Using direct-to-consumer marketing strategies with obsessive-compulsive disorder in the nonprofit sector

Statewide Workforce Development Program to Improve Care for Individuals With Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD), a frequently disabling disorder characterized by distressing thoughts and behaviors, often goes undetected, or individuals with this disorder do not receive evidence-based care. Educating clinicians and individuals with OCD and their families about OCD is a necessary first step to improving quality of care. This Open Forum describes the creation of a workforce development program named Improving Providers' Assessment, Care Delivery, and Treatment of OCD (IMPACT-OCD). This program used implementation science methods to engage stakeholders, assess practice determinants, and develop a multifaceted training strategy to raise awareness of OCD and to improve clinician knowledge and skills in OCD care.

The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial

Background

Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments.

Method

Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT.

Discussion

This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments.

Trial registration

This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00213-x.

Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.

"Sign Me Up, I'm Ready!": Helping Patients Prescribed Sleeping Medication Engage with Cognitive Behavioral Therapy for Insomnia (CBT-I)

OBJECTIVE/BACKGROUND

Cognitive behavioral therapy for insomnia (CBT-I) provides safe and effective insomnia care without the risk of harm associated with sleeping medications. Unfortunately, few patients with insomnia engage with CBT-I, with most using sedative hypnotics instead. This study conducted focus groups with patients with insomnia who were treated with sleeping medication, including older adults, women, and patients with chronic pain. The goal was to explore the perspectives of high-risk, CBT-I naïve patients on increasing access and engagement with CBT-I.

PARTICIPANTS

Participants included 29 Veterans with insomnia who had been prescribed sleeping medication in the last year and had not previously engaged with CBT-I.

METHODS

Semi-structured 90-min focus groups were used to 1) explore messages and appropriate channels for a CBT-I social marketing campaign, 2) determine patient preferences for self-management CBT-I tools, and 3) determine patient opinions on alternative provider-delivered forms of CBT-I. Thematic analysis was used to identify conceptual themes.

RESULTS

Three main themes were identified. First, patient education is necessary but not sufficient. Patients recommended multiple outreach attempts through multiple channels to motivate tired and overwhelmed insomnia patients to engage with CBT-I. Second, patients gravitated toward a stepped-care approach. Most would start with self-management CBT-I tools, moving on to provider-delivered CBT-I if needed. Finally, patients appreciated being able to choose from a menu of CBT-I delivery options and would use multiple options simultaneously.

CONCLUSIONS

These findings suggest promising opportunities to increase the use of CBT-I for high-risk patients through patient education and provision of self-management CBT-I tools.

Introduction to knowledge and competency standards for specialized treatments for obsessive-compulsive disorder throughout the lifespan: Phase two series by the International Accreditation Task Force of the Canadian Institute for Obsessive Compulsive Disorders (CIOCD, www.ciocd.ca)

This paper presents an introduction to the phase two series of papers by the 14 nation International Obsessive-Compulsive Disorders Task Force (ATF) of the Canadian Institute for Obsessive Compulsive Disorders. These papers present evidence-based knowledge and competency standards developed by the ATF for specialized treatments for obsessive-compulsive disorder (OCD) through the lifespan, operationalized as clinician abilities. Specialty standards for OCD do not currently exist and are deemed by experts to be foundational to transformative improvement globally in quality and accessibility of evidence-based treatments for this crippling disorder. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to this disorder. The ATF standards encompass specialized cognitive behavior therapy, and pharmacotherapy, for pediatric and adult OCD. Evidence-based methodology with integration of expert opinion are described. Upcoming ATF phases three and four will involve development and implementation of training criteria and processes for certification (individual clinicians) and accreditation (clinical sites) based on the ATF standards. These standards will require periodic review and updating commensurate with advances in clinical research. We hope that this international initiative constitutes a significant step forward to inform and advance evidence-based specialized treatment and training for OCD.

User-informed marketing versus standard description to drive demand for evidence-based therapy: A randomized controlled trial

Direct-to-consumer (DTC) marketing represents a vital strategy to disseminate evidence-based therapies (EBTs). This 3-phase research program, informed by the marketing mix, developed and evaluated user-informed DTC materials for parents concerned about adolescent substance use (SU). Phases 1 and 2 consisted of qualitative interviews (n = 29 parents) and a quantitative survey (n = 411), respectively, to elicit parents' preferred terms and strategies to disseminate EBT. Building upon prior phases, the current study (Phase 3) developed a user-informed infographic (128 words, 7th-grade level) focused on SU therapy. Parents were randomly assigned to view the user-informed infographic (n = 75) or a standard EBT description (n = 77) from the American Psychological Association (529 words, 12th-grade level). Logistic regressions examined the effect of marketing condition on parent-reported behavioral intentions and actual requests for EBT information, controlling for correlates of parent preferences in Phase 2 (parent education level; adolescent internalizing, externalizing, legal, and SU problems). Counter to hypotheses, condition did not have a main effect on either outcome. However, there was a significant interaction between condition and adolescent SU problems: among parents whose adolescents had SU problems, the user-informed infographic predicted 3.7 times higher odds of requesting EBT information than the standard description. Additionally, parents whose adolescents had legal problems were more likely to request EBT information than parents whose adolescents did not. The infographic was 4 times shorter and written at 5 grade levels lower, thereby providing a highly disseminable alternative. Findings highlight the value of specificity in DTC marketing, while advancing methods to create tailored marketing materials and communicate knowledge about psychological science. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impressions of "Evidence-Based Practice": A Direct-to-Consumer Survey of Caregivers Concerned about Adolescent Substance Use

National behavioral health organizations have recently started using direct-to-consumer (DTC) marketing strategies as a means of promoting increased utilization of evidence-based practice (EBP). Such strategies often encourage patients and caregivers to proactively seek out EBP, based on the assumptions that patients and caregivers understand the concept and view it favorably. We conducted a DTC marketing survey of caregivers concerned about their adolescents' substance use in order to explore how these caregivers define, value, and prefer to describe the EBP concept. We also examined whether caregiver perceptions of EBP vary by socio-demographic (race/ethnicity, income per capital, education level) and clinical (adolescent's history of therapy) characteristics. A total of 411 caregivers (86% women, 88% Non-Hispanic White) of adolescents age 12 to 19 (M age = 16.1, SD = 1.8, 82% Non-Hispanic White) completed an online survey. Caregivers answered a series of questions evaluating assumed definitions of EBP, underlying EBP principles, the appeal of EBP, and alternate terms to describe EBP. Chi-square analyses and multivariate logistic regressions were used to examine which variables were associated with the greatest likelihood of response selection. Results indicated that most parents defined EBP correctly, valued EBP principles, and found EBP appealing. However, caregivers from racial/ethnic minority groups, with lower income per capita, and lower education were more likely to define EBP incorrectly and have negative impressions of the concept. Education level was the strongest and most consistent predictor of caregiver perceptions. Clinical implications for the development of targeted, accessible marketing messages are discussed.

Bridging the Gap Between Research and Practice in Mental Health Service Settings: An Overview of Developments in Implementation Theory and Research

Twenty years after Sobell's (1996) influential call to integrate advances in behavior therapy into clinical settings, significant progress has been made in implementation science. In this narrative review, we provide an overview of implementation research findings and highlight recent findings that can inform efforts to bridge the gap between research and practice in mental health service settings. Key findings are summarized, organized according to levels of influence described in two implementation frameworks: The Exploration, Planning, Implementation, and Sustainment Framework (EPIS; Aarons et al., 2011) and the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). Important levels of influence to consider when implementing new treatments include the outer context, inner context, characteristics of the individual, and characteristics of the innovation. Research on strategies to prepare clinicians to deliver evidence-based psychosocial treatments (EBPTs) and to address contextual barriers to implementation at each level is described, with discussion of implications for the implementation of EBPTs and next steps for research.

Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research

The adoption and implementation of evidence-based interventions (EBIs) are the goals of translational research; however, potential end-users' perceptions of an EBI value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities.

Specialized psychological and pharmacological treatments for obsessive-compulsive disorder throughout the lifespan: a special series by the Accreditation Task Force (ATF) of The Canadian Institute for Obsessive Compulsive Disorders (CIOCD, www.ciocd.ca)

The World Health Organization ranks obsessive compulsive disorder (OCD) among the leading causes of worldwide medical disability. Affecting approximately 3% of the population, OCD, with its damaging effect on psychosocial function, is among the most severe and impairing of mental disorders. In Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), OCD and related disorders form a separate classification, consistent with convergent research that indicates OCD is distinct from anxiety disorders in psychopathology and treatment requirements. Although evidence-based treatments have been developed for OCD, these are not accessible to many sufferers. Timely evidence-based treatment is recommended to avoid unnecessary progression to chronicity, disability, and intransigence of symptoms. Improvement in existing training models is needed to disseminate advanced specialty clinical skills to optimize illness recovery. This special series by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) Accreditation Task Force (ATF) critically reviews evidence-based psychological and pharmacological treatments for OCD throughout the lifespan. The ATF mandate is to establish specialty OCD certification/accreditation standards and competencies. This pioneering initiative aims to achieve transformational change in accessibility to evidence-based clinical care so urgently needed for young people and adults suffering from OCD.

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed.

Direct-to-consumer marketing of psychological treatments for anxiety disorders

Progress disseminating and implementing evidence-based psychological treatments (EBPTs) for the anxiety disorders has been gradual. To date, the dominant approach for promoting the uptake of EBPTs in clinical settings has been to target the education and training of mental health providers, with many consumers remaining unaware of the potential benefits of EBPTs for anxiety disorders. Direct-to-consumer (DTC) marketing may be a promising vehicle for increasing EBPT utilization rates in the treatment of anxiety disorders. This paper provides an overview of the rationale and important considerations for applying DTC efforts to promote evidence-based care in the treatment of anxiety disorders, and reviews current DTC efforts in this area, including resources on the Internet and other media and in-person events. We conclude with recommendations for future efforts in the DTC marketing of EBPTs for the anxiety disorders, including the need for increased funding and grassroots efforts to inform consumers about anxiety disorders and their most effective treatments.

Direct-to-consumer marketing of evidence-based psychological interventions: introduction

The dissemination and implementation of evidence-based psychological interventions (EBPIs) to service provision settings has been a major challenge. Most efforts to disseminate and implement EBPIs have focused on clinicians and clinical systems as the consumers of these treatments and thus have targeted efforts to these groups. An alternative, complementary approach to achieve more widespread utilization of EBPIs is to disseminate directly to patients themselves. The aim of this special section is to explore several direct-to-consumer (i.e., patient) dissemination and education efforts currently underway. This manuscript highlights the rationale for direct-to-patient dissemination strategies as well as the application of marketing science to dissemination efforts. Achieving greater access to EBPIs will require the use of multiple approaches to overcome the many and varied barriers to successful dissemination and implementation.