1. Medical Interviews and Focus Groups in Europe Steve Fuller InforMedix Marketing Research, Inc. Medical-Surgical Market Research Group April 3, 2008

2. The Big Questions Why focus on interviews and groups in Europe? Why focus on interviews and groups in Europe? What are the main challenges? What are the main challenges? Meeting the Challenge … Meeting the Challenge … Setting up the projectSetting up the project Screener and recruitingScreener and recruiting Moderating / interviewingModerating / interviewing ReportingReporting LogisticsLogistics What about Asia, South America, etc.? What about Asia, South America, etc.? Where can I go for help? Where can I go for help? InforMedix Marketing Research, Inc. - 2008 2

3. Why focus on interviews and groups in Europe? European countries are the first place most medical manufacturers go, after researching the US. European countries are the first place most medical manufacturers go, after researching the US. Qualitative research is different in Europe. Qualitative research is different in Europe. It’s easy to make mistakes and reduce the value of your work.It’s easy to make mistakes and reduce the value of your work. “Europe” is not a single market “Europe” is not a single market One cannot get a representative European response to device, supply, and equipment questions.One cannot get a representative European response to device, supply, and equipment questions. Quantitative research in Europe is not as complex as qualitative work. Quantitative research in Europe is not as complex as qualitative work. There is a learning curve, but it is not as steep.There is a learning curve, but it is not as steep. InforMedix Marketing Research, Inc. - 2008 3

4. What are the main challenges? In general terms, the procedures for recruiting and moderating are very similar to those in the US. In general terms, the procedures for recruiting and moderating are very similar to those in the US. However: However: 1.Health systems vary from country to country 2.The roles of physicians, nurses, etc. differ from their roles in the US. 3.Language differences bring many challenges to the process 4.Managing the process remotely – and obtaining good qualitative information – can be difficult. InforMedix Marketing Research, Inc. - 2008 4

5. Meeting the Challenge: Setting up the project InforMedix Marketing Research, Inc. - 2008 5 Decide on target markets. Decide on target markets. UK UK Germany Germany France France Nordics Nordics Define your overall goals and specific information objectives clearly. Define your overall goals and specific information objectives clearly. Are all your questions relevant in each foreign country? Are all your questions relevant in each foreign country? What market segments exist? What market segments exist? What sample size is likely to provide results with confidence? What sample size is likely to provide results with confidence? Write out an overview of goals, terminology, etc. so foreigners know what to expect. Write out an overview of goals, terminology, etc. so foreigners know what to expect. Italy Italy Spain Spain Benelux Benelux Eastern Europe Eastern Europe

6. Meeting the Challenge: Screener and recruiting InforMedix Marketing Research, Inc. - 2008 6 Ideal screener development includes: Ideal screener development includes: Writing in English, asking for review by English-speaking foreign staff (e.g. sales managers)Writing in English, asking for review by English-speaking foreign staff (e.g. sales managers) Include basic questions like “Could you help us understand …?”Include basic questions like “Could you help us understand …?” Clarifying the meaning of terms; asking screening questions two or more ways, to be sure they work.Clarifying the meaning of terms; asking screening questions two or more ways, to be sure they work. Translating, then translating back.Translating, then translating back. Discussing the goals and meaning with foreign recruiters.Discussing the goals and meaning with foreign recruiters. Selection of respondents requires careful planning. Selection of respondents requires careful planning. In translation, some terms mean different things.In translation, some terms mean different things. Even in English, the meaning of technical terms can be different from one country to the next.Even in English, the meaning of technical terms can be different from one country to the next. The translation process is not perfect.The translation process is not perfect.

7. Meeting the Challenge: Moderating / interviewing How to compile consistent and comparable information in multiple countries: How to compile consistent and comparable information in multiple countries: 1.Perform similar interviews / groups in the US first 2.Take the US moderator with you to foreign groups/interviews 3.Conduct UK interviews – and some in other countries – in English 4.Engage native speakers and real-time translators for non-English sessions 5.Watch, listen, and take detailed notes based on English translation 6.Improve the discussion guide as needed, to match your information goals. 7.Do facility or convention interviews first, then office visits InforMedix Marketing Research, Inc. - 2008 7

8. Meeting the Challenge: Reporting Conduct interviews/groups systematically – one country at a time – and try to draw conclusions specific to that country. Conduct interviews/groups systematically – one country at a time – and try to draw conclusions specific to that country. Use English transcripts to review responses and compare. Use English transcripts to review responses and compare. Use brief rating questions to provide quantification of opinions. Use brief rating questions to provide quantification of opinions. Draw conclusions about one major country (e.g. US or Germany) first, then compare each other market to that one. Draw conclusions about one major country (e.g. US or Germany) first, then compare each other market to that one. InforMedix Marketing Research, Inc. - 2008 8

9. Meeting the Challenge: Logistics 1.Avoid a packed travel schedule 2.Learn a little German, French, etc. 3.Find the focus group facility (or hospital or medical office) well in advance 4.Be ready to locate a doctor, etc. within a hospital 5.Be aware of rigid confidentiality standards in Europe 6.Ask a local researcher: trains, planes, or automobiles? 7.etc. InforMedix Marketing Research, Inc. - 2008 9

10. What about Asia, South America, etc.? Similar suggestions apply to other continents. However: Similar suggestions apply to other continents. However: Respondents are less likely to speak EnglishRespondents are less likely to speak English Qualitative research in Japan requires local guidance, knowledge of customs, protocol, incentives, etc.Qualitative research in Japan requires local guidance, knowledge of customs, protocol, incentives, etc. Travel time and cost often preclude attendance by US researchers.Travel time and cost often preclude attendance by US researchers. Extra effort may be needed to explain information goals, technical terms, etc.Extra effort may be needed to explain information goals, technical terms, etc. Research, translation, and incentive costs can be very high.Research, translation, and incentive costs can be very high. InforMedix Marketing Research, Inc. - 2008 10

11. Where can I go for help? ESOMAR maintains a good website to locate specialized foreign researchers. ESOMAR maintains a good website to locate specialized foreign researchers. MedEvent website lists conferences in Europe. MedEvent website lists conferences in Europe. US field services sometimes have alliances with European partners. US field services sometimes have alliances with European partners. Manufacturers’ foreign affiliates may have contacts among market researchers they have used. Manufacturers’ foreign affiliates may have contacts among market researchers they have used. Setup options: Setup options: “Do it yourself” by phone and email to multiple countries“Do it yourself” by phone and email to multiple countries Use a US researcher with foreign experienceUse a US researcher with foreign experience Use a Europe-based research house with a multinational networkUse a Europe-based research house with a multinational network InforMedix Marketing Research, Inc. - 2008 11

12. The Big Questions Why focus on interviews and groups in Europe? Why focus on interviews and groups in Europe? What are the main challenges? What are the main challenges? Meeting the challenge … Meeting the challenge … Setting up the projectSetting up the project Screener and recruitingScreener and recruiting Moderating / interviewingModerating / interviewing ReportingReporting Logistics Logistics What about Asia, South America, etc.? What about Asia, South America, etc.? Where can I go for help? Where can I go for help? InforMedix Marketing Research, Inc. - 2008 12