A trust-building exercise

Editor’s note: Alastair Bruce is executive vice president, global healthcare at Research International, Stamford, Conn.  Luc Rens is APAC regional qualitative director, Research International, Shanghai.  This article is adapted from a presentation made at the ESOMAR Healthcare Conference in New York in February 2006.

It has become increasingly more challenging for health care industry players to connect with the new consumer, who is healthier, wealthier and better informed than ever before. In this changing world, intense consumer connections are often based on trust. Some would argue that trust is the oil in the machine of modern culture. Trust in the state, nation, authority, religion, trust in progress and innovation, marriage and the family, trust in justice and our own identity are all “under review” as trust has been undermined in many cultures.

As trust in institutions breaks down, it becomes just one more commoditized brand attribute, and as such, brands will need to provide trustworthiness. So why might trust be an important attribute to have, and what is the consumer benefit or drawback?

One argument is that although trust in institutions may wane, there is still a human need to trust in something.

Enter brands.

Brands offer certainty in an otherwise complex and baffling global chaos. What kind of certainty? Good or bad? It’s more than just reliability of product performance. In higher-involvement categories brands offer cultural capital and new identities. In lower-involvement categories brand relationships can just be an easy way of surfing the fragmented landscape. So how do you build trust in pharma and other categories? And what can pharma learn from other categories like automotive, finance and consumer electronics?

Consumer trust connectivity

Research International Qualitatif recently conducted ethnographic and traditional qualitative research on trust across several sectors, including pharmaceuticals, automotive, finance, non-alcoholic beverages, alcoholic beverages, consumer electronics and the federal government. Ethnography, for example, was used to help marketers understand the intense relationships pharma brands have with consumers and disease sufferers.

While trust still resides in the bond between the consumer and the brand, there are complementary trusts that resonate with consumers and drive their relationship. These drivers, along with their activation triggers, were identified after conducting focused brand relationship research in pharma and the other sectors. The characteristics and attributes that drive and trigger trust are:

  • quality - performance- and product-related;
  • endorsement – trust in the brand shown by friends, family or experts;
  • familiarity - awareness created by buzz, media and advertising;
  • heritage - trust is rooted in the brand’s country of origin, the origin of its founder or by authenticity;
  • status - trust conveyed by luxury, prestige and superiority;
  • leadership - the ability to lead the category and innovate;
  • socially-conscious - trust in the brand’s integrity.

Sample and method

This research included both a qualitative and a quantitative phase. The qualitative phase encompassed a series of extended group discussions and consumer immersions with sufferers of chronic conditions to understand trust and related brand attributes and personalities.

We built a trust model to identify and understand the underlying consumer needs that drive and activate trust. We explored all brand attributes/personality traits that address the consumer needs for trust across the seven sectors previously mentioned.

We brought the trust model alive by linking:

  • consumer definitions of trust across categories;
  • different underlying consumer needs for trust (trust platforms);
  • ways to address each trust platform - brand attributes and personality traits.

A complementary quantitative phase was conduced online via Lightspeed Research among approximately 700 U.S.-based consumers with chronic conditions to quantify and refine the trust model. The sample included the following: a mix of males and females age 18 and over; and a mix of asthma, Type I and Type II diabetes, allergy, and osteoporosis suffers.

This second phase was designed around quantifying and refining the trust model. The goal was to build upon the learnings identified in the qualitative phase of the research by providing a quantitative understanding of consumer trust drivers that are relevant and unique to health care.

Trust drivers

Based on the findings from this study and previous work, we identified several trust drivers that resonate with consumers and sufferers. The drivers differ by the seven sectors but share key cross-sector relevance, particularly for health care organizations.

Study respondents said they feel a strong bond with brands they trust. The trust is built from past experience, which creates high expectations about future brand performance. Established, trusted brands have more to lose when they fail to deliver. When a newer brand fails to deliver, trust is not as easily broken. People are more willing to forgive brands if the brand image is less established.

Consumers feel protective about the brands they trust. Because they have established a strong investment in what brands mean to them, consumers can disconnect the consumer world from the more rational real world - just as they can disconnect their personal self from their political self. When a brand is truly trusted, people are reluctant to accept negative messages from the real world that challenge their view of the brand. A trusted brand doing “bad” is not always seen as an issue for consumers, unless it affects them very directly (their personal health) or cannot be denied. However, consumers of health care brands, given their personal dependence on these brands, are less likely to forgive if their brands of choice misbehave since consumers are impacted immediately and personally.

Overall, there is a modest trust in pharmaceutical companies compared to non-alcoholic beverage manufacturers, automobile manufacturers and computer companies. However, there is a far lower trust threshold for pharmaceutical brands. This is driven by relatively little knowledge or brand experience with most drugs advertised directly to consumers.

While communication programs may inform respondents about a new drug, they are perceived as doing little to explain the benefits. There is hesitancy to accept the drug when its purpose cannot be revealed. The common “ask your doctor about” line in health care advertising provides little motivation and relevance for the consumer.

However, established OTC brands are very trusted due to their efficacy and heritage. Respondents highlighted Bayer aspirin, Tylenol, Advil and Benadryl as examples. Prescription medications are trusted for their efficacy, while OTC medicines are trusted to have fewer side effects.

Trust in a company will drive product purchase intent. About 65 percent of respondents claim that they need to highly trust a company before they purchase its product (i.e., top three-box: 8-10 on a 10-point scale).

Out of the seven sectors tested (pharmaceutical, auto, computers, alcoholic beverages, non-alcoholic beverages, financial services, federal government), the pharmaceutical sector ranks third in consumer trust, outranked slightly by non-alcoholic beverages and computer manufacturers. The overall ranking is encouraging, but only about 12 percent of the respondents claim that they “trust the pharma companies 100 percent.”

Our trust model identified several key drivers of trust across all seven sectors; an illustrative output is shown in Figure 1.

Across all sectors, consumers see brand trust as being driven by:

  • Product quality

Makes good quality products, offers good value for money, is consistent over time, monitors its safety, makes life easier, is a knowledgeable brand.

  • Leadership and innovation

The category standard, the expert in the category, is a leader by innovation.

  • Familiarity

Is well-known, is successful, has been around a long time, offers variety, and has advertising awareness.

  • Heritage

Is rooted in a country’s origin, is the original in the category, is local and understands the local community.

  • Socially-conscious

Is socially-conscious, treats employees well, is earnest and has good intentions, shows that it is passionate about its customers.

  • Endorsement

Is recommended by family member or friend, or, in the case of pharma, is endorsed by a physician or expert.

  • Status

Is prestigious, offers empowerment, is trendy, is luxurious, is endorsed by the media or celebrity, and conveys status.

Overall trust drivers

Quality, leadership and familiarity are the general drivers of consumer trust. Good quality of the product is the “hygiene” factor of trust. People are always looking for confirmation and evidence of leading and superior product performance.

These consumer drivers of trust need to be addressed by the brands, though it seems difficult to distinguish brands at this level, as most brands claim high quality. Due to this small space, brands can hardly be differentiated by quality alone.

Trust drivers across categories

Additional trust drivers across categories like pharma, automotive and finance are endorsement, familiarity and status. The drivers are the same, though the significance of each driver varies by category (Figure 2).

Endorsement by friends or experts drives trust in pharma. Obviously when the product/category is recommended and endorsed by a specialist, consumers, especially sufferers who depend on the product, are more willing to try or use it.

Trust in pharma is driven particularly by endorsement and familiarity. The automotive sector has status and heritage as key drivers of trust, while trust in financial comes from status, endorsement and familiarity.

Trust drivers at brand level

Within pharma, brands use the same drivers of trust. Endorsement by experts of the product quality, efficacy and safety are the main drivers of trusted brands. Therefore, it seems that consumers do not see the difference between the key players in the pharma industry. A recommendation by the doctor is a key aspect of trust, though it does not help to differentiate the brand in the category. Consumers are looking for more creative and new ways to learn about the brand.

At an individual company/brand level the trust in Bayer, Pfizer and Claritin is strongly driven by quality and endorsement (Figure 3). Other drivers like heritage, status and social consciousness are less important. Claritin in its communication clearly stresses its product quality and characteristics. It is a safe choice within OTC.

In the prescription category the endorsement of the brand is essential to build trust. As stated before, the space of endorsed brands is very crowded. The question is, how can brands differentiate themselves?

A great example is Viagra, which built trust by becoming familiar to consumers through its marketing efforts. A significant trust driver for Viagra is familiarity, which Viagra has built through different and creative steps of endorsement. First Viagra’s maker Pfizer focused on a specific target audience, using older men in its advertising to endorse the brand. Then it broadened the audience by using popular figures, and currently it uses mainstream couples in its ads.

The success of Viagra forces other pharma players to consider this question: How can we endorse our brands in creative ways to build trust through familiarity? Viagra clearly applies some of the same principles used in mass marketing, without losing trust. And Viagra is proof that pharma can apply the trust drivers used in other categories to distinguish the brand in their market.

What can pharma brands take from the automotive and finance industries? Within automotive, the trust in brands like Mercedes and Ford is driven by heritage and status; they are differentiated by the strength of those drivers. Evidently, these brands still confirm the basic driver of trust: product quality. Pharma brands could look into using heritage and status as a way to build trust in their category as well.

Pharma brands could also look at the evolving drivers of trust within the category of electronics. There, trust is mainly driven by category leadership and innovation. Apple is a great example of building consumer trust by its innovative design and superior quality/product experience.

Research indicates that when it comes to trust at the pharmaceutical company/brand, rather than at the industry level, quality (safe, efficacious and of good value) is as powerful a driver as endorsement (endorsed by a celebrity or the media, a doctor or a family member) and familiarity (well-known and successful brand, been around a long time, familiar from advertisements, offers a variety of products).

Therefore, it is natural that the levels of consumer perceptions on efficacy, safety and value of pharmaceutical brands impact the degree of trust. For example, in this research:

  • Overall, about 25 percent of respondents claim that they have some level of trust in the pharmaceutical companies.
  • About 20 percent of survey respondents claim that they consider pharmaceutical products effective (these claims are slightly higher among diabetes, allergy and osteoporosis sufferers).
  • About 20 percent consider them safe (again slightly higher claims among respondents with diabetes).
  • About 10 percent find them a “good value” (higher claims among asthma and osteoporosis sufferers).
  • In addition, consumers seem to have a low tolerance for mistakes made on the part of the pharmaceutical companies. Only about 7 percent of respondents claim to be “willing to forgive” such mistakes.

Therefore, while the development of high-quality health care products is mandatory for a company’s long-term success, this research also suggests that companies that successfully educate gatekeepers and end-users and effectively communicate competitive advantages are more likely to win consumer trust.

Consumer sentiment

Consumer and sufferers feel very strongly that it is their responsibility to look after their health and well-being (82 percent top three-box rating on a 10-point agree/disagree scale). This is also seen as a significant responsibility of their physicians (42 percent). However, to a lesser degree consumers feel it is also the responsibility of pharmaceutical manufacturers (29 percent). Among diabetes, allergy and osteoporosis suffers, there is a strong level trust that the products made by pharmaceutical companies are effective, but there is less trust in their safety. There is a strong belief among sufferers that their interaction with their prescription medications makes them important to drug companies.   More and more so, pharma companies are seeking ways to better understand their end consumers, and are increasingly aware of how important it is to incorporate sufferers’ feedback information into their marketing initiatives. There is, however, very little forgiveness from sufferers for pharmaceutical companies when they make mistakes.

When questioned specifically about pharmaceutical companies, consumers and sufferers alike assessed them as follows:

“Profitable,” “big,” “secretive,” “multinational” and “associated with special interest groups” are statements that the majority (45 percent to 75 percent) of the respondents agree with when asked about the pharmaceutical companies. (Note: Percentages shown in Table 3 are among top three-box [high trust] respondents [8-10 on a 10-point scale].)

On the other end of the spectrum (with claims in the range of 10-20 percent) are agreement ratings for “likeable,” “honest,” “truthful,” “ethical,” “run by good managers,” “trustworthy” and “makers of safe products.”

Between 20 percent and 30 percent of respondents agree that pharmaceutical companies are a “good place to work” and a “good place to invest money.”

Holy Grail

A marketer may ask: “Where do I commit my company’s money so we can get more, lose less, and keep all current customers?” It’s a fair question. It is precisely in the search for the Holy Grail of consumer brand and sector trust that a company will discover the opportunity to establish and own the intense consumer-brand trust relationship that will maximize product uptake and usage.

Furthermore, pharma and health care organizations will create an opportunity to maximize compliance and, hence, long-term profitable growth by figuring out how their brands perform with respect to overall leading quality, leadership/innovation and familiarity trust drivers, coupled with a deep understanding of their own unique brand-specific competitive sector trust drivers (in endorsement, familiarity and status).