Know what you’re getting into

Editor's note: Marc Yates is director of emerging markets at the Research Partnership, a London research firm.

Emerging markets present an exciting opportunity for growth for the pharmaceutical industry, as traditional Western markets mature and there are a limited number of new products in the pipeline offering blockbuster revenues.

Some of the emerging markets, such as the BRIC nations of Brazil, Russia, India and China, are experiencing double-digit growth, as well as burgeoning public and private health care systems. A demographic of wealthy urban patients who can afford better-quality health care is on the rise, with an appetite for Western lifestyles and products.

To successfully launch in these markets, however, pharma manufacturers need an in-depth understanding of the environment in which they are planning to operate and this can be tricky as many lack reliable data intelligence. Custom market research can plug the gaps in knowledge and help marketers make more effective strategic decisions.

But even carrying out research in these lesser-known markets can be challenging, requiring a strong understanding of the local health care environment and an awareness of cultural and behavioral nuances. Getting the help of local experts is key but they might be in short supply in a less-evolved market research industry.

Based on our experience in managing research projects involving emerging markets, here is a three-step guide to conducting effective market research in these territories.

Step 1: Understand the environment

Understanding the environment is critical to ensure the project scope is defined in the best way to achieve the project objectives. This will help you determine the following regarding your research design:

Which emerging market(s) to select. In some cases, there might not be sufficient budget to conduct market research in all markets of interest – effective research starts with careful choice of markets, based on an understanding of the environment. If appropriate, country archetypes can be used as a proxy to understand other markets of interest. (See sidebar.)

Which cities to research. Within each emerging market, the environment is often heterogeneous and there are vast disparities between cities and regions. This is especially the case when considering the self-pay market within health care (those who have to cover the cost of their own treatment with insurance or their own funds). The opportunity in top-tier cities may differ considerably from that in smaller cities and rural areas – meaning that defining the cities to cover within the research is critical.

Which stakeholders to interview. Effective market research necessitates asking the right questions of the right people. The “right people” in emerging markets often vary from traditional markets because the patient journey in emerging markets is less clear-cut. For example, in self-pay situations, there is an increased need to understand the patient, because they have to demonstrate a willingness to pay for treatment.

Consider whether physicians should be practicing in the public or private sector (or both), depending on which sector has greatest ultimate opportunity for the drug.

Some emerging markets have a blurred distinction between ethical drugs and over-the-counter drugs, meaning that prescription-only medications might be purchased without prescriptions, despite government efforts to regulate such practices. In countries such as India or the Philippines, patients can often obtain medication directly from the pharmacist that would require a prescription in other markets. Hence, pharmacists may carry increased weight in the sale of a particular drug and therefore be relevant targets to interview.

Building in a definition phase to define the project scope is highly recommended to address some of the challenges regarding conducting research in these countries. It will also help you agree on any questions regarding market, city and stakeholder selection.

  • A starting point for understanding is often through interviews with internal stakeholders, including local affiliates/teams, who often have on-the-ground knowledge of the relevant health care issues within their market. Involving these stakeholders at the start of a project can often help to facilitate buy-in to the research.
  • There is no point reinventing the wheel – why ask a question if you already know the answer? Reviewing all relevant research gives you a thorough insight audit, from which you can elevate your understanding rather than start from scratch.
  • However, in markets where little research has been conducted, it might be worth conducting a phase of secondary research or including a small number of opinion leader/expert interviews prior to the main fieldwork phase.

The elements which need to be included in the definition phase will vary based on a number of considerations, starting with the client objectives. However, at least some of these elements will be relevant for almost every emerging-market project.

Step 2: Select the best method

To determine which research methodologies are possible and appropriate in emerging markets, two questions need answering: Which methodologies are culturally permissible? Which methods are technologically possible?

Using the MENA region (Middle East and North Africa) as an example, physicians are usually not comfortable interacting without direct human contact. Physicians have a high social status and it is deemed respectful to meet physicians face-to-face. Interestingly this used to be the case in China and South Korea as well but in recent years physicians have become more open to online questionnaires. This demonstrates how cultural norms can shift fairly rapidly in emerging markets.

Technology is also a crucial factor. A lot of emerging markets have bypassed traditional telephone lines and moved straight onto the Internet. However, this does not mean all physicians or patients have reliable Internet connectivity or computer access at the home or workplace. For example, it is common for physicians in Vietnam to share computers, making online research impractical.

While it is common for physicians to have 3G or 4G smartphones, in Latin America data is expensive and the connectivity is also unreliable, meaning mobile-based surveys are not effective and you need to rely on face-to-face or telephone interviews. Mobile telephone calls can also be expensive in some markets such as Brazil, meaning telephone interviews may actually be no more cost-effective than face-to-face.

Which methodologies work where? Figure 1 provides an overview of the methodologies – qualitative; telephone; mobile; online – that are commonly used to conduct interviews with physicians and those which are used less frequently (where greater checks and balances are required). While some of the newer methods using mobile phones for data collection are feasible, they are not yet to be recommended for use in emerging markets for health care, as physicians are still not comfortable with these methods. Having said that, this may become a standard research approach in the future.

Do projective techniques work in emerging markets? The essence of qualitative research, wherever it is in the world, is relating to people so there is no reason why projective techniques shouldn’t work. They should, however, be approached with caution. Here are some tips for researchers considering their use:

  • Use a skilled moderator and brief them clearly on the objectives of the technique so that it isn’t taken out of context. Respondents in some cultures may need more warming up in order to be able to think in more abstract ways.
  • Make sure the technique is culturally relevant, relatable and appropriate. For example, the parties described in the “brand party” technique are not common in Asia and the “brand obituary” technique is considered totally offensive in some markets!
  • Take care with interpretation – the researcher must understand the cultural context of certain associations and be able to interpret responses considerately.

Are focus groups possible in emerging markets? Feasibility for conducting focus groups is market specific and varies by respondent type. In most markets, patient focus groups are possible, although disease taboos differ by market and some therapy areas might be considered too private for patients to open up about in group discussion.

For physicians, feasibility depends on availability plus seniority. In a lot of emerging markets, physicians have high workloads and also spend a lot of time commuting so it can be impractical to schedule focus groups. This does differ by market but as a rule of thumb, the more senior or specialist the physician, the less feasible groups are. Physician focus groups can be conducted in most markets, though may require additional recruitment resources, more time and smaller mini-groups/triads/dyads. It’s also worth bearing in mind the impact of hierarchy on behavior. For example, if there is a mix of senior and junior doctors, the junior will follow exactly the thinking of senior physicians. Having respondents in the same peer group is critical.

Step 3: Build in stringent quality checks and balances

To achieve high-quality research in emerging markets, additional quality control steps, which are not always necessary in developed markets, are recommended. For example:

  • Moderators must be highly experienced in interviewing health care professionals and must demonstrate therapeutic expertise. It is advisable to keep the number of moderators per market to a minimum.
  • When there are numerous materials to test, extended briefings should be undertaken using Web cams and even dummy interviews if necessary to ensure understanding. Briefings should be conducted in the local language, especially if spoken English is not strong.
  • During the fieldwork period, allow time to review the interview transcripts for quality-control reasons and to re-brief the moderator if necessary. This process allows for learnings/hypotheses to be generated for exploration in subsequent interviews.
  • Because emerging markets are often new for the commissioning client, additional questions may be generated after the research has been completed. Provide an option to follow up with the research respondents to explore anything that has not been fully addressed in the initial interviews.

Prepare to be flexible

Following these three steps should provide a framework for conducting effective pharmaceutical research in emerging markets. Ultimately, when conducting research in these regions, one must prepare to be flexible, especially when the project objectives are complicated, because useful insights often follow a considered, iterative approach. 

 

SIDEBAR

Are proxy markets appropriate?

With pharmaceutical market research being subjected to ever-tighter budgets and timelines, marketers and manag-ers alike are increasingly tasked with deciding which markets will be most relevant to their business and yield the greatest return on investment. As conducting market research in all markets of interest is rarely a viable option, country archetypes (i.e., countries which are similar to one another) are a hot topic.

Specifically, you might want to identify markets within a region to conduct research in and use as a proxy to understand other markets. How well this works depends on the extent to which markets can act as effective proxies for one another in order to meet the project objectives:

  • If you need to explore emotional aspects of patient attitudes and behavior, it is probably reasonable to use proxies as long as the markets have similar lifestyles and consumption habits.
  • For branding and communication testing, reactions from health care professionals across the region may be similar although there is a need to consider language (in terms of messaging).
  • For projects where you are looking to increase market understanding or evaluating more tactical aspects of a launch, we would advise against proxies due to the diversity of health care systems within each region.

Assuming it is reasonable to use proxy markets based on the project objectives, how should you go about selecting which market to use as a proxy?

  • We typically consider emerging markets in tiers based on size. The number of middle classes within a market is closely linked to pharma market size and opportunity.
  • Within each tier of markets, there are a number of secondary considerations, including: timing and cost-effectiveness; size of market; internal strategic importance of market; client infrastructure within market; language and culture; and political stability.