Patient engagement is often framed as a universal concept, assuming all patients require the same type of interaction with healthcare systems and pharmaceutical companies worldwide. However, engagement is deeply influenced by culture. Beliefs about health, medicine, and the role of pharmaceutical companies vary widely across societies, shaping how patients interact with healthcare providers, participate in clinical trials, and adhere to treatments.

Despite their global presence, pharmaceutical companies often fail to navigate cultural differences effectively. Many engagement strategies rely on a Western, one-size-fits-all approach that overlooks variations in healthcare beliefs, literacy levels, social norms, and economic conditions. These cultural variations are often invisible, part of the submerged three-quarters of the iceberg of culture: behaviours, practices, and beliefs that are subconsciously taught and acquired. Multi-country studies, such as cognitive debriefing, focus only on the visible part of the iceberg: language and phrasing. They do not often address deeper cultural structures.

What are some of these deeper cultural structures that patient engagement initiatives often fail to consider?

Health Beliefs and Traditional Medicine

Culture plays a crucial role in shaping how people perceive illness and treatment. While Western medicine dominates globally, traditional and alternative healing practices remain highly influential. In some societies, illness is viewed as an imbalance requiring spiritual or natural remedies rather than pharmaceutical intervention. Many patients opt for herbal medicine, acupuncture, or homeopathy as a first line of treatment, especially over expensive prescription drugs, which are often met with scepticism.

In many African, Asian, and Latin American communities, traditional healers hold more authority than medical doctors. Patients frequently seek their advice before or alongside pharmaceutical treatments. This sometimes creates conflicts between modern and traditional medicine. However, pharmaceutical companies often dismiss traditional medicine as outdated rather than exploring ways to integrate it with modern healthcare. Ignoring these cultural factors limits their ability to engage effectively with diverse patient populations.

The Role of Family and Community in Healthcare Decisions

Western engagement strategies assume direct interaction between pharmaceutical companies and individual patients, except in cases involving children, where caregivers are also engaged. However, in many cultures, healthcare decisions are not made by individuals alone but by families and communities. In India, China, and the Middle East, family members often play a central role in treatment decisions, particularly for older adults. Similarly, in Indigenous and collectivist societies, community leaders, religious figures, or local elders influence healthcare choices.

Pharmaceutical companies rarely engage with these key decision-makers, focusing instead on direct relationships with patients. This oversight weakens engagement efforts, as these broader social networks shape health-related behaviours and treatment adherence. This was evident in the acceptance and adoption of vaccination drives in non-Western societies, particularly during the COVID-19 pandemic. Without addressing these dynamics, engagement strategies risk being ineffective. It is interesting to me how, in the health promotion sphere, any kind of outreach or disease prevention initiative engages community leadership first, regardless of whether the activity is in London or Lagos. I do not understand how many pharmaceutical engagement initiatives fall short – precisely my point in an earlier article about ‘Linking Up The Silos’.

Language, Communication, and Health Literacy

Clear communication is critical for effective patient engagement, yet language barriers and varying literacy levels pose challenges. Many pharmaceutical materials use complex medical jargon that is poorly translated, making information unclear or misleading. Even when translated, materials often fail to consider cultural nuances or regional dialects. The quality of the source material also plays a role. Poorly written documents result in poor translations, regardless of the translator’s expertise, resulting in the old “garbage in, garbage out” effect.

It is also essential to understand a culture’s preferred method of receiving medical information. Some communities rely more on oral communication and storytelling than written materials, yet pharmaceutical companies rarely adapt their strategies. The same consent form used in Indiana is given to patients in Burundi, albeit translated, and equally as puzzling. In low-income areas where education levels are lower, patients often struggle to understand medical instructions. The lack of culturally appropriate patient education materials further reduces engagement and trust.

Mistrust in Pharmaceutical Companies

Historical exploitation, unethical medical practices, and healthcare inequalities have led to deep mistrust of pharmaceutical companies in many communities. Some groups, particularly those affected by unethical experiments such as the Tuskegee Syphilis Study and the lesser known syphilis study conducted on prisoners in Guatemala (Tuskegee’s little brother), remain sceptical of pharmaceutical interventions.

In post-colonial nations, Western pharmaceutical companies are sometimes viewed as extensions of past exploitation, leading to resistance against modern treatments. Drug pricing scandals and a lack of transparency reinforce the perception that pharmaceutical companies prioritise profits over patient well-being, making trust-building difficult. Further abuses, such as U.S. intelligence agents posing as polio vaccine health workers in Pakistan and Afghanistan in the late 2010s, have only deepened scepticism.

Addressing Cultural Barriers in Patient Engagement

To improve patient engagement, pharmaceutical companies must collaborate with local communities. Engaging traditional healers and religious leaders can bridge the gap between traditional and modern medicine, fostering trust. Local influencers and grassroots organisations also play a vital role in shaping public perceptions and encouraging healthcare participation.

Adapting communication strategies is essential. Pharmaceutical companies should develop health education materials that reflect local beliefs, languages, and communication styles. In regions with low literacy rates, visual and oral methods. This should include video content, radio broadcasts, and streamed community discussions that are often more effective than written materials.

Transparency is equally important. Acknowledging past medical injustices and outlining steps taken to prevent future harm can help rebuild trust. Clearly communicating drug costs, development processes, and clinical trial results fosters patient confidence in the industry.

Moving Towards True Cultural Competence

Pharmaceutical companies cannot claim to prioritise patient engagement while ignoring cultural realities. To connect with diverse populations, they must move beyond Western-centric models and develop culturally competent, localised strategies.

By respecting traditional medicine, improving health communication, and fostering trust through transparency, pharmaceutical companies can create more inclusive patient engagement strategies. In doing so, they will not only improve health outcomes but also strengthen their credibility within the communities they serve.

Thank you for getting this far!

Written by Mark Gibson

Boston, USA, November 2024