Narrowing the Treatment Gap: A Call to Increase Use of Direct-to-Consumer Marketing in Psychotherapy Practice and Research

A mental health treatment gap exists in which individuals who would benefit from evidence-based psychotherapies (EBPs) do not receive them. It is critical to take effective actions so that individuals with unmet mental health needs feel empowered to seek treatment. Direct-to-consumer (DTC) marketing meets this objective. DTC marketing is an effective, patient-centered approach that creates patient demand for a product or service by influencing patient behaviors, attitudes, and preferences. While primarily used in the United States and New Zealand to promote prescription drugs, uses and practices for DTC marketing with nonpharmaceutical EBPs are less established. This article highlights the value of leveraging this marketing approach to increase awareness and use of EBPs. Additionally, an illustrative example is presented that describes the use of social marketing and marketing mix principles to develop effective DTC marketing campaigns in psychotherapy practice.

Regenerative therapies for erectile dysfunction: the influence of direct-to-consumer marketing on patient interest

Background

Despite a lack of evidence, a number of "regenerative" therapies have become popularized treatments for erectile dysfunction (ED). Platelet-rich plasma (PRP) injections and shockwave therapy have received significant attention through direct-to-consumer marketing and are advertised as viable alternatives to guideline-backed therapies. Additionally, focused low-intensity shock wave therapy (LiSWT) has become conflated with acoustic or radial wave therapy (rWT), although their mechanism of wave generation and tissue penetration is distinct. GAINSWave, a marketing platform for acoustic wave therapy, has also pervaded the marketplace. We aim to evaluate the relative impact of direct-to-consumer marketing of shockwave therapy and PRP by analyzing the quantity of Google internet search queries for selected regenerative and guideline-backed non-regenerative therapies for ED.

Methods

National Google Search trends in the United States (www.google.com/trends) were analyzed to characterize interest in different forms of therapy for ED. Search trends for PRP, LiSWT (and various iterations), intracavernosal injections (ICI), intraurethral injections (IU), vacuum erectile device (VED), and GAINSWave were analyzed. Monthly search data were compiled over multiple years, ending at 2/28/2020, just before the COVID-19 pandemic and state of emergency in the United States. Macro-level changes in public interest were quantified using yearly averages.

Results

Patterns in Google Search interest in PRP and LiSWT increased respectively by 3-fold and 275-fold over the decade, representing a larger share of Google Searches by 2020. Trends in Google Search interest in selected types of shockwave therapy for ED also show that queries for GAINSWave commanded public interest, increasing by 219-fold from 2016 to 2020.

Conclusions

Regenerative therapies for ED have produced interest surpassing other adjunct guideline-backed therapies, despite receiving the designation of "experimental" or "investigational" therapies. The establishment of GAINSWave also constitutes an inflection point for the whole shockwave market: searches for shockwave therapy increased by 782% between 2016 and 2020. Direct-to-consumer marketing of PRP and shockwave therapy has upturned the customary role of physicians in counseling patients about evidence-based therapies for ED. This increase in public interest in GAINSWave emphasizes its success as a marketing platform. The urological community should consider strategies to address misinformation, such as search-engine optimization, social media, and educational outreach.

Vasectomy Reversal Online Marketing Practices: What Are We Putting Out There?

OBJECTIVE

To determine characteristics of providers marketing vasectomy reversal (VR) online, degree of information available online, the ease with which patients can compare providers, and the differences in VR practice patterns between academic and private practices.

MATERIALS AND METHODS

We identified VR practices operating within the top 50 most populous metropolitan areas in the US. Practice websites were reviewed to obtain information such as provider educational background, level of magnification, ability to perform vasoepididymostomy, surgical volume, and cost. Based on information available, providers were assigned a novel REVERSAL score created by the authors. Descriptive statistics were used to compare results.

RESULTS

Of the 107 providers identified (29 academic, 78 private), the majority were male urologists with a Doctor of Medicine degree. Academic providers were more likely to have fellowship training than private practice providers, 96.6 vs 43.6%, respectively (P = 0.00001). Compared to non-urologists, urologists were less likely to purchase online ads or disclose cost. Non-urologists charged significantly less than urologists, $3,584 ± 1,554 and $6,591 ± 1,518, respectively (P = 0.00001). Only one provider provided complete information as defined by REVERSAL score of 12, with the majority (61.7%) of providers achieving score ≤6.

CONCLUSION

There is significant lack of transparency in publicly available information from VR practices. Practices should implement measures to improve dissemination of information to the public, so that patients can more easily compare providers and make informed decisions regarding VR.

Promoting the ethical use of safe and effective cell-based products: the Andalusian plan on regenerative medicine

With regard to regenerative medicine, the expectations generated over the last two decades and the time involved in developing this type of therapies, together with the availability of devices that allow point-of-care treatments through the rapid isolation of cellular or plasma products from patients in the operating theater, represent the perfect breeding ground for the offering of unproven or unregulated therapies on a global scale. A multidisciplinary approach-one based on the collaboration of institutions that, from the perspective of their area of competence, can contribute to reversing this worrying situation-to this problem is essential. It is a priority for local health authorities to take measures that are adapted to the particular situation and regulatory framework of their respective territory. In this article, the authors present the regenerative medicine action plan promoted by the Andalusian Transplant Coordination (i.e., the action plan for the largest region in Spain), highlighting the aspects the authors believe are fundamental to its success. The authors describe, in summary form, the methodology, phases of the plan, actions designed, key collaborators, important milestones achieved and main lessons they have drawn from their experience so that this can serve as an example for other institutions interested in promoting the ethical use of this type of therapy.

Marketing therapy to parents concerned about adolescent substance use: Association of adolescent problems and parent preferences for direct-to-consumer marketing

Parent-directed marketing strategies have great potential to promote the utilization of therapy by adolescents with or at risk of substance-related problems. The extent to which marketing strategies should be tailored to parents of adolescents with various presenting problems - such as substance use, mental health, and legal involvement - is unknown. The current study represents a secondary analysis of a direct-to-consumer (DTC) marketing survey, which used a well-established framework called the Marketing Mix to solicit parent preferences about marketing across three dimensions: Promotion (i.e., how parents prefer to receive information); Place (i.e., where parents prefer to receive therapy); and Price (i.e., how much parents are willing to pay and how far parents are willing to travel). Four-hundred eleven parents of 12- to 19-year-old adolescents (51% girls, 82% Non-Hispanic White) completed the survey and answered five questions spanning Promotion, Price, and Place dimensions of the Marketing Mix. A subsample of 158 parents also reported on their actual therapy-seeking behavior, allowing us to report on both parents' ideal and actual experiences. We explored the extent to which parent preferences varied as a function of adolescent substance use, externalizing, internalizing, and legal problems. Bivariate analyses and multivariate logistic regressions were used to examine which of these variables were associated with parents' responses to specific survey items. Analyses confirmed that both parent preferences and parents' actual therapy-seeking behavior varied as a function of adolescent problems. Recommendations are offered for professional psychologists to use DTC marketing strategies to connect with adolescents in need of services.

Direct-to-Consumer Marketing for Parent-Child Interaction Therapy: Impact of Language and Messenger

OBJECTIVES

Parent-Child Interaction Therapy (PCIT) is an effective therapy to treat early onset disruptive behavior problems and child physical maltreatment. In order to support the successful implementation and sustainment of PCIT, strategies are needed to recruit parents into care, especially for racial and ethnic minority families, who often have lower rates of access and utilization of mental health services.

METHODS

This study investigated the impact of direct-to-consumer advertisements on parents' attitudes towards PCIT. Advertisements were delivered in Spanish and English, with either a parent testimony or therapist explaining the treatment. Participants were parents of children between the ages of 2 and 7, who were recruited through Amazon Mechanical Turk. Participants (N = 204) were 38.2% female and 49.5% Spanish speaking.

RESULTS

There were no main effects for language or messenger related to PCIT Help-Seeking Intentions, Attitudes, or Stigmatization. However, there was an interaction effect for language and messenger for PCIT Help-Seeking Intentions. Specifically, Spanish-speaking participants had higher intentions when the messenger was a therapist rather than a parent, and had lower intentions than English-speaking parents when the messenger was a parent.

CONCLUSIONS

These findings are promising for direct-to-consumer advertising strategies that may help recruit more Spanish-speaking families into PCIT, which could help address disparities in access to mental health services.

Understanding of evidence-based mental health care and the perceived importance of scientific information in a sample of U.S. adults

OBJECTIVES

This online survey sought to qualitatively ascertain the extent to which a sample of U.S. adults understood the concept of evidence-based mental health care (EBMHC). Additional goals included assessing the perceived importance of scientific information in EBMHC, and examining whether understanding EBMHC and science values varied as a function of participant factors.

METHOD

Participants (N = 221) defined EBMHC and rated the importance of scientific information. Open-ended EBMHC definitions were content-coded, and binomial logistic and linear regressions examined predictors of accurately defining EBMHC and of the perceived importance of scientific information.

RESULTS

Participants endorsed seven definitions of EBMHC, and only 20% defined it accurately. Having greater knowledge about mental health conditions was associated with understanding EBMHC and with the higher perceived importance of scientific information. Greater help-seeking efficacy also predicted higher perceived importance of scientific information.

CONCLUSIONS

Results support customized strategies to promote basic EBMHC education among U.S. adults.

Direct-to-consumer marketing of stem cell interventions by Canadian businesses

AIM

This study examines marketing claims of Canadian businesses engaged in direct-to-consumer advertising of putative stem cell treatments.

METHODS

Internet searches were used to locate Canadian businesses selling stem cell interventions. Company websites were subjected to detailed analysis.

RESULTS

In total, 30 Canadian businesses sell stem cell interventions provided at 43 clinics. Autologous stem cells are the most common types of products promoted by such businesses. Company websites minimize risks while making strong claims about benefits of stem cell interventions.

DISCUSSION

Businesses' representations could result in patients making health-related decisions informed by marketing claims rather than best available scientific evidence.

CONCLUSION

Although there is absent development of new regulations and guidance, the Canadian direct-to-consumer marketplace for stem cell interventions appears poised for expansion.

Parent Preferences and Experiences with Psychological Treatment: Results from a Direct-to- Consumer Survey using the Marketing Mix Framework

Direct-to-consumer (DTC) marketing strategies represent an increasingly popular approach to promote patient awareness of psychological treatments (PTs). The Marketing Mix is a well-established framework used to inform marketing decisions consisting of four "P's": Product (or Service), Promotion, Place, and Price. We conducted the first DTC marketing survey using the Marketing Mix framework to explore how parents concerned about their adolescents' behavioral health receive information about PTs. A sample of 411 parents (51% girls, 82% Non-Hispanic White) of 12- to 19-year-old adolescents completed an online survey asking how they would prefer to receive information about PTs, including five questions spanning the Promotion, Price, and Place dimensions of The Marketing Mix. A subsample of 158 parents also reported on how they had received PT information during their adolescent's most recent therapy experience, allowing us to compare ideal versus actual therapy experiences. We explored the extent to which experiences varied as a function of parent race/ethnicity, income per capita, parent education level, and adolescent treatment history. Bivariate analyses and multivariate logistic regressions were used to examine which of these variables were associated with parents' responses to specific survey items. Analyses revealed that parent preferences varied as a function of income per capita, education level, and history of treatment. In addition, there were significant gaps between parents' ideal and most recent therapy experiences. Implications for the marketing of PTs are discussed.