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The visual aid (which also is referred to as a detail aid or sales aid) remains the cornerstone of the pharmaceutical sales representative’s promotional arsenal for detailing physicians in the field. Ideally, the visual aid is either a hard copy or an electronic booklet which contains the most important clinical facts about a pharmaceutical product and (as necessary) other relevant information about the disease state or market, e.g., epidemiological information, other relevant clinical trial results and/or market facts.
The objective of the visual aid is to educate the physician or other health care provider (HCP) about a pharmaceutical product or a topic relevant to the usage of a particular product. It should motivate the physician or other HCP to prescribe the product in an appropriate and optimal manner consistent with labeled indication(s). When considering the standards of an effective visual aid, the main criteria are that it should be:
- Organized in a manner that engages the physician/HCP;
- Reflective of a logical argument or story flow; and
- Presentable in an efficient and unobtrusive manner by a sales representative.
While the entire visual aid may not be presented during each individual sales visit – rather, the representative may elect just to present a particular graph or chart – it should generally be organized in a story-like order or format. The sales aid typically contains a number of classic ingredients including (but not limited to):
- Promotional statements (headlines, body copy and taglines) that are clear, succinct and reflective of the clinical trials data;
- Graphs and charts stemming from the clinical trial data;
- Information and guidance surrounding the tolerability and safety of the product;
- Any adverse events or drug interactions; and
- Other guidance relevant to product usage (e.g., dosing, pill size, administration, etc.)
- Information relevant to cost, access, formulary and/or company-sponsored patient assistance programs.
The visual aid often may also contain patient case studies and/or epidemiological information or information reflecting the market, such as the market share of the product within its class. Additionally, the visual aid should reflect the creative promotional flavor, including branding imagery, icons and logos as well as scientific graphics (which often are used to describe a drug’s mechanism of action).
In this article, our aim is to elucidate a rigorous customer-based, research-driven methodology for the purpose of constructing an effective visual aid that meets the criteria we have enumerated: appealing to and engaging the physician, reflecting a logical story, and being able to be presented in a quick and unobtrusive manner by the sales representative, all toward the goal of motivating appropriate and optimal usage of the product. While the process we delineate is research-driven, it involves three key players:
The process of developing a visual aid should first begin with the establishment of a behavioral objective (or objectives) which should be reflective of the brand positioning and stem directly from the indication. The product positioning statement is meant to encapsulate the brand’s strategy from the standpoint of how the pharmaceutical company would ideally like physicians to think about and use the product. The behavioral objective should succinctly articulate the specific behavioral change that the company wants to foster or motivate through its marketing campaign. The behavioral objective may identify:
- A particular type or types of patient(s);
- A particular placement within the course of therapy that a product would be prescribed by physicians;
- Or even a particular competitor that the company is seeking for its own product to be used in preference to or over.
The behavioral objective also may describe a change in beliefs or attitudes that is required for optimal and appropriate usage of the product.
In developing a visual aid, our experience has shown that establishing an effective, realistic and understandable behavioral objective (or objectives) is critical since it articulates what the representative is trying to convince the physician to do differently. Additionally, a well-written behavioral objective also tends to be better understood by physicians within the context of primary market research interviews, particularly when it comes to asking the physician to judge a message, individual page/spread within the visual aid or specific promotional element (such as a headline, chart or graph) relative to a desired behavior. While the positioning statement is perhaps the most seminal aspect of the marketing campaign – the idea from which the promotional campaign should spring – since it reflects aspiration and not an on-the-ground functional behavioral change, it is often difficult to use as the basis for establishing the story flow underlying the visual aid or the yardstick for later judging the effectiveness of the elements of the visual aid itself.
Once the behavioral objective has been established, the next step is to ascertain the optimal story flow to utilize in constructing the visual aid. As noted earlier, the visual aid should reflect a logical story flow. In our experience, the recipe for constructing the optimal story for the visual aid is as follows:
First, the team needs to determine the entire scope of potential promotional messages for the brand, i.e., the marketing claims. These claims can be distilled from the Phase III data and/or the draft label and should be written in a succinct and simple manner by a copy writer within the advertising agency. For the market research process described below to work properly, each of these messages/claims should be:
- Reflect a singular idea or concept;
- Include, to the extent possible, a “reason to believe” in the sense of some succinct reference to the specific data that supports the claim
- Be non-redundant with other messages/claims; and
- Be approved by the pharmaceutical company’s regulatory group, indicating that it is sanctioned for use in physician marketing.
It is important for each statement to reflect a singular idea so that physicians can appropriately react to and determine the placement of that particular idea, as opposed to having to choose between (and place) multiple ideas with the story flow. The messages should be nonredundant to help keep physicians focused on broad concepts as opposed to wording differences (or wordsmithing). And the messages should be regulatory-approved prior to the research to preclude the need to revisit the story flow later should certain messages not be usable externally.
One helpful tip in conducting this market research exercise is that the messages or claims should be printed up on paper or board and labeled in a nonsequential manner (to avoid order bias) and that a corresponding message menu be produced so that those observing the research either from the back room or remotely can easily follow along as the interviewee and moderator refer to each message by its code.
Once these claims have been developed, they would then be tested with target physicians (i.e., those deemed to be likely future customers) in the context of one-on-one 45 to 60-minute qualitative individual depth interviews (IDIs) or telephone depth interviews (TDIs). IDIs are usually ideal for qualitative story flow development since they permit the focused evaluation by physicians and other HCPs of individual message elements and the construction (and discussion) of these story flows in a very detailed manner. During these IDIs, physicians are asked to perform a series of discrete tasks (which may vary depending on whether the team is developing a visual aid for a launch brand, or refreshing the marketing campaign for an existing brand in the case of a labeling update):
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- After the physician provides some details of her practice and prescribing behavior, which can be accomplished either verbally or with the usage of a self-administered questionnaire that would be completed in the waiting room, she is exposed to a detailed product profile that contains the most important and relevant clinical facts about the brand in question. After being exposed to the profile, the physician would then be queried as to the strengths and weaknesses of the product in relation to competitors, as well as her likely utilization and placement of the product within her treatment armamentarium for the disease in question.
- Next, the physician would be exposed to the behavioral objective(s); here it is important for the marketing researcher to ensure more than anything that the physician understands the behavioral objective(s), whether or not he/she subscribes to it. Understanding the behavioral objective is critical so that the physician can subsequently employ the behavioral objective as a yardstick against which to include or exclude messages or claims from the visual aid story flow.
- The third element of the exercise involves the physician reacting to the individual claims one by one, answering a series of two to three simple questions for each claim:
- What is the claim telling the physician and what does the claim mean to her (to ensure comprehension and impact);
- How motivating is the claim relative to the behavioral objective (here it may be helpful to use a 1-7 rating question as a way of gauging and comparing physician responses from message to message); and
- Whether or not the claim supports the behavioral objective.
It is important to limit the number of messages or claims to be tested within this type of research to no more than 25 to 30 since it would be expected that the respondent would take about a minute to answer these three questions for each claim. During the process of evaluating each message/claim, the physician would be asked to sort them into one of two piles: on the one hand, claims that do support and/or are compatible with the behavioral objective(s); and on the other hand, claims that do not support the behavioral objective(s).
- The fourth part of the process involves the physician creating a story flow using the claims that survived the sorting exercise. More specifically, the physician would be asked to select five to six claims that best support the behavioral objective and to place them into a story-like sequence as though he/she were arguing for the use of this product to a colleague or colleagues. Here, it is critical that the moderator explain to the respondent that this is not an importance ranking exercise; the respondent should be thinking in terms of building a logical story or argument for the product in question. Often the moderator will leave the interview chamber for five to eight minutes to allow the respondent time to put together the optimal story flow since this is the most critical aspect of the research exercise.
- Once the story flow has been constructed by the respondent, the moderator will first announce the codes in order (so that those watching from the back room or remotely can follow along; this recitation often sounds like a Bingo game) and then ask the respondent to walk through her story or argument, justifying the key messages selected and the order in which they were sequenced. Here, it is incumbent on the moderator to challenge the physician’s selection of messages relative to the way in which she reacted to them earlier in the interview.
- At the tail end of the discussion, the moderator will challenge the respondent to articulate an elevator story – a brief encapsulation of the main point or points within the story flow that the respondent would repeat to a colleague on a quick one floor elevator ride. Ideally, this elevator story should be consistent with the behavioral objective – in which case the interview is concluded. If the elevator story does not jibe with the behavioral objective, it is incumbent on the moderator to challenge the physician as to how her story can be altered to more closely correspond to the objective, often asking the physician to re-review and rearrange the message claims.
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Armed with the output of this story flow development process, the advertising agency should next construct a prototype B&W visual aid draft that reflects the general sequence of messages. We have used this story flow development process extensively and have found it to consistently produce a sturdy skeleton upon which to develop a compelling, engaging and effective sales piece.
The goal of the next phase of the process should be to confirm that the story flow is effective in motivating appropriate and optimal usage of the product and to initiate testing of a more elaborate layout of the brochure than just individual messages. This process also should involve one-on-one 60-minute IDIs for a number of reasons: (a) They permit the focused evaluation of the B&W visual aid stimulus, and (b) since physicians generally are detailed in an individual manner, IDIs are reflected of the authentic environment in which the visual aid is utilized by sales representatives in the field.
For this research, the advertising agency’s copywriters typically generate a B&W mock-up of the visual aid; this incipient edition of the piece should start to incorporate charts, graphs and other scientifically oriented visual imagery in addition to headlines, body copy and taglines. The reason this edition of the visual aid should remain in a B&W format (i.e., devoid of all creative imagery) is so that the physician can more specifically focus on and react to facts about the product without being distracted by pictures. We often recommend that this B&W mock-up be formatted in a three-ring binder (or on individual boards) in case respondents feel that the order of the various components should be reshuffled.
Based on our experience, the best way to present the B&W visual aid to physicians is through use of an audiotaped voice-over. When created properly, an audiotaped voice-over provides an excellent simulation of the authentic manner in which a physician would be exposed to the visual aid in her office and helps ensure that key points are conveyed verbally (as opposed to just relying on the physician reading through the document silently); indeed, the audio presentation essentially helps the physician react more effectively to the content of the brochure. In order to maintain the physician's interest and attention, this audio presentation should generally be no more than five minutes, around the maximum amount of time that representatives have to present a detail piece. Additionally, it should include some indication of when the moderator should turn the page of the brochure (e.g., a beep).
The audiotaped voice-over tends to be superior to having an actual sales representative present the piece since the representative’s presentation often can be variable and because the physician may be influenced by the persuasiveness and/or appearance of the sales representative.
Following is the general flow of the marketing research interview that is conducted in testing the B&W visual aid.
- First, the physician should be asked to introduce herself and to discuss specific, relevant aspects of her practice, e.g., years in practice, setting, as well as volume of patients within the disease area. These attributes can also often be captured via a short, written questionnaire that the physician completes in the lobby of the facility. In the up-front part of the discussion, it is often helpful to discuss the physician’s current prescribing practices and perceptions of the products within a class since these views often can serve as a baseline to determine if the detail piece will effect a change in her practices and/or views.
- Next, the physician should be exposed to the detail piece accompanied by the audiotaped voice-over. Note that in this research the physician is usually not (in this type of research) exposed either to the product profile or to the behavioral objective, so we can gauge the physician’s reactions to and the overall effectiveness of the visual aid as a stand-alone piece. After having been exposed to the visual aid presentation, the physician would be asked a series of key diagnostic questions in relation to her overall reactions to the piece:
- Initial gestalt – what did the physician think about the piece as a whole (i.e., favorable, neutral, unfavorable), as well as whether there was anything that popped out to her, e.g., particularly new information, etc.;
- Key take-home messages – more specifically, how would the physician summarize the main take-home points that were communicated during the sales aid presentation;
- Reactions to these messages – the physician would be asked to weigh the credibility, relevance and motivational influence of the messages in impacting his/her attitudes and/or behaviors; here, it is useful for the moderator to refer back to the physician’s answers to the upfront questions about perceptions and current usage of competitor products;
- Recall of specific numbers – since physicians tend to have limited attention and give little of that attention to sales representatives and sales pieces, it is important to discover which number or numbers stick (often a number is a helpful way for a physician to think about a product, whether high efficacy or low side effects);
- Any key questions that the physician would have wanted to ask the sales representative had this been a real detail visit – this often helps to determine whether there was anything confusing or problematic that was presented in the piece and what the potential objections would be;
- Suggestions or recommendations that the physician has regarding potential improvements to the piece – here, it is often useful to re-expose the physician to the sales piece and ask specifically whether there are any overall, gross changes, such as changes to order, and/or sections that the physician would take out;
- Another line of inquiry that may be infused at this stage is whether or not the brochure jibes with the behavioral objective – here, the moderator may present the behavioral objective to the respondent to see how effectively the brochure conveys the objective and, more specifically, which components of the brochure are consistent with the behavioral objective. Alternatively, the behavioral objective may be presented at the very end of the interview as a way to determine whether the brochure jibes with the objective.
- After an overall review of the piece, the next component of the qualitative interview involves more of a page-by-page or a spread-by-spread deep dive, in which the physician would be asked a series of diagnostic questions for each individual page or spread:
- What is the main take-home point of this page? This is asked to ensure that the message/information on a given page/spread is being communicated in a lucid and straightforward manner.
- What the physician thinks about key promotional elements on that page, especially the headline, body copy, graphs/charts and/or other components. This is asked to ensure that the headline is clear and supported by the information on the page; that the body copy is clear and understandable; and that the graphs/charts are well understood. Often it is during this page-by-page or spread-by-spread drill-down that alternative versions of charts and/or graphs are tested to gauge which one optimally communicates the information; for example, should the information be conveyed via a line graph or a bar graph?
- During this page-by-page or spread-by-spread line of questions, there may be specific questions that the brand team wants to ask about the page, e.g., whether to include or exclude a specific headline, the lucidity of wording of a specific statement, etc.
- Also, during this component of the interview, the moderator also may ask the physician to discuss whether and the extent to which each page or spread effectively supports the behavioral objective.
- After the page-by-page/spread-by-spread drill-down, the physician may then be asked a series of important concluding questions. First, she may be asked to reassess the overall order or sequence of the piece to ensure that it is presented in a logical format. Again, it is helpful for the brochure to be presented in a three-ring binder/loose-leaf manner, and for the pages to be coded in a nonsequential manner, to aid in any reordering that the physician may wish to undertake. Also, and more importantly, the physician should be asked to articulate the elevator story, which again should be a succinct recitation of the key points that she heard during the detail aid presentation.
- As an alternative to presenting the behavioral objective in the middle of the interview (mentioned above), the behavioral objective also can be presented at the tail end of the interview to gauge whether the overall content of the brochure is consistent with this objective. Here, the moderator should ask the physician which components of the visual aid map to the behavioral objective and which do not.
Another component to the interview that is often debated is whether and where to test the summary page to the brochure. The summary page is typically the back page of the detail aid and enumerates the main points in the piece. Based on our experience, testing it properly is important because in time-constrained situations it may be the only aspect of the detail aid that the physician is exposed to. The summary page can be tested within the confines of the page-by-page or the spread-by-spread drill-down or as a separate component at the end of the interview. It is our preference to test it at the end of the interview, after the physician has been exposed rigorously to the visual aid and is in the optimal position to judge its contents.
Based upon this B&W testing research, the major analytic output should generally reflect both the overall reactions to the brochure – essentially, is the brochure conveying the key messages effectively and properly motivating the physician to act in a manner consistent with the behavioral objective? – as well as any feedback based upon the page-by-page/ spread-by-spread drill-down, i.e., key modifications, ensuring that specific elements are being communicated clearly, etc. Using this key feedback, the advertising agency should implement changes to the brochure toward the goal of developing a full-color version.
After one or several iterative rounds of B&W visual aid testing, the next step is to test a full-color version of the visual aid that would incorporate all the content of the B&W visual aid infused with the creative elements of the campaign (i.e., imagery). The development of the creative imagery should also result from a systematic research process that we’ve described in a previous article.
Essentially, the full-color visual aid should be tested in a similar way to the B&W visual aid, i.e., it should involve an audiotaped voice-over and should utilize a similar series of questions; it should cover overarching reactions to the visual aid and then a drill-down on each page or spread. The main difference between testing the B&W and the color visual aid is that the moderator also should ask a series of questions as to the concordance and placement of the imagery with the headlines, body copy, taglines and other elements (i.e., graphs, charts, etc.). Often, within the context of this research, the agency may want to test a variety of different cover art, taglines and/or other branding elements such as logos or branding font. The color visual aid testing should be used to determine any final finetuning of the visual aid.
After the visual aid has been largely finalized, we recommend a final piece of research in which a few sales representatives actually use the visual aid to detail physicians. This field testing of the visual aid can be useful in determining:
- How long it truly takes for a representative to get through the entire visual aid, from start to finish;
- Whether the physician truly does pay attention throughout the presentation – where she exhibits particular interest and/or where her attention lapses;
- Anticipating questions and objections that physicians may raise as a result of particular information presented in the brochure.
Field testing also can be useful in identifying and correcting any lingering errors in the visual aid prior to its being launched for use by the sales force.
The visual aid remains a critical element in the toolbox of promotional tools available to the pharmaceutical sales representative. It should be reflective of the product position, engaging to the physician, containing a logical story flow and easily presentable in a succinct manner by any sales representative. Overall, the goal of the visual aid is to educate a physician or other HCP toward the goal of appropriate and optimal usage of a pharmaceutical product consonant with the approved labeling. This article delineates a systematic research-driven approach that manufacturers and their agencies of record can utilize to productively harness and channel the input of customers into the crafting of a visual aid that will motivate changes in physicians' attitudes and behaviors.
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A Systematic Approach to Developing an Effective Professional Visual Aid
