Using Behavioral Science to Uncover the Real Drivers and Barriers Behind a Key Prescribing Behavior for a Long-Acting Injectable Therapy

Claims data showed a pharmaceutical company that a significant share of patients on its long-acting injectable (LAI) for a CNS disorder were transitioning directly from oral therapy, bypassing the expected step-through of a shorter-duration LAI. With upcoming market events making it imperative to expand that direct oral-to-LAI pathway, descriptive analytics were not enough. Traditional research could characterize the behavior, but the client needed the underlying mechanisms — what was enabling, motivating, or preventing HCPs from prescribing this way — in order to design interventions that could broaden adoption.

Blue Matter conducted in-depth qualitative interviews with prescribers who had adopted the direct oral-to-LAI transition, structuring the research around the COM-B model (Capability, Opportunity, Motivation) rather than stopping at surface-level attitudes. The framework let the team decompose a complex, multifactorial treatment decision into discrete behavioral components, separating knowledge gaps (Capability) from environmental constraints like formulary restrictions (Opportunity) and mindset challenges like discomfort with proactive advocacy (Motivation). The team applied that lens across practice settings — inpatient, private practice, and community mental health — and patient populations to pinpoint where the dynamics differed.

COM-B surfaced insights conventional qualitative work would have conflated or missed. The most critical barrier was not awareness or access but motivation: HCPs strongly endorsed the direct transition in theory, yet only advocated for it forcefully after a crisis event. For clinically stable patients, a patient-centric mindset and emphasis on shared decision-making created a paradox in which HCPs recognized the benefit but deferred to patient preference, slowing uptake. The decomposition also exposed distinct Opportunity barriers — notably the product’s absence from inpatient formularies — that were costing conversions during the very crisis moments when motivation peaked. The client used this mapping to build interventions by component: education and peer advocacy for Capability, formulary and sample access initiatives for Opportunity, and reframing strategies to help HCPs advocate proactively absent a crisis, each tied to the lever most likely to move adoption.