Using a psychographic approach can help improve health equity and participant diversity in biomedical research when demographic and socioeconomic categories fall short.
One of the most important things that we do at Vibrent Health is support health and medical research teams by creating digital health technologies like websites and mobile applications that make research studies more efficient and easier to run. In some cases, these digital technologies are used by hundreds of thousands of people as they join and actively participate in health research studies.
A critical component for the research teams we support is making sure the people who participate in the research studies come from a diverse range of demographic and socio-economic categories. Although these categories are important, there is more to the issue than people simply checking off the appropriate box on a survey indicating their age, race, gender, or education level.
We must understand at a deeper level what it takes for people to take the first step and sign up for research and—later—to stick around for a repeated or longitudinal study. This is particularly true for research studies that need people to participate outside of a tightly controlled in-person laboratory or clinic. This requires us to get inside peoples’ heads and look at factors such as the behaviors and motivations that go beyond what their demographic or socio-economic profile might suggest.
As a user researcher, my job is to put digital health research tools into the hands of eligible participants to get feedback to improve the tools. In trying to reach diverse populations (many of whom have low rates of technology adoption and digital literacy), it is my job to discover what impact, if any, demographic and socioeconomic factors have on how potential participants use a research program’s technologies.
While I am assuming for now that demographic and socioeconomic categories play a role in research participation, I know that they do not tell us everything we need to know about recruiting for and running a health research study. This is the same challenge that many health research companies face.
That is because we still need to address critical questions such as: Why do some people readily sign up for health research while others do not? Who will persevere through a difficult research website or digital form and who will not? Who is willing to link their research study’s mobile app to sensitive data on their mobile phone?
Who will try to reset a website account password and who will give up and quit the study due to difficulties logging on? Who will be motivated to stay engaged in a study to get access to their research results? Who will spend 15 minutes reviewing in detail a consent form about DNA testing, versus those who will skim it, or those who will throw up their hands in frustration at the inconvenience?
Ethnicity, income level, gender, or age will not tell us WHY some people will participate in activities needed for health research—it is too simplistic and assumes that all members of such groups think and act alike when it comes to health research participation. That is why we need to expand our thinking beyond demographic and socioeconomic categories as they relate to research technologies and look at how psychographic factors play a role in how they use technology.
You can learn more about psychographics in this web article and this one too. For our purposes, psychographics focuses on understanding how a person’s values, activities and interests shape their (typically consumer) decisions. For us, that means looking at how these values would likely influence whether they would participate in health research or not.
A psychographic framework for health research participation
Let us look at what makes up a psychographic framework. Patient Bond created a psychographic framework for health patients that includes five types of psychographic profiles (see figure 1).
As you can see from the framework, two types of psychographic profiles are proactive regarding their healthcare – Self-Achievers and Balance Seekers. Two psychographic profiles are more reactive – Direction Takers and Willful Endurers. The proactive and reactive nature of the profiles has tangible implications for how people in those groups are likely to respond to health care decisions and situations.
While these psychographic profiles were developed within a healthcare context, they may also apply to participation in health research. In fact, the proactive, self-achieving profile states that, “they stay on top of health issues with regular medical checkups, screenings, and research.” People from this profile should be amenable to hearing about a health research study, being actively interested in the nuances of consent, and willing to take time (if they have it) to provide answers and information about their health that could contribute to a study.
On the other end of the spectrum are the willful endures. Their participation in health research may be incredibly difficult, or even a non-starter. For these individuals, interacting with the healthcare system would not normally enter their minds. For them to engage with a health research study, the direct, tangible benefits must be stated up front and made immediately apparent.
A major theme and differentiator in the Patient Bond psychographic profiles is the degree of trust and credulity that people have in their doctors. A similar degree of trust and credulity can be applied to health research institutes and organizations. This likely plays a role in peoples’ willingness to actively partner with, take directions from, or refuse a health research study.
The method that Patient Bond uses for determining a person’s psychographic profile is to tabulate responses to survey questions based on much they agree or disagree with statements like the examples below. To improve your ability to engage effectively with underrepresented populations in both health research and digital adoption, you can incorporate their approach into your participant engagement strategies to better segment and predict how likely those individuals are to participate. Here are some examples of questions that they ask:
We often use these questions and psychographic methodology in the health research technology studies that we are conducting. As a health researcher, if you are also considering using psychographic profiles to augment your recruitment efforts, keep in mind that it is a journey that requires alterations and course correction along the way. Psychographics is not an exact science, though in many studies it has helped to improve participant recruitment methods. Psychographic methods should augment and help focus research participant recruitment strategies to improve representation and health diversity across demographic and socioeconomic categories.
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