Perception of the use of social media for disease awareness in Tunisia

1
Perception of the use of social media for disease
awareness in Tunisia: Pharmaceutical companies’
perspective
Jamel Charabi
Student number: 1314080
This research study was submitted to APBS of Tunis and UBIS
of Geneva, in partial fulfillment of the requirement for the degree
of Executive Master in Business Administration
March 2016

2
STATEMENT OF DECLARATION
I hereby declare that all the work in this dissertation is entirely my
own and has not been taken from the work of others. Ideas,
statements and thoughts of other authors have been cited and
acknowledged within the text and referenced with the original
source.
A full reference list is found within the Bibliography.
No part of this work has previously been submitted for assessment,
in any form, either at Avicenne Private Business School of Tunis or
UBIS of Geneva or any other institute.
Signed: Jamel Charabi
Date: March 2016.

3
Table of Content
I. PROBLEM STUDY……………………………………………..……….4
II. WHY THIS RESEARCH?.........................................................4
III. INTRODUCTION ……………………………..…………………...…..5
IV. LITERATURE REVIEW……….………………………………..….…..7
1. SM definitions……………………………………………….....................7.
2. SM overview…………………………………………………………………….7.
3. SM and marketing ……….…………………………………………………13.
4. Company’s marketing strategy and social media…………………16.
5. SM and public relation ……………………………………………………18.
6. SM and market research …. ……………………………………………19.
7. SM Metrics………………………………………………………………….…21.
8. SM in Pharmaceutical companies ………………………………….…23.
a. Pharmaceutical marketing Overview………………………………………23.
b. Healthcare professionals and social media…………………………….…27.
c. SM Strategy in pharmaceutical companies ………………………………29.
d. Pharmaceutical companies digital targets………………………………..31.
e. Social media content impact in pharmaceutical companies……………32.
f. Impact of connected objects on Health …………………………….……33.
g. Best practice of pharmaceutical companies ………………………..……34.
h. Regulatory framework…………………………………………………….….35.
V. SM & TUNISIAN PHARMACEUTICAL COMPANIES ………….36
1. Pharmaceutical market Overview ………………………………………………..……36.
2. Regulation in Tunisian Pharmaceutical market…………………………..….…...37.
3. Social media in Tunisian pharmaceutical market………………………..…..…..38.
VI. PROBLEM RESEARCH………………………………………….…...40.
VII. METHODOLOGY………………………………………………….…..41.
VIII. RESULTS…………………...……………………………………..…...43.
1. 1st
In-Depth Interview…...................................................................46.
2. 2nd
In-Depth Interview……………………………….................................….48.
3. 3rd
Interview …………………………………………………………….…………………..51.
4. 4th
Interview ……………………………………………….……………………………..…52.
5. 5th
Interview ………………………………………………………...……….…….……….53.
6. 6th
Interview ………………………………………………………..………..………….....54.

4
IX. DISCUSSIONS ………………………………………………….…54.
1. How Tunisian pharmaceutical company is facing social media strategies?
Also to understand the potential role of social media to increase patient’s
awareness…………………………………………….…………………………………………..55.
2. To value the impact of social media on company sales performances……..59.
3. How Tunisian pharmaceutical companies are using social media in a
balanced way seeking for global and local ethics?….……………..…….………..60.
X. LIMITS………………………………………………..……………62.
XI. FUTURE DEVELOPMENT …………………………….………..62.
XII. CONCLUSION …………………………………………..…….….63.
XIII. RECOMMANDATIONS…………………………………..……….64.

5
ACKNOWLEDGEMENTS
I would like to express my special thanks for every person who
contributed and helped me during my dissertation phase.
I would like to express my love and thanks for my family ,my wife
Najwa ,my daughter Nisrine ,my son Aymen also my mother Salha
Bacha who supported and encouraged me to continue to broaden
my knowledge in addition to my doctorate in medicine
accomplished twenty years ago .
I also should mention my father, who unfortunately passed away
when I was fifteen but he will be always present in my memory.
I need to express my thanks for my mentor of thesis Dr Ahmed
Dammak, who was always available and helped me to improve my
research.
Also, great thanks for all my classmates in this executive MBA
courses, Nizar, Soufiane, Maissoun, Asma and Mehdi, with whom I
spent exciting moments of hard working ,but also of fun ,I wish all
of you a lot of success.
Finally, I would like to thanks all professionals of Tunisian
pharmaceutical companies who were enthusiastically dedicated the
necessary time to answer my qualitative research.
This research was possible thanks to you!

6
I. PROBLEM STUDY
The main argument of this research is to study the perception of
the Tunisian pharmaceutical companies’ of social media use to
develop "patients education and disease awareness".
II. WHY THIS RESEARCH?
My passion for digital media and my professional experience in the
sales and marketing department at multinational pharmaceutical
company in North African markets, where I worked for a Swiss
company in several positions in sales ,marketing and management
from 1998 -2015 .
My particular interest in social media and digital marketing
tendency.
In my previous company as business unit head, or Product
manager, I had the opportunity to develop a media campaign
oriented for patient education and awareness in collaboration with
patients associations, in several diseases areas such as cancer or
rheumatoid arthritis.

7
III. INTRODUCTION
Social media has started to be one of the key marketing terms in
the industry. The number of social media users was estimated to
exceed 3 Billion by 2018. (E-Marketer, American Marketing
Association, ©Statistica 2015)
In Tunisia there are more than 53% (5, 81 millions) of Tunisian
households using the internet, and 42% (3, 6 millions) are using
Social media networks, mainly Facebook, Instagram, LinkedIn, and
Twitter.
Globally, all pharmaceutical companies are involved in using social
media for several purposes; creating patient and professional
communities also exploring their medicine’s side effects, identifying
and monitoring threats to their brands.
Other pharmaceutical firms use social networks to discover new
product ideas and try to understand patient experience with
diseases in order to increase patients’ awareness also fulfillment to
its medicine.
However, pharmaceutical companies try to perform a trend
analysis of customer perception, also identify new audiences
through specific messages in particular communities.
The effective integration of social networks into the pharmaceutical
company's environment will help certainly to focus on collecting
valuable information’s among users, but also providing trustful
information for both patients and physicians, with whom it is
important to establish the required ethical balance.

8
The complexity of the problem is further strengthened by some
regulatory barriers imposed by health authorities (Code of
marketing practice IFPMA, FDA, and EMA) within the industry.
Unfortunately, I didn’t find any paper related to the use of social
media by Tunisian pharmaceutical companies.
My research focused on, the perception of pharmaceutical
professionals of the use of social media on their marketing strategy
for patient education, also how they are managing to reach the
required ethic balance between raising disease awareness among
patient community and the enthusiasm to develop brand sales.
Six Tunisian top managers from pharmaceutical companies
accepted to be interviewed .The aim of the discussion was
performed to collect the maximum of information regarding their
perception of social media use in a pharmaceutical environment.
The sample was selected to include mainly multinational based in
Tunisia because the use of social media in my country is still new
in the pharmaceutical market.

9
IV. LITERATURE REVIEW
1. Social media definitions
As part of a marketing approach, the term generally refers to social
networks all the websites to build a network of friends or
professional knowledge and providing their members with tools
and interaction interfaces, presentation and communication.
The best known social networks are Facebook, Twitter, Linkedin,
Viadeo, Pinterest, etc. Youtube can also be considered partly as a
social network to the extent that the service has developed tools of
interaction between its members.
From a marketing perspective it is a low cost and little biased tool
and that will be the marketing’s future (KOTLER et al 2010- pg.9).
Social Media is part of Web 2.0, in this environment, marketing
efforts are focusing on consumers retaining and satisfaction
(KOTLER et al 2010-pg.6).
For pharmaceutical companies, social media start to be a part of
the marketing strategy, with specific objectives such as driving
observance for its medicine also patients’ empowerment not only
to increase disease awareness but also to drive patients to the
clinic.
2. Social media overview :
The ratings success of the major social networks has made often
essential marketing and advertising media.
Social media is a group of individuals linked by social attach,
interest and interactions and because of the rapid growth of their
digital structure (Social media ) on the Web, the social structure
that represents a social network exists in a more or less elaborated

10
way, more or less dynamic and evolving, since man interacts with
his similar.
But the appearance of Web 2.0 development fast and simple
connection of services provided to this feature of human society
not only a global dimension, but also a mode of operation much
faster and a lot more interactive.
They all used to connect individuals with each other and facilitate
exchanges sometimes playful, professional, sometimes dealing with
everyday life, and focusing on a field of particular expertise.
For the marketer, they quickly became a space that not only had to
watch carefully, but the need to invest in the best. On the one
hand because their success is that they capture a more or less
important part of the discretionary consumer time, which can no
longer be affected / sensitized by the traditional media.
Moreover, because consumers exchanging them and their
exchanges can optionally carry on the business, brand or its
products. Theses information could then lead marketers to identify
insights that conventional marketing studies do not always
verbalize exactly.
"A social network allows you to be in touch with your family
,friends and business relations, to find people lost sight of
acquaintance based on affinities, common interests, know what
your contacts (via the newsfeed).
Sharing data (information, photos, videos, etc.) can also be a way
(dating networks) or end (networks in which the user is active) in
this context sharing. Social networks have been a fertile ground for

11
the development of the economy of sharing, or access premium on
possession, collaboration on individuality.
Personal social networks also allow you a better understanding of
yourself through interactions with contacts.
We should know that in 2013 more than 3 billions of peoples are
online worldwide, and more than 2 billion are active on social
networks.
As shown in the diagram below ,Facebook is the main social
network with more than 1.4 billion monthly active users ,then
descendant :Twitter , Google + and Instagram .
*Number of Social media active users
1400
300
500
288
Active Users/Month
Facebook
Instagram
Google+
Twitter
Few years ago, there has been renewed interest in understanding
the consumer perception of advertisements to findout the best
ways to catch consumer’s attention. Traditional advertising, such
as television channels and computers has lost the interest of
consumers thanks to the change of life style.

12
In fact, what built social media popularity is its ability for
consumers to share information.
Social media could be assimilated as a viral marketing and defined
as “a company’s activities to make use of customers’
communication networks to promote and distribute products.”
(Helm, 2010, p. 158).
Jurvetson and Drapers article from 1997, in which the rapid
Internet diffusion of the email service, Hotmail, was described as
one of the earliest and most groundbreaking viral marketing
strategies.
The strategy in this case is considered as a fast and cheap
marketing solution with wider reach compared to traditional
marketing campaigns.
Kotler & Armstrong, 2011 and Helm (2010, p. 158) explained how
the traditional promotion procedure moves from a company to its
consumers when we use viral marketing.
Thus, companies are expressed to take advantage of customers’
online WOM (word of mouth) tendencies in their promotional aims,
and consider viral marketing as a cause achieved via the word of
mouth. The online WOM has got the potential to reach larger
audience as information is spread among both known and
unknown users online, whereas for the traditional WOM
information is spread among real life networks (Sun et al., 2006, p.
1109).
The viral marketing was defined by Kaplan and Haenlein (2011, p.
255) as “media WOM whereby some type of marketing messages

13
related to a company or brand are spread in an increasing way,
often through the use of social media applications”.
Some scholars within the social media marketing field focus on
underlying behavioral factors to why individuals pass on viral
messages such as Dhaoui, 2014 and Mangold & Faulds, 2009.
Mangold and Faulds (2009, p. 363) argue that customers
tendencies to forward social media content is enhanced when the
customer have knowledge about the firm and its products. In order
to bring more clarification on the motivation to forward a social
media content, Dhaoui (2014), proposes four constructs:
 Endorsement
 Feedback
 Conversation
 Recommendation
Other academics focus on how individuals pass on viral messages
(Keller, 2010; Phelps et al., 2004). Keller (2010, p. 827) articulate
a certain understanding for that .All customers are different and
consequently are driven by different aspects when interacting with
messages and content.Kietzmann et al., (2011) explained how
social media platforms overall are build and what implications they
have for marketers.
Singh et al., (2008, p. 283-288) status in their study that blogging
can be considered as viral marketing and accordingly companies
can retain their targeted customer segments without any effort as
the customers following them are already interested in the
company or their products .

14
Furthermore, there is a shift in people's internet usage, from
computers to phones, maybe related to the fact that main social
media have a mobile platform (apps).
When social media appears on mobile platforms, firms are not
going to simply maintain their websites for conventional advertising
but they will findout new ways to interact with customers, in the
purpose of a sustainable relationship and double way
communication which conventional websites ideally propose.
Few years ago, all futures that are using consumer generated
marketing or media are considered as the most up-to-date tools of
marketing.
The consumer-generated media include marketing messages and
brand exchanges created by consumers themselves which will
create by the end a “buzz” about the subject.
Now days, the tendency is to use social media and create video
messages related to brands and companies ,meanwhile exchanging
them through networks such as forums, and micro-blogs.
More and more, what marketers appreciating is that social media
strengthening consumers to spread information from one to
millions.
In fact social media networking foundation is quite old, as stated in
the first MASLOW pyramid when people had a need to belong to a
community, much like what we see today. It is advancement to a
basic biological need enjoyed by online groups, forming for
example family groups, business group …
People in groups share information because they belief in each
other; That’s why, social networks subscribers are considered open

15
to share information with their close friends, their business group
,although the personal word created locally with close and intimate
friends has now been spread to mean a few hundred intimate
friends .
Now, something shared by one of these few hundred friends is
likely to be more trustful messages that come from outside the
group.
3. Social media as Marketing tool
Certainly, social media is a tool that could be used to network in a
formal and informal way with their customers and employees to
create awareness also builds personal or professional relationship.

16
It is obvious that the classic marketing mix added to trustful
relationship building, through social networks will make a perfect
combination for a successful business.
Hearn, Foth, and Gray (2008) stated that in social media,
advertising and communication is typically directed from few to
many, and in order to be effective it should be interactive, with an
engaging process, which could improve relationship building.
The effectiveness of social media may not be as quick to reveal.
Young (2008) believes that just like any other relationship, the
relationships formed through social networks take time to show
their value, that’s why companies need to remain devoted to it in
order to gather these benefits.
Internet technology, and social media perception means that there
are changes in the marketing planning, strategy creation, and
especially in market communication (Vasiljev, Cvetkoviv, Kancir, &
Pantelic, 2007).
The social network have different focuses; for example LinkedIn is
oriented to business related purposes; Facebook at the beginning
has perhaps almost all the university student population, which
was also the original purpose of this social networking site.
Furthermore, the marketing spend on social networks sites have
also increased by 166% from 2007, thus reaching $2.4 billion in
2009 (Mintel, 2010).
From another side, adding any new form of marketing tool requires
integration into the overall marketing strategy. In the same way,
social media marketing needs to be included into companies’

17
strategy in order to interact and get engaged efficiently with the
main chat’s drivers, which is customer (Brown, 2010).
Thus, advertising must take into consideration the change in the
consumer way of life. Indeed, the increasing role of technology in
marketing communication is correlated to lack of trust toward
classic advertising concept as it doesn’t take into consideration
consumer desires. That’s why digital investments are growing up in
American (US, Canada, Brazil) and European markets like UK and
France, to gain customer trust and increase confidence in the
Internet as a platform for advertising and selling. Therefore, there
is an increasing digital advertising investment in the world, related
to its importance for marketers and researchers.
As well known, the main objective of publicity is to push people to
buy something. Therefore, understanding how marketing
influences people will lead to understand how persuasion
techniques are usefully applied in advertising to turn on the buying
decisions.
“Rational or irrational persuasion techniques can be used either
one of them or a combination of both”.
In Sweden for example ,a mobile social media universe ,the
popularity of smartphone and the technologically improved rapidity
of the portable internet performance (Davidsson, 2015, p. 5) have
resulted in that the Swedish population nowadays are more
constantly online (Swedish Media Council, 2015, p. 4).
Recent statistics shows that 12-35 year olds spend in total more
than one hour each day using their Smartphone, and most time is
spent by the 16-25 year olds who use almost two hours each day

18
to browse their phones (Findahl, 2014, p. 19). Kaplan and Haenlein
(2010, p. 67) recognizes this technological shift from stationary to
mobile social media use. At the end of 2014 78% of 9-12 year olds
and 95 % of all 13-16 year olds had their own Smartphone
(Swedish Media Council, 2015, p. 19).
4. Company’s Marketing Strategy and Social Media
Enabled by Internet-driven new media consumers become in the
center and empowered to interact and filter messages to raise up
awareness and strengthen brand loyalty.
So, changes in the way of media use have lead companies to shift
their focus from products to people (customer) and from simple
information delivery such Tv channels and websites for information
exchange and analysis (digital 2.0).
Currently, it’s vital for companies to find more trustful and
sustainable ways to communicate with their customers something
innovative which encourage interactions...
Therefore, the use of social media in marketing strategy is
designed to raise awareness, inform instantly audience to gain
empathy, make trust, and finally provide consumers’ thankfulness
and feedback.
By the end of the day a reason to buy will be not the unique aims
of social media use, but further, developing new products and
brands use to be a program that enables companies to reach
bigger objectives and building sustainable brand sales.
More than 90% of social media users believe that companies
where they buy from should have a presence in social media.

19
Therefore think that a company should interact with its clients via
social media and more than fifty percent feel a stronger connection
and more satisfaction with the service received by a company
when they interact in a social media environment (Cone Inc.,
2008).
Firms that want to make a presence in a social network must focus
their efforts on creating content, in order to foster and engage with
their customers in a more personalized way.
Customers will accept and for sure appreciate this and will become
more receptive towards brands.
Social media has brought a huge change to the ways that we were
communicated therefore enables marketers to directly converse
with their audience and strengthen their effectiveness to generate
worth for both sides.
This interactive form of media now touches individuals globally
from very young children who are looking to connect with friends
to senior who are branching out into the world of social media to
have a new level of interaction with business peoples, this is show
how social media makes people more engaged with brands.
Social media is considered as an effective tool for business to
business activities also business to customers because it can help
increasing brand awareness, Humanizing business, establish
connection with prospects and clients, which will lead surely to
increase conversion rate.
Carter (2009) is convinced that since the market has evolved the
creation of the value of relationships is by going through social
media. The Web 2.0, or Marketing 2.0, is a powerful mix of new

20
and traditional marketing tactics where it allows people to share
and participate (Weber, 2007; Tomlinson, 2008; Carter, 2009).
In fact, may be the originality of Web 2.0, and its originality, social
marketers will be fascinated to integrate the related digital tools
into their promotional plans ,with less dependency on traditional
communication channels.
5. Social Media and public relation
The fundamental difference between Marketing Public Relation
(MPR) and the other types of marketing is the connectors that
spread the message. MPR is mainly focusing in creating the “buzz”
around the product through heartening traditional media channel,
social media networks, or individuals to spread messages to their
audience which could be a business partners or consumers.
Social media creates a company environment that encourages a
two-way exchange to capitalize on it in a way that can benefit their
image and their customers.
Companies that wish to make a presence in a social network must
focus their efforts on creating an interesting content, supporting
and engaging their customers’ community in a more direct, and
casual way. Customers embrace and appreciate this and they can
become more receptive towards their favorite brands. The change
that social media has brought to communications has been quite
significant. Appreciating this, marketers will surely accept the fact
that a great amount of information (either negative or positive) is
being communicated by individual consumers to other consumers
via social media and this information is directly influencing all

21
aspects of their purchase and post-purchase behavior. They will
realize that consumers are turning away from traditional elements
of the promotion mix, by reducing the reliance on advertising as a
source of information.
In addition, the majority of public relations professionals state that
their job has been made easier because of the use of social media
by expediting the circulation of information to reach broader
audiences; Social media enables practitioners to directly enter into
conversations with their audience, but it is also used to strengthen
effectiveness of their relationship.
Moreover, since smart phones use is increased this is led to easy
access to social media and people are keen to exploit social media
to access information.
From one hand, this helps the community’s knowledge grow also
companies analyze their competitors, from another hand; all
unhappy customers get an amazing place to express their thoughts
and expect a quick feedback from companies.
6. Social Media and market research
Companies can simply, go through social media to elaborate a
market research regarding a particular subject related to its area of
activity, ask questions or going deeper for an investigation.
There are at least 5 ways to get data through social media:
1. Ask: If the company wants to get an opinion or feedback from
their "fans" or "followers" on a meticulous subject, they just have
to ask them directly and engage discussion on the matter of the

22
research. This way, the company will not only collect data but also
will build the relationship with target customers.
2. Test Market: Social networks are a great way to test company
ideas or projects before jumping into the creation and production
which is considered as a heavy process, this can save lot
resources.
3. Identify Innovations: How followers or fans of the company web
or social media account page are they using the products? All new
uses could provide new opportunities to explore or exploit.
4. Listen & Watch: One of the simplest ways to do market research
through social media is observation.
If the company starts listening to what their target customers said
on Facebook pages, Twitter or in LinkedIn group of their
competitors they can learn a lot of information that could be used
later at their leisure. (Eg.What users are saying to you? What do
they think of your competitors? What are the main keywords? )
5. Investigation: The Company can perform an online survey
through social media as part of it marketing strategy or market
research, and to be more successful, publish the survey results
throughout network.
The invention of Smartphone’s has boosted social media
interaction and the value of shared information became important
and could be extracted and used.
So, internet mobility, then social media networks makes research
in marketing simple as you can plan to reach available and future
customers through a new dynamic ways as well as cost cutting.

23
Social media data can be gathered through various research tools
such as focus groups, in-depth interviews, teleconference, surveys
and finally “consumer panels” which bring to the researcher full
control of dialogues.
With social networks we can build brand or fan pages, and the
respective company will set up its dedicated investigative research.
Social media networks could be used to measure customers or
potential clients reach, engagement, feeling, inquiries and sales
conversation. In fact there are a number of techniques which can
be used to measure the perceptions of customer, for example the
customer sentiment analysis could be recognized through the
analysis of the emotion associated with the posting using Viral
Heat, or Tweet Feel ….
Now -a- days, the online survey became one of most popular tool
to conduct a market research. Through social media we can track
live what specific company customers are discussing about, or
sharing.
7. Social Media metrics
When it comes to measure social media added value in company
close environment such as its notoriety, commercials, sales or
marketing strategy, most managers are afraid, because they do
not master measurement tools and they have to focus on
identifying the value of operating in the social media environment.
Marketer who wants to know the immediate effect on sales of any
social media campaign can do so through calculating the difference

24
of the revenue generated before and after a campaign, also from
each dollar spent on.
Before deciding indicators to watch in priority, it is essential to
define its strategic objectives. The analyzed figures should answer
the questions you are asking you in terms of performance.
Moreover, it often makes sense to combine several indicators to
obtain a consistent and accurate view of your activity on social
media. The traffic on company’s website generated by social media
is probably what is easier to quantify. However, this simple
audience measurement is not enough to analyze visitor
engagement, that is to say, the interactions they'll perform with
you. To get a clearer picture, for example you can filter the traffic
on your site according to the origin of visitors through your
analytical tool. You can then compare this data rate conversion on
your site, example the number of actions performed (act of
purchase, subscription to a newsletter, etc.). You can compare
your different campaigns, on Twitter or Facebook for example, and
see which generates the most qualified traffic to your site.
Most social media show only the number of fans or followers
following your page. This basic indicator allows you to determine
your audience. Nevertheless, it is not enough and you need
additional tools to study the behavior and commitment of the
people who actually interacted with your brand or business
The extent of participation can observe how people interact with
your social marketing campaigns. These interactions can take
different forms: a comment, a like ,a retweet or sharing. There is
several type of interaction: simple like a message posted on your

25
Facebook page, for example, less impact than posting on a blog
referring affecting your campaign.
Therefore its necessary important to know properly how to assess
interactions to understand the impact of campaigns on social
media.
8. Social Media in Pharmaceutical companies
a. Pharmaceutical Marketing overview
Pharmaceutical Marketing has some strict regulation compared to
other markets, the strategies used by pharmaceutical companies to
engage with social media are low risky as well as non innovative,
compared to those used in similar industries.
Pharmaceutical companies are investing more and more in social
media since a decade as shown below.

26
The main objectives of pharmaceuticals companies in using social
media have been resumed in the following figure:
Opportunities For
marketer
Improve Customer
penetration and
relationship
Raise Brand
Visibility
Bring Patients and Doctors
together
Decrease
Marketing Cost
Improve Brand Loyalty
Digital Marketing
/Social Media
Network
*Pharmaceutical company Objectives
Source: International Conference of Advance Research and Innovation (ICARI-2015)
Pharmaceutical companies worldwide have been creating
communications focus on pull strategy. It is usually done through
direct to consumer (DTC) or disease awareness advisement (DAA)
campaigns when local regulations permit that.
Some published articles has demonstrated the benefits of DTC
advertising, Amaldoss and He (2009) concluded that DTC has a
significant positive effect on brand sales, once it is focus on
disease, it helps firm to expand the overall market, therefore there
is an opportunity for firm to free ride on DTC of the competing
firm. On the other hand, some authors believe that DTC increases
traffic to clinic where detailing is the main strategy and has been
found to be far more effective in determining brand share (Ladeira
et all, 2011).

27
Finally, some authors defend the combination of pull and push
strategies because it seems clear that the combination of these
push and pull strategies are aimed at increasing the awareness of
various types of products by both the consumer (patient) and the
physician, and ultimately increasing the sale of those products
(Cavusgil and Calantone 2011).
For example, social media engagement of Johnson & Johnson was
found to be the best and far ahead of companies like GSK, Novo
Nordisk, Pfizer and others.
Pharmaceutical industry marketing strategy is an example of
combination of both “push” and “pull” strategies in their
promotional efforts (Parker & Pettijohn, 2005) , and marketing
expenses are usually focused on “push” strategies through
detailing and personal sales directly to physician and “pull”
strategies represents a small part of marketing activities.
It’s clear that industries from different sectors are using social
media to start new marketing strategies to engage their customers
in a buying process.
Healthcare and especially pharmaceutical companies have a large
potential ‘online’ market that they can influence via social media.
A recent report by “IMS Health” suggests that half of the top
pharmaceutical companies are actively involved directly or
indirectly in the use of social media such as LinkedIn, Facebook,
Twitter and YouTube, but their investment in this area remains
small compared to other industries because of the complexity for
these companies to assess return on investment, also to restriction

28
settled by international and local health authority as well as” the
weight of responsibility on the pharmaceutical companies arms” .
Healthcare area has traditionally been known having a high level of
competence, trust and independence of information brought to
patients’ by Physicians and Nurses….
Few years ago the internet started to be the first source for
medical and health information for patients and caregivers,
students and seekers in general.
*Push and Pull Strategy in Pharmaceutical Market
Pharmaceutical company Physicians Patients
Push Strategy
Pharmaceutical company Physicians Patients
Pull Strategy
Recent American study demonstrate that more than 70 % of
citizen seek healthcare information from internet and more than
40% use social media to understand issues such side effects ,but
only 20% joined health community or forum.
It’s obvious that, most peoples who seek for online health
information start by engines (Google) search to land on

29
“Wikipedia” first which is considered as well-known source of
online health information compared to others.
The value chain of pharmaceutical companies is illustrated as
below:
*Pharmaceutical industry Value Chain
R&D :
Products
development
Preclinical
Clinical
Regulatory
approval &
Market
Authorization
Supply Chain
Production
Manufacturing
Marketing
,Sales
Distribution
Post-Marketing
Pharmacovigilance
Source: Pharma summit 2013 [http://www.pwc.in/assets/pdfs/publications/2013/changing-landscape-of-the-indian-
pharma-industry.pdf
b. Healthcare professionals and social media
Usually patients trust in physicians and healthcare professionals are
the primary driver of healthcare information on the web but less on
social media and Healthcare professionals are not as strictly regulated
for online social engagement and have the trust of patients to deliver
independent and reliable information. But much like the
pharmaceutical industry, healthcare professionals (HCP) are usually
perceived as slower adopters of new technologies.
Social media could be an excellent occasion for HCP to provide
support for patients by answering questions for a large number of
people online. Time is very limitative for individual doctors to help

30
versus network where he can provide support for a millions of
patients.
Collaborative work with both pharmaceutical companies and
healthcare professionals (HCP), encourage information sharing and
gathering, and strengthen the relationships between companies
and its customers.
In general the collaborative relationship between pharmaceutical
companies and HCP is characterized by the mutual interest
traditionally recognized by both sides in their disclosure.
In fact, pharmaceutical company professionals, marketers before
to plan a scientific congress about the disease for example, he
invites the HCP as speaker, or expert in the subject or the disease
to give conference or meeting for peers or caregivers (nurses…).
Finally the audience percept the disease connected with the brand
and the pharmaceutical company related.
In this case stakeholders involved could be:
1. Medical doctors to gain information about the disease
2. Patients’ to be diagnosed with care
3. Pharmaceutical company to serve drugs as a treatment which fit
to patient’s disease and doctors needs.
The effectiveness of the communication depends on the way that
physicians and patients learn about the information, and their
perception of the importance of the information.
HCP and pharmaceutical company relationship was well regulated
and a public disclosure is required.

31
Moreover, the Internet provides fantastic opportunities for training
of healthcare professionals through e-learning, webinar, also to
develop patient monitoring or remote clinical tests.
It is important to underline that the majority of people who engage
with healthcare online are looking to fulfill an unmet need, be it a
need for information or emotional support. Those seeking
information are more likely to turn to usual digital sources, while
those in need of emotional support will be more drained to social
media.
In 2012, a study by Kurt Salmon revealed that more than 90% of
decision makers in the pharmaceutical world allocate larger
budgets to marketing online also wanted to move towards the
development of digital application.
The traditional role of the pharmaceutical industry representative,
devoted until now to medical visitors, is in decline. As proof, the
number of medical representatives which is falling gradually for
over a decade. While this development is partly explained by the
desire of the pharmaceutical industry to rationalize its costs, it also
has its roots in the new abundance of sources of information for
healthcare professionals (HCP). And of course, the Internet has
become a new battle field for marketing and education,
information. The shift in the pharmaceutical companies’ business
model is well coupled with the % of Health care professional and
Health care organization that is using increasingly social media
networks.
This intention is now reality. The digital communication is indeed
essential to promote products and innovations. It should thus

32
occupy a key role in the marketing strategies of pharmaceutical
companies.
c. SM Strategy in pharmaceutical companies
Pharmaceutical companies are maintaining their presence on social
media websites for providing information on new drugs, to educate
patients about their health issues and also deepening the relation
with patients and healthcare professionals.
Some sectors are more hesitant than others to invest in social
media, and the pharmaceutical industry has long been one of
them, that’s why marketers are still confused and a lot of questions
remain without clear answer and needs to be covered before going
further, such as:
 How to go to eHealth?
 How to suggest a subject as sensitive as the medication
and health over an open network at all?
 How to be sure that user will understand and assimilate
medical information?
 How to avoid dangerous behavior?

33
List of pharmaceutical companies using Social Media Sites 2012
Source: Pharma and Healthcare Social Media wiki
Face book Twitter YouTube Google+ Linkedln Flickr
Astrazeneca AstraZeneca AstraZeneca Pfizer AstraZeneca GSK
Novartis GSK Eli Lilly Roche Novartis Novartis
GSK J&J GSK Pfizer
J&J Merck J&J Roche
Merck Pfizer Merck
The benefits had made social media a part of online business.
Social media tries to give the opportunity to develop a healthy
relationship with the customers and learn about positive and
negative experiences that the company had with their products or
services and further make improvements to the key areas of their
business. Co-creation is a recent phenomenon in marketers and
consumers interaction. Social media had given the possibility to the
concept of co-creation. Social media is not only a channel for the
sales representatives to sell their products but is about to connect
and collaborate with individuals and treating the patients properly.
It is all about delivering a promise and providing customers with
high quality products and services as Sanofi Laboratories has used
face book and twitter for creating a community of 4000 diabetic
patients.

34
There is a clear opportunity for pharmaceutical companies towards
social media marketing and with the high rate it is increasing day
by day. Henceforth, social media marketing has become important
for listening and learning about consumer behavior, market
perceptions and massive new opportunities.
From another side, pharmaceutical companies could use social
media as a post-marketing tool ( after obtaining the market
authorization ) to get brand feedback and assess safety ,in USA
for example when the Food & Drug Administration (FDA) approves
a new prescription drug there is still a great deal remaining to be
learned about the safe and proper use of that product. When new
information addressing these topics emerges post-approval, the
FDA may issue a drug safety communication (DSC) to alert patients
and physicians.
d. Pharmaceutical companies digital targets?
In fact, health is one of the topics that generate more research and
discussion on the Internet, among the most searched topics to find
information on specific or chronic diseases, medical treatments or
dosages, hospitals, clinics or health professionals.
Also in this sense, a 2013 study of Echos indicates that 40% of
French population do not feel sufficiently informed by the doctors
prescribed drugs , hence the logic tend to go inquire via other
channels (internet).

35
A survey conducted in February 2015 by Harris Interactive revealed
that more than thousand pharmacies and meanwhile that 82% of
respondents regularly practice self-medication.
The pharmaceutical industry main concern was to make directly
online answers even to personal questions.
If the digital targeting strategy of the pharmaceutical industry is so
crucial, it is mainly due to the increased competition in the sector,
especially in a context where generics are increasingly present.
Result, all laboratories are actively seeking ways to better position
their products to increase sales.
Caregivers are also key decision makers because they often
influence and sometime make decisions in healthcare
management, especially for baby and elderly peoples.
That’s why more marketers have added them to their target lists.
e. Social media content impact :
With content marketing, the brand becomes a content producer, a
full-fledged media: it "simply" more than make a product and sell it;
it now has many digital tools to "talk to" the product through its own
voice.
Transmedia storytelling, blog, entertainment communities via social
networks ... All of the "tools" of content marketing can be
particularly effective for the pharmaceutical industry.
f. Impact of connected objects on health

36
The other important point that pharmaceutical companies can’t
miss: the explosion of connected devices and related health apps.
With the emergence of connected objects (smartphones
,tablets….), the pharmaceutical industry is invited to think about
data management and production of appropriate content.
In USA, in the field of mobile apps, a recent study has shown that
69% of respondents wanted to use a mobile application to manage
their health.
There is no doubt that this trend is already widespread in Europe
and Asia today.
This study also found that effective site content and or “apps” of
pharmaceutical actors should be directly linked to concrete actions,
with genuine Internet offer in their health management tools.

37
In the US market, users are more actively engaged in their
health management and some of them have asked for specific
branded medication from their doctor to treat a specific condition.
In North Africa there is no data founded in the subjects.
g. Best practice of pharmaceutical companies :
Laboratories Roche stands with his 100,000 followers on Twitter.
Their community management is extremely active, with many
tweets and retweets daily. The topics discussed relate to the
company product news, corporate news (conferences, earnings
announcements), health information of general interest; but we
also find many answers to individual tweets.
As it was demonstrated in a recent publication, in the context of
today’s socially connected society, using social media strategies
have to be one of the winning business strategies as its role is
crucial to embrace the different challenges facing the
pharmaceuticals companies.
h. Regulatory framework
If we look across worldwide regulatory organizations that supervise
the two largest mature markets we find similarities but differences.
What is common include recognizing that Pharmaceutical
companies can only be held responsible for content posted on
digital platforms and that’s why they have a direct control over,
and that the content of a company’s digital offerings should be

38
covered by the same regulations that govern conventional media
channels.
Despite guidance, gray zone remain, and often addressed through
warning letters from regulators authorities’.
So it’s important for pharmaceuticals companies to be aware of
what has happened to similar companies, to understand impact of
previous decisions, and remain focused on the evolving regulatory
environment.
Source: Engaging patients through social media. 2014 Report by the IMS Institute for Healthcare Informatics.
V. SOCIAL MEDIA & TUNISIAN PHARMACEUTICAL COMPANIES
1. Pharmaceutical market Overview
The health sector in Tunisia has always a particular attention from
the Tunisian authorities. Indeed, the budget allocated to it is
growing from year to years (the second sector after education).

39
The pharmaceutical industry is an essential and indispensable link
which reflects this purpose of the improvement in human health
care development indicators.
The broad guidelines of the Tunisian pharmaceutical system, which
seeks to find the right balance between public and private sector,
have been reaffirmed over the past decade.
Nevertheless, developments in drug policy have occurred,
particularly in terms of local drug production and some incentives
(Tax , Commercial , Regulatory ) was putted in place to help local
and multinational pharmaceutical companies to make a local
manufacturing .This allowed some private operators to create
pharmaceutical units. Today, the Tunisian pharmaceutical industry
is made up of 40 companies and 2 public manufacturers. Among
these companies, dug produced locally are either generic (46%) or
licensed products (54%).
2. Regulation in Tunisian Pharmaceutical market
The Tunisian Direction of Pharmacy and Medicine (DPM) Role:
“DPM “is a technical and administrative unit of the Ministry of
Health. The DPM is comparable to the FDA in USA or EMA, NICE in
Europe, and were recently recognized internationally as a
collaborating center of World Health Organization in the field of
drug registration and drug regulation.
Among its broad responsibility, and related to our topic, the DPM
ensure the control of the promotional material elaborated by
pharmaceutical company and dedicated for HCP and granting of
visas advertising.

40
Unfortunately this activity is still not fully operational yet, and
limited, so we could understand that for advertising through social
media also as well as the management of medical representatives’
activities (grants licenses to sell) and agencies for
Medical/Scientific/Pharmaceutical information.
3. Social media in Tunisian pharmaceutical market
Digital settlement is still in its early stage in our region but due to
the high number of youths, more than 50% of the population,
there is home for growth.
In Tunisia, we have the same figure and the popularity of online
information is gaining audience share from traditional news media,
a proportion that is expected to grow as some media channel have
ceased print editions to focus on online editions.
Since the Tunisian “Revolution” ,even before, local social media
platforms has strived to go beyond simple blogging, to bridge with
community-driven quality news, online video stories, and forums
for greater interactivity around timely issues, as well as the
showcasing of art, culture and science.
Social media marketing is bringing a new revolution to
pharmaceutical industry. The triangular linkage among doctors,
pharmaceutical companies and patients is scaling new horizon.
In long run, the pharmaceuticals market will be largely driven by
the social media marketing as already seen in the previous part
related to Europe.

41
This research focus in Tunisia, in my country, drugs regulation
prohibits Pharmaceutical companies to promote drugs under
prescription through “direct to consumer” (DTC) neither “Disease
Awareness Advisement” (DAA) through marketing campaign.
In fact, DTC campaign in developed countries for those products is
allowed just in USA and New Zealand. In Brazil, as well as in
Canada, firms can make only DAA and unbranded or “see your
doctor” campaign targeting patients. Only physicians can be
targeted for medical information & advertising purposes with
promotional materials and campaigns including benefits and risks
also the drug commercial name.
The impacts of DTC and DAA have been largely studied in many
researches and we find out that there are two extremes point of
view in this practice ; initially critics who are usually from health
organizations and accuse pharmaceutical marketing of creating
new diseases and encourage patients to be treated of diseases
they may not have. On the other side, marketers of pharmaceutical
industry believe that pharmaceutical marketing is giving to people
the opportunity to be treated of conditions that did not know that a
treatment is available and once they are treated, they are going to
have a better quality of life.
Moreover patients can not treat themselves before seek for a
doctor because a prescription is needed to buy a drug, as
conclusion patients those are sick will be treated after seek for a
doctor and have a prescription.
DAA or DTC would directly influence the patient decision making
process about looking for doctors but not about buying a drugs.

42
Due to the introduction of technology and new communication,
pharmaceutical and health marketing have changed the range of
channels used to target patients and doctors on their campaigns.
Channels such as mobile applications, websites and social media
have been included into the global pharmaceutical marketing mix
targeting either doctors or patients.
Social Media tends to be a new way of communication around the
world for all the industries, but in Tunisia it seems to be higher,
data from 2015 show that more than 53% (5, 81 millions) of
Tunisian households are using Internet, and 42% (3, 6 millions)
are using Social Medias, mainly (Facebook, LinkedIn, Twitter)
Facebook Report on 2015 has demonstrated that Tunisia is the 1st
North African country in the number of active members on
Facebook.
According to a report published in The Times of India (2014),
online medical consultation is becoming popular in which new
options like online appointments, video calls with doctors, getting
knowledge from social media is at higher side. It was concluded
that holistic social media marketing can stimulate more innovation
by touching multiple stakeholders. It creates a sustainable
environment that can change doctors, patients and employee
experience. Social media networks has become a channel that no
one can ignore, given that many patients connect to the Internet
to understand the symptoms of disease they are suffering , before
going to doctors . Pharmaceutical industry need to embrace a
global approach to engage efficiently with patients and healthcare
professionals through their products and services.

43
VI. PROBLEM RESEARCH
The theoretical part of my research helped us to clarify the
important role of social media as an innovative communication
tools in the internet area, where multinational pharmaceutical
companies are well involved despite the heavy regulation imposed
but also self-regulation in the sector.
Pharmaceutical companies in Europe and North of America even in
Brazil are investing more and more since a decade in social media
for several purposes, mainly for diseases awareness and patient’s
education but also for brand and institutional objectives.
Social media become a part of company’s marketing strategy and
budget in place accordingly.
There are no studies neither research regarding the use of social
media by Tunisian pharmaceutical companies including
multinationals based in Tunisia.
Therefore, the empirical part of my research was initiated:
1. To understand the perception of the potential role of social
media network to enhance patient’s education and awareness.
2. To worth the impact of social media activities on company’s
sales performance and how pharmaceutical company manage
their eagerness for profit balanced with their social responsibility
as one of the majors actors for better healthcare outcomes .
3. To study, how Tunisian pharmaceutical companies are using
social media in a balanced way seeking for global and local
ethics.

44
VII. METHODOLOGY
In this subject, the principal research method was to make a face
to face interview with top manager of Tunisian pharmaceutical
companies and collect the maximum of information regarding the
way that professionals are managing the expansion of this new
strategic tool of communication.
Interviews were conducted through a pre-established questionnaire
(see model in annex) and recorded to get testimony.
The questionnaire contains a total of 12 questions, made in order
to allow the interviewee to talk openly. Ten professionals Managers
and decision maker were asked for their knowledge about, how
they are facing worldwide social media use expansion in their
respective company and if social media activities could impact
Sales performance
Participants were also asked whether they use social media
networks marketing for brands or diseases awareness and
challenges which could be faced during such activity.
Finally, about barriers there are encountering when using social
media.
Responses of the participants were recorded and collated and a
deep analysis was done to understand the level of awareness and
how this innovative communication tools are used in the Tunisian
pharmaceutical industry area. And to compare their feedback with
companies who are operating in Europe or USA.

45
*Ethical Issues and Procedure
Potential ethical issues in this research should be the code of
conduct within the organizations as well as with the professionals
interviewed.
Thus, in order to reduce ethical issues, all participants were
informed that the interview was being recorded and that the
information would be used exclusively for the research and their
names, and products strategy would be conserved.
VIII. RESULTS
To understand the potential role of social media network for
patient’s healthcare awareness and the perception of professionals,
about using new technologies of communication to develop disease
awareness and education among patients and healthcare givers.
All interviewee stated the fact that social media could be one of the
pillars of marketing strategy for pharmaceutical companies in
Tunisia to strengthen their visibility through diseases awareness for
specific diseases.
Even all of them are top manager in their respective companies
they are not fully a decision maker when we talk about social
media use, as the subject is very sensitive they do not have the
total ability to decide in the subject as stated by one of the
interviewee:”we have to follow our internal regulation and seek for
the HQ approval for each step done”. The same situation stated by
the second interviewee who is top manager at a French
multinational, because the decision making process is so long and
complex, and we have to use by the end of the day a pre-

46
established tool or digital application already used by the Head
Quarter or regional in Dubai or France .
Only 2 among 6 pharmaceutical companies are using social media
network in their marketing strategy for patient’s education and
disease awareness, using a small budget less than 5% and 2%
respectively in diseases awareness but also as a digital marketing
tool for Health care professional information, which is replaces
print materials in some cases, regardless the lack of clear rules
from local health authorities …
From another side and despite the fact that all of them are
enthusiastic to start using social media in their marketing strategy,
no one of them has worked to push forward local regulation to be
updated except the president of SEPHIR who stated clearly his
ability to work closely with all member of his association to start
soon in moving forward definitive and clear regulation in the
subject.
All interviewees underlined the fact that in absence of regulation
they still huge risk and gap to be closed before getting the
required balance with global ethics objectives.

47
Below the resume:
Pharmaceutical
Company
Use
SM
Budget
2016
Disease
Awareness
Need Local
Regulation
Ethics Balance
 <5%  Yes, Crucial
 <2%  Yes Crucial
No No No Yes Difficult to gain
No No No Yes Crucial
No No No Yes Important
No No No Yes Important
*The recommended channels:
All those interviewed were aware about Facebook popularity in
Tunisia and cited that as the main channel to be used for social
media campaigns.
And a few of them mentioned that the social media campaign
should be linked with other digital marketing activities as SEO
(Search Engine Optimization) and Medical Society webpages. Other
channels were mentioned: YouTube, LinkedIn and twitter.
Interviewee N° 2 declared: “But definitely, Facebook has a bigger
range in the country. After Facebook, I would say that twitter and
YouTube.”

48
The 3rd
Interviewee: “Generally, the patient or the caregiver (family
members, nurses) begins on Facebook or twitter, then visit the
website and finally watches the YouTube channel.
Which social media local pharma company they use ?
1. 1st
In-Depth Interview:
Dr MB the first interviewee is a senior medical manager at a
multinational declared that officially in Tunisia, “we do not have to
use social media in the company for business purposes ,and all
colleagues are aware about the sensitivity of the subject as there is
no clear rules about the use or not ,either for pure medical
purposes neither for brand advertising ,But employee are so eager
to use it as all of them are well connected and aware about the
importance of social media networks in the new era of
pharmaceutical marketing”.
He found that social media should be integrated into the company
marketing strategy to improve disease awareness and create the

49
required discussion among blog and other internet networks ,to
collect feedback about their drugs as required by
“pharmacovigilance authorities “ .Which is something interesting
and could bring the added value needed in such sensitive subject
for the company. From another side it will for sure improve
targeted population healthcare outcomes .Because, when a
campaign is oriented for specific population, ei. “Rare diseases “
where their involvement is central in order to increase awareness
among both concerned communities including healthcare
professionals and explain to patients how to manage their daily
adverse event of products .
When I asked him about the possibility for social media to be used
effectively for specific populations like disabled persons with
chronic diseases, in order to test messages and interact with this
community to improve health outcomes ,the participant reply
positively, and gave an example of “How beneficial for patients to
discover a program for compassionate use of specific drugs” but in
this case we need to be cautious in using such tool, and put in
place all necessary and qualified human resources to manage such
tool in order to avoid falling in non ethical process for example
brand advertizing or indirect selling products .it could be used also
to collect information and feedback, for pharmacovigilance related
to our products .
Regarding if his company prefer a direct use of social media with
their name and brands or not, he states that it’s impossible to do
so as there is no MOH regulation in the subject, and they do use

50
social media indirectly through third party (agency) for the time
being.
In order to investigate how could his company make the required
balance between ethics and brand sales objectives , the participant
affirm that “there is one solution is to stick to FDA and EMA and
internal regulation which is very strict to be sure that we are using
social media properly in the balanced way to avoid grey zone ,
that’s why MOH regulation is required to avoid brand promotion
through social media mainly in our country where patients still
need more awareness about the negative effect of auto-medication
“.
Finally, he affirmed that “Social Media could promote successfully
pharmacovigilance and make the necessary disease awareness
better than medical representative” ,without impact on sales ,as
it’s not our objective .But the lack of clear MOH regulation in the
subject makes us against the use of social media in our marketing
strategy also dedicate budget for the subject.
And the key success factors of social media use in pharmaceutical
company will be from my point of view:”Start with disease
awareness, follow the strict regulation and submit all document to
“Direction de Pharmacie et Medicaments” (DPM) of Tunisian
Ministry of Health (MOH) for approval and we have a lot of
Standard Operation Procedure (SOP) on the subject, as it’s very
sensitive to deal with social media in patients’ disease area”.
2. 2nd
In-Depth Interview:

51
This interview ,was made with the president of SEPHIR
(Association of multinational pharmaceutical based in Tunisia)
meanwhile top manager in multinational , who stated his positive
perceptions on the use of social media for patient education and
awareness but he underlined its weakness and strength but also
challenges ,the aims here is to support the first problem research,
which is to understand the potential role of social media to
increase patient’s education and awareness also investigate how
pharmaceutical company in Tunisia are using social media as an
option for their marketing strategies .
Find out barriers for pharmaceutical companies to accomplish their
crucial role for Tunisian patient’s healthcare outcomes despite the
lack of regulation.
Finally how to get the right balance between ethics and brand
awareness?
Awareness, education, low investment, reach improvement, it
seems to be perceived as the main benefits of social media.
Through social media “You can reach regions and places you could
not reach with your sales forces. You can reduce costs and reach
more people.”
Also with social media, you could bring to small or huge number of
patients what you have predefined as objectives education: “It is
important to generate awareness and provide content. It works
with a low investment and with a pre-defined target”
Other benefits were mentioned that sales force cost could be
reduced thought the use of social media and mentioned for
example a product that had a large market but due to the size of

52
the country it was impossible to reach doctors and patients in some
places, in this case social media was used to reach people that
would not be reached by a traditional way (Medical representatives
visit). On the other hand, another example which social media was
used to reach patients diagnosed with a rare disease and due to
limited: “When you talk about rare disease market you can reach
people you would not reach before”. So I had an example, I used
to work for, there is a product manager in my team that he
manages a product with 20 patients in Tunisia, which targeting a
very rare disease, so she had a media plan using the social media
as a way of the awareness of the disease because if you think
about it, with 20 patients is not the brand that need an field team
sales force. So, you can reach places and people that you wouldn’t
do and you cut the sales force cost”.
There is an opportunity to bright our institutional image using
social media. These are an important but also issue in social media
use our region due to the lack of clear rules from MOH.
It was possible to perceive that the mentions regarding risks and
weaknesses were directly related to the participants’ experiences,
success and fails with their social media campaigns.
When you are working with a more structured and successful social
media campaign which has proved enormous benefits and has
generated a positive repercussion among doctors, patients and
medical society. However when you have a small project which has
not been well structured since it’s begun; consequently results
have not been perceived. “Sometime the excess of information can
bring some confusion. Either because you don’t know the origin of

53
the dates or the media targets. The big risk I see today is that
there is a lot of false information on the internet, a lot of
information which is difficult to verify….. Today people tend to get
more information on internet and end up believing in everything
they read.”
In order for me to investigate how pharmaceutical companies could
make the necessary balance between ethics and brand sales
objectives, the country manager stated the fact that:”we have to
stick to corporate rules and code of conduct in absence of MOH
regulation to avoid brand promotion through social media which
will be highly risky and the negative impact on our image will be
huge”.
3. 3rd
Interview:
The second interviewee also top manager in multinational affirms
that his company officially use, “LinkedIn only for recruitment, to
hunt potential talent, all my Colleagues are also connected, but
there is no rules, and we want to develop blogs for disease
awareness, to develop tools for pharmacovigilance, to track all
what is sad about our medication”.
He further explained that Integrity should be the master word in
this area, at the moment social media is useful, but we need to
clarify rules, as there is no regulation in Tunisia.
Furthermore we don’t have a dedicated budget, because there is
no local regulation, but he expressed his deep conviction that once
the problem was regulated, the use of social media in
pharmaceutical market use will be expended to bring the required
added value to his company, and he will be able to raise disease

54
awareness for example and explain to patients how to manage
their daily adverse event of our products.
He also underlined ,that social media could be used effectively to
target specific populations (disabled ,chronic disease), to improve
general health outcomes, without any intension for promotion
,”push” ,by listening to them ,meanwhile he stated that “we need
to be cautious in using such tool, and put in place all necessary
and qualified human resources in order to avoid falling in non
ethical process (brand advertizing, selling products ...) to collect
information, and feedback, pharmacovigilance related to our
products”
The participant mentioned also that in order to get impact on sale,
it would be needed a high investment. “Yes, it’s possible and not at
the same time, it’s a little bit risky because you can control if you
generated an awareness…but you only can complete the chain, if
you have just one commercialized drug in the market and you can
sell it direct to doctors which is not allowed ….but if you have a big
market, with already established disease, you can’t control the
awareness neither sales.”
Regarding the fact, if he is sure to get return on investment (ROI)
the interviewee confirmed: “That’s what we hope. But we are not
completely sure because we can’t measure it. If you put in place
an important investment, I think it does but when the investment
is low (less than 2%), I can’t say that it is impacting on the brand.”
Finally, he is persuaded that social media is the future of
pharmaceutical promotion, once regulation is in place, the required

55
balance between the aims to increase sales objectives and ethics
will be assured.
4. 4th
Interview
The Forth interviewee stated from the beginning that there a strict
regulation internally, final approval is coming from the global and
we have to follow these rules without default to avoid problems.
Further, despite the fact that globally we are well involved
institutionally through social media, «but no way in Tunisia without
MOH regulation in place “.
“Even we are not allowed to use Social media in our company
today, but I think that social media will be the near future in
pharmaceutical industry in Tunisia as our Tunisian population is
well connected ,using Facebook and LinkedIn “.So for disease
awareness or pharmacovigilance use ,it will be easy to penetrate
but we have to be cautious as social media use in our area is a
“double impact weapons”, and we have to “warranty the best use
of such tool, in respect of internal code of conduct and the
mandatory involvement of all internal stakeholders (Medical
department, regulatory affairs, Web-marketers manager ..)”.
He was very cautious regarding the use of social media by
pharmaceutical companies in Tunisia in absence of a legal
institution who manages the negative impacts in the patient health.
5. 5th
Interview

56
The interviewee N°5,as a top manager and decision maker in the
subject of social media in the company ,affirmed having a limited
use of social media due to the sensitivity of subject ( patients
health ) , the use of social media is focused in disease awareness
,mainly Diabetic patients with a small dedicated budget less than
5% of the total marketing budget .
In fact the company is sponsoring patients Facebook pages who
are promoting quality of life for diabetic patients and gather
patients’ feedback about how they live with their disease.
Finally the participant claim on necessity for Tunisian
pharmaceutical company to seek for local MOH regulation in
respect of the code of deontology and conduct to avoid falling in
the “prohibit” non-intentional promotional activities.
6. 6th
Interview:
The sixth Interviewee, affirms that using social media in Tunisian
pharmaceutical market is so complex and they need to ask
automatically for HQ approval before thinking to develop or use
social media, when the patient is targeted even for disease
awareness, because their responsibility will be engaged and they
need to invest and put in place a dedicated human resources to
follow and collect information regarding company’s product for
pharmacovigilance purposes.
Meanwhile he didn’t hide his excitement to develop social media
use, mainly, for patient’s education in the Tunisian context where
diseases awareness level is very low and possibility for patient’s

57
auto-medication is high, due to the low financial income of
population and the increase of the cost of medical fees.
IX. DISCUSSION
The objectives of this part are to review interviewee’s feedback
and the interpretation of the findings demonstrated in the previous
chapters.
Based on the literature review, primary research and the
researcher knowledge and experience this chapter brings to us an
overview of this research, including an evaluation of this research
and also demonstrating how this research contributes to the
marketers and the pharmaceutical industry.
To be consistent and facilitate the understanding of the
information, this chapter is guided by the main research question
and objectives.
1. How Tunisian pharmaceutical company is facing social
media Strategies? Also understand the potential role of
social media to increase patient’s awareness.
In Tunisia Pharmaceutical companies represent an important
business; there are 30 units of production of human medicines,
veterinary 6 and 22 devices medicines.
• Employment: 5,000 people of which 48% of senior executives
• Turnover 2011 = 509 Million TND (250 Million €)
• Investment: 500 Million TND (250 Million €)
• Export: 42 Million TND.

58
• Generic drug share: 49% (for imported products it is less than
10%)
Pharmaceutical is a very dynamic and competitive market that
requires innovation from the drug development to the drug
promotion. “To be innovative requires a smart idea coupled with
high market understanding”.
In our time, despite the industry type, innovation in marketing
almost always involves digital activities.
Social media is part of digital activities used by a lot of companies
and it was already included into pharmaceutical marketing plans
worldwide.
The role of social media in healthcare and impact on patient
education & awareness also engagement is moving to center-
stage, propelled by mobile technology, patient demand and
growing influence of the digital native generation (IMS, 2014).
The first research objective is to provide an overview about how
Tunisian pharmaceutical companies are facing social media use
expansion strategy.
The results obtained from my research reinforced that all
professionals interviewed are aware about the importance of social
media in their Marketing activities and they have to push forward
expanding the use of such innovative tool, this point is aligned with
literature review where pharmaceutical companies are well aware
of the era of pharmaceutical marketing and the impact of social
media on their new business opportunity offered by social media.

59
In the same time, a small number of them have used effectively
social media to communicate with patients for disease awareness
or education at least once time in the last 12 months.
When we try to focus on Tunisian pharmaceutical professionals’
use of social media, we find a limited use confined mainly to a
small media campaign using one social media, or using LinkedIn
for employee recruitment without any planning or budget
allocation.
This is considered as a sporadic utilization none incorporated into
the marketing strategy of the company.
Awareness, education, low investment, seems to be perceived as
the main benefits of social media. As stated by an interviewee,”
Through social media, you can reach regions and places you could
not reach with your sales forces. You can reduce costs and reach
more people.”
The first interviewee also confirmed that with social media you
could bring to small or huge number of patients what you have
predefined as objectives education: “It is important to generate
awareness and provide content. It works with a low investment
and with a pre-defined target”
On the other hand, another example which social media was used
to reach patients diagnosed with a rare disease and due to limited
cited by the 1st
interviewee: “When you talk about rare disease
market you can reach people you would not reach before”. So I
had an example, I used to work for, there is a product manager in
my team that he manages a product with 20 patients in Tunisia,
which targeting a very rare disease, so he had a media plan using

60
the social media as a way of the awareness of the disease
because, if you think about it, with 20 patients is not the brand
that need an field team sales force.
So, you can reach places and people that you wouldn’t do and you
cut the sales force cost”.
Other benefits were mentioned that sales force cost could be
reduced thought the use of social media and mentioned for
example a product that had a large market but due to the size of
the country it was impossible to reach doctors and patients in some
places, in this case social media was used to reach people that
would not be reached by a traditional way (Medical representatives
visit).
There is an opportunity to bright our institutional image using
social media. These are important but also an issue of social media
uses in our region due to the lack of clear rules.
But we have to notice that there is a lot of risk in targeting
unaware population through social media because there is huge
risk of auto-medication with dramatic consequences.
It was possible to perceive that the mentions regarding risks and
weaknesses were directly related to the participants’ experiences,
success and fails with their social media campaigns.
When you are working with a more structured and successful social
media campaign which has proved enormous benefits and has
generated a positive repercussion among doctors, patients and
medical society. However when you have a small project which has
not been well structured since it’s begun; consequently results
have not been perceived. “Sometime the excess of information can

61
bring some confusion. Either because you don’t know the origin of
the dates or the media targets. The big risk I see today is that
there is a lot of false information on the internet, a lot of
information which is difficult to verify….. Today people tend to get
more information on internet and end up believing in everything
they read.”
So, pharmaceutical company has the opportunity to offer reliable
information to patients, doing so, and pharmaceutical industry is
also gaining because providing reliable information will help to
clarify possible unclear questions regarding diseases, drugs and
behavior.
This finding corroborates with Moorhead and Korda and Itani,
2013; research that demonstrated that social media offers
opportunities for modifying health behavior and monitor the spread
of misinformation and intervene with credible information.
During my research, it was investigated the benefits of social
media for patients, the item patient’s access to reliable information
was the one of major perceived benefit for patients, followed by
increase of interaction among patients and ability for patient to be
aware about treatment options .
2. To value the impact of social media on company sales
performances
In order to shape the impact of social media on sales objectives
and going deeply to understand, how pharmaceutical companies
manage their eagerness for profit balanced with their social
responsibility as one of the majors’ actors for better healthcare

62
outcomes. All participant were very clear on that and underlined
the role of the corporate regulation in the subject matter and
stated the fact that “our integrity “avoid us to go further disease
awareness and patient education, “law and local regulation have to
be followed” and he didn’t put out of sight the possibility that
brand sales could be impacted even without any intension of direct
promotion.
All interviewee didn’t demonstrate to be secure about the use of
social media and it impacts on product performance. The
Interviewee N° 3, also, affirmed that social media will impact on
awareness but he believe that due to the lack of track is difficult to
affirm that social media activities will impact on sales and it would
be possible only on niche diseases market; it was also mentioned
that “when there are more than one player in the market it is more
difficult to impact on sales”.
Nevertheless ,Tunisian pharmaceutical market is known by the
strong relationship between doctor-sales force compared to the
major market in Mediterranean region and north Africa but the
majority of interviewees confirm that social media starts to be an
import tool into their marketing strategies, the objective of social
media strategies “is not to replace the sales force” but my findings
from the deep interview with N°1 & 2 participant demonstrated
that in some cases, when the disease prevalence is very low and
you have a few patients to treat or when the currently sales force
cannot cover all regions, the industry could use social media to
reach places and people that was not possible to reach through the
traditional way.

63
In fact, accomplishment seems to be perceived as one of the main
benefits of social media for pharmaceutical company’s leaders. It
was mentioned by all the participants of the qualitative interviews.
“Healthcare professionals (Doctors) depend a lot on medical
representatives for their information and there was a risk of
offending doctors if this traditional line of communications was
broken” , stated the sixth interviewee.
3. How Tunisian pharmaceutical companies are using
social media in balanced way “seeking for global and
local ethics “
In order for me to investigate on the third objective of my research
how pharmaceutical companies could make the required balance
between ethics and brand sales objectives, the first interviewee
stated that:”we have to stick to corporate rules and code of
conduct in absence of MOH regulation to avoid brand promotion
through social media which will be highly risky and the negative
impact on our image will be huge”.
In order for pharmaceutical companies to avoid falling in the black
zone or “grey zone” of brand promotion through social media, this
research aims to fill this important gap in the literature: To
document how Tunisian pharmaceutical companies are using social
media in a balanced way seeking for global and local ethics, all
interviewee stated the importance of integrity and the strict respect
of the corporate regulation. “In absence of ministry of health
regulation in the subject we have to seek for patient’s awareness
and education without intension of promotion”.

64
But the issue raised here, is it sufficient to base such important
tools for communication and Marketing strategy only on
Pharmaceutical professionals Integrity only?
Based on marketers experience and pharmaceutical employees’
feedback, we need more and more quantitative and qualitative
research in the subject to close the huge gap.
They were worried about the misuse of social media and felt that
since this was a growing market there would be a lot of barriers in
the mind of users and viewers of social media. It had a lot of
potential for misuse and high risk of lack of accuracy.
Expediting the implementation of a regulatory framework will for
sure reduce the uncertainty and provide Tunisian pharmaceutical
companies and patients with a stronger and more effective basis
for social media activity and engagement.
Also, if we work forward the quality of information online
improvement and support trustworthy sources provided for patient,
regulators will possibly give some type of quality standard label to
for credible social media sources. Furthermore, the development of
local regulatory framework and possible solutions that could
support pharmaceutical companies’ effort, beside the
heterogeneous regulatory oversight, where there are no country
borders.
X. LIMIT
The main limitations of this research are time also the lack of local
research in subject resource.

65
In Tunisia neither in our region, I didn’t find study related to my
subject to make the basic comparison or challenge for my
research.
To have the whole view of the subject, unfortunately it was
impossible to conduct a quantitative research coupled with a
qualitative research due to the few number of pharmaceutical
companies in Tunisia.
XI. FUTURE DEVELOPMENT
In order to have the whole picture of Tunisian pharmaceutical
company perception use of social media, we need more and more
qualitative and quantitative research to understand more and close
up the gap with literature, where global pharmaceutical companies
are well involved in social media and structured to provide a
substantial content.
If we make a quick comparison of what I found out regarding the
main purposes of my research and what is already shaping in
Europe and USA, we found that there is a huge gap to be filled
such as the perception of the role of social media in Tunisian
pharmaceutical companies also the very low investment in social
media, finally the local Ministry of Health regulating the use of
social media have to be clarified.
XII. CONCLUSION
Based on the research questionnaire, this research support with
previous findings, related to the perception of the strong potential
role of social media in patient education and disease awareness. In

66
addition, it has provided a first insight about the role of social
media, mainly when you are in front of young community of users’
like Tunisian patients and these elements should be included in a
social media strategy for pharmaceutical companies.
It was recognized that Tunisian pharmaceutical professionals are
confident about Social media’s effectiveness to generate disease
awareness and patient’s education. Unfortunately, this assurance is
not perceived when it comes to sales performances.
Nevertheless, we have to assert that, it is not only a
pharmaceutical industry concern as metrics not well developed and
clarified sufficiently and other studies are required to evaluate the
impact of social media on patient education and disease awareness
related to sale accomplishment.
Furthermore, this research provided some information about the
difficulty for pharmaceutical professionals to make the necessary
balance between their eagerness for sales development and their
social responsibility for patient’s education.
One could argue that, the lack of clear local regulation related to
the use of social media by pharmaceutical companies, is a real
limitation of social media in Tunisia, an issue that has to be juggled
quickly to make social media profitable for Tunisian patients.
These media can be used as a data-store for information by
healthcare professionals who were open to use such media as
stated in the theoretical part.
Therefore, pharmaceutical companies and local top manager have
to be less stressed about global regulation and must seek for local
guide who will help them to deal with local patients’ requirement

67
and embrace social media as integral part of their marketing
strategy.
My specials suggestion to a local pharmaceutical company is to
invest more in social media ; through putting in place the qualified
human resources also qualified digital media professionals (agency,
third party ) while conforming to regulatory guidelines.
Despite the limitation exposed in the previous paragraphs, I am
deeply persuaded that this first research on the subject will bring a
significant tool for Tunisian pharmaceutical professionals who could
support pharmaceutical marketer’s decision making process, also
offer a first aid guide focusing on clarifying the Tunisian
pharmaceutical company’s potential role when using social media
for patient education and disease awareness.
XIII. RECOMMENDATIONS
Social media cannot be ignored any more by pharmaceutical
companies’ .For social media to be integrated efficiently into
marketing strategy for patient education and awareness;
pharmaceutical managers should take into consideration several
implications.
The first recommendation is regulatory managers in the company
have to work closely with pairs from other companies and the
Ministry of health to put in place a regulatory guideline. Once
done, they have to familiarize themselves with theses new
regulation and establish a dedicated position to focus and manage
social media propositions in the company .Another important
consideration is to plan a specific budget to support the integration

68
of social media into the marketing strategy of the brands and
company as a whole.
A dedicated team has to include regulatory, medical, marketing,
sales, finance and information technology department to speed up
the integration of social media initiative inside the company.

69
Appendix
Interview of Pharmaceutical Company
QUESTIONNAIRE OBJECTIVES
To understand the potential role of social marketing in the Tunisian
pharmaceutical industry
Q1: What is your position in the company, are you a decision maker in the subject?
Q2: What kind of Professional relationship you have with social media in your daily work?
Q3: Are you using social media in your marketing strategy, what is your own perception of
the use of SM in your company?
Q4: Can social media be integrated In marketing strategy? What will be the purpose?
-To improve disease awareness
-Pharmacovigilance
-Public health management?
How social media activities could impact Sales performance?
Q1: Do you think that social media could bring an added value to your company?
Increase brand sales? , Brand awareness?
Q2: In practice where you are using social media in your company?
Q3: Direct or indirect use (through third party: agency, Medical association or PAG)
Q4: Do you have budget for social media, how do you used, through what? What is your
budget?
To investigate how pharmaceutical companies could make the necessary
balance between ethics and brand sales objectives
Q1. Can social media be used to effectively target a specific populations (disabled, chronic
disease), in order to test messages or interact with specific community to improve health
outcomes?
Q2: There are limits for social media use? If yes? Why and what are the limits?
Q3: Do you have a Corporate/Local regulation, regarding use of Social media in your
company?
./.

70
REFERENCES:
1. Amstrong, G., & Kotler, P. (2009). Marketing: An introduction (9th ed.). Upper
Saddle River, NJ: Pearson Prentice Hall.
2. Blackshaw, P., & Nazzaro, M. (2004). Consumer-generated media (CGM) 101:
Word-of-mouth in the age of the web-fortified consumer. Retrieved from
http://www.nielsen-online.com/downloads/us/buzz/nbzm_wp_CGM101.pdf
3. Brassington, F., & Pettitt, S. (2007). Essentials of marketing (2nd ed.). Harlow,
UK: Pearson Education.
4. Brown, E. (2010). Working the crowd: Social media marketing for business.
Swindon, UK: British Infomatics Society.
5. Carter, S. (2009). LISTRAK, from a whisper to a scream: Marketing 2.0. Retrieved
from http://www.listrak.com/Webinar/Whisper-to-a-Scream/View/CIPR. (2010).
6. Social media guidelines. Retrieved from http://www.cipr.co.uk/socialmedia/Cone
Inc. (2008).
7. Cone finds that Americans expect companies to have a presence in social media.
Retrieved from http://www.coneinc.com/content182
8. DJ and PRSA. (2007). MPR and social media. Retrieved from
http://www.prsa.org/SearchResults/download/2D0010/0/Wired_for_Change_A_S
urvey_of_Public_Relations_Prof
9. E-Consultancy. (2009). Social media trends briefing February 2009. Retrieved
from http://econsultancy.com/reports/social-media-trends-briefingfebruary
10.Ellison, N. B., Steinfield, C., & Lampe, C. (2007). The benefit of Facebook
“friends”: Social capital and college students use of online social network sites.
11.Journal of Computer-Mediated Communication, 12(4), 1143–1168.
12.Eyrich, N., Padman, M. L., & Sweetster, K. D. (2008). PR practitioners’ use of
social media tools and communication. Public Relations Review, 34, 412–414.
13.Fulgoni, G. (2007). Consumer trends in social networking. Retrieved from
14.http://www.comscore.com/blog/2007/10/consumer_trends_in_social_net
15.Giannini, G. T. (2010). Marketing public relations: A marketer’s approach to public
relations and social media. Upper Saddle River, NJ: Pearson.
16.Gummesson, E. (2008). Total relationship marketing: Marketing management,
relationship strategy, CRM and a new dominant logic for the value-creating
network economy (3rd ed.). Oxford, UK: Butterworth-Heinemann.
17.Harris, T. L. (1993). How MPR adds value to integrated marketing
communications.
18.Public Relations Quarterly, 38(2), 13–17.
19.Hayes, M. (2008). INTERACTIVE—WEB 2.0: In the right social circles. Retrieved
from http://goliath.ecnext.com/coms2/gi_0199–7578119/INTERACTIVEWEB-2–0-
In.html
20.Hearn, G., Foth, M., & Gray, G. (2008). Applications and implications of new
media
in corporate communications.
21.An action research approach. Corporate Communications: An International
Journal, 15(1), 49–61.
22.Henry, R. A. (1995). Marketing public relations: The hows that make it work.
Ames,IA: Iowa State University.

71
23.Holzner, S. (2009). Facebook marketing: Leverage socialmedia to grow your
business.
24.New York, NY: Que Publishing. Jefkins, F. (2000). Advertising. London, UK:
Pearson Education.
25.Kitchen, P. J. (2010). A marketing communication scenario for 2010. Research
Paper for CIPR. London, UK: Chartered Institute of Public Relations.
26.Kotler, P., & Armstrong, G. (2006). Principles of marketing (11th ed.). Upper
Saddle
27.River, NJ: Prentice Hall. Mangold, W. G., & Faulds, D. J. (2009). Social media:
The new hybrid element of the promotion mix.
28.Business Horizons, 52, 357–365.Mintel. (2008). Keeping consumers connected,
market intelligence essentials: UK reports. Retrieved from
http://academic.mintel.com
29.Mintel. (2010). Social networking. Retrieved from http://oxygen.mintel.com/
sinatra/oxygen/display/id=482479 Murphey, C. (2011). In depth: Twitter
terrorism. Retrieved from http://www.themarketer.co.uk/articles/features/twitter-
terrorism/ OFCOM. (2008).
30.Social networking: A quantitative and qualitative research report into attitudes,
behaviours and use. Retrieved from
http://www2.ofcom.org.uk/advice/media_literacy/medlitpub/medlitpubrss/socialn
etworking/report.pdf
31.PQ Media. (2007). Word-of-mouth marketing forecast 2007–2011. Stamford, CT:
Author.Tomlinson, C. (2008).
32.The internet advertising bureau: The recommendation generation. Retrieved from
http://www.iabuk.net/en/1/therecommendationgeneration 140308.mxs
33.Tuten, T. L. (2008). Advertising 2.0. Wesport, CT: Praeger.Vasiljev, S., Cvetkoviv,
L., Kancir, R., & Pantelic, D. (2007).
34.Marketing management.Subotica, Serbia: Faculty of Economics. Voight, J. (2007).
35.The new brand ambassadors, ad week. Retrieved from
:http://www.adweek.com/aw/content_display/news/strategy/e3i9ec32f006d17a
91cccd2559f612b0f42
36.Weber, L. (2007). Marketing to the social web: How digital customer communities
build your business. Hoboken, NJ: John Wiley & Sons.
37.Young, S. (2008). Online marketing’ walking the talk. Retrieved from
www.ebscohost.com
38.Arab Media Outlook 2008-2012, published by the Dubai Press Club.
39.Pharma and Healthcare Social Media wiki:
http://www.doseofdigital.com/healthcare-pharma-social-media-wiki/
40.SAFKO & BRAKE 2009 cited in NEIGER et all 2012
41.See “Relevant Metrics for Social Media Applications Organized by Key Social Media
Objectives,” p. 44.
42.SIES J of Pharma-Bio Management Vol 2(1): pp 72-84 (2014))
43.([CIPR], 2010; Kitchen, 2010)

72
44.Perspective Pharmaceutical Marketing and the New Social Media :
http://www.nejm.org/doi/full/10.1056/nejmp1004986
45.Are social media replacing traditional media in terms of brand equity creation?
http://www.emeraldinsight.com/doi/pdfplus/10.1108/01409171211255948
46.The Corporate Social Responsibility of the Pharmaceutical Industry: Idealism
without Illusion and Realism without
Resignation :http://dx.doi.org/10.5840/beq200515440
47.Prevalence and Global Health Implications of Social Media in Direct-to-Consumer
Drug Advertising :http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222189/
48.The Truth About the Drug Companies: How they deceive us and what to do about
it Marcia Angell R :http://www.bmj.com/content/bmj/329/7470/Reviews.full.pdf
49.Digital Drug Safety Surveillance: Monitoring Pharmaceutical Products in Twitter
http://download.springer.com/static/pdf/459/art%253A10.1007%252Fs40264-
014-0155-x.pdf?
50.Perception of the use of social media in the Indian pharmaceutical industry :A
survey of marketing ,advertising and medical professionals:
http://www.researchgate.net/profile/Suhas_Tambe/publication/277926025_PERC
EPTIONS_OF_THE_USE_OF_SOCIAL_MEDIA_IN_THE_INDIAN_PHARMACEUTICA
L_INDUSTRY_A_SURVEY_OF_MARKETING_ADVERTISING_AND_MEDICAL_PROFE
SSIONALS/links/5576b44308ae7521586c472e.pdf
51.2011 Survey of Health Care Consumers Global Report. (2011). 1st ed.
52.[ebook] Washington, DC: Deloitte Center for Health Solutions. Available at:
http://www.deloitte.com/assets/dcomunitedstates/local%20assets/documents/us_ch
s_2011consumersurveyglobal_062111.pdf.
53. Amaldoss, W. and He, C. (2009). Direct-to-consumer advertising of prescription
drugs: A strategic analysis. Marketing Science, 28(3), pp.472--487.
54.Behance.net, (2014). Behance. [online] Available at:
https://www.behance.net/gallery/14652043/Galderma-Telas-para-aplicativo
55.Caley-Reidenbach Consulting, L. (2011). Tools and Trends in Medical
Communication. Research Report: Medical Communication Practice and
Trends in Pharmaceutical and Biotechnology Companies, p.78.Cates, J., Shafer,
A., Diehl, S. and Deal, A. (2011).
56.Evaluating a county sponsored social marketing campaign to increase mothers'
initiation of HPV vaccine for their preteen daughters in a primarily rural area.
57.Social marketing quarterly, 17(1), pp.4--26.
58.Chou, W., Prestin, A., Lyons, C. and Wen, K. (2013). Web 2.0 for health
Promotion: reviewing the current evidence. American journal of public
health,103(1), pp.9--18.
59.Dooley, J., Jones, S. and Iverson, D. (2014). Using Web 2.0 for Health
Promotion and Social Marketing Efforts: Lessons Learned From Web 2.0 Experts.
Health Marketing Quarterly, 31(2), pp.178-196.

Perception of the use of social media for disease awareness in Tunisia

Perception of the use of social media for disease awareness in Tunisia

Recommended

Recommended

More Related Content

Similar to Perception of the use of social media for disease awareness in Tunisia

Similar to Perception of the use of social media for disease awareness in Tunisia (20)

Recently uploaded

Recently uploaded (20)

Perception of the use of social media for disease awareness in Tunisia