Health Mindsets: How Attitudes and Beliefs Impact the Way Consumers Engage with Healthcare

Consumers are more engaged with their healthcare than ever before. At least, that’s the assumption. Certainly, it’s what recent changes in the healthcare system have come to demand. And, with the profusion of digital tools and resources for finding health information and quantifying the health-related aspects of the self, it is hard not to see increased engagement as a natural outgrowth of the information age—a sign of the liberation of the consumer afforded by social media, the Internet, and the overall relentless pace of technological advances.

But how are consumers engaging with their healthcare in today’s environment? More importantly, what drives engagement, and what hinders motivation or ability to engage? The behavioral science literature points to attitudes, beliefs, and behaviors that are known to lead to better health outcomes. This includes everything from following the doctor’s advice on medication adherence to believing one can be effective at various aspects of health self-management. But, do these beliefs and attitudes align to produce the kind of consumer that marketers desire and that the healthcare system expects?

At Syneos Health Communications, our Behavioral Science team partnered with one of our ad agencies, GSW, to conduct a consumer survey exploring these questions.

Contrary to the expectation that “engaged with information = engaged with healthcare,” our online survey of 515 American consumers points to a divide in the way consumers are oriented toward their health that can cause this equation to break down. Broadly speaking, individuals across the spectrum of attitudes and behaviors place a high value on preserving their health. But no one group fits the anticipated ideal of healthcare product or service marketers, who sometimes take the above equation for granted.

The divide comes down to the presence among consumers of two broad, opposing health mindsets—constellations of beliefs and attitudes that can facilitate or hinder health behavior, depending on the situation. On one side, we find what might be called invested individualists, who generally have positive attitudes toward the healthcare system, are confident about what needs to be done, and are self-starters when it comes to seeking care. On the other side of the divide, we find mildly defiant or disaffected communitarians, with a more negative attitude toward the healthcare system and an appetite for alternatives. In lieu of mainstream medical experts, they turn to family, friends, and their local communities for health-related recommendations.

These mindsets—invested versus disaffected, individualist versus communitarian—summon the limitations of any binary classification scheme. They are no more crystalline or foolproof than distinctions such as “extroverts” and “introverts,” or “optimists” and “pessimists.” But, like these other polarities, the health mindsets we’ve identified are predictive: They tell us who is likely to engage with what variety of outreach as the individual travels the health behavior journey from information-gathering to treatment and back again. In particular, the two mindsets help explain why some consumers who are highly wired and information-seeking may still fail to engage effectively with modern medicine, while others who fit the model of the confident, individualistic patient who is ready, willing, and able to engage head-on with modern medicine may not be heavy users of digital information.

We then wanted to know which consumers were described by which of the two mindsets. Specifically, we hoped to identify which consumers have the fiercely confident, “take charge” mindset that makes them willing-and-able equal partners with modern medicine.

What we discovered is that these mindsets track with observable consumer segments, doing so in ways that further reinforce the gap between healthcare-system engagement and healthinformation use. This becomes particularly clear when we look at how the mindsets track with consumers’ age. Counter to expectations, we find it is the older, less tech-savvy consumers who prove to be more engaged with modern medicine. And we find that the way the mindsets distribute across the age groups parallels this difference in engagement. Similar patterns emerge, albeit in slightly more complex ways, when looking at other group differences, such as those involving gender or caregiver status.

The upshot is that, by mapping these mindsets to identifiable consumer segments, it becomes possible to leverage them in targeted marketing interventions. By knowing which segments are described by which mindsets, marketers are empowered to address each segment’s unique sensibilities on their own terms, rather than marketing to a single, potentially unfounded ideal consumer. And, when analyzed through our evidence-based behavioral lens, the mindsets provide actionable clues for what marketers can say and offer—and where and how they should do it—to encourage desired forms of engagement.

On the left are the invested individualists, with a mindset that bespeaks confidence and independence. Relative to other consumers, people who have this mindset believe that they have the ability to engage effectively with the healthcare system and to manage their health. They are less likely than others to see their health as being due to factors outside their personal determination and will, and are more likely to listen to their own inner voices when making decisions about their health. Yet, rather than taking their independence to an extreme, they are more likely to want healthcare decisions to occur in collaboration with their doctors— a preference that fits the consumer who values the opinion of medical practitioners while being sufficiently self-confident to engage with them as equal partners.

Contrasting with this is the more skeptical, family-centric mindset that appears on the right. Compared with other consumers, those we are calling disaffected communitarians are more wary of the medical system. They believe that healthcare providers are condescending and put profits before people, that vaccines are potentially unsafe, and that the healthcare system is biased against people like them. They are more likely to believe their health is due to external factors, such as luck, God, and the choices of other people. They are also less likely to be confident in their ability to be effective in a number of key health behavior domains, such as following a doctor’s orders and getting social support for their care, and are more likely to defer to family members in health decisions. Yet, despite all of this, they prefer not to defer to HCPs or work with them in equal partnership when it comes to decisions about treatment. Instead, they are more likely to want to be the final arbiters on treatment choices—something that looks more defensive than empowered when considered in the context of their other beliefs and attitudes.

What is important about these mindsets is that they are not just constellations of beliefs and attitudes that happen to cluster together when consumers are queried about them. Rather, they are behaviorally meaningful, having relationships to self-reported behavior that are relevant to healthcare marketing. In particular, the attitudes and beliefs that characterize invested individualists are associated with greater self-reported medication adherence and engagement with the healthcare system for preventative and acute care needs. That is, they are associated with precisely the behaviors that are prerequisites for receiving and staying on the products that pharmaceutical manufacturers produce. By contrast, the attitudes and beliefs of our disaffected communitarians are associated with a greater tendency to manage one’s health through everyday diet and exercise, to turn to the Internet, pharmacists, or friends and family for advice when sick or injured, and to seek out alternative or homeopathic treatments to address acute care needs—all while being associated with lower levels of medication adherence and healthcare system engagement across the board.

And it is not just with respect to self-care and system engagement that these mindsets turn out to be behaviorally relevant. They also have important associations with where people choose to turn for health information—key to understanding the channels through which people can be reached. Not surprisingly, invested individualists are more likely than others to turn to their healthcare providers for health information, but they are also less likely than others to rely on friends and family, healthcare-related stories in the news, or health information encountered on digital and social media, to obtain information relevant to their health. The opposite is true for the more defiant communitarian camp.

That these mindsets should relate to self-reported health behavior in the way just described is, in our view, no accident. In a world of ever-expanding options where patients are expected to take greater responsibility for their healthcare, the best-equipped consumers are those who believe they have control over their health, and have a measure of faith in the healthcare system, so they can pursue what the system offers and take action on the available options. Indeed, research shows that patients who are activated—that is, who take an active role in health decision-making, and who can do things like navigate the healthcare system and choose providers—are more likely to be adherent to medication and to experience better health outcomes. They are also more likely to believe they can control their health, and to have positive feelings about key system stakeholders such as their healthcare providers.1,2 It is no surprise, then, that communitarians should disengage with the healthcare system, or have poorer rates of medication adherence, relative to those we call individualists. It is also no surprise the individualists should show lower rates of reliance on digital and social channels for health information, since they may already have HCPs who are meeting many of their healthcare information needs, reducing the urge to consult WebMD or other media. The opposite can be said for communitarians, for whom other channels may be more appealing precisely because of their disengagement with the medical system.

Therefore, what makes differentiation of these mindsets valuable from a marketing perspective is that recognizing the difference helps clarify what kinds of behavioral patterns we should expect from consumers, and may even improve the healthcare marketer’s ability to reach and engage them. Specifically, by knowing which consumers have which mindset, marketers may be able to anticipate where they are likely to turn for health information, or how likely they are to adhere to medication. Marketers may also gain valuable insights about the channels they should use to reach the consumer and the behavioral gaps they must address if their marketing is to be effective. Even more critically, the mindsets themselves provide vital clues for how to intervene, whether by illuminating beliefs and attitudes that might be influenced directly by marketing or, at a minimum, suggesting ways in which messaging can be crafted to make it more resonant.

Yet, for all of this to have practical value, marketers must have a way to identify which groups of consumers have which mindsets. Ideally, this would be based on markers that are readily accessible, such as those involving demographics or observable behaviors indicative of group membership.

Fortunately, our survey reveals that these mindsets do, indeed, track with at least some easily observable demographic splits. And perhaps nowhere do we find this to be clearer than when it comes to consumers’ age.

To begin, consider the differences in self-reported behavior that exist between consumers under the age of 45 and those who are 45 or older. Relative to their older counterparts, younger consumers are flexible and expansive: They are more likely to cite a broad range of channels, from digital and traditional media to close friends and family, as sources they often rely upon for health information. They consult HCPs when they have acute medical issues, but are also more likely to explore these other options. Evidence suggests they are also more likely to use alternative or homeopathic treatments to meet those needs. In our survey, this stands in contrast to older consumers, who, by a margin of 67% to younger consumers’ 45%, are much more likely to say that they go straight to HCPs for acute treatment.

On the other hand, older consumers are not just more likely to turn to doctors when sick or injured; they are also more likely to report going to doctors for screenings and other routine care needs, such as dental checkups and eye exams. Older consumers cite these behaviors at rates between 59% and 69%, in contrast with younger consumers who do so at rates between 36% and 54%. Older consumers also appear to have the highest level of medication adherence, reporting taking their medication as directed or promptly refilling it at least 86% of the time on average. By contrast, younger consumers report taking their medication as directed, or promptly refilling it, less than 60% of the time on average.

These behavioral patterns do not fit the idea that older patients tend to be less agentive, nor the idea that “engaged with information = engaged with healthcare.” Yet, they are exactly what one would expect if invested individuals are predominant in the older group and disaffected communitarians make up the greater part of the younger cohort. And it is exactly that association between mindsets and age groups that we find. Age Differences in Mindsets and Health Behavior: An Illustrative Example 8 HEALTH MINDSET REPORT 2018 Older consumers may be persuadable, but they may need tools and resources to help them respond effectively to calls to action.

Younger consumers’ attitudes toward the medical system are deeply conflicted. They believe by wide margins (> 70%) that the best treatments are the ones that have been scientifically tested, and that doctors have specialized knowledge that patients should listen to. Yet, roughly one in two of them say that healthcare providers put profits before people (56%), that doctors tend to be condescending toward patients (51%), and that the healthcare system is biased against them (47%). This stands in contrast to older consumers, who endorse these negative beliefs at rates less than 25%.

Likewise, a firm majority of younger consumers (a little over 61%) believes pharmaceutical companies are important to bringing about the best possible treatments—yet nearly one in two also say that there are good reasons to believe that vaccines are not safe. Again, the contrast is with older consumers, only 21% of whom express skepticism of vaccines.

Younger consumers also have beliefs that can get in the way of self-care. Although more than 8 in 10 believe that they are directly responsible in some way for whether their health gets better or worse, 48% to 60% of them believe that their health is controlled by forces external to them, such as luck, the choices of other people, or God’s will. They also have, on average, only modest confidence in their ability to effectively do the things they need to do to manage their health—none of which is true of older consumers.

Lastly, the groups diverge on who they say influences their decisions about their health. Asked whether they would defer to others in their family when making health decisions, only 10% of older consumers said that their willingness to accept a doctor’s recommendation would depend on what their family had to say about it, while only seven in 100 said they’d choose an option that would please their family but not themselves. This contrasts with younger consumers, over 43% of whom say that they would defer in these ways to the desires of their family members. Yet, 36% of older consumers say that they’d like treatment decisions to be made with their doctor as a co-partner, while only 18% of younger consumers say the same thing. Not surprisingly, older consumers are more likely to endorse beliefs that support proactive patient communication, such as saying that it is important to tell doctors about their eating and exercise habits, or whether they have a stressful job.

These statistics do not imply that a given mindset describes everyone who belongs in a particular age group. As noted earlier, 21% of older consumers say that there are good reasons to question the safety of vaccines—much lower than the 48% of younger consumers who say this, but still leaving one in five older consumers with this attitude. Moreover, mindsets vary within the age groups by other demographics such as income, making it clear that they are not just another reflection of the well-worn “generational divide.”

Yet it’s clear that the two health mindsets track with groups in ways that are consistent with their overall patterns of self-reported health behavior. And that tracking occurs closely enough to provide an opening for the marketer who wishes to market to each group on its own terms rather than attempt to market to an even fuzzier global average.

Our survey suggests that the key to understanding differences in health behavior lies with consumers’ underlying health mindsets, and that these mindsets should be taken seriously as key drivers of health engagement. It also points the way toward things marketers can do to increase engagement within the different groups, such as those defined by age.

To illustrate, consider older consumers. Clearly, they have the mindset to be engaged. Yet the fact that they might be primed to engage with the healthcare system does not necessarily mean that they know how to do it. They may be persuadable, but they may need tools and resources to help them respond effectively to calls to action. These resources should resonate with older consumers precisely because they enable them to carry through on their desire to engage. They can be digitally-based, but they should not be exclusively so.

Now consider younger consumers. They are channel-diverse, both in terms of how they acquire information and where they go to for care, which should make it easier to reach them. Yet they also appear to have beliefs and attitudes that get in the way of their ability to be engaged. That said, although our research shows they are skeptical, it also shows that they see the world in shades of grey as opposed to being entirely closed-minded. This actually puts them in a position of being willing to “hear you out,” provided you bring the right arguments to the table. It may even make them uniquely open to persuasion through cool, rational argumentation, as opposed to simpler yet highly emotive arguments that might come across to them as “slick” and manipulative.

This means more than just looking at social networks as an aspect of younger consumers’ digital life that can be used as a channel for message dissemination. Given young people’s proclivity to have family influence their healthcare decision-making, messages directed at the family members of young adults may ultimately nudge them to engage more effectively with the system. In fact, a social-centric marketing strategy that brings the target audience’s social unit into the conversation, or connects health decisions to consequences for others, may be far more effective than one that emphasizes messages and tools designed around a “can do” ethos, or that includes appeals to willpower and individual initiative.

In sum, what marketers can do is meet each of these groups on their turf, speak to them on their terms, and provide them with tools and experiences that fit with their existing attitudes and behavioral tendencies. We believe that this holistic approach to the consumer has a vital role to play in making marketing successful, and that an understanding of the mindsets of consumers can make a key contribution to that effort.