The American Heart Association/American Stroke Association conducts consumer marketing research just like for-profit companies, with similar objectives: to change attitudes, beliefs or behavior. Our end goal, however, is markedly different from companies aiming to sell products and services.

We aim to help everyone make choices that we believe will lead to healthier, longer lives. Essentially, we are aiming to sell the best ways people can prevent heart disease and stroke – the two leading causes of death in the world. Understanding knowledge, perceptions, motivations and barriers to heart and brain health are key to achieving our mission of building lives free of cardiovascular diseases and stroke.

We use qualitative research for various exploratory purposes. Most often it is to direct or supplement quantitative research. Sometimes it has stand-alone merit for creative development or communications. We traditionally use in-person focus groups as our primary qualitative methodology. While this approach still makes sense in certain situations, we have begun to explore other options and are finding deeper insights in hybrid approaches. Though technology has opened up many new opportunities to gather qualitative insights online, observational discoveries through ethnography have significant value. Here are some examples of qualitative methods we have utilized.

Online Chat Sessions
We recently conducted a quantitative online survey to test message and image concepts to convey our new brand positioning. The positioning is designed to portray our role in the community and our role in influencing a culture of health. We tested several messages that communicated key elements of the positioning. We also tested mood boards – photo collages of people who represented activities and emotions we wanted to elicit. Questions were crafted to detect the emotions triggered by the positioning, as well as the extent to which respondents felt it was relevant to them.

We supplemented the survey with online chat sessions to further explore the motivations and emotions tied to the positioning. Twenty survey respondents were invited to participate in 30-minute chat sessions immediately following the survey, conducted with a live moderator. The verbatim comments added color and richness to the online ratings that we wouldn’t have received otherwise. We learned that the most effective positioning messages and images incorporated positive elements that convey hope and aspiration. Messages relating to family and friends, as opposed to self, were most powerful. Results-focused facts (e.g., number of lives saved through our scientific discoveries) illuminated the impact that our organization is having. Finally, imagery that reflected the viewer’s life stage heightened the relevance of the positioning.

In another study, we tested names and messages related to hypertension. We were consolidating current programs and rebranding the umbrella initiative. This umbrella program encompassed a new name, tagline and messaging for our website, and in social media and brochures in doctors’ offices. The aim of the research was to determine what would motivate people to check their blood pressure, change their lifestyle if they are hypertensive, and control their blood pressure. An online quantitative survey obtained ratings of names, taglines and messages, followed by live online chat sessions with 40 respondents. The qualitative probing helped us understand what words and phrases would motivate consumers to take action. We moved forward with the name “Check. Change. Control.” because it was action-oriented. The most effective message elements were “longer, healthier life” and “helping millions,” which gave us direction for communications strategies.

Online Software-Moderated Surveys
We conducted a quantitative online survey that incorporated automated software-moderated questions to probe on particular responses and discover consumer insights not revealed through a traditional tracking study. This approach elevated qualitative to the statistical power of quantitative. The software is designed from analyses of thousands of verbatim responses and intuitively knows what probing questions to ask. Respondents feel like they are chatting with a live moderator instead of a computer program.

From this in-depth approach, mental maps were developed on a sample of over 500. We were able to understand health priorities of diet and exercise, how consumers view the amount of effort they personally invest in their health and what motivates them to make an effort to be healthy. Understanding the nuanced differences of what the term “effort” means to multicultural audiences allows us to encourage healthy behaviors when someone tries as well as succeeds. The confidence in these qualitative results quickly impacted the relevancy of our messaging.

In-home Ethnography Groups
For a study about healthcare, we conducted focus groups in respondents’ homes. Our objectives were to gain an understanding of consumers’ awareness of the concept of healthcare quality improvement, determine what factors drive their decisions around hospital choice and assess their perceptions of our role in the healthcare quality arena. The association has developed healthcare quality improvement programs that help ensure consistent application of the most recent scientific guidelines for heart disease and stroke treatment at more than 2,000 hospitals nationwide, as well as in outpatient settings.

The focus groups followed an online quantitative survey and allowed us to probe on key issues. We recruited participants who met our criteria and asked them to invite friends and family to participate in focus groups at the hosts’ homes. The friends and family shared similar participant qualifications we were seeking to ensure they represented our audiences. The participants felt at ease to discuss personal and emotional issues regarding their health and views about healthcare quality. The rapport among participants led to candid and honest opinions that may not have been revealed in traditional groups of eight strangers.

We found that familiarity with the healthcare quality improvement concept was fairly low. But, once educated about it, consumers believe these programs are essential because patients need someone to advocate for them and help them choose the hospital that meets their health needs. They believed their level of care at hospitals with AHA/ASA accreditation would have the most up-to-date technology and procedures, and the highest quality.

In-Culture Focus Groups
Many of our initiatives focus on specific races and ethnicities, so we conduct research among African-Americans, Hispanics, Asians and Caucasians. Historically, the composition of our focus groups was representative of these segments, but it was insufficient to understand the differences among the segments. Now, we conduct in-culture groups, recruiting separate groups for each segment with a moderator of the same race and ethnicity, to help us discover cultural differences that influence attitudes and behavior regarding health. We explored motivations and barriers to manage high blood pressure, uncovering many cultural beliefs, traditions and habits. Hispanics tended to have a fatalistic attitude toward their health; if they have high blood pressure, that’s their cross to bear and there’s little they can do about it. African Americans held a similar belief, that high blood pressure is prevalent in their family, so it’s inevitable that they’ll have it. These cultural nuances have provided direction for crafting communications strategies to each segment.

Discussion Boards
Sometimes it’s not convenient or feasible for some audiences to attend a focus group in person. Stroke survivors may have physical conditions that prevent them from being mobile or driving to a facility. Additionally, family members who provide care for a stroke survivor may not be able to leave their loved one to attend a group. Those were among the key reasons we conducted online discussion boards with stroke survivors, caregivers and stroke support group leaders. The objectives were to identify issues and concerns related to post-stroke recovery in order to provide us with direction for materials and tools that we could develop to meet their needs.

The discussions lasted three days, with the moderator posting questions in the mornings and again in the afternoons. Participants could view and comment on one another’s posts. The moderator made the participants feel comfortable and open to sharing personal experiences. The conversations evoked intimate comments about their emotions – fears, grief, frustrations and joy – that they felt as they managed their post-stroke lives. We found that there is an opportunity to proactively reach out to new patients and caregivers, in partnership with a hospital advocate, to answer initial questions and help them during the recovery period.

Journaling/Photos and Discussion Boards
Evaluation of a nutrition program was a good opportunity to use a multi-mode approach. The need to understand changes in knowledge, attitudes and behaviors around food shopping, preparation and consumption led us to integrate an online quantitative pre/post study with two different qualitative methods. All pre-test respondents received an email with recipes, information about food preparation and cooking skills, and encouragement to use resources on a healthy living website. A sub-sample of 31 participants from the pre-survey participated in three weeks of online journaling, activities and photo sharing regarding their thoughts and experiences on shopping and cooking more nutritiously.

At the end of four weeks, the journaling participants also took part in a three-day discussion bulletin board. Feedback was first captured individually and then shared among the group. Finally, all participants completed the quantitative post-survey. This method allowed us to quantify change in knowledge, attitudes and behaviors related to fruit and vegetable consumption, and eating at home. We were also able to gain insights into daily struggles, challenges and successes. The richness of the personal perspective brought the quantitative data to life, which helped secure additional funding for the project.

Friendship Mini-Groups
These groups were conducted to explore women’s beliefs and attitudes about heart health. The learning provided direction for communications, positioning and touch point activation. Just as we did in the in-home ethnography groups, we recruited one person who in turn invited friends. All participants met the screening criteria.

These groups were held in a traditional focus group facility, behind a two-way mirror, but the environment was anything but traditional. Couches, pillows, a coffee table, drinks and snacks made the experience comfortable and relaxed. Participants more quickly eased into the topic and tended toward more open dialogue. We did, however, learn that the type of friendship influenced this comfort level. In our situation, groups with friends from work were not as productive. We now know to tighten up our screening criteria.

We found through these groups that though awareness of heart disease as the number one killer of women has significantly increased over the past 10 years, women still underestimate the possible personal impact. These learnings are being used to develop new communications to further elevate heart disease as a priority for women.

Conclusion
The American Heart Association/American Stroke Association values qualitative marketing research approaches so we can better understand health concerns, challenges and motivation. Writing this article makes us realize the breadth of qualitative methods and the value we receive from them. New qualitative and hybrid approaches are well received and deliver against stated objectives. We will continue to use traditional methods while exploring new qualitative approaches to provide rich insights into how we can engage individuals and communities to create a culture of health, so that all Americans live healthier, longer lives.