By Christopher Brace and Jessica Krauser
Every market researcher in healthcare has experienced this. You ask a patient why they decided to switch treatments, skip a refill, or continue with a behavior that is counter to their overall health, and their answer sounds confident, reasoned, and believable. Yet somehow, it doesn’t really make sense. The patient isn't knowingly making something up, they are telling you what they believe is true and what makes them appear rational. But the most important part of what shaped their decision is the part the patient can't put into words. The actual decision happened in the patient’s non-conscious mind, a part of their brain to which they do not have direct access, so they do their best to reconstruct the decision after the fact. There is a gap in today’s market research methodologies that needs to be filled; the ability to uncover a patient’s non-conscious narratives that drive their decisions and shape their experiences.
In order to understand how to fill this research gap we must first internalize a key insight into how humans make decisions. It’s called the 95-5 rule and it states that about 95% of the human decision-making process occurs in the non-conscious mind. This means only about 5% takes place in our conscious awareness. Even though this is supported by decision science, neuroscience, psychology, and sociology, traditional research methodologies struggle to effectively research the 95%. Researchers spend way more time, effort, and money understanding the 5%.
In fact, the vast majority of patient data companies hold comes from that 5%, because it is what can be easily measured through behavior. As covered earlier, when you ask a patient why they made a decision, they can only post-rationalize. Their explanation is built in the conscious mind, which cannot see into the non-conscious mind where the actual decision was made. What patients can't say, because they don't have conscious access to it, is what is really shaping their decisions.
This means brands are making multi-million-dollar decisions with only a fraction of the story. Reaching the 95% is not a matter of asking more questions or running bigger samples. It requires a different kind of methodology, one designed to access the non-conscious processes that are actually driving the patient's decisions and shaping their experiences. Story Legacy's methodology combines three concepts, each of which addresses a specific part of the gap the 95-5 rule lays bare.
Facilitated Storytelling
One of the most reliable ways people reveal their non-conscious narratives is through the stories they tell about their lives. Facilitated storytelling is a structured methodology for engaging patients in telling the life stories that reveal the narratives most relevant to their healthcare needs.
Emotionally Coding the Non-conscious Narratives
A patient’s stories are rich with narratives, but they are not immediately operationally useful. To make them actionable, they need to be coded into variables that gives each narrative a clear structure:
• Beliefs: What the patient holds true about themselves, others, and the world.
• Attitudes: Their judgments about a specific set of circumstances.
• Behaviors: The actions they take based on their belief-attitude combinations.
• Benefits to Target: How those behaviors benefit the patient.
• Benefits to Others: How those behaviors benefit the people in the patient's life.
Together, these five variables capture what is emotionally meaningful to the patient and why. They turn the narrative material into a structured representation a brand team can analyze, compare across patients, and act on.
Fuzzy-trace Theory1
The third component is the cognitive science that explains why this kind of coding produces a more accurate picture of the patient than traditional research can. Fuzzy-trace Theory, developed by Valerie Reyna and Charles Brainerd at Cornell University, describes how the mind handles information in decision-making moments. When a patient takes in information from a clinician, two kinds of memory form in parallel: verbatim and gist.
Verbatim memory holds the precise details, the exact stats and facts, such as "20 – 40% of Parkinson's patients may eventually require a wheelchair." Gist memory holds the essential meaning the patient attaches to those details. Gist answers the question, “what is the bottom-line meaning for my life?” Verbatim memories tend to fade over time, but gist memories remain. Emotional meaning, not the facts, is what drives the decisions a patient will make in the months and years that follow.
The same verbatim fact can produce more than one gist, and the gist can be limiting or motivating. The wheelchair statistic, for example, can produce three very different gists in three different patients: "this disease will take away my freedom," or "my future may become visibly disabled," or "I need to do everything I can to avoid that future." One fact and three bottom-line meanings, each potentially driving different behaviors.
Research based on Fuzzy-trace Theory has shown that within minutes of a conversation with a healthcare professional, patients are already relying more on the emotional meaning than on the facts and statistics they were just given2. This is particularly important when a patient is under stress or heavy emotional load. Fuzzy-trace Theory is what makes Story Legacy's coding scientifically meaningful. The five variables are not arbitrary, they are a structured representation of the gist a patient is using to make their decisions.
Emotionally Coding the Parkinson’s Journey
We partnered with Changing Parkinson’s and applied the facilitated storytelling methodology to understand the first twelve months of a Parkinson’s patient’s journey. Specifically, we uncovered the six primary emotional states that shape the patient’s experience: fear of loss, feeling overwhelmed, need for control, determination to fight, acceptance, and finding meaning. We then coded each of those emotional states for men and women separately and used that coding to create new intervention solutions for each.
The 95-5 rule explains why traditional research in healthcare keeps falling short: the 5% it can measure is not where decisions are made. Fuzzy-trace Theory explains what kind of data does drive decisions: not the facts, but the emotional meaning a patient extracts from them. Facilitated storytelling is how that meaning is accessed. The five-variable coding system is how it is made structured and actionable. The three together form a methodology built to produce a deeper, more nuanced understanding of patients.
About The Authors
Christopher Brace is the Founder & CEO of Story Legacy, a qualitative research partner that uses storytelling as their foundational methodology. He can be reached at: chrisbrace@storylegacy.us
Jessica Krauser is the Co-founder of Changing Parkinson’s, a non-profit that empowers individuals to make a difference in their own lives and in the Parkinson’s community. She can be reached at: jessica@changingparkinsons.org
Sources
1. Reyna, V. F. (2012). A new intuitionism: Meaning, memory, and development in fuzzy trace theory [Presidential Address]. Judgment and Decision Making, 7(3), 332-359
2. Reyna, V. F., Edelson, S.M., Hayes, B., Garavito, D.M.N., (2022). Supporting health and medical decision-making: Findings and insights from fuzzy-trace theory, Medical Decision Making, 42 (6), 742 – 754.