Activating Patients to Improve Healthcare: Lessons from Direct-to-Consumer Marketing of Pharmaceuticals

1. Activating Patients toImprove Healthcare:Lessons fromDirect-to-Consumer Marketing of Pharmaceuticals Ronald I. Shorr, MD, MS, Director, GRECC, NF/SG Veterans Health SystemProfessor, Department of Aging & Geriatric Research, University of Florida Department of Veterans Affairs North Florida/South Georgia Veterans Health System Gainesville, Florida

2. Question Viagra is a medicine used to treat: • Hair loss • PMS • Acid indigestion • ED

3. Marketing Health to Laypeople • DTC info (you have) • Question: if DTC can get people to “ask their doctor” for medications, can patients be activated to get evidence-based health care from the health care system?

4. Today’s Discussion • Theoretical approaches to persuasionDebbie Treise • Social Marketing in the VAKristen Wing • ExamplesRebecca Beyth

5. Theoretical Approachesto Persuasion Debbie Triese, PhDAssociate Dean, University of Florida College of Journalism and Communications, Division of Graduate StudiesProfessor, Department of Advertising Department of Veterans Affairs North Florida/South Georgia Veterans Health System Gainesville, Florida

6. DTC and Social Marketing Approaches Successes Defined

7. Message Design • The Truth Campaign • Success • Awareness doubled in first 10 months of campaign • Those exposed to message significantly less likely to consider smoking “cool”; more likely to believe tobacco companies lie to sell products • Based on social marketing: campaign designers apply principles of commercial advertising to health promotion efforts

8. Social Marketing – the 4 P’s Product – issue or behavior to adopt Place – message dissemination Price – costs/barriers of adopting Promotion – message Others

9. Message Research • Before developing message, insight is needed: • Appropriate target audiences • Unique characteristics • Information needs • Awareness level • Motivation level • External factors • Competitive influences • Health literacy level

10. Theory in Message Development ELM – (attention) – attitude development/change TTM/Stages of Change – stages to behavior TPB (decision) Health Belief Model (behavior)

11. Elaboration Likelihood Model (ELM) • Attention to/processing of/forming attitudes about message depends on: • Motivation/involvement • Relevance • Message comprehension • Argument quality • Knowledge Passive (peripheral) Active (central)

12. Transtheoretical Model (TTM) • Stages of Change model • Precontemplation: not aware • Contemplation: thinking • Preparation: deciding to take action • Action: making change • Maintenance: sticking to it

13. Theory of Planned Behavior • Rational decision making • Strength of belief that behavior will lead to positive outcome • Strength of belief that others are in favor of taking prescribed behavior • Efficacy

14. Health Belief Model • Motivation to behave is based on: • Personal susceptibility • Seriousness of consequences • Belief that behavior will prevent undesirable outcome • Effort/cost of behavior is worthwhile • Moved to action

15. Take-away message Communication research involves extensive audience analysis to create messages that resonate with audiences and take into consideration a complex array of factors

16. Social Marketingin the VA Kristen Wing, BAPublic Affairs/Dissemination Specialist,VA Rehabilitation Outcomes Research CenterResearch Enhancement Award Program Department of Veterans Affairs North Florida/South Georgia Veterans Health System Gainesville, Florida

17. What is Health Marketing? According to Jay M. Bernhardt, PhD, MPH (2006): “Health marketing uses the science and strategies of commercial marketing to promote its products, namely evidence-based health information and interventions.” Improving health through health marketing. Prev Chronic Dis [serial online] 2006 Jul [date cited]. Available from: URL: http://www.cdc.gov/pcd/issues/2006/jul/05_0238.htm.

18. What is Health Marketing? Centers for Disease Control (CDC) National Center for Health Marketing NCHM activities fall into four functional categories of marketing: • Product Design/R&D • Product Production and Packaging • Product Distribution • Customer Relationship Management

19. What is Social Marketing? Social marketing is the systematic application of marketing along with other concepts and techniques to achieve specific behavioral goals fora social good. Wikipedia. Available from: URL: http://en.wikipedia.org/wiki/Social_marketing

20. CASE STUDY Disseminating Stroke Prevention Materials to Veterans:The Development of aDirect-to-Consumer Implementation Strategy ThisStrokeQUERICenterProjectwasfundedbytheDepartmentofVeteransAffairsHealthServicesResearch&DevelopmentGrant#QLP71-001.

21. Rebecca J. Beyth, MDPrincipal Investigator GAINESVILLE Kristen Wing, BADissemination Specialist/Project Coord. Connie Uphold, PhD, ARNPCo-Investigator Diane Cowper, PhDCo-Investigator Patricia Linn, MAResearch Assistant Haijing Qin, MSStatistician Consultant Chona Macalindong, MD, FACPAssociate Chief of Staff, Quality Mgmt,NF/SG Veterans Health System Teresa Damush, PhDCo-Principal Investigator INDIANAPOLIS Linda Williams, MDCo-Investigator Laurie Plue, MACo-Investigator Monta HouserResearch Assistant Consultants Peter Woodbridge, MD, MBAACOS for Ambulatory CareRoudebush VAMC Tony Cox, PhDProfessor of MarketingIndiana University Project Team

22. Our Partners • North Florida/South Georgia Veterans Health System/Richard L. Roudebush VA Medical Center • American Stroke Association/American Heart Association (ASA/AHA) • National Stroke Association (NSA) • Partnership for Clear Communication (“Ask Me 3”) • VA National Center for Health Promotion and Disease Prevention (NCP) • VA MOVE! • VA Public Affairs Office (Local/Regional/National)

23. Getting The Word Out • Campaign information was presented to: • VA Clinicians at Grand Rounds • ACOS for Education • ACOS for Research • ACOS for Quality Management • CBOC Medical Directors • Chiefs of Cardiology, PM&R

24. Getting The Word Out • Dissemination of campaign information: • Primary Care/Cardiology/PM&R contacts and CBOC Medical Directors and Nurse Educators in NF/SGVHS • E&L Statement and “Hey VA! Have you heard?” E-mail • NCP Web site, E-mail to Preventive Medicine Group, and monthly Wellness Call

25. Mort WalkerKing Features Traditional Marketing Leverage the power of a recognizable figure. Establish and stick to a consistent branding strategy.

26. Implementation • May 2006, National Stroke Awareness Month • Waiting Areas:Primary CareCardiologyPM&R • CBOCs

27. Tracking Code Implementation

29. The Results… • Close to 2,000 “Preventing Stroke” packets have been distributed to Veterans and VA Providers (Nurses, Nurse Educators, Hypertension Group/Clinic Directors, etc.) sinceMay 2006 • 73% of surveyed Veterans who received the packet and reviewed the educational materials felt that they may be at risk for a stroke • 84.37% of surveyed Veterans found thepacket Extremely Useful/Very Useful

30. The Results…

31. The Results… • 38% survey response rate • Comments from Clinicians • “It was very direct and easy to read. The motivationalhandouts surely will stimulate many veterans to makelifestyle changes.” • “I liked the how simple it is written, even those whocan't read well can read this.” • “I liked the Beetle Bailey tie in.” • Comments from Veterans • "It woke me up and made me realize that i could live longer if i just applied myself. Even though I'm disabled, I can still live longer.“ • "It renewed information that I knew in the past and allowed me to be efficient enough to raise educated questions to my healthcare provider." • "I recommend that they send one to everybody." I went through this a long time ago and if I had known about it earlier it would have helped." • “THANK YOU!”

32. Examples of DTC Marketing for Health Promotion Rebecca J. Beyth, MD, MScGRECC, NF/SGVHS, Associate Professor and Chief, Division of Career Development & Education UF College of Medicine, Department of Aging & Geriatrics Department of Veterans Affairs North Florida/South Georgia Veterans Health System Gainesville, Florida

33. “Real Men Wear Gowns” • Agency for Healthcare Research and Quality (AHRQ), Advertising Council by McCann Erickson Detroit • Problem: • Men 25% less likely to visit doctor in past year • Men 38% more likely ignore screening tests (cholesterol) • Men 1. 5 x more likely die heart disease, cancer, and chronic lower respiratory disease

34. “Real Men Wear Gowns” • Identified “family” as key motivating factor for men take more active role in their health • Incorporate being a real man = taking care of themselves (and their health) to be there for their families

35. “Real Men Wear Gowns” • Goal: Raise awareness among middle-age men (> 40 yrs old) about preventive screening tests • Mediums: Television, radio, print and Web advertising • http://www.ahrq.gov/realmen/index.html

36. “Real Men Wear Gowns" 15-second Public Service Announcement video. http://www.ahrq.gov/realmen/videos/MenInGowns_15_captions.wmv

37. "Real Men Wear Gowns 2" 30-second Public Service Announcement video MenInGowns_30_captions.wmv

38. Quit TobaccoMake Everyone Proud • Department of Defense (DOD) • Marketing tobacco cessation to young enlisted personnel • Problem: • Junior enlisted active duty personnel more likely use tobacco than older higher ranking service members or civilians

39. Quit TobaccoMake Everyone Proud • Goals: • Increase awareness effects of tobacco • Decrease acceptance of tobacco use in military environment • Motivate quit attempts and consideration of quitting

40. Quit TobaccoMake Everyone Proud • Target audience was exposed to more pro-tobacco messaging • Tobacco use overestimated, perceived as normative • Web-based services more appealing than telephone-base quit lines

41. Quit TobaccoMake Everyone Proud • Identified motivating factors: • Pride in the uniform • Influence on children • Military themes and imagery were not motivating • Themes: • People watch what you do • Kids look up to you and want to be like you • Do it for yourself and for those who care about you

42. UCANQUIT2.ORG

43. Promotional Tools

44. Summary • Clearly identify the problem you are trying to address • Know your target audience • Partner with experts in communication and marketing research to develop and plan your program

45. Activating Patients to Improve Healthcare:Lessons from Direct-to-ConsumerMarketing of Pharmaceuticals Thank you! Department of Veterans Affairs North Florida/South Georgia Veterans Health System Gainesville, Florida

46. Contact Information • For information about this specific presentation please contact Connie Uphold, PhD at connie.uphold@va.gov. • For any questions about the monthly GRECC Audio Conference Series please contact Tim Foley at tim.foley@va.gov or call (734) 222-4328 • For the link to the evaluation form for this conference that will confer CE credit please go to http://vaww.sites.lrn.va.gov/vacatalog/cu_detail.asp?id=24636 and click the “Handout: Registration and Evaluation” link