In the midst of all this social media talk and the Internet being completely global, one of the essential aspects of effective healthcare delivery is often overlooked: the connection between clear communication and cultural background. When stakeholders come from different backgrounds, clear communication, and subsequently competent healthcare delivery may be hindered.

It is important to recognise that not everyone possesses Western views in relation to healthcare, illness, and treatments – both in the physical and spiritual sense, as the cultural backgrounds of patients can shape their views on the topic of well-being.

While a health belief model that attempted to explain patient behaviour in relation to cultural background was developed by social psychologists in the 1950s, it is important to explore the ways in which it is possible to predict and explain health behaviours in an era where digital health information is more widespread than ever.

Traditionally, studies on patient compliance are produced from a medicocentric perspective, where non-compliance is seen as a problem. If we consider non-compliance from a patient’s perspective, however, we may learn more about what motivates their actions. An anthropological study on patient attitudes towards drugs and illnesses concluded that non-compliance is rarely the result of patients misunderstanding the doctor but rather a result of them having different ideas and applying their rationality vis-à-vis the doctor’s. This rationality is comprised of political, economic, and social elements.

In the aforementioned study, Van der Geest, Whyte and Hardon concluded that especially in non-Western societies, pharmaceutical products are often recast in another knowledge system and used differently from the way they were intended in the regime of value where they were produced.

In order to exemplify just how relevant cultural background is from a patient’s perspective, we will take a look at a few examples.

According to a survey conducted by the Taiwanese Bureau of Health Promotion, up to one third of asthma sufferers in Taiwan do not take any kind of medication for the condition, and another third only use inhalers occasionally, or in the case of emergency, as opposed to taking long-term anti-inflammatory medication. A deeper look into Taiwan’s attitudes towards well-being reveals that almost 80% of asthma sufferers in Taiwan prefer to control their symptoms through a balanced diet and exercise, according to another article in The Taipei Times. Although the Taiwan Association of Asthma Education is encouraging sufferers to find out what their allergens are and take anti-allergy drugs, asthma is the 12^th leading cause of death among Taipei city residents and Hsu Shi-ta, director-general of the association states that it is often difficult to identify mild asthma symptoms, as they are viewed as ‘habitual’.

Another interesting example to consider, as presented in the study featured in the Annual review of Anthropology by Van der Geest, Whyte and Hardon, identifies a tendency towards what the author calls ‘defective modernisation’ in South-East Asia. This trend manifests itself through the belief that health is something one can obtain solely through the use of pharmaceuticals. A potential upside to this is the fact that commodification of medicine in the area means that patients have more choice and are able to put more pressure on healthcare providers by refusing a treatment.

Lastly, we will also look at how outlooks towards prescriptions can differ from region to region, also based on Van der Geest, Whyte and Hardon’s anthropological study.When medication is seen as the essence of the medical practice, prescribing is the main action that will be expected from the physician, perhaps serving as a legitimization of sickness. Whilst in some cases, not prescribing might be preferable on medical grounds, it is not rational according to cultural criteria and doctors might feel like they have to comply with patient demands. A refusal to prescribe may cast doubt over the genuineness of the patients’ complaint, so it can be said that in certain regions prescriptions serve a social and cultural logic. A written referral to a medical specialist may often serve the same purpose.

The concerns associated with this practice are many: it may lead to erratic buying of medicine, it might encourage patients to self-medicate by imitating the prescriptions they have received, and in poorer areas it might force patients to choose arbitrarily from the long list of medicines prescribed if they cannot afford them all (the cheapest one, the first one on the list, the one in stock, etc.)

All this being said, however, it is preferable not to make assumptions regarding an individual’s health beliefs based on their cultural background, as opposed to simply asking about their own understanding and concerns, advises the UK Health Protection Agency.

Conclusion

Although anecdotal, these examples show us that that understanding attitudes towards drugs should be a priority for pharmaceutical companies looking to launch a drug in emerging markets, as it is in these markets that one tends to be confronted with less conventional attitudes (at least from a Western viewpoint) towards illness and wellbeing. That is why deep local knowledge and market-tailored decisions are necessary to transform information into healthy behaviours. Patient-oriented analytics are also needed to extract meaningful intelligence from large amounts of information about populations and patients.

Creation Healthcare helps pharmaceutical marketers and communicators to translate insights about stakeholder behaviour into successful engagement strategies. With specialists in fifteen countries, Creation Healthcare supports global and regional strategy leaders, informed by local insights. To talk to us about how these insights can inform your international engagement strategies, click here.

Since the fall of the Soviet Union, the poor state of health of the Russian population has been a topic for national and international discussion. Life expectancy is around 15 years less than in most European countries, and HIV/AIDS, cardiovascular diseases and alcohol-related problems are all major concerns. The Russian population is declining, and inequalities begin right at the start of life – a baby born in Russia is more than twice as likely to die by age 5 than a baby born in Britain.

As grim as this picture may seem, much of the disease burden is preventable. The real problem lies in delivering public health initiatives in a country where many of the aspects of unhealthy living, such as excessive alcohol consumption, smoking and risk-taking behaviour are commonplace. Additionally, ensuring consistency of healthcare services and messages in a territory that spans 9 time zones and encompasses a variety of ethnic groups, standards of living and religions, requires an innovative approach.

A number of governmental and government-associated initiatives have been set up in Russia, aimed at preventing disease through encouraging a healthier way of life, and requiring effective engagement with the population.

So healthy, how great!

The Ministry of Health’s “Healthy Russia”  project has a number of components, including the website www.takzdorovo.ru, the name of which has a double meaning -  “so healthy”, and “how great!”. It is a portal for prevention-related activities and represents a communication channel between the Ministry of Health and the population.

www.takzdorovo.ru

Users can gain a greater understanding of disease risks through questionnaires, create profiles with health goals and progress charts, and connect with others as “friends”. The site offers information on healthy living, covering topics such as choosing foods correctly, giving up smoking and examining alcohol intake, as well as specific diseases.

Examples of information, tips and tests featured on www.takzdorovo.ru

The site is linked to Twitter, Facebook and the Russian networking site Vkontakte, and features running totals of users who have committed to give up smoking or eat more healthily for example, harnessing the power of popularity, which may help to normalise the concepts of disease prevention; additionally, there are a range of options for “liking” or commenting on articles.

Welcome bar showing running total and network activity

Users are encouraged to engage, with “likes”, comments, Tweets and shares

Interactive and informative sites such as www.takzdorovo.ru thus educate users about improving health and preventing and managing diseases, as well as provoking discussion and providing calls to action. They have the potential to develop further still, with “friends” networks becoming powerful resources where patients, the health-conscious and healthcare providers can interact.

Health centres

Information on the network of health centres, including location details and a range of  educational brochures is available on www.takzdorovo.ru. Health centres were introduced in 2009, and this winter, child-specific centres are planned.

The centres provide free health checks and advice to all health-insured Russian citizens. Attendees can choose to undergo tests such as assessments of the cardiovascular and respiratory systems and disease risk; where the investigations suggest a health problem, referrals can be made to local specialists. Advice is provided on healthy eating, exercise, safe use of alcohol and smoking cessation, and each person receives a Health Card after their first visit.

Health centres are centrally planned, and across Russia have the same equipment and multidisciplinary teams. Some centres offer additional services, though, such as exercise rehabilitation and a “Health School” for children.

Health centres are a tangible aspect of the drive to improve health – in contrast to hospitals, with associations of sickness, health centres are proactive and convenient. Anyone can drop in, have their questions answered and be directed towards a healthy way of life. Whilst online engagement is important for raising awareness and enabling the Russian population to re-brand itself as health conscious, health centres can reach non-internet users, and facilitate further change in those inspired via the internet.

Other initiatives

There are a number of other organisations that hold conferences and run projects for improving health across Russia, such as the League of the Health of the Nation, and the Healthy Russia Foundation.

The Healthy Russia Foundation currently has a range of engagement programmes, including a healthy lifestyle education programme for young people, Text4Baby, HIV communication training for healthcare professionals and HIV prevention initiatives, aimed at reducing transmission in drug users, as well as a pilot scheme for reproductive health.

It is thus clear that Russia is aware of its health challenges and is approaching the main problems in a number of creative ways.

Conclusion

Overcoming Russia’s health problems is a huge task, but engaging the population in prevention activities, and using social media-type platforms to provide information and normalise the concept of healthy living may provide a viable way forward. Digital media may be particularly helpful in driving change across such a large country, but other forms of communication and action are important for a diverse society.

As the focus of the current initiatives is preventative, it may be that a difference will not be seen for some years, but it is clear that Russia is an area where engaging with the population about health will have a decisive impact on the country’s society and economic well-being.

If you would like to have a conversation about healthcare engagement in Russia or other emerging markets, a member of Creation Healthcare’s team would be very pleased to speak with you. Simply contact us now.

Earlier this year I wrote about how language barriers are creating a new digital health divide and I suggested that the single biggest barrier to successfully connecting patients online internationally is language. On the one hand, the Internet has broken down many boundaries and has changed the geography of healthcare, uniting patients and healthcare stakeholders all over the world so that people are not constrained by information available in their own country alone. Yet on the other hand, language has become an even greater barrier as it separates people into groups – the advantaged or the disadvantaged – based on the information they can access.

I concluded that innovation is required, and offered some ideas about how to tackle language barriers in healthcare engagement. Now, in this report, I explore some of the innovative solutions being developed that are transforming healthcare engagement, improving access to healthcare, and literally saving lives by breaking down language barriers.

Solving patient-clinician language barriers

In the United States, over 34 million people speak Spanish as their primary language at home. When it comes to providing effective and reliable healthcare to this Spanish-speaking population, it is in the face to face encounter between physician and patient that any language barrier becomes critical.

I spoke with Dr Martha Bernadett, Executive Vice President at Molina Healthcare, a leading national healthcare provider in the United States, about the challenges of ensuring effective healthcare communication amongst non-English speaking communities in the US.

“It’s in the patient-clinician face-to-face encounter that patients gain the most important information and have the most important interaction,” says Dr Bernadett. “All other non-face-to-face interactions are trusted in a secondary manner, compared with the face to face encounter with a nurse or physician. After that is any written communication that the patient might take home, that they use to convey to family members what happened at that encounter. Those are the two critical elements in healthcare delivery where you don’t have as much margin for error.”

Molina Healthcare focuses on enhancing the relationship between patients and physicians, enabling them to communicate effectively with each other. Dr Bernadett told me that matching physician and patient language is an important aspect of the work they do. Where language matches or bilingual healthcare professionals are not available, interpreters are used for face-to-face encounters. Pre-translated documents also play an important role in efficient and accurate cross-language interactions.

Automating patient-physician interaction

Meanwhile, new technologies for automating translation are emerging and have been used successfully in healthcare. Staff at Bayshore Community Hospital in Holmdal, NJ, communicate with Spanish-speaking patients using an automated spoken translation tool that listens to a sentence in English, translates it to Spanish and speaks the Spanish sentence to the patient.

I spoke to Dr Mark Seligman, President and Founder of Spoken Translation whose product, Converser for Healthcare, is the innovative tool used by the hospital to engage patients in their own language and I asked him what makes the product reliable enough for use in a medical environment.

One of the keys to the product’s effectiveness, as Dr Seligman demonstrated to me, is ‘back-translation’ which confirms to the original speaker in text, what the translated text looks like when translated back into its original language. Through this innovation, it is easy to identify whether the context of an English word with multiple possible meanings has been correctly understood. If not, the correct meaning or inference can be specified by the user before the correct translation is spoken by the tool.

In the example below, the ambiguous meaning of the word ‘right’ in “Your right knee is broken” is clarified by selecting the correct meaning:

This is certainly an effective tool for reliable, context-sensitive translation that is making a real difference to areas including patient safety and compliance. The tool includes pre-translated compliance tools such as an informed consent form.

“Consent becomes a stronger thing when you can know and prove what you have said in a foreign language”, says Dr Seligman. The tool retains a transcript of conversations so it is possible to review exactly what was said. This opens another possibility for the future – the integration of transcripts with electronic medical records. Dr Seligman hopes this will be achieved next year.

“The challenge [of integrating with electronic medical records] is organisational rather than technological”, says Dr Seligman.

If this is starting to sound a little too much like a move towards fully-automated medical interactions, Dr Seligman is quick to reassure that Converser is not trying to replace human interpreters.

“Human minds, human hearts, human cultural understanding is irreplaceable.” says Seligman. “We’re not trying to replace humans. Converser will always work along with human interpreters.”

Emerging applications for automated translation

I asked Dr Seligman about the potential application of Spoken Translation’s technology into digital engagement channels such as social media. He explained that this is where he started out in the mid-1990’s, working on automating chat translations and it is certainly something that he hopes Spoken Translation will return to in the future. The company has a vision for applying their technology of today to live, verifiable, chat translation:

Spoken Translation’s vision of the future: live, verified chat translation

Other innovation in the pipeline includes server-based technology that would allow Converser to be used from portable and mobile devices. Dr Seligman hopes this will be available for iPhone and Blackberry during 2011.

Purpose built automated healthcare translation

During my research for this article, I was pleased to learn from TAUS, a think tank on translation strategies, about customized machine translation systems (aka automated translation) which are designed for use in specific sectors. This is in contrast to Google translate which can be unreliable for specialist areas such as healthcare. These customized engines are trained using database of previous translations from a specific industry and include features to ensure consistent use of terminology. The result is better quality, more accurate translations.

Just such a sector specific solution is used by the Pan American Health Organization (PAHO). Their system was originally developed in the 1970s, and today covers all combinations of English/Spanish and Portuguese and is being used daily for 90% of all PAHO’s translation needs, as well as by 75 clients. Another example is a Danish customized machine translation provider, Languagelens, whose purpose built solutions are used during clinical trials by pharmaceutical companies. Whilst human translators are needed to ensure that the final text is up to the high quality needed, the use of such customized automated engines drives down the cost of translation, increasing the amount of translation that can be done, and speeds up time to market.

TAUS also told me that it is possible to create automated engines rapidly when needed – within three weeks of the recent crisis in Haiti both Google and Microsoft added Haitian to the list of languages supported by their automated engines.

Real-time translation crowdsourcing

As automated translation technologies are deployed into healthcare environments, other innovative approaches to solving the automation challenge are emerging. New York, US based SpeakLike has developed a process that is enabling social media engagement to take place across 37 languages. Sanford Cohen, SpeakLike’s CEO told me that they were looking for a solution to enable real-time chat amongst people speaking different languages.

“We explored machine translation and found it was not good enough for our needs,” explains Cohen. “So we thought, ‘if machine translation were perfect, it would be integrated into everything we use – it would be in our email systems, in our chat systems, and in our content  management systems; but it’s not. But why can’t we have something that can be integrated into everything we use, with good quality translation?’ That’s when we started looking at crowdsourcing.” Cohen says this idea was how SpeakLike started:

“We got a large number of translators on our system, and users could send in a request when they needed it, 24/7, and then whatever translators were available or logged in first would provide the translation.”

The first application of the process was live chat, and in a 2008 beta SpeakLike demonstrated live, real-time chat between three users speaking English, Spanish and Chinese. This technology was implemented by PETLinQ, a provider of radiology imaging software management tools, to enable their user base of 71,000 doctors to collaborate in their own language.

After experimenting with the physician-patient interaction, where a dental reconstructive surgery in New York could support its worldwide patients pre- and post-surgery via international chat, SpeakLike started to develop other applications of the process. The translation platform was expanded to integrate with email, website content, and social media applications.

Today, a Twitter connector automates the translation of tweets, enabling either a single, multilingual Twitter feed or separate feeds for each language. Meanwhile, for bloggers using WordPress, a plugin automatically posts translated content into languages selected by a content author.

SpeakLike’s system is designed to manage the end to end process, automatically notifying translators, managing translated content, and publishing based on user options.

Cohen told me of a customer who was previously waiting typically for two weeks to have website updates translated into nine languages, but their content was out of date within four days. By integrating SpeakLike into their content management system, they were able to publish translations within less than 24 hours.

Responding to international health crises

The potential for transformation that can be achieved when people from different countries collaborate to solve healthcare challenges is exemplified in the work of international aid organisations such as Médecins Sans Frontières, where healthcare specialists from around the world work together in response to a crisis. But when the international team leaves an area of need, local physicians are often left without access to the international knowledge pool that exists during an aid mission.

Murdo Bijl, Founder and Executive Director of Health Connections International, saw this situation first hand when working with Médecins Sans Frontières in the former Soviet Union. The experience inspired him to set up an organisation focused on facilitating and promoting communication between professionals through multi-lingual exchanges of information. Health Connections International operates on a non-profit basis and focuses on improving responses to the HIV, tuberculosis and drug use epidemics in developing countries and resource-poor environments.

The organisation’s online knowledge and information sharing platform has been designed to allow healthcare professionals across the globe to share their experiences and exchange information, quickly and easily across multiple languages.

Healthcare professionals register as members of My Health Connections and can ask medical questions in their own language. Most questions are then manually translated and labelled by subject area (such as HIV/AIDS, treatment, medication) before being routed to an appropriate expert to be answered. Once answered, the response is translated back into the language in which the question was originally asked. It’s a laborious process but the result is a rich and growing knowledge base accessible in multiple languages.

MyHCI includes a growing, multilingual expert medical information knowledge base

I spoke with Murdo Bijl about his vision. He told me that in the proof of concept that has been running since April this year, 600 unique questions and answers have been posted. He said that as the number of questions and answers continues to grow, the knowledge base will be able to provide the answers to most commonly asked questions:

“There will be a moment when the knowledge base will have enough information for people to find the answers to their questions. Then all the questions will be translated into Russian, Spanish, Arabic and Chinese. Right now we have 500 Q&As online, translated into Russian.”

Supporting hard-to-reach healthcare professionals

In Kyrgyzstan and Tajikistan, local ‘focal points’ have been set up to bring Health Connections International’s service as close as possible to those healthcare professionals who may not have access to the Internet. As Bijl told me:

“We work with the medical academies and the ministry of health in the countries where we operate. They create their own knowledge centre in the capital city, with small focal points throughout the country which are equipped and manned by local physicians.

“In Kyrgyzstan and Tajikistan, we have twenty four ‘focal points’ on the premises of the ministry of health’s facilities, such as an AIDS centre or tuberculosis clinic, where local doctors who may not have access to the Internet can take their questions.”

Bijl says that the online model has allowed Health Connections International to continue to support medical professionals when other more traditional methods and have been unable to:

“What we’ve seen in Kyrgyzstan is that when many organisations had to halt their programmes because of political unrest and violence, we had an increase in user traffic. So even in political unrest, the work goes on.”

But Bijl is not content to stop at the existing online solution. He is already exploring new channels to increase the reach into low-income countries using mobile technologies.

“The next step for us will be to use mobile technology. 3G is virtually everywhere now in the low-income countries where we operate.”

Global collaboration

Amidst these examples of innovation in translation, TAUS supports the translation industry and aims to help the world communicate better through better translation, actively encouraging collaboration, sharing of knowledge amongst stakeholders and open innovation.

I spoke with Rahzeb Choudhury, TAUS’ Operations Director, about their vision for collaboration between translation organisations. He told me about the TAUS Data Association, a collaboration platform for sharing translation data, where Molina Healthcare is one of 40 founding members. This non-profit organisation provides an open platform for sharing translated texts into a single shared database which is a key enabler for experimentation and innovation, providing open access to language resources to help train better customized automated language solutions such as those used by PAHO and Languagelens.

The resulting repository of translations currently contains 2.6 billion words in 315 languages, including a giant corpus from the European Medicines Agency. The benefit of such a platform for healthcare (or any industry) can be seen by searching for a medical term in the free language search engine.

A glimpse of what is possible

From face to face physician-patient interaction in the United States to crisis response in the former Soviet Union, it is encouraging to see innovators establishing approaches and technologies that are breaking down barriers and achieving successful multi-language healthcare engagement. There is much still to be achieved, yet the examples here provide a hopeful glimpse of what is possible.

I am grateful to TAUS for their support in researching this report. My thanks are also due to the following:

Health Connections International
Molina Healthcare]
SpeakLike
Spoken Translation

Creation Healthcare, the global healthcare engagement consultancy, will open an office in Tokyo dedicated to serving healthcare companies in Asia on 1st July 2010.

The launch of the Tokyo office is part of Creation Healthcare’s strategy to continually improve its provision of global strategy with local insights and implementation.

Creation Healthcare’s consultancy activity in Japan will be led by Chris Earnshaw, Ph.D. Chris has lived and worked in Japan for 35 years and has spent much of that time consulting to major pharmaceutical companies on product positioning, branding, and regulatory compliance in the Japanese healthcare market.

Daniel Ghinn, Creation Healthcare’s Global Director of Digital Engagement, said:

“Our new Tokyo office provides a local presence from which to lead our work with pharmaceutical and healthcare organizations in Asia.

”

With thirty consultants based around the world, Creation Healthcare’s Asia office makes it the best placed consultancy for worldwide and Asian pharmaceutical and healthcare organizations who want to improve the effectiveness of their communications, marketing and digital engagement activities.

“Creation Healthcare in Tokyo will not only support clients in Japan and Asia, but will also improve the effectiveness of our international strategy development for global clients in Europe, the United States and the rest of the world.”

Creation Healthcare’s Tokyo office is located at:

Creation Healthcare
Shinjuku Park Tower 30th Floor
3-7-1 Nishi-Shinjuku
Shinjuku-ku
Tokyo
163-1030
Japan

Telephone: +81-3-5326-3369
Email: tokyo@creationhealthcare.com

Creation Healthcare’s global headquarters in London can be found at:

Creation Healthcare
53 Chandos Place
London
WC2N 4HS
United Kingdom

Telephone: +44 (0)207 812 6474
Email: london@creationhealthcare.com

If you live or work in Japan, or have visited the country, you will know it is a nation of contrasts. This is as true when it comes to online healthcare communication as anywhere else.

On the one hand, much of Japan’s healthcare communication is highly conservative. Yet in the midst of this, some Japanese pharmaceutical companies are becoming world leaders in developing patient-focused corporate websites.

Whilst the corporate websites of many pharmaceutical companies outside of Japan are primarily focused on content for investors and media, Eisai Co, Japan’s fifth-largest pharmaceutical company, has developed a highly consumer-centric website. In a regulated environment, direct-to-consumer marketing by pharmaceutical companies can be a sensitive subject, but for Hiroshi Kaihatsu, Manager, Business Strategy & Planning at Eisai, focusing on the consumer was essential.

“We must use the right words and terminology for consumers”, said Mr Kaihatsu at Marketing Excellence Japan 2010 last month. “This is not the same language we use for physicians.”

For Mr Kaihatsu and his team, the key to this was the development of an imaginary ‘persona’ around whom the website could be built. Following an extensive consumer research process, the persona was defined as an ‘ordinary’ lady; a healthy mother, the key family influencer. Her father has senile dementia; her mother has osteoporosis. She is fashionable, teaches flower arranging, and is 46 years old.

Eisai’s research process explored the magazines the persona reads, and the way she uses the Internet. Consumer interviews revealed that she checks the Internet for health information, although she is not a specialist in medical terminology. She likes to use the Internet to find out things she wants to know. Her favourite search engine, according to Eisai’s Japanese consumer research, is Yahoo!.

Eisai’s consumer persona features prominently on the website home page

The result of Eisai’s persona development is http://eisai.jp, featuring images of the persona around whom the website has been designed and a unique ‘Wellness Finder’ which was inspired by Amazon to direct consumers to relevant content based on their website activity.

Whilst the whole website experience has been designed with the consumer in mind, the home page’s Wellness Finder is a particularly innovative health information tool using consumer-centric language. On first appearing, the tool suggests a range of health-related terms such as ‘pain’, ‘stomach’, ‘pain’, ‘shoulder’, ‘fatigue’ or ‘osteoporosis’.

Eisai’s unique Wellness Finder tool

When a consumer clicks on a term, a series of related words is displayed. So for example, clicking on a term such as ‘pain’ updates the Wellness Finder to show words that will help narrow down a search for information, such as ‘neck’, ‘throat’, ‘stomach’. A further click on ‘stomach’ narrows down suggestions further and offers terms including ‘nausea’.

The Wellness Finder constructs relevant search terms through a simple process

With each click, the selected search term is added to a search query to return relevant information from the Eisai website.

Placing the Wellness Finder health information tool at the centre of user functionality has resulted in a website that is able to provide relevant health information to consumers easily and intuitively.

Eisai’s Wellness Finder’s provides relevant content based on simple user selections

What can others learn from Eisai’s website and Mr Kaihatsu’s experience? Getting the right information in a relevant way to consumers is a challenge that many pharmaceutical companies have yet to overcome. For Eisai, there was certainly a lot of work to achieve the new consumer-focused website. The work of mining and indexing the extensive content using specialist tools, and planning and designing the user experience around the persona, were only possible because of a culture that focuses on serving the consumer. As Mr Kaihatsu put it when describing Eisai’s 365-days-a-year call centre operation:

“Our call centre operates 365 days a year. Why? Because our patients don’t have a holiday from being a patient.”

Whilst Eisai’s corporate website does not cater for every health stakeholder – it is in fact just one of thirty websites operated by Eisai in Japan, including a search-based clinical website for doctors – its place at http://eisai.jp reflects the value placed by Eisai on putting the patient at the heart of its online communications.

If you would like to develop a strategy for engaging consumers in a relevant way about health matters, Creation Healthcare can help. Contact us in Tokyo or London to find out how.

In recent years, the world has witnessed the emergence of China as an economic driving force. At the same time, the emergence of social media has dramatically changed the way people use the Internet worldwide. How about social media in China? Do Chinese people use social media as much as anywhere else in the world? Since Facebook, YouTube, Twitter and many other services are banned in China, what are their local counterparts? This article provides a snapshot of the current social media landscape in China.

Since it has been made available to the Chinese population, the Internet is not only used as an information tool but also as a powerful communication tool allowing netizens to easily interact between each other. Nowadays, although the Internet penetration rate in China was only 28.7% at the end of 2009 (source: China Internet Network Information Center), this percentage represents around 384 million Internet users, 90% of them benefiting from broadband access and 30% accessing the web from their mobile devices.

Taking a closer look at the most visited websites in China (via the Google Adplanner 1000 most-visited sites on the web list), we notice that web portals like Sina, Sohu or QQ rank among the favourite sites. Dominating the local Internet market, Chinese portals offer a wide array of social media services, from forums, instant messaging, blogging, photo and video sharing, to free email addresses and comprehensive social networks.

BBS – Forums

One of the most popular forms of social media in China, BBS (Bulletin Board System, or online forums) is also the oldest as it was launched in 1994. We can find it either integrated within classic websites or portals (Comsenz being the biggest China BBS software provider), or on dedicated websites such as Tianya. Differing from classic social networks where browsing content often requires logging in, BBS is a popular destination for Internet users to browse free content, and to engage in conversations anonymously. Used by 30% and more of Chinese Internet users every day, BBS can be considered as the living heart of social media in China offering great snapshot of the vox populi, despite frequent abusive use of it.

Blogging

Another popular form of social media used in China is blogging. From a Western perspective it may be interesting to learn that Chinese people do like sharing their ideas and feelings online. Thanks to local web portals offering easy-to-use blogging features, at the end of 2009, an impressive 57.7% of Internet users had a blog or micro blog and two thirds of them have updated it at least once in the last 6 months. Increasingly used by companies, celebrities or organizations, blogging will also benefit from the functions of micro blogging such as instant messaging or mobile phone texting. For traditional and micro blogging services, Sina controls most of the market (featuring many celebrities and high profiles) hosting both the most important blogging service in China through its dedicated portal and the most important local Twitter competitor, Weibo.

Instant Messaging

As a strong online habit of Chinese Internet users and accepted in many local companies for employees, instant messaging (IM) is also one of the first widely used social media services in China. In fact, 52% of China’s Internet users go online to use instant messaging. Microsoft is the most successful provider, as 93% of Chinese people using IM services have a Windows Live Messenger (MSN) account. The Chinese counterpart to MSN is powered by Shenzhen-based company Tencent and named QQ (a name derived from the main competitor at the time – ICQ). Launched early in 1999, the company went public in 2004 and serves (figures vary according to different sources) around 80% of those who use IM in China.

More importantly, QQ defined and is still defining a whole part of China’s Internet culture, inspiring a new form of language quickly adopted by younger generations. Internationally, Tencent launched QQ versions in different languages like English, French and Japanese.  Except in South Africa where the service met a brief local success in the mid 2000’s, QQ is mainly used outside the country by Chinese expatriates, students or members of Chinese communities to communicate with their friends and relatives back home.

SNS – Social Networks System

With an estimated 124 million users at the end of 2009 (source: China Internet Watch), Social Networks System is playing an increasingly important role in social media in China. Although most users choose a social network according to the number of their known friends, colleagues or classmates, the main purpose for joining such networks is entertainment. Among the top social networking sites, Tencent (QQ) Qzone ranks first, with 388 million registered users. Formerly known as Xiaonei, Renren defines itself as the largest online community website among universities and copying the Facebook model (opening from students to all) now counts an estimated 120 million members. Focusing on young professionals, Kaixin001 has seen a rapid growth thanks its popular gaming platform and now claims around 75 million users. And among the many other networks existing on the Chinese market, Wealink is an interesting LinkedIn counterpart, becoming popular among white collar individuals.

Video

Watching videos is one of the favorite activities of Chinese Internet users. 90% of them admit actively watching videos online and 58% having already uploaded content (source: Universal McCann wave4). User-generated content accounts for 30% of videos posted on these websites. The recent ban of YouTube (March 2009) did not have much impact as local websites like Tudou, Youku or Ku6 already have strong audiences. Moreover, these websites are teaming up to develop common technology standards. Some of them have been granted the broadcasting rights for the FIFA 2010 World Cup, and they are now considered as fully integrated TV networks. In the near future, video will certainly play a more important part in social media strategies in China as it is easily embeddable within social networks and benefits from an attentive and avid audience.

Conclusion

Whilst this article provides a brief introduction to social media channels in China, there are some specific online platforms in China that would deserve further study including online gaming, wiki (such as Hudong, as Wikipedia is blocked in China), search marketing (Baidu benefiting from Google’s withdrawal), rating websites ( such as Dianping), photo sharing, and online music.

Understanding the unique way in which the Internet and social media are used in cultures and nations around the world is key to effective healthcare engagement. Creation Healthcare’s international team of consultants, located across the globe and supported through offices in Tokyo and London, allows us to partner with healthcare companies and organisations that want to develop global and regional strategies based on local insights.

At the recent Marketing Excellence Japan 2010 conference, I caught up with some of the pharmaceutical company speakers and asked them about the unique aspects of pharmaceutical marketing in the Japanese healthcare environment.

In this video interview, Brent McCain, Head of Marketing Excellence for sanofi-aventis K.K in Japan, and Gabrielle Pastore, Managed Markets Brand Director with AstraZeneca, share some of their experiences in the Japanese market.

Outlining the importance of Japan for a global pharmaceutical company, Gabrielle Pastore points out that Japan is the second-largest market in the world for pharmaceutical companies, and it continues to grow.

Pastore says there is an opportunity to bring Western market research techniques such as unique focus groups to Japan, to understand what drives prescribing. But she says that bringing new ideas can be challenging:

“Japan is an island, and they are very happy with the way they do things here. To bring ideas and change is a significant challenge.”

Brent McCain highlights the enormous number of Japanese patients who are not only accessing the Internet, but also creating content. He says that this provides a real opportunity for pharmaceutical companies to carry out market research, and also points out that this means changing the perception of the role of the Internet in pharmaceutical marketing:

“The role of the Internet is going to become a little bit different from what we thought before… it’s going to be a lot more about learning from social media and the Internet than it is about getting our message out to customers …that’s where we’re going to get insights.”

Creation Healthcare’s new Tokyo office opens 1st July 2010. Contact us if you would like to speak with a specialist about healthcare engagement in Japan or globally.

In the past few years we have seen some societal and technological changes in the Western world that are enabling consumers to manage their own personal health records.

Google Health and Microsoft’s HealthVault are some of the emerging platforms creating interesting new options for early adopters who want to manage their own healthcare information, or that of people close to them.

According to a recent paper, advancing electronic medical record (EMR) technology is also a high priority for governments in the U.S., U.K. and Australia, with investment over the next five years totalling $100 billion USD.[1]

Some other statistics from “HealthCast: The customisation of diagnosis, care and cure” (PwC 2010) suggests that;

• 85% of health leaders said EMRs would reduce duplication
• 71% said patient self management would be more efficient
• 42%  said EMRs would be operational in their countries within five years

Ilias Iakovidis of the Health Unit for the European Commission speaks on the European context;

“Most of the 27 European Union (EU) Member states have an active political agenda for integrated electronic health record (EHR), but fewer than a dozen countries have regional or national scale EHR in routine operation. For example, Scandinavian countries embarked on e-health projects in the early 1990s and have achieved high levels of connectivity and use of information technology, ahead of most other countries, including the U.S. “

At the Health 2.0 conference held in Paris earlier this year, Morten Elbæk Petersen presented a compelling case study of Denmark’s sundhed.dk; the Danish National e-Health Portal. For many Health 2.0 delegates this was recognised as a leading innovation in electronic medical records.

Yet on the other side of the world, possibly unbeknownst to many Westerners, there is another healthcare revolution taking place.

Over the past 16 years, Taiwan has been creating a health management system that enables its 23 million citizens to carry a so-called ‘IC Card’ medical record everywhere they go. This Integrated Circuit card contains information about the last six medical visits, prescriptions, allergies, organ donation willingness and vaccinations.

It might be said that this is ’mHealth’ in the simplest and truest form of the word. There are no network or portable device or mobile operating system issues; just a straightforward application of technology to allow every citizen to carry their health information with them wherever they go.

One of the key ingredients to success for this project can inevitably be attributed to the convergence of systems and processes – starting with consolidating various insurance programmes into a single National Health Insurance (NHI) during 1994.

For any project designed for knowledge assets or information management, streamlining the many silos of data is imperative to introducing efficiency and reliability. Yet often it is cultural or human factors which prevent this from happening, particularly on issues around freedom of information, personal privacy, or resistance to change.

The introduction of electronic billing during 1995, and the eventual introduction of the IC Project during 2004, has led to increases in efficiency and reduction in outpatient visits (10%). Additionally, fraud, waste, and adherence have all seen improvements.

Achieved through enforcement and penalties, this compulsory change has transformed healthcare in Taiwan – albeit in a manner which might have been difficult in a populous western country.

In any case, Taiwan is now an excellent example of the ways in which the Far East is embracing digital possibilities to increase engagement, and to introduce efficiencies. Starting at the very root of the problem – the information silos and human factors – has led to an infrastructure that can support many new and emerging platforms, from iPhone to Android to the next big thing.

Any company looking to bring about transformation in mobile health inevitably needs to strategically look first at the underlying information and infrastructure that will support it.

To learn more about the way that Creation Healthcare is bringing global engagement strategy to Asia, contact us at our new Japanese office opening 1st July 2010, or at our Global Headquarters in the UK.

Reference:
[1]      Various authors, “HealthCast: The customisation of diagnosis, care and cure,” PricewaterhouseCoopers’ Health Research Institute, 2010, p. 58.

Following the highly successful Marketing Excellence Japan conference in 2010, Healthcare Engagement Strategy is delighted to be working with Eyeforpharma in Japan as media partners for Marketing Excellence Japan 2011 in May 2011. We’ll keep you informed as the conference programme takes shape.

The 2010 conference brought together marketers, communicators and business leaders amongst global and local pharmaceutical companies in Japan. With a focus on matching market needs and developing patient-centered marketing strategies, the conference included some excellent examples of innovation and challenging discussion about effective marketing in Japan’s changing healthcare landscape.

As Neil Aubuchon, Senior Director, Marketing with Eli Lilly Japan K.K and Chairperson for the 2010 conference said beforehand,

“The pharmaceutical industry in Japan is going through a period of rapid change. R&D productivity has never been lower, consolidation is occurring and there is constant pressure to reduce costs. …it is time to move our practices out of the 20th century and into the 21st.”

Now in its fourth year, Marketing Excellence Japan 2011 is set to showcase the latest innovative approaches being taken by pharmaceutical companies in Japan, and bring together industry experts for what will be another highly engaging conference.

For more information about Marketing Excellence Japan 2011, please contact conference organizer Kunie Akahoshi kakahoshi@eyeforpharma.com.