Recruitment Management for Global Healthcare Provider Studies

Background

Imagine you are planning to conduct a research study with healthcare providers in a region of the world that you do not live in. How does the culture of the region affect the recruitment process and what factors need to be accounted for?

Let’s look at one example - a seemingly straightforward quantitative study with neurologists across Eastern and Central Europe. Launched by Bazis Americas in 2023, the project quickly revealed the unique challenges. What a clear illustration of healthcare market research across diverse regions! There were unexpected variables and delays across both regions that affected the timeline. We encountered sudden delays, lengthy regulatory approval processes, etc.

Recruitment for global research projects vary based on the region and the cultural norms. The health system itself is an important variable. This affects recruitment for Providers, Payers and Patients. Here, we decided to look at each audience - one article at a time.

While healthcare systems have their own nuances in each country, there are commonalities that drive provider recruitment efforts. We found that the three below can make or break the project success:

• Close relationships with local physicians
• A network of partners - two or three per country
• Expertise in regulatory nuances in each country

Recruitment Approach: Online HCP Panel vs Traditional Methods

When conducting international healthcare provider research, we use two methods: online panels and traditional recruitment via phone and email. In practice, hybrid approaches are often necessary—online panels work well in developed markets, while traditional methods are still a default in emerging markets. North and Western Europe have strong panel infrastructure with broad specialty representation, making panel recruitment accessible and efficient.

In contrast, Eastern Europe and countries like Kazakhstan, Uzbekistan, lack this infrastructure, relying on traditional recruitment and local connections with physicians. This difference was clear in our study: German fieldwork faced delays due to regulatory approvals, but Eastern Europe posed a bigger challenge. Without robust online panels, recruiting neurologists required extensive personal outreach, stretching timelines from one week to over four.

There are also regions that fall in the middle with moderate or mixed panel coverage. Japan and South Korea have moderate panel coverage that often requires supplementation with traditional methods. Ultimately when recruiting across various countries, we recommend accounting for the need to boost recruitment outside of online panels even if they have good coverage: note both cost and timeline implications!

Translation and Localization

When running a multi-country project, you will have the choice of using a large translation firm or passing translation to local suppliers. When using a central translation agency, always specify the language and the target country. If you have Spain and Mexico in your sample you will need the materials translated to the Spanish used in both countries. An example of this would be the word “Healthcare”. In Spain, “Healthcare” is commonly translated to “Asistencia Sanitaria” while in Mexico it’s referred to as “La Atención Médica”.

While the translations have similarities, the nuances of each dialect are the real opportunities to establish a personal link with your audience. Localization must be factored into both budget and timeline, too, as adapting translations to local dialects adds work. It may also influence the choice between a centralized translation agency or local suppliers.

One approach is centralizing the main translation while requiring local partners to handle localization. Local suppliers can also verify translations before proceeding. You can now use technology for initial contact. Android users can enable a feature that translates WhatsApp messages live into another language.

Technology Infrastructure and Communication Styles

There are many ways to communicate and make connections, but not all countries are fully digital when it comes to healthcare. The style and preference of communication technique can vary for initial contact, regulatory protocols and negotiations throughout the recruitment process.

Many regions like North America, Southeast Asia, and the German speaking countries of Western Europe have requirements for communication through official channels and formal protocols especially for introductions.

Be prepared to tailor communication format to what’s acceptable in each region. It may become a big task, if you are managing more than three countries with different communication styles. In some cultures, communication becomes informal after introductions, while in others, formality remains. Local messenger apps (WeChat, WhatsApp, Telegram) may also get you further in establishing quick links with partners.

Regional Regulatory Requirements

As expected each region has certain regulatory requirements and compliance differences that have to be considered for conducting market research with healthcare providers. Western Europe has country specific healthcare advertising laws and requires GDPR compliance.

In Italy, for example, market research discussions must maintain clear separation from promotional activities, and consent forms must explicitly state how the healthcare provider's opinions will be used while meeting GDPR requirements. Other regions like Japan have specific documentation requirements - such as detailed tracking of interview duration and explicit consent for recording market research discussions.

Knowledge of the regulatory and privacy frameworks is of the utmost importance before starting any research process. For example, in Brazil, conducting market research with public institution physicians requires advance notification to their administrators.

The types of healthcare systems also vary sometimes from country to country in a region. Many have mixed healthcare systems like Latin America - in Mexico, for instance, providers often work in both public institutions (IMSS) and private practices, requiring careful scheduling of market research interviews around their dual commitments.

Local Calendar and Time of Communication

Timezone differences are a factor that must be considered for almost any project even in our local region of North America. When you are in different timezones there can be a pressure or lack of pressure to communicate outside of your standard work hours. This is an important aspect that should be discussed and agreed upon with local partners at the beginning of communication.

In addition to time, the local calendar is another factor that must be considered. There are certain periods when HCP recruitment in specific regions is the most challenging. In China and many countries of South East Asia, Lunar New Year officially lasts between 1 and 7 days. It makes  recruitment practically impossible for 2-3 weeks because many HCPs travel to home provinces and do not respond to recruitment attempts.

Another example is December in Eastern and Western Europe. Our neurologists study recruitment took place in December. While Christmas celebrations are well-known in this season, it is important to account how early the holiday season begins in some Eastern European countries, with religious observances starting weeks before Western European Christmas celebrations.

Confirmed interviews began to fall through as physicians' schedules filled with holiday commitments and end-of-year responsibilities. Holidays combined with union strikes typical for this time of the year can quickly result in a perfect storm, impacting research feasibility.

Conclusion

As researchers we are always trying to bring awareness of cultural nuances into our work. Every culture has its own values, requirements and preferences when it comes to the healthcare system. When trying to understand physicians' thoughts on various topics, the country that they live in and the infrastructure of their healthcare system all play a role in their experiences. Then when it comes to recruitment specifically, healthcare providers in different regions have varying engagement patterns and culturally there are norms and hierarchies that influence research in healthcare.

Clients rely on researchers to integrate cultural nuances and advice on the best recruitment approach. Every culture shapes healthcare values, preferences, and system requirements. Physicians' perspectives are influenced by their country's healthcare infrastructure. In recruitment, regional engagement patterns, cultural norms, and power hierarchies impact healthcare research.

Our years of experience conducting multi-country projects taught us valuable lessons about regional differences in healthcare market research. From varying recruitment infrastructures to cultural customs and healthcare system challenges, each region presents its own unique set of considerations that need to be carefully factored into project planning and timelines. When planning to move a project with HCPs outside of the US, we recommend taking these elements into account.

*We would like to thank Heaven Russell for her contribution to the writing of this article