Enhancing patient engagement through social media: cross-cultural insights from pharmaceutical enterprises

Digital transformation (DT) has improved the integration of information, communication and connectivity technologies (Vial, 2019), influencing individuals, organizations and the ways they interact (Verhoef et al., 2021; Balta et al., 2021). Many emerging technologies reshape enterprise strategies to optimize efficiency, enhance user experiences and create value (Dressler and Paunovic, 2021; Robu and Lazar, 2021). Technologies like artificial intelligence (AI), the internet of Things (IoTs) and mobile technologies make healthcare more accessible for rural patients or those with limited mobility (Currie et al., 2015), enable personalized care (Khan and Alotaibi, 2020) and improve treatment quality and communication channels (Ahmed et al., 2020). Apps and portals also help patients better navigate their care (Timmers et al., 2020). In parallel with these technological advances, consumer involvement in healthcare has grown significantly over the past decade, contributing to more patient-centered care models. Access to online health information has laid the foundation for consumer health informatics (Dasgupta, 2023), and digital platforms now empower patients to seek, share and interact with health information, transforming healthcare processes and outreach strategies (Czerska, 2023). Social media channels (SMCs) have also fostered this transition to patient-centered care, with research showing that social support among patients positively impacts outcomes (Priego-Cubero et al., 2023; High et al., 2023). SMCs strengthen customer relationships and have reshaped enterprise strategies, especially in healthcare marketing. More than ever, patients use online tools to find information, while companies use SMCs to engage, educate and support patient relations (Ba and Wang, 2013; Fan et al., 2014).

Social media's benefits for firms include generating value in relationships (Abeza et al., 2020), ease of implementation and user-friendliness (Georgescu and Popescul, 2015). The ability to rapidly share content and foster engagement can also boost sales (Autio et al., 2011).

However, these advantages are accompanied by challenges. Engaging stakeholders on social media (SM) remains complex and uncertain (Czakon et al., 2024), and risks such as misinformation, breaches of privacy or reputational damage must be considered (Lim and Rasul, 2022). This increasing complexity requires firms and their managers to adopt efficient communication strategies (Drummond et al., 2020) to engage patients.

Despite extensive studies on SM's role in building and maintaining networks (Ellison et al., 2014) and in improving service management, patient engagement and communication (Zhan et al., 2021; Dhar et al., 2018; Afful-Dadzie et al., 2023), few have examined how pharmaceutical companies tailor their SM strategies to boost patient engagement (Costa et al., 2018; Farsi, 2021; Farsi et al., 2022).

Moreover, the culture can impact the information shared on SM (Chai, 2020) and affect how individuals present their information. In lastly years, the task of the pharmaceutical company isn't only to sell the drug but also to educate the patient and build a relationship and maintain their brand identity to identify it as a reference point (Reva et al., 2020). Based on these considerations, this study aims to address the gap in understanding how pharmaceutical companies use SM to engage patients across cultures. Specifically, it explores how companies adapt engagement and communication strategies to fit cultural differences in health information, privacy and trust. Our research question (RQ) is: How do pharmaceutical companies use SM strategies to improve patient engagement while considering cultural differences? To explore this, we conducted an analysis of Pfizer's Instagram presence in Spain and United Kingdom, chosen for their cultural similarities and differences, to investigate how culture influences communication.

This study contributes to literature regarding SM strategies and patient engagement. Moreover provides insights for the practitioners that operate in the pharmaceutical enterprise. Furthermore, provides food for the managers who develop the SM to extend and attract the interest of patients. In addition, it provides insights for policymakers concerning the proper use of digital tools for patients.

In the literature, user engagement is described as a psychological state in which a system can maintain users’ attention (Jacques et al., 1995). According to O'Brien (2008), users are involved due to their interest and motivation. Social exchange theory (SET) has been applied to understand people's behaviors involved in the process of information sharing. SET is a sociological and psychological concept that explains how human relationships are formed and maintained based on a cost–benefit analysis (Zafirovski, 2005). It treats social life as involving a series of sequential transactions between two or more parties (Mitchell et al., 2012).

SET has often been used to explain knowledge sharing in various contexts, such as social commerce sites, SM and networking platforms (Liu et al., 2016; Chung et al., 2016). However, the context of SM in healthcare is distinct from other business contexts, as healthcare companies' use of SM often serves data mining purposes. Patients are typically more sensitive to the potential benefits and risks related to their health decisions (Bansal and Gefen, 2010; Mirzaei and Esmaeilzadeh, 2021). Resources are exchanged through a process of reciprocity, where one party generally reciprocates positive (or sometimes negative) actions from another party (Gouldner, 1960). Consequently, before seeking or sharing information on SM, individuals evaluate whether the benefits outweigh the risks, analyzing the costs and benefits to ensure favorable interactions (Chung et al., 2016). The quality of exchanges is often influenced by the relationship between the actor and the target (Organ, 1990).

The healthcare sector's online channels differ from other business contexts because healthcare consumers tend to be more sensitive and cautious regarding potential benefits and risks associated with their health choices (Bansal and Gefen, 2010). Online information can enhance participants' psychological and functional well-being (Mirzaei and Esmaeilzadeh, 2021). SET is primarily used to explain individual behaviors across contexts, including information sharing (Shiau and Luo, 2012) and behavior in online communities (Jin et al., 2010). Scholars applying SET can explain many social phenomena in a post hoc manner.

In the context of SM and online channels, SET suggests that users assess the benefits and costs of participation (Liu et al., 2016), weighing the informational and emotional support they gain (Liang et al., 2011) against what they must give up. In online services, users are often motivated by material rewards (Jiang et al., 2013). For the SM, however, the reward is primarily social support, which includes informational and emotional dimensions (Xiao et al., 2014). Therefore, users turn to SM both to enrich their knowledge and to find emotional support, sharing experiences and receiving empathy from people facing similar issues or from informed individuals with an educational role. This exchange of information and experiences enhances users’ well-being by providing direct or indirect solutions to their problems.

Companies also benefit from SM interactions by gaining valuable insights into patient needs, improving brand perception through direct dialogue and transparency, and fostering patient engagement (Agusiady et al., 2024). This approach can enhance consumer trust and loyalty, promoting brand recognition and encouraging the adoption of new products or services (Ibrahim and Aljarah, 2023). However, companies incur costs not only for maintaining a continuous presence but also for managing potential reputational risks, as public interactions can impact the company's image, especially in the face of criticism (Shymanska et al., 2024). Therefore, it is essential to balance the costs and benefits of engagement, maximizing return on investment through strategic and targeted social interactions.

Accordingly, in SET terms, interactions through SM, both for patients and companies, must strike a careful balance between benefits and costs, allowing both parties to derive value from online connections in the sensitive healthcare context.

The definition of SM is constantly evolving (Ventola, 2014; Appel et al., 2020), and it is considered one of the most powerful communication tools of the twenty-first century. In recent years, digitalization has driven an increase in SM tools and their use, creating new opportunities to communicate, connect, create and share information more easily (Lafferty and Manca, 2018; Dwivedi et al., 2021; Haque et al., 2025). In healthcare, traditional services have been complemented by SM (Farsi et al., 2022). Both healthcare providers (HCPs) and patients increasingly use it as a resource alongside traditional health tools. Through SM platforms, health professionals can spread positive messages to a wide audience, quickly influencing behavior in beneficial ways (George et al., 2013; Gong et al., 2025). Various SM channels, such as Instagram, LinkedIn, Twitter and Facebook, enable the sharing of new messages and encourage communities to adopt healthy behaviors (Alanzi and Alsaeed, 2019; Tayyem et al., 2025).

SM reaches different age groups, from the youngest to the oldest. For many, especially younger individuals, social networking sites are the primary source for general and health-related information (Jain and Bickham, 2014; Tang and Soltwisch, 2025). Patients now receive information in radically different ways compared to the past, often seeking answers online to virtually obtain them anytime, from anywhere (Chaet et al., 2017).

Over recent years, SM has become an essential tool for pharmaceutical companies to engage patients, healthcare professionals and other stakeholders. Patient engagement, indeed, refers to the active involvement of patients in their healthcare and management (Domecq et al., 2014). These strategies enable firms to promote products (Sajid, 2016; Infante and Mardikaningsih, 2022) and create valuable interactions that foster trust and brand loyalty (Puspaningrum, 2020). The more informed, motivated and supported patients are in making health-related decisions, the greater their adherence to treatment, adoption of healthy lifestyles and satisfaction with the healthcare system (Nuari Harmawan and Al Farizi, 2025; Ciasullo et al., 2022; Usher and Denis, 2022).

In this regard, the SM communication and the way it is implemented open up new avenues related to the engagement of different actor groups and also pose several challenges (Czakon et al., 2024).

Particularly, for companies, SM plays a crucial role in information sharing, dissemination of educational content, promotion of positive messages and encouraging patients to take an active role in managing their health (Farsi, 2021).

Organizations and all actors in the health sector are increasingly active on SM, as they can access vast global networks to quickly disseminate information and mobilize large groups toward public health goals (Ventola, 2014; Appel et al., 2020). Pharmaceutical companies use various SM channels to communicate with multiple audiences, collecting feedback through comments and reactions to measure and improve patient engagement (Proença, 2021). SM has also played a role in enhancing HCPs’ rankings on search engines, attracting and retaining patients, and boosting their reputations (Dorfman et al., 2019). SM can also serve as a marketing strategy to attract new patients across demographics and has proven effective in engaging new patients (Alalawi et al., 2019). SM tools allow for the dissemination of visually rich public health messages to the general public. Health actors can share messages on SM, post videos, participate in health discussion forums and share scientific information (Dizon et al., 2012). Health promotion messages from social networks, rather than from experts, are often perceived as more effective (Levac and Osullivan, 2010). It is essential to develop customized messages for specific segments of the population, as these are more effective than generic messages and meet the recipients' specific needs (Stellefson et al., 2020), complementing traditional health promotion.

Thus, companies need to develop new capabilities to adapt their Internet marketing skills on SM, not only to sell products but also to communicate messages, and deliver training and educational initiatives to patients (Barreto and Whitehair, 2017). These platforms foster the formation of supportive communities, increasing motivation and a sense of belonging among patients. In this way, SM actively engages patients in their healthcare journeys, ultimately improving adherence and health outcomes.

To answer our RQ, first of all, we conducted an exploratory analysis using the single case study approach (Eisenhardt, 1989; Yin, 2017).

The focus was to explore how pharmaceutical companies use the SM channel in several countries to engage patients through communication channels.

This study examines the two branches of Pfizer, one of the largest pharmaceutical enterprises in the world. We have chosen this pharmaceutical enterprise that operates in several geographical countries through its branches and that applies the marketing SM strategies through several channels. In fact, the successful pharmaceutical enterprise adopts SM platforms to attract new customers and to retain the relationship with their current customer base (Kukreja et al., 2011). We selected as our case study Pfizer, a multinational company operating in several countries. We analyze two of its branches, located respectively in the United Kingdom and Spain, to examine how the different cultural variables can influence communication strategy in the pharmaceutical sector.

Adopting single case study allows for more precision in examining phenomena within the society (Eisenhardt, 1989; Saunders et al., 2007). For the description of the case study, we triangulate data and we collected from secondary sources (Yin, 2017). Particularly, data were gathered from (1) online documentation, (2) archival data and (3) website. Moreover, according to Gandomi and Haider (2015), the analytics of SM can be categorized as content-based analysis, which is focused on the analysis of the posts of the firms and the customers’ comments. It is possible to look at social networks and relationships that have the pharmaceutical enterprise with a specific target of customers. We chose to collect the data on the range from 20 August to 20 October 2024, on Instagram SM, in particular from two Pfizer’s accounts, one for the English audience “Pfizer UK”, the other for the Spanish one “Pfizer España”. We have chosen Instagram channels because they offer analytical tools that allow you to monitor the level of engagement and the effectiveness of campaigns, providing useful data to optimize the communication strategies of the companies that use it. Instagram is used by young people, adults, professionals and non-professionals; therefore, it allows you to reach different customer segments, making it a versatile tool for those who apply communication strategies. This social network is mainly used for interaction and involvement, for entertainment, and to share and view personal and informative content.

Each account represents a distinct case, in a specific national cultural context which has different sociocultural characteristics (Hofstede, 2020). Indeed, the cultural differences significantly influence how companies design and implement their communication strategies through SMs (Izogo and Mpinganjira, 2020; Noman et al., 2024; Li et al., 2024). According to previous studies, culture is considered an important factor in the sharing of information between members of the organization (Chai and Kim, 2012). The way people use the Internet and SM varies around the world; in fact, the frequency of use, type of interactivity and content varies between countries (Goodrich and de Mooij, 2016). To understand how culture influences the way people communicate and use media, national cultural values have often been used in the literature to help explain and predict behavior (Goodrich and de Mooij, 2016; Hofstede, 2001). Dimensional models, in particular Hofstede's (2001) one, is extremely helpful to understand the influence of culture on the way people and companies communicate by using SM, to understand how culture influences the way people communicate and use media (e.g. Goodrich and de Mooij, 2016). According to Hofstede's cultural dimensions theory (Hofstede, 2001), it can help to individuate the varying levels of trust, privacy concerns and information-seeking behavior across different countries, which influence how companies communicate with the public to share their information. For these reasons, Hofstede’s model is considered as a valid tool to address our RQ. According to the literature, when applying digital communication strategies, companies have to consider the cultural attitudes because, depending on the culture, the values and norms shared on social networks change (Li et al., 2024). The research conducted by Farsi (2021) highlights that firms need to navigate regulatory and cultural differences to practice online patient engagement. On the basis of what was said about culture, we compared the results obtained with respect to the cultural variables of each country on the basis of which communication strategies can be developed. But first of all we have extracted our data.

To ensure the robustness of the findings, data collection continued until data saturation was reached, meaning that the addition of new posts, comments and reactions within the defined timeframe did not yield substantially new insights (Bouncken et al., 2025).

To extract the data, we have used the Apify tool, which is a web scraping and automation platform (Apify, 2024). The free version allowed us to extract the data by scraping individual SM accounts that were the subjects of interest to us. By entering the account reference link and the time frame limit chosen in our analysis. We extracted all posts from the official company accounts (see Table 1).

In our data extraction (in.txt format), we obtained information on various aspects of posts, including content, number of shares, comments, reactions and the type of post (image or video).

The content of the posts was analyzed through text mining methodology, that is, the extraction of insights from textual documents and after tries to convert collected data into meaningful explanations. Generally, in the literature has been used to analyze the data of SM channels (He et al., 2013; Singh et al., 2018) and has become the most widely used method for extracting useful information from SM data (Grover et al., 2019; He et al., 2016). We analyzed the extracted data using Orange Data Mining Software (Orange, 2024), an open-source tool, which we utilized to conduct text mining analysis.

As mentioned before, we collected data from two of Pfizer's Instagram accounts: “Pfizer España” and “Pfizer UK”. By using regular expressions on metadata text files, we identified and recorded the content of posts, comments, likes and other relevant information, such as whether the content was an image or video.

The post data and metadata were organized into the following categories (see Table 2).

1. Post content,

2. Number of comments,

3. Number of reactions (likes).

We analyze the content of the post through text mining and then we have analyzed manually the posts that generated the most reactions from users through likes and comments, and grouped them according to the main topic of interest (see Figure 1). To select the posts that have received the most reactions' people we calculated the average number of reactions for each post and selected those with numbers higher than the average.

After data collection, the dataset was loaded via the File widget. The data were linked to the Corpus widget to identify the column containing the text to be analyzed. Subsequently, the preprocess text was performed to clean the data, removing stopwords, numbers, alphanumeric words and URLs. Subsequently, the preprocessed text was visualized via Word Cloud and Concordance to explore the frequency of words and the context in which they appear, and the full content, respectively (see Figure 2).

Pfizer is one of the world's leading pharmaceutical companies, with a long history of continuous innovation, development and production of drugs, vaccines and therapies. The company was founded in 1849 in Brooklyn, New York, by Charles Pfizer and Charles Erhart, with a vision to create a chemical company. Over the course of 170 years, Pfizer has played a significant role in various medical advancements, from the mass production of penicillin during Second World War to the development of revolutionary vaccines that combat devastating diseases. The company has also created groundbreaking treatments, such as those for breast cancer, which have prolonged the lives of over 350,000 women. Through the development of drugs and vaccines, Pfizer has improved the lives of billions of people around the world (Pfizer, 2024a, b, c). Currently, Pfizer operates in approximately 150 countries, with its international headquarters located in New York.

Pfizer is committed to broad collaboration to achieve life-changing innovations for patients. The company collaborates with entrepreneurs and innovators to continuously enhance its scientific endeavors, actively seeking partners to explore science-based ideas, capabilities and technologies that have the potential to deliver innovative treatments to those in need. Effective communication with stakeholders, including patients, is vital for the company. Pfizer utilizes various channels, such as its website and information portals, to provide details about products and answer questions regarding treatments. Additionally, the company engages with SM (including Instagram, Facebook, LinkedIn and Twitter) for updates and direct interactions. Pfizer also collaborates with health bodies, such as the National Health Service (NHS) in the United Kingdom, to improve access to treatments and implements educational and support programs to encourage adherence to treatment. Finally, the company conducts awareness campaigns on public health issues, such as vaccination and prevention.

Pfizer started operations in Spain in 1952 and opened its first plant in 1961. It operates in the universalistic and public national health system, but is highly decentralized, where each region has decision-making autonomy. As a result, Spain has become a reference point for the company's clinical research, with 70 active studies and almost 1,400 patients involved. Currently, Pfizer distributes 130 drugs in the country and has a plant in San Sebastián de los Reyes that produces treatments for hemophilia, covering 17,000 patients in more than 70 countries. Pfizer's mission in Spain continues to be to innovate to improve patients' lives (Pfizer, 2024a, b, c). The company communicates and shares information with patients in Spain using the Instagram channel.

Pfizer has been operating in the United Kingdom for over 70 years and is strongly committed to researching and developing innovative solutions for the prevention and treatment of diseases. It operates in one of the most centralized and universalistic public health systems in the world. The company actively collaborates with the National Health Service and various healthcare organizations to improve healthcare effectiveness and patient health outcomes, contributing to and enhancing the well-being of the population not only in the United Kingdom but also globally, by promoting more advanced and accessible healthcare for all (Pfizer, 2024a, b, c). The company communicates and shares information with patients in the United Kingdom using the Instagram channel.

We have obtained that, first of all, the firms apply different ways of communicating on SM that have different aims and audiences. Instagram is a platform that attracts niche consumers, mainly young people who use SM to spend their time in a fun way. Therefore, firms have to apply their communications in a simple way, using straightforward language.

The way to communicate with customers depends on the platform where the marketing strategy is published. Moreover, firms develop their marketing strategies differently in different countries, identifying which communication approaches work best. This allows for greater customization of future campaigns and more efficient use of invested resources. Finally, we expect to detect new trends that enable the needs of patients and consumers and improve the effectiveness of their campaigns.

Through the posts of the companies, one can understand how their SM strategy serves as a means of expressing their policies and goals. In fact, it can be seen how they inform and promote their products and services, and how they spread their messages to educate the public on how to engage in proper prevention and, therefore, adopt a correct lifestyle. After the text analyses, we have obtained the word cloud for each account (see Figure 3).

In the concordance, we have seen the repetition of the word and the meaning that assumes in the post's comment (see Table 3).

A certain degree of user perception can be measured by likes and comments, as these are well-known forms of interaction for users.

The number of likes could indicate a positive reaction from individuals; however, comments do not necessarily signify a positive or negative reaction. From the manual analyses of the posts that generated the most reactions from users through likes or comments and grouped them by primary interest, we have identify the identified the topics that were most relevant.

Comments and reactions to posts, particularly in the form of “likes”, are considered the two most important actions that a user can take regarding a post. To observe user reactions to posts, we can analyze both the reactions and the comments. We calculated the average number of comments and selected the content that exceeded this average to identify the posts that received the most reactions from users (see Table 4).

To support our discussion, we rely on Hofstede's cultural dimensions for Spain and United Kingdom (see Figure 4). In section 5.1, we provide a cultural comparative analysis of these two countries, highlighting their cultural profiles. These data will help us understand how they may influence the differences observed in our results.

Analyzing the posts of Pfizer España with the highest number of interactions (i.e. likes and comments) reveals several themes that resonate strongly with users. Users particularly appreciated content that combines art, corporate history, mental well-being, oncology support and educational initiatives for sustainability. These themes are grouped below.

1. Art and culture: Pfizer's participation in the “Meninas Madrid Gallery” received significant engagement, suggesting that artistic initiatives combining cultural heritage with corporate identity generate strong public interest.

2. Anniversaries and corporate traditions: Posts celebrating Pfizer's 175th anniversary garnered high appreciation, reflecting the importance users place on the company's long-standing history and values. This response may stem from the Spanish orientation toward tradition due to its short-term orientation. Furthermore, a lengthy corporate history reinforces the brand's “authority” in the market, and this increased brand relevance aligns with the high level of Power Distance in Spain, which fosters trust in established brands.

3. Mental health support: The “Salud Mental” campaign, aimed at raising awareness of mental health and combating the stigma surrounding depression, indicates a strong public interest in mental well-being. Such topics resonate with the Spanish public's focus on community well-being, characteristic of a consensus-oriented society.

4. Collaborations with oncologists and breast cancer patient support: Initiatives such as “Charlas más allá del espejo,” a video series featuring oncologists and specialists discussing integrated care for breast cancer patients, received substantial engagement, indicating strong interest in oncology support. This content appeals to the Spanish audience as they tend to value insights from authorities and experts over peer-to-peer feedback. This respect for expert opinions reflects Spain's high Power Distance, where people show deference to individuals with greater expertise and knowledge.

5. Educational initiatives and sustainability: Educational events like “Health Guardians 2030”, promoting sustainability among young people, highlight users' keen interest in sustainability and educational innovation. This aligns with Spain's individualistic yet consensus-oriented society, where education is seen as essential for empowering individuals to contribute positively to their communities.

Analyzing the posts of Pfizer UK, particularly those with the highest levels of engagement (likes and comments), reveals several themes that resonate with users. Users seem to appreciate themes of innovation, collaboration with patients, promotion of inclusion and diversity, education and social responsibility. These themes are grouped below.

1. Mission and innovation in healthcare: Pfizer's commitment to developing innovations that change patients' lives is evident in posts that highlight the contributions of its employees toward the company's mission, “Breakthroughs that change patients' lives.” This theme resonates with British society, which is generally open to innovation due to its low level of uncertainty avoidance and high long-term orientation.

2. Collaboration with patient organizations: Pfizer hosted 30 patient organizations to discuss their needs, promoting dialogue aimed at improving healthcare and living conditions. This initiative underscores Pfizer's dedication to working closely with patient associations, which aligns with the low Power Distance in the UK reaching patients directly helps bridge the social gap between HCPs and recipients. Openness to patient feedback also contributes to a sustainable strategy that values co-creating with key stakeholders over time, characteristic of a culture with long-term orientation and low uncertainty avoidance. Here, ambiguity is not shunned, and flexibility to change, along with paths that arise through dialogue, emerge from these cultural dimensions.

3. Diversity, equity and inclusion: Recognizing team members for promoting “DEI” demonstrates Pfizer's focus on diversity and inclusivity. This theme resonates with the British audience, where the low Power Distance helps explain the positive reactions. In the United Kingdom, diversity, equity and inclusion are valued pillars that counteract social disparities often found in hierarchical societies, which are minimized in the United Kingdom.

4. Leadership and people development: Announcing new leadership in the United Kingdom sparked interest among the public, who are curious about Pfizer's evolution and strategic direction. This interest reflects the British value placed on organizational success, as culturally, there is a focus on achieving the best possible results.

5. Support and promotion of education: Pfizer's participation in the “Empowered Females in STEM” program underscores its commitment to advancing women in Science, Technology, Engineering and Mathematics (STEM) fields and creating career opportunities for young female students. This initiative aligns with values in the United Kingdom, where education as a tool for personal and professional growth is highly valued. An individualistic society with a strong orientation toward success and achievement, like the United Kingdom, supports programs that motivate individuals to pursue their goals. Education as a long-term investment also aligns with the United Kingdom's long-term orientation.

6. Social responsibility and volunteering initiatives: Pfizer's participation in a triathlon for disabled athletes highlights its support for socially inclusive events and values employee involvement. The belief that social disparities can be countered through personal achievement aligns with the following cultural dimensions: low Power Distance, high individualism and high motivation toward success and achievement.

Spain's Power Distance score is high (57); hence, people accept a society built on a hierarchical order in which everybody has a place, and some people's roles are more influential than others. In communication terms, this means that customers only trust the opinions of important people, authorities or experts on companies and their services. Moreover, Spain is an Individualist country (67), which means individuals are expected to take care of themselves and their immediate families. In this context, a company's communication style should emphasize individuals' power to generate wellness for themselves and among family or close friends. In this sense, individualist cultures are highly engaged in marketing content that highlights the personal benefits derived from the product and the personalization of it, like individual success, self-realization and self-satisfaction. However, individualism is moderated by a low score of motivation toward achievement and success (42), classifying Spain as a consensus-oriented country. In fact, excessive competitiveness is not appreciated, and people are educated from a young age to reach harmony with others in all contexts. In fact, the Spaniards people are particularly sympathetic and careful toward weak or needy people.

The Uncertainty Avoidance score is the highest (86) among all the dimensions. Spanish people have rules in each aspect of their life but do not follow them if this means bringing some kind of change. Whatever creates disharmony or could change their state of mind destabilizes them. They do not accept ambiguity in communication and trust products where quality and safety are clearly declared and proven, possibly by past customers who describe their experience. This attitude is only related to the present time. In fact, Spain is a short-term-oriented nation (47) where citizens are not concerned about the future and want to achieve results as quickly as possible. At the same time, they are looking for immediate benefits deriving from some kind of experience, even the purchase of one. Moreover, since they are really close to traditions, they want to feel that these are respected in every context. This tendency is also demonstrated by the Spanish low level of Indulgence (44), which means it is a restraint context. In fact, individuals feel restrained by social norms and are generally cynical and pessimistic. A formal language and way of doing things is preferred; self-indulgence makes Spaniards feel guilty, so the communication content must be aligned with this principle.

Britain has a low level of Power Distance (35), which creates intra-cultural tensions due to the deep-rooted and historical British class system and the strong belief that the context in which someone is born does not affect who they could become. Equality is relevant and protected. In communication terms, the British prefer testimonials from common people and pay more attention to peer-to-peer feedback. The United Kingdom is a strongly Individualist country (76): privacy truly matters. Moreover, citizens are educated to find their unique purpose in life to contribute to society. Personal fulfilment is what a company must promise when promoting its services or simply communicating with its audience. Furthermore, individuals are highly competitive because of the high score of Motivation toward Achievement and Success (66). The British success-driven value system is hidden by the modest ways that people adopt, which can be misunderstood as low ambition in being the best. The “read between the lines” attitude should be implemented to communicate with the English audience, what is said is not always what is meant.

If risk helps to achieve goals, it is always well accepted, also because in the United Kingdom there is a low level of Uncertainty Avoidance (35). Britain is open to whatever the future brings, and this tendency makes the British very flexible and fosters a positive attitude toward change. The communication style, thus, could be informal and focused on product/service innovation and different kinds of news. Unconventional marketing strategies are well accepted and preferred in this type of culture. Ambiguity is not something to avoid, and the future is the horizon. In fact, the low level of Uncertainty Avoidance is strengthened by the high score in the long-term Orientation dimension (60). This means that the English are pragmatic and believe that truth is linked to reality and time. Traditions could change if conditions require it. In the United Kingdom, people save and invest, so companies could use marketing strategies aiming to create a bond with customers built on perseverance and made up of a loyalty program that rewards loyalty over time. English customers also respond positively to content highlighting the long-term benefits generated by products, even if this involves some initial costs. Sustainability, for example, is an important topic in the United Kingdom because it promises future advantages for society.

Moreover, the United Kingdom is Indulgent (69), meaning individuals feel confident in doing what they like and want to fulfil their desires, enjoying life. Optimism should be reflected in marketing strategies, which must focus on leisure time and freedom. Self-expression is fundamental and must be enhanced by firms.

The term “Sciencefact” is used by “Pfizer UK” to emphasize their commitment to fact-based science, rather than hypothesis, misinformation or speculation. This communication strategy underlines the importance of rigorous scientific evidence and reliable research in the context of medical and pharmaceutical discoveries. One notable difference in Pfizer's Instagram content between Spain and the United Kingdom is the focus on prevention and patient engagement in Spain, which includes guidance on ways to improve individual health through preventive measures. In the United Kingdom, posts emphasize the disparities and inequalities in patient treatment, possibly reflecting the different economic conditions and healthcare systems between the two countries. For instance, a study conducted by Pfizer with “Shine Cancer Support” and “Lane Clark and Peacock” highlights the disparities in breast cancer treatment pathways between women living in England and Scotland, influenced by socioeconomic factors affecting patients' experiences.

The term “drug” appears frequently in posts published by “Pfizer UK”, often related to advanced technologies like nanotechnology, which supports drug production. Additionally, Pfizer promotes the use of Antibody Drug Conjugates (ADCs), a class of innovative drugs for cancer treatment. Pfizer España frequently mentions the company’s name, leveraging the brand's authority. Additionally, Pfizer collaborates with platforms like Spotify and Amazon to broadcast audio content. A unique project Pfizer launched in Spain is a thriller called “Premonición”, a futuristic audio drama created in collaboration with “El Extraordinario”. This production aims to raise awareness about migraines by exploring the condition's impact within a dramatic, science-fiction context.

The word “Breakthroughs” is recurrent in “Pfizer UK's” posts, reflecting the company's dedication to sharing information on scientific developments, medical innovations and advancements in pharmaceutical research. Similarly, the word “learn” is frequently used in “Pfizer UK’s posts, emphasizing their commitment to continuous learning and raising awareness of critical public health issues. “Pfizer UK” adopts “learn” to promote the idea that knowledge is essential for improving health and reducing inequalities. This difference in focus reflects distinct communication objectives in each country: in Spain, the goal is to increase awareness of specific health conditions, while in the United Kingdom, the focus is on educating the public on a range of scientific advancements.

The word “health” is used differently by Pfizer's accounts in each country. “Pfizer UK” emphasizes the social and economic inequalities affecting health, highlighting the roles of income, education and employment in limiting access to care. Their initiatives aim to improve health equity by collaborating with patient communities and the National Health Service (NHS) to address disparities. In contrast, “Pfizer España” uses the term “salud” to address issues related to mental health, pollution and environmental sustainability, mirroring growing concerns about the impact of environmental factors on health. Their communication also promotes awareness-raising campaigns on health days, such as World Mental Health Day and Melanoma Day, focusing on the prevention and treatment of specific diseases. Both branches demonstrate a strong commitment to health, but each focuses on different issues aligned with the local context.

While we observed that the “Pfizer España” account focuses its content on prevention, seen as a way to reduce the emergence of uncertain medical issues, reflecting Spain's high level of Uncertainty Avoidance. Since this topic directly impacts individuals and their personal health, it is well-received, aligning with Spain's relatively high level of Individualism. This communication approach combines a tendency to avoid negative changes with the benefits of prevention, which appeal to both future and present orientations.

In contrast, “Pfizer UK”'s content is centered on highlighting inequalities in treatment access due to economic conditions and other social disparities. This focus on social issues affecting health aligns with the United Kingdom's low level of Power Distance. “Pfizer UK” often uses the word “health” to promote initiatives aimed at improving health equity, collaborating with patient communities and the National Health Service (NHS) to reduce disparities. Additionally, the British performance orientation leads “Pfizer UK” to emphasize “Sciencefact,” stressing that their results are rooted in fact-based science, distinguishing them from hypotheses, misinformation or speculation.

Moreover, “Breakthroughs” is a recurring term, as “Pfizer UK” has developed a platform to communicate advancements in scientific development, innovation and progress in medical and pharmaceutical research. The word “learn” is also widely used on “Pfizer UK's” account, reflecting the company's commitment to continuous learning and underscoring its drive to lead in the market. Pfizer uses “learn” to highlight how essential knowledge is to improving the health system.

Conversely, Pfizer España frequently emphasizes the company's brand, reinforcing the authority of Pfizer as a well-recognized leader in the pharmaceutical sector. In Spain, this approach resonates due to a high level of Power Distance, where quality is often associated with established authority. Spanish culture tends to promote responsible behavior toward the community through initiatives such as the Premonición project. This unique production a futuristic audio drama created in collaboration with “El Extraordinario” uses science fiction to raise awareness about migraines. The novel approach to discussing a sensitive health issue might be unconventional for a traditional culture like Spain's, but the high Uncertainty Avoidance and Restraint dimensions may increase receptivity to this kind of innovative marketing.

Further reflecting Spanish cultural values, Pfizer España's content often addresses health concerns impacting the community. Although Spain has a high level of Individualism, it also has a consensus-oriented society that values the common good over individual achievements. Consequently, health topics that benefit society at large are positively embraced. Pfizer España uses the word “salud” to discuss issues such as mental health, pollution and environmental sustainability, which are increasingly concerning in terms of public health. Communication also includes awareness campaigns during health observances, like World Mental Health Day and Melanoma Day, to promote the prevention and treatment of specific diseases.

This last point highlights that Pfizer España emphasizes preventive measures through awareness campaigns on significant health days, tailoring content to encourage proactive health behavior among citizens.

The above-mentioned analysis shows that the company tailors its messages to a specific cultural audience. In particular, in Spain, it highlights the relevance and scientific authority of the sources and preventive messages. Institutional credibility and the promotion of responsible behaviors are the main pillars of the communication with the Spanish audience. In contrast, when it comes to the United Kingdom, the same company implements an informal and peer-driven communication style. The contents focus more on the future and the innovativeness of the solutions. Another key factor is reducing inequalities in health contexts through the company’s future-oriented actions, which is crucial for the British culture, which is open to change and safeguards individuals’ empowerment.

In conclusion, Pfizer aligns its communication with the national culture profiles, presenting itself as aligned with the expectations and priorities of the audience. This is consistent with previous works stating that cultural dimensions affect the international use of SM for companies (Noman et al., 2024; Li et al., 2024). Indeed, even though a standardized strategy is used in SM management, it always needs to be adapted to the audience to be effective (Okazaki and Taylor, 2013; Goodrich and de Mooij, 2016). Furthermore, pharmaceutical companies must adopt well-targeted international communication strategies to operate effectively in different cultural contexts (Okazaki and Taylor, 2013). In particular, they should balance overall coherence with local cultural sensitivity. Therefore, in addition to the segmentation of users on demographic factors but also for cultural dimensions such as individualism, avoiding uncertainty or long-term orientation. Indeed, in collective societies, the emphasis on community health and shared responsibility can be more persuasive, while in individualistic cultures, messages focused on personal empowerment and self-protection are more effective.

Analyzing the SM posts of a company like Pfizer, which operates in two different markets, involves several challenges and opportunities, particularly given the varying cultural, regulatory and public perception contexts in each market. In our research, we analyzed two countries Spain and United Kingdom that exhibit cultural differences (Hofstede, 2001).

The markets in which Pfizer operates display cultural differences that impact consumer perceptions of pharmaceutical products and the level of trust they place in the company. These differences are reflected in SM posts through variations in language, tone and topics discussed.

In this paper, we performed an analysis of textual and visual features on Instagram for a major pharmaceutical company over a selected time period. Few studies have investigated the SM strategies of pharmaceutical companies, and even fewer have done so through a cross-cultural lens (Zhan et al., 2021).

SM platforms like Instagram support brand awareness and enable real-time, visual interaction. Unlike other platforms, Instagram emphasizes image and video content, making it a popular channel for sharing personal moments, promoting products and storytelling, especially among influencers, artists and brands. Each platform thus attracts a distinct audience and serves specific communication goals.

By integrating Hofstede’s model, this study provides insights into how cultural differences influence consumer engagement with Pfizer's Instagram presence. Pfizer tailors its marketing and communication strategies to each market, responding to local preferences. These differentiated approaches are evident in the terms used, types of content posted, message tone and frequency of interactions with consumers.

In fact, an analysis of the posts reveals how Pfizer adjusts its messaging based on what resonates with each market's audience, using targeted and personalized content. Analyzing Pfizer's Instagram posts across different markets requires an approach that considers variables such as cultural differences, local regulations, marketing strategies and public sentiment. This data provide valuable insights for optimizing communication strategies, particularly for companies that need to adapt to local regulations and improve patient engagement.

Pfizer has chosen to differentiate its Instagram accounts for the markets in which it operates in this case, Spain and United Kingdom. This decision reflects the nature and purpose of the platform and the distinct audiences of patients it engages. Instagram, a highly visual and informal platform with global reach, allows Pfizer to create separate accounts for each market to tailor content to local cultural interests and sensitivities. By doing so, Pfizer can better respond to local preferences by adapting messages to the cultural and linguistic context.

Instagram also enables Pfizer to interact directly with local communities, fostering greater audience engagement by responding to user questions, sharing news relevant to the specific country and participating in discussions of national importance. Our research shows that Pfizer is a dynamic company that readily adapts their strategies to meet societal needs and continuously explores innovative ways to improve patient lives.

From a theoretical point of view, this study fills the gap in understanding how companies can reinforce the use of SM to engage patients while taking into account cultural aspects. Although there are numerous studies that study SM as a tool for engagement, few studies focus on what international strategies can be adopted, taking into account cultural differences. This research provides interesting insights regarding the greater inclusion of the patient, taking into account their sociocultural aspects. It contributes to the academic debate on the reliability of SM as a patient engagement tool (Lim and Rasul, 2022).

The results of this study have significant implications for practitioners in pharmaceutical companies. First, it is recommended to take advantage of SM platforms through which to disseminate accurate health information and guidelines and promote a sense of community and social responsibility. Health professionals should place greater reliance on the use of SM platforms by choosing simple and effective ways to communicate with citizens while recalling cultural characteristics.

Second, the company, through the use of SM, can build a reliable social relationship within the communities with patients by involving more and more society and providing continuously tailored content ad hoc on the sociocultural context in which they operate.

Third, greater efforts should be made to improve and integrate the online world with the offline world in order to promote a continuous interaction between patients and pharmaceutical enterprises.

From a managerial point of view, this document highlights the need for managers to promote a SM culture focused on the needs and culture of the human being, in which the use is focused on a functional tool to bring the patient closer to the pharmaceutical company. In addition, policymakers should pay more attention to regulation that stimulates public trust to bring patients closer to these kinds of digital tools.

In conclusion, the authors design a conceptual framework to apply to the analysis of the results, to allow the replication of the study (see Figure 5).

Our research has several limitations that can generate insights for future research. First, we selected only two branches of one enterprise that operate in two different countries to perform a comparative analysis in different countries, specifically Spain and United Kingdom. In future research, it could be interesting to expand the sample of enterprises to include additional enterprises. In addition, we have collected data from only one type of SM that involves a specific audience, but in future research, data could be collected from other SM platforms with different audiences. It would be interesting in future research to involve other large pharmaceutical companies and to analyze other platforms besides Instagram, such as LinkedIn, which targets a different audience.

Moreover, we have limited our analysis to a period of two months, justifying the reason for the following study; however, a longer time frame could be analyzed as it could provide more complete information. In this study, we observed the number of comments and likes. We assumed that a high number of reactions indicates a positive response or at least agreement with the content. However, conducting a sentiment analysis of users' comments could help to more accurately determine whether reactions are positive, negative or neutral, providing a deeper understanding of users' responses.

Finally, our research is focused on patient engagement only, but future research could investigate how the company collaborates with key healthcare stakeholders to implement initiatives that streamline processes and facilitate communication with these stakeholders.

Federica Zeuli is a doctoral student in Entrepreneurship and Innovation at the University of Naples “Parthenope.” She graduated with honors in Business Administration from the University of Naples “Federico II.” Her research focuses on AI, IoT and digital transformation in healthcare management to improve patient engagement and experience. Since 2023, she has been a member of the Research Network of Innovation (RNI), and since 2024, a member of the European Academy of Management (EURAM). She is currently conducting research at Universidad de Castilla – La Mancha.

Annaluce Mandiello is a PhD candidate in Entrepreneurship and Innovation from the Department of Management and Quantitative Studies, University of Naples Parthenope. Her research is focused on innovation diffusion, value co-creation, customer-centricity, digital transformation, entrepreneurship, healthcare management. In this field, she is particularly interested in the pediatric sector. Moreover, she collaborates with VIMASS lab, the innovation and healthcare management research laboratory of the University of Naples Parthenope.

Francesco Schiavone is a full professor of Innovation Management for the Department of Management and Quantitative Studies at the University Parthenope of Naples (Italy). Scientific director of VIMASS, the research lab in healthcare innovation and management at University of Naples Parthenope. Associate editor for Technological Forecasting and Social Change, the Journal of Intellectual Capital and Innovations /Journal of Innovation Economics and Management. Guest Editor in leading academic and professional management journals including Production, Planning and Control, Journal of Business Research, and Journal of Intellectual Capital.

Fabian Bernhard is an associate professor of Management and part of the Family Business Center at EDHEC Business School in Paris, Lille, Nice and London. He is a research fellow at the University of Mannheim in Germany (Mittelstand Research Institute, ifm) and previously at Stetson University in Florida. Equipped with the insights from his own family's business, Fabian Bernhard worked several years for a renowned financial consulting company in New York. In his academic work, he specializes in the emotional dynamics in family businesses, the preparation of next generational leaders and the psychological attachment to the family business. His articles have been published in various academic and practitioner outlets as well as in the public media. Fabian Bernhard is a recipient of several honors and awards for his work on family businesses, such as the best dissertation honorable mention by FFI at Harvard. Since 2014 he has been serving on the editorial boards of the Family Business Review (FBR) and the Journal of Family Business Strategy (JFBS). Since 2017 he has been a member of the Board of Directors of the Family Firm Institute (FFI) in Boston.