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Introduction

pharmaceutical business marketing

The pharmaceutical industry is an important sector of the world economy and social welfare (Manchanda and Honka, 2005). According to the report of Quintiles IMS Institute, the total volume of medicines consumed globally will increase by approximately 6% annually through 2021, primarily driven by newer medicines in developed markets and increased volume in pharmaceutical markets in the countries with emerging economy. The so-called pharmerging markets volume of medicine usage grew by an average 10.3% in 2007-2011, slowing to 6.6% from 2012 to 2016, and is projected to slow further to 3-6% from 2017 to 2021. People in emerging countries will consume more than half of the medicines used globally, consistent with the more than half of the world's population who live there. Russia is still considered a country with an emerging economy. The recent improvement in its economy has been the key driver of greater medicine use, contributing both to governments' policies to expand health care provision as well as to personal incomes which drive so much of the drug purchases in the Russian market.

This study attempts to contribute to the knowledge base by exploring the existing models of purchase funnel, such as AIDA model and other types of sales funnel. After that, it amplifies the theoretical base by considering both classical contemporary models of sales funnel including the conversion funnel and the sales funnel for mobile appications evaluation. Later on, the comparative analysis of customer journey model and the sales funnel is indroduced followed by a brief history of the consumer buying decision process model and its modifications applicable to the pharmaceutical business.

It is quite evident that the structure of marketing investments of any pharmaceutical company operating worldwide may differ from country to country. The general business problem addressed in this study is that characteristics of the Russian market, such as social and demographic features of the population, governmental policy, state regulation and economic situation considerably alter the conventional customer journey model. Moreover, constant access to the Internet changes not only the behavior and habits of people, but also their way to purchase. According to the survey conducted by Google, 71% of Russian users turn to a specialist only in case of acute necessity and 20% believe that the pharmacist's advice can replace the visit to the physician. These results show that nowadays, when the answer to any question can be found online, consumers are less likely to rely unconditionally on the opinions of doctors and take care of their health in their own hands. All these factors have to be taken in mind by phamaceuticel companies that want to to keep up with the times and change their marketing strategies in accrodance with market changes.

The patient journey is the way a consumer goes through from the moment of problem origination and information search for a solution to the problem of choosing and buying a particular medicineб, which consists of many important points. The specific business problem is the difference between customer journey for the prescription drugs and OTC (over-the-counter) drugs based on these factors. Therefore, the key objective of the study is to identify this difference and demonstrate by example of Abbott brands how the patient journey might look in real business environment. The paper also examines global trends in the pharmaceutical industry and new technologies involved. It aims to define the problems that global brands may face when operating in the Russian market and the possible solutions to them.

The major goal of my study is to investigate the environmental context in which consumers make purchase decisions on prescription and non-prescription drugs. I am going to conducting a qualitative research, which will help me to understand how the patient journey to Rx drugs differs from the journey to OTC drugs and identify the number of factors affecting the buying decision. My research will begin with the collection of qualitative data and its analysis, which will occur simultaneously. I will continuously describe the data obtained, code the notes, and unify them into logical categories to provide the explanations of the concept examined and, thus, a new theoretical framework. I will conduct my qualitative research basing on the method of the case study of Abbott. As a part of the study, I will interview nine Abbott employees, review the corporate documents and directly observe the management operations and processes in the company. The combination of three the above-mentioned data collection instruments, or a so-called triangulation method, will enable me to counterbalance the deficiency of a single data collection strategy, thereby increasing the ability to interpret the findings.

The results of the following study may be of interest not only for business administration and marketing students but also for the employees of pharmaceutical companies and scholars in the relevant field. The obtained models of the patient journey will serve as a guide for the marketers and provide them with a consistent framework. In addition, the research findings may be of primary significance for top managers in pharmaceutical corporations, as they offer the rationale of how creating such models contributes to evaluating the sales volume, NPS (net promoter score), and return on marketing investment (ROMI).

Chapter 1. Literature review

In the following section, I aim to examine both theoretical and empirical studies in the field of marketing and sales. By doing so, I aim to shed some light on the concept of customer journey giving particular emphasis to the origin of this notion and its evolution up to the present moment. First, I am going to articulate the concept of the purchase funnel tracing back to the roots of AIDA model. Then, I will scrutinize the most significant modifications of this framework considering classical models as well as contemporary models of XXI century, such as AISDALSLove model and conversion funnel. I will also give a particular emphasis to the managerial implications of the model and its practical significance. As a next step, I will focus on the key differences between the sales funnel model and the customer journey framework providing the comparative analysis of both. After that, I will generally introduce the customer journey origins beginning with the consumer buying decision process model, narrowing the focus of the investigation to the patient journey mapping in the pharmaceutical industry to establish a theoretical framework for studying of consumer behavior in respect of prescription and non-prescription drugs and factors influencing the the decision process.

Purchase funnel

The model of the purchase funnel, also known as “sales funnel,” “customer funnel” or “marketing funnel,” has had major consequences for the marketing field. Originally designed to represent the stages, which a salesperson should take a customer through, it was later adopted as a conceptual framework in order to account for communication with a prospect and the path he goes through on the way to the product.

The history of the purchase funnel traces back to the end of the 19^th century. In 1898, E. St. Elmo Lewis formulated the slogan, "attract attention, maintain interest, and create desire." In his later works, he added the fourth term "get action" (Strong, 1925). These four postulates represent four mental states which must pass through the mind of the potential customer before he will buy a product or a service. It became commonly accepted to attribute the authorship of the AIDA model to Lewis since 1925 when “The Psychology of Selling and Advertising” by Edward K. Strong, Jr. was published. AIDA is an acronym, which stands for Awareness, Interest, Desire, and Action (Fig. 1). Lewis developed a model which theoretically depicted a customer journey from the moment a brand or a product attracted consumer attention to the point of purchase or other target action. He presupposed that if the consumer experiences attention, interest, desire, he will be more likely to act (buy a product or a service). Hence, an advertisement or sales talk must be planned to arouse these states in a potential customer (Strong, 1925).

Figure 1. AIDA model.

The following table describes four cognitive steps proposed by Lewis's AIDA model:

Table 1.

Modifications of AIDA model

Classical models of purchase funnels: XX century

Advanced by Lewis in 1898 AIDA has repeatedly been discussed both by academicians and practitioners and has undergone significant changes. The development of information technologies has fundamentally changed the way people communicate and socialize increasing companies' opportunities to reach their consumers. Furthermore, marketing has experienced a general shift from conventional product-oriented paradigm to the contemporary customer-centric or people-oriented approach. Thus, the variables in hierarchical models, such as AIDA, had to be updated as a respond to the latest developments in light of increasing power of consumers. In this section, I am going to make a make a retrospective journey into the history of hierarchical models developed by academicians, researchers, and practitioners since the inception of Lewis' theory over a century ago.

Arthur F. Sheldon called into question the sufficiency of the four stages offered by Lewis and proposed a new five-staged model AIDAS (Attention, Interest, Desire, Action, Satisfaction) (Sheldon, 1911). In fact, he anticipated modern theories of selling by adding `permanent satisfaction' as a necessary part of the efficient and long-run selling process. Later on, the model continued to evolve as a five- or six-staged one (Barry and Howard, 1990). In 1921, Harry D. Kitson put forward a new definition of sales funnel, namely, AIDCA (Attention, Interest, Desire, Conviction, and Action). The punch line of Kitson's study was grasped as the focus on how the mind of a buyer works, which gave a psychological direction to the issue under discussion. Lavidge and Steiner (1961) also made an attempt to represent the communication process in their hierarchy models. Lavidge and Steiner believed that by investing in advertising, a company triggers a long-term process that moves its consumers through a variety of stages, beginning with product `unawareness' and moving step-by-step to the purchase (Barry & Howard, 1990). Therefore, they added the stages of “knowledge,” “liking” and “preference.”

It should be noted that until the latter half of the 1960s the majority of researchers did not include any post-buying stages in their models. The line of research changed dramatically due to McGuire's paper “An information-processing model of advertising effectiveness” published in 1969. McGuire was the first to propose that the stages of the purchase funnel could be associated with probabilities which may be used to evaluate the ultimate behavioral impact of advertising (McGuire, 1969). The second key point was the presence of several non-conventional stages in his PACYRB model: Presentation, Attention, Comprehension, Yielding, Retention, and Behavior. The theory advanced by McGuire comprised an important hallmark adopted afterward by researchers in order to study the sequence of steps during the buying process.

Although the purchase funnel seems to be a general business model, there has been dissent concerning its effectiveness within academic research. For example, in his article “Theories of selling,” Strong tends to place stress on the fault line of common standpoint that notion "conviction" could be employed instead of "desire" (Strong, 1925). Another vital point of his is the absence of “satisfaction” level or post-buying experience analysis in most of the works related to the topic.

Many scholars insist that "attention" and "interest" stages are of highest importance. Clearly, there is no doubt that attention and interest must be present whatever a customer aims to buy. Nevertheless, Strong challenges this viewpoint displacing the concern with attention and interest by a preoccupation with the goal that the seller desires to reach. Indeed, a company should aim to establish certain ideas and emotions relative to what the consumer can get out of his product. Time and again it has been proved that the mistaken emphasis on advertisement (especially when it is poorly designed) leads to poor product image and low sales volume, consequently.

Despite the great variety of the existing classical models of purchase funnels, it appears necessary to mention a number of shortcomings. First, most of the scholars failed to support their theories with sufficient empirical evidence which would prove that consumers actually go through each stage (Egan, 2007: 46). Second, the abovementioned models tend to put emphasis on a specific stage missing the potential for interaction between stages. Third, as it has already been said, the majority of classical models does not include any post-purchase experience. On the top of that, classical hierarchical models do not take into account the phenomenon of IT revolution and creation of the Internet in particular, which gave birth to social media that have entirely changed human communication and socialization and considerably influenced customer behavior.

Vakratsas and Ambler (1999) call into question the validity of many hierarchical models, including the buying funnel. Some practitioners have also theoretically challenged the buying funnel aspects directly (Rimm-Kaufman, 2006). As the model evolved, more and more scholars concurred that previous validations of the sales pipeline might not have held on the web (Court et al., 2009; Haven, 2007). Such a discrepancy urged the need for a new framework of the online buying process, and in light of this, the so-called conversion funnel has been advanced (Jansen and Schuster, 2011).

Contemporary models: XXI century

Conversion funnel

The model describes the journey a customer takes through the Internet, usually, beginning in a search system (e.g. Google) or the company's online shop and ultimately ending up with the sale. According to Kireyev, Pauwels, and Gupta (2016), there may are two possible scenarios. In the former case a consumer may be exposed to a brand through display advertisements, he may click on these advertisements to get more information and may eventually convert. Alternatively, he may search for a product online, encounter a search advertisement, click on it and convert. When a customer adds the product to the shopping cart, registers or provides contact information, the number of step-by-step along the funnel reduces. The more steps there are, the fewer visitors get through to becoming paying customers. Thus, websites with similar pricing and products can have absolutely different conversion rates of visitors to customers and, consequently, greatly differing profits.

Typically, only a small percentage of those who have seen the advertisement or link actually click on it. The direct effects of display and search ads are commonly measured via online metrics, such as CTR (click-through rate), CPC (cost-per-click), and CPA (cost-per-action) (Kireyev, Pauwels and Gupta, 2016). CTR index is highly exposed to small changes such as link text, link size, link position, creatives and many others. The cumulative effect of these factors helps to understand which ads bring the highest CTR and optimize the ad.

In the context of online sales, recent empirical studies focus on the effectiveness of the sales funnel as a model for understanding customer interaction with keyword advertising campaigns on web search engines (Jansen and Schuster, 2011), defining the interaction between paid search and display ads and advancing a model using relevant data (Kireyev, Pauwels and Gupta, 2016), and even the role of nudges as enhancers of acquisition and conversion outcomes within digital business models (Koch, 2017).

Use of sales funnel for mobile applications evaluation

As reported by ComScore, in the past twenty years, the proportion of non-US Internet users has increased from 34% up to 89% of the global desktop population, with EMEA region accounting for a third of this figure. [65] The evidence of 2016 Global Future in Focus report suggests that mobile apps globally dominate time spent on the Internet on mobile devices and “are already approaching even the largest desktop sites in terms of reach.” Due to such rapid growth, several researchers have focused the attention on applying the traditional sales funnel to mobile applications (Bцhmer, Ganev, and Krьger, 2013; Schuch, Holzmann and Lettner, 2013; Even, 2015; Shankar et al., 2016). Bцhmer, Ganev, and Krьger (2013) even propose a so-called App Funnel - a framework that includes di?erent stages of user's application interaction sequence and engagement (see Fig. 2).

Figure 2. The App Funnel.

AISDALSLove model

In XXI century, numerous attempts were made to modify the theory of Lewis. The one that stands out is the AISDALSLove model offered by Wijaya. The author considered a broader advertising role as a communication device and instrument for brand development and therefore developed AIDA's hierarchy of effects model by adding several relevant elements, such as Search (S), Like or Dislike (L), Share (S) and Love or Hate (Love), which then become AISDALSLove (Wijaya, 2015). The second innovative idea of Wijaya was to classify advertising effects as the short-term and long-term ones, especially related to the development of the advertised brand. It can be clearly seen from the figure below that the stages of short-term effect are those from Attention to Action and Like/ dislike, while Share and specifically Love/hate pertain to the long-term effects (see Fig. 3 ).

Figure 3. AISDALSLove Model.

All in all, Wijaya's model comprises four new elements: S (Search), L (Like/Dislike), S (Share) and L (Love/ Hate). The presence of Search testifies that this model introduces the assumption that modern consumers are becoming more and more demanding. Information obtained from an advertisement is simply not enough for them to buy a product regardless of how entertaining and exciting the key message is. Wijaya argues that the process of information search comprises both internal and external search. The internal search involves a variety of information stored in the human brain: brand names, specific facts about a product or service, and experiences. All these facts help a prospect to identify and evaluate the alternatives and make the right decision. Once the internal search is finished, prospects initiate the external search using the outside sources, such as friends or relatives, magazines/books, the Internet (websites, blogs, etc.), social media and so on and so forth. External search enables the consumers to collect additional information about brands available on the market and their special features, benefits, and flaws as the consideration set (Hoyer, MacInnis and Pieters, 2016).

One more advantage of Wijaya's model is the fact that it makes allowance for “consumers' experience after purchasing and using the product.” In other words, the stage of like/dislike reflects the level of customer's satisfaction - the crucial element which most of the abovementioned models lack. The greatest contribution of his paper to the marketing field is a description of the long-term effects of advertisement: the consumer's willingness to share information about the product and his love or hatred to the brand or product. Regarding NPS framework proposed by Reichheld (2014), these last stages may account for the number of those who have turned into promoters from ordinary consumers. Furthermore, the inclination of a consumer to tell his friends in person about a brand or share his experience in social media is the bright example of how the word-of-mouth (WOM) advertising works. WOM can be classified as earned media regarding POE framework (paid, owned, earned media). Earned media is thought to be the most trusted source of information for consumers and is most likely to stimulate them to buy (Stephen and Galak, 2012). Hence, companies should focus not only on short-term effects of advertising but also consider such long-term effects, as loyalty to the brand or brand image. As a result, while planning marketing communication strategy and media campaigns particularly, companies should be very careful with `what to say' and `how to say' about their products.

Practical significance

A considerable amount of valuable work has been done to broaden the theoretical basis for a hierarchy of effects in sales and advertising. It is necessary to emphasize that all the work done by scholars has a number of important managerial implications. First and foremost, the above-listed models may help marketing managers to measure the effect of advertising and understand consumers' attitude and behavior towards brands. Moreover, when deciding on what strategy should be developed at every stage of the marketing funnel, managers get the opportunity to predict consumer behavior with the help of hierarchical models and identify factors influencing consumer behavior on each stage (Seiler and Yao, 2017; Abbasi, Lau and Brown, 2015). Second, understanding the sequence of stages leading to purchase provides information on what advertising strategy to emphasize. Consumer behavior may differ depending on each stage. For instance, it is likely to be “exploratory” at the initial stages and tends to be “goal directed” when a prospect gets closer to the stage of purchase (Novak and Hoffman, 2003). Third, the hierarchical models are commonly accepted to be valuable for helping to organize training, planning, and conceptual tasks within a company (Barry & Howard, 1990: 108). The fourth reason is that besides being highly applicable for the B2C sector, the sales funnel can also be applied to B2B companies (Buttle and Ang, 2002; Leake, Vaccarello and Ginty, 2012). The purchase funnel is widely used in SaaS (software as a service) and cloud computing applications for businesses, such as Zoho, SalesForce and other CRM systems. The key benefit of this model is the fact how it eases the process of analytical CRM which involves the collection, storage, analysis, interpretation, and use of data created from the everyday interactions with customers by providing a visual representation of the sales process.

Customer Journey vs. Sales Funnel: comparative analysis

Some contemporary scholars still claim that consumer journey can be conceptualized as a conversion funnel (Kireyev, Pauwels and Gupta, 2016). None the less, almost all classical funnel models have recently become somewhat outdated since they imply that any buying path is linear and is confined to the final stage of purchase (Lingqvist, Plotkin and Stanley, 2015). The truth is that present-day consumers care much about brands and are more readily influenced by advertising, media messages, special deals, and coupons. Moreover, they are likely to turn to friends and relatives for advice on their purchase, are inclined to impulse buying, and can switch from one brand to another with little cost (Elzinga D. et al., 2009).

As the journey of today's customers is no longer linear, the funnel approach does not cast much light on “what drives purchases or cements loyalty” (Lingqvist, Plotkin and Stanley, 2015). Therefore, as the number of decision influencers increases from day to day, the funnel logic is facing root and branch transformation. Nowadays it is possible to follow the lead of customers instead of forcing them to follow the sales organization. With the help of state-of-the-art information, new buying patterns that defy well-trod linear paths can be found (see Fig. 4). Customer experience and decision-making become multichannel, which creates additional opportunities to influence purchases (Wolny and Charoensuksai, 2014). The decision making process can be represented in the form of a circular journey with four stages: initial consideration, evaluation, or the process of gathering information about potential purchases; purchase phase, and postpurchase, when consumers experience products (Elzinga D. et al., 2009). More complex interactions represent various stages of consumer behavior that firms can evaluate using big data and analytics. Those insights, in turn, may facilitate more targeted sales actions.

Customer journey mapping is a relatively new technique which recognizes that the decision process is anything but linear, and, what is crucial, the post-purchase period is often even more important than other steps along the way. The customer journey is a strategic model that helps companies to pinpoint the key stages of the consumer route and maximize relevant marketing metrics for success. As opposed to the purchase funnel, which is mostly based on the number of potential or actual customers, it includes both qualitative and quantitative validation of a company's strategy (Norton & Pine, 2013). That is to say, customer journey includes numerical performance indicators, as well as key points where it is urgent to concentrate on. The sales funnel, in its turn, is a tool used to help a marketing manager understand when and where the conversion takes place, whereas customer journey is a tool used to understand how a customer behaves during the entire period of interaction with a brand. Sales funnel is a small part of the customer journey, for the journey comprises not only the purchasing experience but also how customers find out about a product or service (brand awareness), how they use it and what they feel like when a product or service is fully integrated into their lives. If we look at the purpose of the two tools concerned, we can easily see the difference. Broadly speaking, the sales funnel is used to measure the volume of customers through different stages of the selling process, while the consumer journey is aimed at understanding consumers' behavior, informing decision making, and analyzing their experience to provide a better product or service. Both models are meant to tackle the present bottlenecks in the buying process. Sales funnel enables managers to define the overall sales potential and key points in general. It is mainly aimed at strategic goals, such as defining areas of growth, while the customer journey can be used define and set tactical objectives as well.

Customer journey origins

It is worth noting that it is quite a challenge to track the origins of customer journey model since it is so closely intertwined with the model of the purchase funnel. It appears reasonable to begin the narration with a model of consumer motivation and behavior originally introduced by Engel, Kollat, and Blackwell in 1968 (Blackwell, Miniard and Engel, 2001). The model of the consumer buying process (see Fig. 5) consists of five main stages, as follows: problem recognition, information search, evaluation of alternatives, the decision on purchase, and post-purchase behavior (Kotler and Kelle, 2016).

Figure 5. The model of consumer buying process

Problem recognition or need recognition is usually triggered by internal or external stimuli (Kotler and Armstrong, 2016). According to Maslow's hierarchy, the internal stimuli usually include material needs, such as hunger or thirst. The external stimuli may be the admiration of others or the effect of an advertisement seen. If marketing managers succeed to understand and identify the elements that trigger a particular consumer need, they attract or even anticipate the most potential customers' interests.

Information search is the stage when consumers collect information on a desirable product from various sources. Kotler and Kelle (2016) distinguish four types of information sources, namely, personal sources (friends, relatives, neighbors), commercial sources (advertisement, salespeople, and packages), public sources (mass media, government, and social organizations), and experiential sources (personal experiences of consumption).

Although the process of alternatives evaluation may vary from one consumer or situation to another, it is generally based on consumers' preferences and rational judgment (Kotler and Kelle, 2016). Unfortunately, as time is considered to be a limited resource, customers cannot endlessly search for information and evaluate possible options. Thus, a prospect might stop searching for the information when the cost of getting it outbalances the value received.

Despite the process of evaluation being generally rational, purchase decision can be made both rationally and irrationally. As offered by the expectancy-value model, the purchase decision is a rational process where product benefits may compensate negative features. Yet, customers might also make irrational decisions influenced by different heuristics and mental shortcuts, let alone impulsive purchases (Kotler and Kelle, 2016; Hausman, 2000).

Post purchase behavior has recently become the stage of the highest importance, as it defines whether a one-purchase consumer can become a long-term loyalty customer. Kotler and Kelle (2016) classify post purchase behavior as follows: post-purchase satisfaction, actions, uses, and disposal. The level of satisfaction depends on the discrepancy between expectations and product features. Post purchase actions may also vary. If consumers are satisfied, they may repurchase the product and even share their positive experience within their inner circle or in social media. If not, there may be such unpleasant implications for business, as customer churn and adverse publicity (Knox and van Oest, 2014).

Patient journey mapping in pharmaceutical industry

Although the customer journey is largely based on the model of the buying decision process, it seems appropriate to draw the line between these two concepts. The buying decision model is by nature of cognitive and psychological steps which a consumer goes through on the way toward the purchase, while customer journey presents a sequence of actors and authorities that a prospect meets moving to the desirable product or service combined with factors which affect the purchase decision. As far as the current spheres of application are concerned, the technique of customer journey mapping has been widely used in various fields, such as airlines (Gustafsson, Ekdahl and Edvardsson, 1999), mobile services (Moon et al., 2016), public services (Cruickshank, 2011), and even libraries (Andrews and Eade, 2013).

In order to provide critical insight into the topic under investigation, it is necessary to examine a body of empirical research in the given business area, namely, the pharmaceutical industry. In fact, studies of the kind are not numerous. The existing ones are focused on understanding the influence of advertising on patients (Ong, 2015), perceived risk in the buying process and trust to doctors (Jin, 2016), factors that define decision making on OTC drugs (Hanna and Hughes, 2011), and social factors affecting the consumption of pharmaceutical products (Karmanova, 2010). Jin (2016) proposes a framework only for the Rx drugs, eliminating to consider the corresponding framework for the OTC pharmaceuticals (see Fig. 6).

Figure 6. Patient's buying process of prescription drugs

Jin maintains that the patient journey towards the purchase of Rx medicine is closely intertwined with various actors and institutions, such as insurance companies, health care organizations, physicians, pharmacists, any other health care workers. Physicians are commonly accepted to play the key role in prescription drugs marketing, as they make the decisions for patients (e.g. while the latter are on admission) or give patients several alternatives during the appointment. A more general but at the same time, a more detailed model was suggested by the global market research company Ipsos. The Ipsos Healthcare Dynamics Model (HDM) is aimed to build an understanding of each of the important stakeholders in a therapeutic area. The underlying assumption of HDM, distinguishing it from other models of the kind, is that nowadays physicians do not make unilateral decisions on the treatment to be taken and medicine brands to be chosen. On the contrary, their role tends to be combined with “patients' perspectives, caregiver concerns, pharmacists' influence, health plan decisions, and governmental policies.” [66]

The patient journey is divided into several steps, as illustrated in Figure 7. First of all, a patient perceives he has a health problem. Usually, patients try to search for the information on the Internet before making an appointment with a healthcare professional. As time goes by, the patient defines the health issue by himself or seeks for medical advice and treatment in the healthcare system. The following stages include the treatment itself and compliance with treatment recommendations.

All in all, HDM provides a 360-degree view of the buying process of pharmaceuticals integrating data collected from various stakeholders, such as patients, physicians, and pharmacists, family members, and non-physician practitioners. The milestones that patients pass by while solving their health problems are the critical points to be understood and evaluated as potential leverage points for marketing. Despite the integrity of Healthcare Dynamics Model, it still can be defined as a general framework applicable both to prescription and non-prescription drugs regardless of their peculiarities. On the top of that, it does not take into account cultural patterns and national context, which are extremely substantial for any pharmaceutical business expanding on the Russian market.

One of the rare studies on the subject of the patient journey for Rx and OTC medicine has been done by Afanaseva (2012). She proposes two models which reflect the features of communication processes in the promotion of prescription and non-prescription pharmaceuticals. Despite the substantial contribution made, Afanaseva's paper is not devoid of some drawbacks. First, the research is focused on the communication between a pharmacist and a customer in a drugstore missing and does not include the contribution of the before mentioned actors. Second, the findings are majorly based on popular communication theories advanced by Lasswell, Schramm, Berlo, Shannon and Weaver and other renowned scholars, so the author somehow fails to offer any practical results.

To conclude the given literature analysis, it appears that there is a lack of studies that describe how the classical customer journey model is applied by the health care companies. While there are plenty of papers which examine the patient journey and contributing factors only for one specific type of drugs, few papers distinguish between the patient buying process of Rx and OTC drugs using the classical 5-stages model offered by Kotler (2016) or a so-called patient journey. Still, there are blank pages in the empirical studies on patient journey mapping conducted by pharmaceutical companies in the Russian market. Therefore, in my project, I intend to examine in detail how the framework of customer journey is adapted by pharmaceutical enterprises in the Russian market and give a particular emphasis to the alteration of conventional stages of the buying process due to macro-environmental and other kinds of factors influencing the consumers.

Transition

The primary objective of this review was to examine the scientific literature on the concept of customer journey with a particular emphasis on the origin of this framework and its evolution up to the present moment. In this chapter, I covered the prerequisites of the customer journey model briefly describing the main stages of AIDA model advanced by Lewis (Strong, 1925). In the XX century, the sales funnel model underwent root and branch transformation, as various scholars altered it by adding new stages of the buying process, such as satisfaction, conviction, comprehension, retention and many others. In XXI century, the purchase funnel continued to evolve with the development of Internet technologies and e-commerce in particular. Among the latest modifications, there are the conversion funnel, the so-called app funnel for mobile applications and the AISDALSLove model offered by Wijaya (2015).

A particular emphasis was given to the managerial implications of the model and its practical significance. The considered buying decision model enable marketing managers to measure the effect of advertising, understand consumers' attitude and behavior towards brands. Furthermore, with the help of hierarchical models brand managers get the opportunity to predict consumer behavior and identify factors influencing consumer behavior on each stage. As consumer behavior may differ depending on a particular stage, managers also get the opportunity to understand what they should emphasize in advertising strategies.

The next step of the literature review was to identify the key differences between the sales funnel and the customer journey providing the comparative analysis of both. As a result, I came to a conclusion that, as opposed to the purchase funnel, which is mostly based on the number of potential or actual customers, customer journey includes both qualitative and quantitative validation of a company's strategy. Generally speaking, the sales funnel is used to measure the volume of customers through different stages of the selling process, while the consumer journey is aimed at understanding consumers' behavior, informing decision making, and analyzing their experience to provide a better product or service. While the sales funnel is mainly aimed at strategic goals, such as defining the potential areas of growth, the customer journey can be used define and set tactical objectives as well.

After introducing the customer journey origins beginning with the consumer buying decision process model and narrowing the focus of the investigation to the patient journey mapping in the pharmaceutical industry I established a theoretical framework for studying of consumer behavior in respect of prescription and non-prescription drugs and factors influencing the the decision process. On the whole, it appears that there is a lack of studies that describe how the classical customer journey model is applied by health care companies. Thus, in my research, I intend to examine in detail how the framework is adapted by pharmaceutical enterprises in the Russian market and give a particular emphasis to the alteration of conventional stages of the buying process.

Chapter 2. Methodology

Objectives of the Study

The pharmaceutical market in Russia, as one of the largest emerging markets in the world, is getting a considerable attention from global healthcare companies. Hence, international drug companies naturally strive to increase their market presence and sales volume on the Russian pharmaceuticals market. Russia is fairly considered as a highly specific market environment, so global pharmaceutical giants have to put some efforts to understand their customers' minds. Previous literature on the subject has generally introduced the overview of the sales funnel, the buying decision process, social factors that affect the patient journey and a number of stakeholders involved. Despite the overall picture of the patient journey being described in details, the distinctive features of the patient journey in the Russian market have eluded the attention of researchers.

The purpose of my research is to get a more detailed picture of Russian pharmaceutical market by drawing the customer journey maps in the segment of prescription (Rx) and OTC drugs. In addition, it appears necessary to outline the key differences between the two models and identify a number of environmental factors and the factors of company's microenvironment that could influence the patient buying process in the Russian market. Studying these, I hope to offer some useful recommendations that may help other pharmaceutical companies on the market adopt the best practices of Abbott and improve their marketing performance. In this chapter, I will explain the qualitative research approach, research methods, and instruments used to collect data. In addition, I will mention the possible limitation of qualitative approach in general and specifically in this project, and discuss the reliability and validity of the results anticipated.

Research questions

As the following qualitative study is aimed at helping managers of pharmaceutical companies enhance their marketing strategies, the research questions of this study have been formulated in alignment with specific business problems faced by Abbott's product managers.

Research Question №1: What is the difference between patient journeys for prescription and non-prescription drugs?

Specific business problem №1: as stated in the literature review, the existing body of literature on the topic, despite being quite voluminous, does not give any examples of empirical studies distinguishing between the two types of patient journey. As for the companies, only a few of them rely on this technique because it is quite expensive and difficult to apply.

Research Question №2: How do marketing managers of Abbott interact with Russian customers?

Specific business problem №2: The existing methods of pharmaceutical marketing turn out to be insufficient to efficiently communicate with all the stakeholders along the patient's way to the purchase. Interviewees will be asked to specify the milestones of patient flow and the communication tools they use to reach the consumers on each stage so that I can generalize them into recommendations for other, less successful market players.

Research Question №3: What factors affect international pharmaceutical business located in Russia?

Specific business problem №3: All international pharmaceuticals brands including Abbott face the same challenges when entering the Russian market. These include Russian mindset, strict regulation of promotion of prescription drugs and other factors that I hope to find out from the interviews. Acquiring this data will help me to carry out a PESTLE analysis of Abbott microenvironment.

Qualitative research design and methods

In the following part, I will give a brief comparison of quantitative and qualitative research methods and explain which one I am going to apply in my project and why.

Morgan (2013) offers a laconic description of quantitative and qualitative research methods. Quantitative method is a natural science approach primarily used to test theory through observations and oriented to cause and effect. This deductive approach usually implies a predetermined design and separates data collection and analysis. Its main purpose is to prove the existing theory with empirical results. Qualitative research, on the opposite, focuses on understanding social world, using words rather than numbers, and explaining the relationship between theory and research questions in an inductive way. This approach merges data collection and analysis, making it possible to capture data through respondents' perceptions and empathetic understandings.

A qualitative approach has been widely used in various studies on consumer behavior. After the 1940s, qualitative studies were used to explore the lives of consumers, their life cycles, and their decision-making (Levy, 2005). Levy claims that “the more fully researchers want to understand consumer behavior,” the more they engage in the varieties of research activity called qualitative research (2005: 343).

One of the goals of my research is to investigate the environmental context in which consumers make purchase decisions on prescription and non-prescription drugs. Conducting a qualitative research will help me to understand how the patient journey to Rx drugs differs from the journey to OTC drugs, what factors influence the buying decision, and how marketing managers of Abbott overcome the environmental obstacles. The main technique of my research will be one of the core approaches of qualitative research - grounded theory that serves to bridge the gap between theory and empirical results and offer detailed and rigorous methodological procedures (Service, 2009). My research will begin with the collection of qualitative data and its analysis, which will occur simultaneously. I will continuously describe the data obtained, code the notes, and unify them into logical categories to provide the explanations of the concept examined and, thus, a new theoretical framework.

I will conduct my qualitative research basing on the method of the case study. Marshall and Rossman claim (2014) that case study is one of the most popular methods in qualitative investigations because of its “explicit focus on context and dynamic interactions, often over time.” Among its advantages, there is flexibility, ability to apply multiple data collection instruments, and the focus is on a contemporary phenomenon within its real-life context (Yin, 2013).

Limitations

The major limitation of qualitative research method applied is concerned with in-depth interviews as an instrument of data collection. Face-to-face interviews, as no other interview method, can take advantage of social cues, such as voice, intonation, body language, etc., which may give the interviewer lots of extra information that can be added to the verbal answers. That being said, there is still a possibility of the notorious interviewer effect (the interviewer guides the interviewee in a specific direction with his gestures, intonations, etc.). This shortcoming can be diminished by using an interview protocol and by the awareness of the interviewer of this effect (Opdenakker, 2006). As for the specific limitations of this research, there may appear an inability to transfer that the best practices of Abbott managers to other companies on the Russian pharmaceutical market.

Data collection instruments

According to Gummesson (2015), the case study research method requires the usage of multiple data collection instruments. As the main research tool, I will use the semi-structured in-depth interview since it allows the interviewer to establish trustful relationships with respondents obtain unique information, and use projective methods and visual materials. Moreover, this instrument allows the interview topics to emerge during the dialogue and helps the researcher to collect “depth and detail on a range of factors related to a subject” (Morgan, 2013). The guideline for the interview is introduced in Appendix 10.

As a part of the study, I will interview nine respondents from the marketing department of Abbott Laboratories, three of whom hold the position of junior product manager, four - product manager, one - senior product manager, and one manager of trade marketing. At the request of the respondents, their initials and all brand names are listed anonymously. For further information on the respondents, please, see Appendix 11.

Along with in-depth interviews, I am going to review corporate documents of Abbott and directly observe the management operations and processes in the company. The combination of three the above-mentioned instruments, or a so-called triangulation method, will enable me to counterbalance the deficiency of a single data collection strategy, thereby increasing the ability to interpret the findings (Thurmond, 2001). Carter N. et al. (2014) mention four types of triangulation: (a) method triangulation, (b) investigator triangulation, (c) theory triangulation, and (d) data source triangulation. In my qualitative research, I will apply the strategy of multiple lines of evidence, which will help me to develop a comprehensive understanding of patient journey phenomena and test the results validity through the convergence of data from different sources.