Dermatology space, wished to better understand the compliance dynamic so that they could develop new forms of administration that encourage compliant behaviour.

"In dermatology, compliance is a
major issue"

Our approach

We prioritised understanding in a number of key areas:

Goal-setting: Were patients setting over-ambitious targets for symptom resolution?
Impact of time: Were patients giving up without immediate improvements?
Treatment perceptions: e.g. side effects or problems with administration
Patients personality, beliefs and motivations: e.g. their level of concern with the condition
Patients level of ‘self efficacy’: i.e. understanding of their role on outcomes
Environmental influences and norms: for example social or societal pressures

We used a mixed methodological approach:

Digital ethnographic diaries
to explore patients daily routines, and how the condition (and its treatment) fits into their days.

Mobile intercept questions
sent at random intervals without warning to ascertain whether patients had taken prescribed treatment that day, or not, and understand why.

Social media listening
to observe uncontaminated conversations and observe the types of issues patients are discussing with their peers.

Depth interviews with patients and Dermatologists
for a more direct understanding and to pick up on trends identified in other elements of the research.

Our solution

COM-B behaviour change model
We used the COM-B behaviour change model to organise and prioritise influences on compliance. This is a great model for consolidating a wide and extensive range of influences on very broad behaviour. The model suggests that behaviour change is induced by positively modifying at least one element of the framework.

Limitations in patients prevents compliance
Our research identified that it was potential limitations in both the physical and psychological capability of patients that can lead to non-compliance. From a physical perspective, teenagers sleep patterns are misaligned with modern schedules – a lack of time in the morning means treatment often gets forgotten or de-prioritised; an issue compounded by high cognitive load about which treatment to take when. From a psychological perspective patients had low recognition of their role in achieving outcomes (poor self-efficacy) and a lack of self-regulation to form effective habits to achieve these goals.

The outcomes

The research re-affirmed our client's belief that a truly innovative approach to administration is necessary to drive long-lasting behaviour change among patients with this condition, and the research is now feeding into development plans for potential new assets, such as a very infrequent injection, patch or implant with long-lasting efficacy.

This directed the client to a more “population health” style strategy that mitigates the chance of non-compliance. This approach is becoming more commonplace in therapy areas such as cardiology, rather than more gimmicky, social forms of administration (e.g. sprays, drinks, mists, etc.) they initially perceived would hold value.
We await to see what the future holds but acknowledge that a more vaccine-like approach to treatment will likely create its own, further behavioural challenges….