Pan European Health Study 2009 InSites Consulting

Pan-European Health Study 2009

InSites Consulting, Taking Health Research Forward
Magali Geens, Director Health Research
Magali.Geens@insites.eu, T +32 9 269 16 04, M +32 497 523 526

May 2009

PAN-EUROPEAN HEALTH STUDY
PATIENT STUDY in 7 EUROPEAN COUNTRIES, 2ND EDITION
Edition 2008:
1.400 consumers (18+), representative total country population.
Data collected on proprietary research panels from InSites Consulting, field in the summer of 2008.

Edition 2009:
2.800 consumers (18+), representative total country population.
Data collected on proprietary research panels from InSites Consulting, field in the spring of 2009.

Online data collection
on proprietary
research panels by
InSites Consulting
© InSites Consulting

Pan-European Health Study, © InSites Consulting, 2009. 2

2008
2008 Edition
Content – freely available on request

Do we manage to control our Patients have massively discovered
weight? What happened to sports? the internet as a source for health-
How many suffer chronic pain? Is related information. Do patients act
depression a problem in Europe? as doctor now with the help of
How healthy are we actually? ... Doctor Google? ...

I have stress, you have stress, we Are we on prescription drugs? What
all have stress!!!!!!!!!! And we about generic alternatives? What
mainly blame our jobs. How close is medication do we keep in our
Europe to a total burn-out? What do home pharmacy? Which medication
people do to relax these days? ... do we pack to go on holiday? ...

Are we too fat? Or are some too „And me‟ is all about personal
skinny maybe? And if people face hygiene. What products do we
weight problems, are they also use, do we buy them in the
acknowledged? Learn about popular supermarket or the pharmacy, how
diets across Europe and more ... much do we spend on them ...

Do we all have a personal general Do you want us to tell the story live?
physician? What is (s)he like? Have we raised certain questions
How often do visit them? Do you would like to ask us? Our
Europeans trust their GP? And how contact details are included and
well do GP‟s know their patients? ... we are happy to pay you a visit.

Pan-European Health Study, © InSites Consulting, 2009.
2008. 3

2009
2009 Edition
Content of this report

89% of the 2.841 participants report On average 1 in 5 patients does not
having been ill during the past year. follow any kind of treatment.
What is the prevalence of Mostly treatment also involves
various acute and chronic disorders medication. Also diets are adapted
across Europe? In which countries... and physical exercise increased....

Obviously not all patients are alike. What is the relationship with the
By means of factor analysis and a physician like? Do different patient
three-dimensional segmentation, 4 segments have a different level of
distinct patient segments confidence in their GP?
were brought alive. We present... Do patients follow the advice?...

When people get sick, they can do When do patients go the pharmacy?
different things: look in the home How do they make choices? What is
pharmacy, visit the GP, address an the influence of a pharmacist?
SP, go to the pharmacy, etc. Learn Do patients ask for the pharmacist‟s
about the patient action flow... advice? Do pharmacists actively...

The obvious first step for patients is What are drivers and barriers for
to look for information. The compliance to treatment?
internet, friends and family, health Does compliance differ between
encyclopedia... The sources are patient segments? What is the
diverse and usage differs between...

influence of health professionals...


2009
2009 Edition
More on the methodology

Fieldwork
Countries: UK, Germany, France, Italy, Spain, Netherlands, Belgium
Online quantitative survey
Data collection period: March 2009

Sample size
+/- 400 respondents per country
Recruited from the InSites Consulting consumer panel (TalkToChange Panel, > 2.5 million consumers)
Error margin results: 4%

Sample composition
Screener criteria: adults
Quota criteria: representative for the total population in terms of gender and age per country

Word version of the questionnaire (English version):

Icon legend used throughout the report
Significant difference (95% confidence):
Be careful with interpretation: counts in a sub-cell are below 30:


2009
2009 Edition
How healthy is the European?







2008
In 2008 we have learned that...

NOT
WE ARE
SOHEALTHY
Less than 50% says to have a HEALTHY life-style
At least 40% admits to have OVERWEIGHT

On average 30% indicates CHRONIC PAIN

Around 20% is DEPRESSED occasionally

Up to 10% is DIABETIC

Pan-European Health Study, © InSites Consulting, 2009.
2008. 7

2009
In 2009 we have measured that...

89%
of all participants has been
sick during the past year

N Europe = 2841 / Filter = None


2009
Prevalence
Acute and chronic / recurrent

89%
of all participants has been
sick during the past year

Headache 22% Headache 27%

Allergy 19% Influenza 14%
CHRONIC /
Hypertension 17% RECURRENT Muscle ache 14%

Stress 14% CHRONIC / AND Allergy 12%
RECURRENT ACUTE ACUTE
Sleeping disorder 13% Stress 12%

Muscle ache 13%

Obesity 12%
16% 66% 6% Sleeping
disorder 11%

Heartburn 10%
Migraine11%
Migraine 9%
Depression 10%
High blood
Influenza 10%
pressure 7%
Heartburn 9%
Stomach problems 7%
High cholesterol 9% Herpes labialis 6%

Anxiety 8% ...
... N Europe = 2841 / Filter = None


2009 Headache 22%

Allergy 22%

Headache 22% Influenza 16% Allergy 22%

High blood pressure 21% Muscle ache12% High blood pressure 22%

Depression 20% High blood pressure 11% Influenza 16%
Stress 15%
Stress 19%
Headache 13%
Asthma 17%
N United Kingdom
= 401 N Netherlands
= 401

N Belgium
= 405
Heartburn 17% Overview
chronic
Headache 16% N Germany diseases
CHRONIC / = 400
Allergy 15%
RECURRENT
High blood pressure 12%

Obesity 12% 82% Allergy 23%

N France High blood pressure 19%
N Italy
= 408 = 417
Influenza 15%
Headache 25% Allergy 21%
High cholesterol 14%
Heartburn 20% Muscle ache 18%
Headache 13%
Allergy 17% Obesity 16%

Sleeping disorder 16% Heartburn 16%
N Spain Sleeping disorder 16%
Muscle ache 16%

= 409



2009 Headache 25%

Influenza 20%

Headache 24% Muscle ache17% Headache 33%

Stress 11% Allergy 13% Influenza 19%

Muscle ache 8% Stress 10% Stress 13%

Sleeping disorder 8% Allergy 13%

Heartburn 8% High blood pressure 10%

N United Kingdom
= 401 N Netherlands
= 401

N Belgium
= 405
Headache 22%
Overview
acute diseases
Heartburn 20% N Germany
= 400
Stress 17%
ACUTE
Muscle ache 15%

Allergy 13% 72% Influenza 29%

N France Headache 20%
N Italy
= 1073
408 = 417
Muscle ache 14%
Headache 35% Muscle ache 24%
Migraine 12%
Heartburn 22% Heartburn 23%
Allergy 10%
Muscle ache 19% Allergy 19%

Sleeping disorder 15% Headache 19%
N Spain Stress 16%
Stress 13%

= 409



2009
2009 Edition
Are all patients alike?







2009

BUT ARE THEY
ALL ALIKE?


2009
Different patient segments
Factor analysis: 3 important segmentation dimensions

Factor analysis

What is it?
Factor analysis is a procedure for data simplification through reducing the rating scales to a smaller set of factors or
composite variables by identifying dimensions underlying the data.

How was it measured?
In the survey we asked each respondent to rate 11 statements regarding health on a scale from 1 to 5. Via factor
analysis, we reduced the total set of over 11 statements to 3 underlying factors.

How to interpret?
On the next slide you will see the extracted factors and the different items belonging to each factor. The “alpha-
scores” assess the reliability of the different items that measure each underlying factor. The α-scores are values
between 0 and 1. The higher the α-scores, the more reliable the underlying factor is.


2009
Factor analysis: 3 important segmentation dimensions

Q :To what extent do you agree with the following statements?

Healthy life-style (alpha = .81)

I have a healthy lifestyle
I have healthy eating habits
I get sufficient physical exercise
Friends see me as a person who highly values a healthy way of life

Health involvement (alpha = .72)
I go to the doctor every year for a check-up
I regularly enquire about health-related matters
I collect health-related information
I influence my family and friends when it comes to health-related matters

Alternative viewpoint (alpha = .59)
I think natural products are better
I believe prevention is better than cure
I would more likely change my eating habits and lifestyle than take medication to tackle medical problems


2009
3-dimensional patient segmentation

Clustering

What is it?
Cluster analysis is an explorative classification method to sort respondents into a limited number of groups (= clusters),
so that the degree of association is strong between members of the same cluster and weak between members of
different clusters. To determine the ideal number of groups, hierarchical cluster analysis (Ward‟s mean) was used. To
allocate each respondent to a cluster, we used K-Means clustering. Note that standardized scores were used. As they
are hard to interpret, color codes are reported instead.

How was it measured?
As input for our segmentation we used the scores of all respondents on the 3 different factors (created via a factor
analysis on the 11 statements of health). The factors were standardized to eliminate the response behavior of the
respondents.

How to interpret?
Via cluster analysis, we discovered 4 segments. On the next slide we mapped our 4 segments on the 3 factors that are
the most discriminating between the segments in a 3-dimensional field. Each bubble stands for a particular segment.
The percentage within the bubble indicates the segment size. On the next slides, we described the different segments
on their factor scores and other relevant variables (e.g. socio-demographic profile).


2009
3-dimensional patient segmentation

Healthy Laidback
21% Health Conscious

Alternative
Non-Conformist
24% NonConfirmist
Expert
29% Expert

Involvement

Hedonist
25% Hedonist of life


2009
Meet the NON-CONFORMISTS

Non-Conformist

24% Healthy Laidback

Alternative
24% NonConfirmist
Expert
29% Expert

Involvement

Hedonist

N Non-Conformists= 634


Meet ‘the’ patient
2009
Meet the NON-CONFORMISTS

Un-healthy life-style, bad eating habits, little to no physical exercise
No regular doctor‟s visit, no health reference for friends and family
They say they would rather change habits than take medication

24% Healthy Laidback

They are more likely ...

Alternative
24% NonConfirmist
29% Expert
Gender 56% Female
Age <34
Country France / Italy
Income Lower Income
Household size Average
Involvement
BMI Overweight
Smokers Smokers
Stress Level High
Visit Frequency GP Only if necessary

Hedonist

N Non-Conformists= 634


2009
Meet the HEALTY LAIDBACK

21%

Healthy Laidback

Alternative
Non-Conformist
24% NonConfirmist
Expert
29% Expert

Involvement

Hedonist

N Healthy Laidback = 654


2009
Meet the HEALTHY LAIDBACK

Healthy life-style and eating habits and lots of physical exercise
But they are little involved in health because they have no need to worry
Prevent is better rather than cure 21% and natural products are better

Healthy Laidback


Alternative
Non-Conformist
24% NonConfirmist
Expert
29% Expert
Gender 59% Male
Age Equal Spread
Country Netherlands / France / UK
Income Higher Income
Household size Average
Involvement
BMI Normal
Smokers Mix
Stress Level Low

Hedonist

N Healthy Laidback = 654


2009
Meet the EXPERTS

Healthy Laidback
21% Health Conscious 29%

Alternative
Non-Conformist
24% NonConfirmist
29% Expert

Expert

Involvement

Hedonist

N Experts = 835


2009
Meet the EXPERTS

Healthy life-style, healthy eating habits, physically active and go to the doctor for a yearly check-up
Highly involved in health, inquire about health and collect health information
Believe in prevention, but natural product are not necessarily better

Healthy Laidback

Alternative
Non-Conformist
24% NonConfirmist
Gender 58% Female 29% Expert

Age 55+ Expert
Country Germany / Spain / Italy
Income Higher Income
Household size Small
Involvement
BMI Normal
Smokers Non Smokers
Stress Level Average
Visit Frequency GP Frequent

Hedonist

N Experts = 835


2009
Meet the HEDONISTS OF LIFE

Healthy Laidback

Alternative
Non-Conformist
24% NonConfirmist
Expert
29% Expert

Involvement

Hedonist
Hedonist of life

25%

N Hedonists of Life = 714


2009
Meet the HEDONISTS OF LIFE

They do not highly value a healthy way of living, but they do not feel particularly unhealthy either
They are not a health reference for their surroundings, but do search for health info when needed
They are not prevention-oriented and take medication whenever necessary to feel better

Healthy Laidback

Alternative
Non-Conformist
24% NonConfirmist
They are more likely ... Expert
29% Expert

Gender Male/Female
Age <34
Country Netherlands/Germany
Income Lower Income
Involvement
Household size Small
BMI Normal / Overweight
Smokers Smokers
Stress Level Average

Hedonist
Hedonist of life

25%

N Hedonists of Life = 714


2009
Distribution across the countries

Belgium 21% 24% 29% 26%

Netherlands 10% 37% 32% 20%

France 27% 25% 20% 27%

Germany 21% 16% 36% 28%

Span 25% 20% 19% 36%

Italy 28% 16% 21% 35%

UK 23% 28% 24% 25%

NON-CONFORMISTS HEALTHY LAIDBACK HEDONISTS OF LIFE
Nonconformist Health conscious Hedonist Health Expert
EXPERTS

2
9
%
Significant differences between the countries (95%).

2009
What is their typical profile?

Where are the
Non-conformists Healthy laidback Hedonists of life Experts
older people?
(24%) (21%) (25%) (29%)
Where are the
smokers?...
Find out here:

Gender 56% Female 59% Male Equal spread 58% Female

Age < 34 Equal spread < 34 55+

Country France / Italy Netherlands / France / UK Netherlands / Germany Germany / Spain / Italy

Income Lower income Higher income Lower income Higher income

Household size Average Average Small Small

BMI Overweight Normal Normal / Overweight Normal

Smokers Smokers Mix Smokers Non-smokers

Stress level High Low Average Average

Visit frequency GP Only if necessary Only if necessary Only if necessary Frequent


2009
Headache 30% HEALTHY LAIDBACK
Headache 23%
Muscle ache 19%
Influenza 12%
Stress 17%
Muscle ache 11%
Sleeping disorder 14%
Heartburn 10%
Heartburn 14%
21% Allergy 9%

24%

Alternative
24% NonConfirmist
29% Expert

EXPERTS
NON-CONFORMISTS
Allergy 23%

Involvement High blood pressure 21%

Headache 19%

Muscle ache 15%
HEDONISTS OF LIFE
Stress 12%

Headache 28%
CHRONIC / Allergy 18%
25% Hedonist
RECURRENT N Non Conformist = 634
N healthy laidback = 654
25% High blood pressure 18%

82%

N Hedonist of Life = 714
Stress 16% N Expert =835
F = No filter applied
Migraine 16%

2009
Headache 23% HEALTHY LAIDBACK
Headache 17%
Stress 19%
Allergy 17%
Obesity 18%
Sleeping disorder 10%
Allergy 17%
21% Stress 9%

24%

Alternative
24% NonConfirmist
29% Expert

EXPERTS
NON-CONFORMISTS
Allergy 23%

Involvement High blood pressure 21%

Headache 19%

Allergy 14%
HEDONISTS OF LIFE
Stress 12%

Headache 30%

Influenza 14%
ACUTE 25% Hedonist
N Non conformist = 634
N healthy laidback = 654
25% Allergy 13%

72%

N Hedonist of Life = 714
Migraine 12% N Expert =835
F = No filter applied
Stress 12%

2009
2009 Edition
What is the patient action flow?







2009

WHAT DO PATIENTS
DO FIRST WHEN
THEY ARE SICK?


2009
Flow of action
What do patients do?

Q : What were the consecutive actions you undertook after you discovered you suffered from your disorder?

Please drag and drop the consequent actions you undertook in the order you
undertook the actions. Of course it is possible to use the actions multiple times.

I waited some time without doing a thing 1
I looked for information myself 2
I looked in the home pharmacy
3
I went to the pharmacy
4
I went to the general physician (GP)
5
I went to the specialist physician (SP)
I did something else (I‟ll specify later) 6
I did nothing ...



2009
Flow of action

Before undertaking any action, they
FIRST WAIT FOR A WHILE…
The large majority of patients waits!

In the action flows that are outlined
on the following pages, “waiting” is
not reported as it is not distinguishing
between segments, countries or ages.



2009
Flow of action

Q : What were the consecutive actions you undertook after you discovered you suffered from your disorder?

Looked for information This flow shows – for each
step, the action with the
highest frequency.
General Practitioner
We have considered on an
overall level all frequencies of
Pharmacy each action in each step, and
retained the action with the
highest frequency in each step.
General Practitioner E.g. “information search” received the
highest frequency score in step 1 if
„waiting‟ was not taken into account.

Special Practitioner More information in the Excel file below:

Flow of actions
EU total
Something Else



2009
Flow of action
Flow of actions
Q : What were the consecutive actions you undertook after you discovered you suffered from your disorder? Country split

Looked for
Home Looked for General Looked for Looked for
information/ Home Pharmacy
Pharmacy information Practitioner information information
Home Pharmacy

Special
General General Special General
Practitioner / Pharmacy Pharmacy
Practitioner Practitioner Practitioner Practitioner
Pharmacy

Special
General General Special Looked for
Practitioner / Pharmacy Pharmacy
practitioner Practitioner Practitioner information
Pharmacy

Special General Special Looked for
Pharmacy Pharmacy Something Else
Practitioner Practitioner Practitioner information

Special Special General Special
Something Else Something Else Pharmacy
Practitioner Practitioner Practitioner Practioner

Special Special
Something Else Pharmacy Something Else Something Else Something Else
Practitioner Practitioner

N Belgium = 405 / N Netherlands = 401/ N France = 408/ N Germany = 400 / N Spain = 409 / N Italy = 417 / N United Kingdom = 401


2009
Flow of action

Flow of actions 18-24 25-34 35-44 45-54 55-64 65+
Age split

Looked for Looked for Looked for Looked for Looked for Looked for General
information information information information information information Practitioner

General
General General General General General
Pharmacy Practitioner /
Practitioner Practitioner Practitioner Practitioner Practitioner
Pharmacy

Special General
Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy
practitioner practitioner

General Special
Special General General General
Practitioner Pharmacy practitioner /
practitioner Practitioner Practitioner Practitioner
Pharmacy

Special I did something Special Special Special Special Special
practitioner else practitioner practitioner practitioner practitioner practitioner

Something Special
Something else Something else Something else Something else Something else

else practitioner


2009
Flow of action
What do patients do? NON-CONFORMISTS HEALTHY LAIDBACK HEDONISTS OF LIFE EXPERTS

Flow of actions
Segment split

Looked for Looked for Looked for
information information information Home Pharmacy Looked for information

General Pharmacy /
Practitioner General General General
General
Practitioner Practitioner Practitioner
Practitioner

Pharmacy General Information / Pharmacy
Pharmacy Pharmacy
Practitioner / Specialist

General General
General Pharmacy Pharmacy Practitioner Practitioner
Practitioner

Specialist / Specialist Specialist
Specialist
Special Something Else
practitioner

Something Specialist Specialist Something Else Something Else

else


2009
Flow of action
What do patients do in France?

TOTAL

General Looked for General
practitioner Home Pharmacy Home Pharmacy
information Practitioner

General
practitioner General General Pharmacy Pharmacy

General General General General
practitioner Home Pharmacy
Practitioner Practitioner Practitioner

Pharmacy Pharmacy Pharmacy Waited some time
Pharmacy

Something Else Something Else Specialist Specialist
Something else

Special Specialist Waited some time Something Else Something Else

practitioner

N Non conformist = 116 / N Healthy Laidback =92 / N Hedonist of Life = 68 / N Expert = 130 / F = No filter applied

2009
Flow of action
What do patients do in Germany?

TOTAL

Looked for
information/ General Looked for
Home Pharmacy Home Pharmacy
Pharmacy Practitioner information

Pharmacy General
Home Pharmacy Pharmacy Pharmacy
Practitioner

Pharmacy Looked for
Something Else Something Else Pharmacy
Information / Pharmacy

General General General
General Pharmacy Practitioner Practitioner
Practitioner
practitioner

Looked for
Specialist Specialist Specialist
Special information
practitioner

Something Else Waited some time Something Else Something Else
Something else

N Non conformist = 90 / N Healthy Laidback = 61 / N Hedonist of Life = 149 / N Expert = 100 / F = No filter applied

2009
Flow of action
What do patients do in Spain?

TOTAL

Home Pharmacy Looked for
Home Pharmacy Home Pharmacy Specialist
information

Pharmacy General General Practitioner
Pharmacy Pharmacy
Practitioner / Specialist

Special Looked for
Practitioner Specialist Waited some time Specialist
information

General General Something Else Specialist
Something else Practitioner Practitioner

General Looked for
Specialist Specialist Practitioner information
General
Practitioner

Special Pharmacy / Specialist Something Else
Waited some time
Specialist

Practitioner


2009
Flow of action
What do patients do in Italy?

TOTAL

Looked for Looked for Looked for Looked for
information information information Home Pharmacy
information

Special
Practitioner General General
Specialist Something Else

Pharmacy Pharmacy Pharmacy Pharmacy Specialist

General
Looked for Practitioner / Pharmacy
Special Specialist
information Something Else
Practitioner

Looked for
Something Else Specialist Specialist
Special information
practitioner

Something Else Waited some time Something Else Something Else
Something else


2009
Flow of action
What do patients do in the UK?

TOTAL

Looked for Looked for Looked for Looked for Looked for
information information information information information

General
Practitioner General General Looked for
Specialist Practitioner information
Practitioner

Looked for Looked for
information Home Pharmacy Specialist Pharmacy
information

Looked for Specialist Something Else
Looked for Pharmacy
information
information

General Pharmacy Pharmacy
Specialist
Practitioner
Pharmacy

Looked for
Specialist Specialist Something Else
Something else information

N Non conformist = 232 / N health conscious = 299 / N Hedonist= 249 / N Expert = 268 / F = No filter applied

2009
Flow of action
What do patients do in the Netherlands?

TOTAL

Looked for Looked for Looked for General
information information information Home Pharmacy
Practitioner

General Looked for
Practitioner Looked for General
Home Pharmacy information / information Practitioner
Specialist

Special
Practitioner/ General Looked for
Specialist Pharmacy
Pharmacy Practitioner information

General Pharmacy Something Else
Pharmacy
Pharmacy Practitioner

General General
Something Else Practitioner / Something Else
Practitioner
Something else Specialist

Pharmacy Specialist Waited some time Pharmacy
Pharmacy


2009
Flow of action
What do patients do in Belgium?

TOTAL

Home General
Pharmacy Home Pharmacy Home Pharmacy Home Pharmacy
Practitioner

Special
Practitioner/ General
Pharmacy Pharmacy Specialist Pharmacy
Practitioner

General General General General
Practitioner Pharmacy Practitioner Practitioner
Practitioner

Special Something else Specialist Specialist Specialist
Practitioner

Specialist Something Else Something Else Something Else
Special
Practitioner

General
Specialist Pharmacy Something Else
Something else Practitioner


2009
2009 Edition
Where do patients look for information?







2009


Pan European Health Study 2009 InSites Consulting

Pan European Health Study 2009 InSites Consulting

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