This piece by guest blogger, Dr. Sara Becker, summarizes ideas from her recent manuscript, Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and Implementation Efforts for Mental Health and Substance Abuse Interventions, published in the March 2015 edition of Clinical Psychology: Science and Practice.
Increasing the Use of Effective Behavioral Treatments through Direct-to-Consumer Marketing
One of the greatest challenges facing our field is the enormous divide between those who need treatment for mental health and substance use (M/SU) and those who receive an effective intervention. Recent estimates from the 2013 National Household Survey on Drug Use and Health suggest that only 45% of those with a mental health diagnosis and 11% of those with a substance use diagnosis receive specialty treatment (Substance Abuse and Mental Health Services Administration, 2014a, 2014b). Meanwhile, reviews of the U.S. treatment system (see McLellan & Meyers, 2004) suggest that even fewer individuals receive a treatment designated as effective or “evidence-based.” Two gaps contribute to the low utilization of effective treatment: 1) the gap between what we know about treatments that work and what is available in the community (commonly known as the “research to practice” or “evidence to practice” gap) and 2) the gap between those who need treatment and those who receive it (commonly known as the “treatment gap” or “unmet need”).
Over the past two decades, our field has invested significant resources towards increasing the use of effective M/SU treatments. Arguably, the bulk of our efforts have been directed towards treatment providers and agencies in order to increase the supply of effective treatments in the community. For instance, we have seen numerous new attempts to: train providers in M/SU interventions, embed M/SU treatment into routine practice, and evaluate the effectiveness of M/SU models under “real world” conditions (see Becker, 2015a). These efforts have made slow (though important) progress toward bridging the research to practice gap, but have done little to address unmet need. A comprehensive approach needs to balance attempts to increase the supply of treatment with novel strategies to increase the demand for the treatment provided.
Direct-to-consumer (DTC) marketing efforts that target M/SU patients and caregivers have the potential to address systemic barriers contributing to unmet need, such as lack of patient knowledge and interest in behavioral treatment, and can serve as a complementary approach to provider-directed approaches. While contemporary approaches try to “push” treatment to patients through treatment providers (or “bring treatment to the patient”), a DTC approach attempts to increase awareness of effective treatment so that customers will request it and “pull” it through the system (or “bring the patient to treatment”).
DTC marketing initiatives vary significantly, but a standard program will generally consist of at least four stages (see http://www.business.vic.gov.au/marketing-sales-and-online/increasing-sales-through-marketing/doing-market-research for a business example): 1) defining the objective of the initiative; 2) defining the target audience; 3) conducting (and refining) market research; and 4) using data to make decisions. Each stage builds logically upon the one before and requires significant preparation. For instance, defining the target audience of DTC marketing requires a clear articulation of the marketing objective. If the goal is to increase the number of people requesting a specific intervention, then the target audience is not necessarily the person who receives treatment, but rather might be the person who selects treatment. As an example, a developer of therapy for youth anxiety might direct marketing towards parents, since it is well established that parents are more likely to make treatment decisions than youth. Similarly, a creator of a treatment for court-ordered individuals might target marketing towards judges if individuals need to be mandated to a specific intervention.
Once the objectives and target audience have been established, the next and most critical step is conducting qualitative market research. A well-established framework in the marketing literature that can be used to guide both preparation and data collection is the Marketing Mix or the “4Ps” (see Zeithaml et al., 2012), which refer to: Product (or Service), Price, Place, and Promotion. Some key questions that a clinician or researcher aiming to use DTC marketing should consider are outlined below in Figure 1. Additional lists of questions that can be used for planning and data gathering purposes are listed in Becker’s March 2015 piece in Clinical Psychology: Science and Practice.
In the data collection stage, it is especially important to test whether the language and terms used by treatment developers are appealing and clear to the target customer. As an example, recent DTC marketing efforts by several national organizations use the term “evidence-based practice” when describing effective approaches, even though multiple studies suggest that M/SU patients have negative impressions of and reactions to the concept (see Becker et al., 2015; Carman et al., 2010; Tannenbaum, 2008). Ideally, the data gathering phase is not a one shot deal, but rather an iterative process that consists of initial data collection and identification of “signals,” followed by larger-scale data collection, refinement, and replication as needed (i.e., through market research surveys or additional focus groups and interviews). Only after several rounds of qualitative market research is it finally time to make decisions about how the Marketing Mix will be used to shape the DTC initiative.
DTC marketing should not be viewed as a panacea and additional research is sorely needed to determine whether and under which conditions DTC marketing is most effective. Still, it makes logical sense to begin considering DTC marketing as an important part of a comprehensive strategy to increase treatment utilization. We cannot meaningfully close the research-to-practice gap if customers do not demand the treatments provided, nor can we reduce unmet need if there is an insufficient supply of treatment in the community. Our field’s attempts to “cross the divide” have the potential to be most effective when we engage both providers and customers in a coordinated fashion. By taking the time to define our target audience, listen to our customers through market research, and tailor our marketing efforts accordingly, we can potentially better meet our goal of connecting effective interventions with those M/SU patients in greatest need.
- What do you see as the greatest potential benefits of using DTC marketing to engage M/SU patients in behavioral treatment? What do you see as the greatest potential challenges?
- In the clinical psychology field, who do you think should bear the primary responsibility of DTC marketing efforts (e.g., treatment developers, professional organizations, research funders, insurance companies, etc.)? Why?
About the Author
Sara Becker is an Assistant Professor (Research) in the Department of Behavioral and Social Sciences at the Brown School of Public Health and the Evaluation Director of the New England Addiction Technology Transfer Center. She earned her Ph.D. in clinical psychology from Duke University, completed her clinical residency at McLean Hospital / Harvard Medical School, and completed postdoctoral training at the Center for Alcohol and Addictions Studies at Brown University. Prior to her graduate work in clinical psychology, she worked as a Consultant with the Boston Consulting Group and Mapi Values, where she learned marketing strategies to optimize demand for pharmaceutical products. Building on her multidisciplinary training, she conducts clinical research focused on the use of direct-to-consumer marketing to improve the utilization of effective behavioral treatments for adolescents with substance use disorders.
- Becker, S. J. (2015a). Direct-to-consumer marketing: A complementary approach to traditional dissemination and implementation efforts for mental health and substance abuse interventions. Clinical Psychology: Science and Practice, 22, 85-100.
- Becker, S. J. (2015b). Evaluating whether direct-to-consumer marketing can increase demand for evidence-based practice among parents of adolescents with substance use disorders: Rationale and protocol. Addiction Science & Clinical Practice, 10: 4. http://www.ascpjournal.org/content/10/1/4
- Becker, S. J., Spirito, A., & Vanmali, R. (2015). Perceptions of “evidence-based practice” among the consumers of adolescent substance use treatment. Health Education Journal, online before print. doi:10.1177/0017896915581061.
- Carman, K. L., Maurer, M., Yegian, J. M., Dardess, P., McGee, J., Evers, M., & Marlo, K. O. (2010). Evidence that consumers are skeptical about evidence-based health care. Health Affairs, 10-1377.
- McLellan, A. T., & Meyers, K. (2004). Contemporary addiction treatment: A review of systems problems for adults and adolescents. Biological Psychiatry,56, 764-770.
- Substance Abuse and Mental Health Services Administration (2014a). Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-49, HHS Publication No. (SMA) 14-4887. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Substance Abuse and Mental Health Services Administration (2014b). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Tanenbaum, S. J. (2008). Consumer perspectives on information and other inputs to decision-making: Implications for evidence-based practice. Community mental health journal, 44, 331-335.
- Zeithaml, V., Bitner, M. J., & Gremler, D. (2012). Services marketing: integrating customer focus across the firm (6th ed.): McGraw-Hill Higher Education.