Data-Driven Nudging and Institutional Framing: A Health Marketing Innovation Through Intermediaries

This study explores how an innovation-driven enterprise reconfigured its marketing strategy to relaunch a cardiovascular biomarker following an initial adoption failure in the Italian healthcare system. Drawing on Nudge Theory and Institutional Theory, we examine how behavioural insights and institutional alignment can be leveraged to influence professional intermediaries, particularly physicians, who mediate access to innovation in complex and regulated environments. Using a historical analysis approach, the study combines a structured literature review with a desk-based case study, drawing on press articles, scientific publications, industry reports, and internal interviews. We investigate how the firm responded to heterogeneous adoption patterns across secondary prevention centers, focusing on embedded sub-cases classified by test uptake performance. Our findings reveal a dual trajectory of innovation. First, the enterprise utilized real-world data to segment clinical centers and tailor engagement strategies. Second, it activated high-performing clinicians through a national advisory board to foster peer-based nudging via benchmarking. This approach encouraged physicians to align with evidence-based practices and institutional expectations, reframing performance metrics from volume to quality. Conceptually, the study contributes to understanding how nudges—when designed for expert intermediaries—can function as mechanisms of institutional coordination rather than simple behavioural triggers. We advance the innovation–marketing nexus by showing how data-driven, legitimacy-based strategies can influence professional decision-making and facilitate systemic diffusion. These insights have broader relevance for healthcare innovation and other highly regulated, intermediary-driven sectors.