Let’s say I told you that we surveyed your peers, and 65% of them said that when they have a health concern, they usually go to the doctor with a preferred treatment in mind. Do you think this would influence your own attitude about going to the doctor with a treatment in mind? If you’re in the U.K., chances are it would—but if you’re a patient in Italy, not so much.


This is an example of social norms bias, the unconscious tendency to behave as you think others are behaving. We surveyed patients with chronic conditions across five markets in North America and Europe and found several differences in biased responses that have implications for pharma brand teams and their marketing strategies.


ZS studied how both cognitive biases, the simple rules the human brain uses to make decisions, and social norms bias influence behavior to guide brand teams in different markets toward success. One of the most common behaviors our healthcare clients are interested in is patient activation, inspiring patients to actively speak with their physicians about healthcare products. In a survey of 5,000 patients (five markets, 1,000 patients per market) we tested 12 well-known cognitive biases to see if they play a role in patient activation.


In one test, we studied how people reacted to social norms bias. Respondents were randomly assigned to either see showing that 65% of people say they go to the doctor with a treatment in mind, or to see nothing. Then everyone was asked whether they agree with the statement, “When I have a health concern, I usually go to the doctor with a preferred treatment in mind.” For patients who had seen the poll data:

  • U.K. agreement rose 21%
  • U.S. agreement rose 16%
  • Canada agreement rose 12%
  • In Germany and Italy, there was no difference in agreement between the people who saw the poll data and those who did not.

We also conducted a test on construal level theory, the idea that people are unconsciously more practical and likely to embrace near-term thinking when they think concretely and are more optimistic and future-oriented when they think abstractly. You can think about this as the difference between a doctor asking a patient, “Walk me through the last week” (concrete) and “How are you feeling?” (abstract).


For this test, we told respondents to imagine a patient, Ron, has diabetes. He and his doctor are discussing treatment options, and they each prefer different treatments. We then asked them to rate how likely Ron is to persuade his doctor to prescribe the treatment Ron prefers. Before we asked them to rate Ron’s success, we randomly assigned half of the respondents to describe why they think Ron would try to persuade his doctor (abstract), and the other half of respondents to describe how Ron would try to persuade his doctor (concrete).


Respondents in Italy and Germany thought Ron would be more successful when they were thinking in concrete terms (how). We found that estimates of success:

  • Increased by 7% in Italy
  • Increased by 5% in Germany
  • Respondents in the U.S., U.K. and Canada made the same estimates of success (no impact) regardless of whether they were thinking about it abstractly or concretely.

For brand teams seeking to lean into or circumvent cognitive biases and influence patient behaviors, these findings have clear implications:


In the U.S., U.K. and Canada:

  • Social norms: Tactics (polls, patient stories and implicit messages like “Many patients…”) and confirmation bias (doctor dialogue tools that ask, “Why would asking your doctor about this treatment be a good idea?”) should improve response, while in Germany and Italy we wouldn’t expect an impact.

For Germany and Italy:

  • Construal level theory: Should be explored in messaging and tactics that elicit concrete thinking – for example, disease state education that focuses more on how a patient would talk to their doctor about a symptom or treatment.

Globally, there are many ways that marketers can and do leverage social norms bias if it is present in their market. Consider the following:

  • Lean into social norms bias when it’s working in your favor and there’s a perception that your brand is used by many people. Emphasize your position in the market by using social data in marketing tactics. For example, incorporate messages that showcase a social norm behavior, such as, “X% of people choose this brand over competitive products.”

  • Combat social norms bias if there’s a perception that a competitive brand is the social norm or if people underestimate the commonality of the condition. You can introduce actual data and messages that challenge these social norm perceptions, such as, “In a recent poll, X% of your peers said they would try this new brand” or “You are not alone. X million are affected by XYZ every year.”

While these findings are both fascinating and actionable, it bears remembering that the survey participants were general patients – there may be significant differences in individual disease states. Furthermore, there are many factors beyond geographical market that can activate certain cognitive biases, including the therapeutic category, the nature of the product itself, competitive landscape and the role of the stakeholder. Before targeting specific bias triggers for your brand, do research and ensure the biases you are working against will have the impact you need.