Direct to consumer marketing to engage Veterans in evidence-based psychotherapies for PTSD

循证心理疗法是治疗创伤后应激障碍最有效的方法 疾病（PTSD;阿帕，2017; VA/DoD，2017），但仍然明显未得到充分利用（Hundt et al.，二〇一七年; Kehle-Forbes等人，2016年）。患者层面的EBP使用障碍，包括患者对EBP的了解，耻辱， 以及对治疗效果或治疗需求的关注（例如，Hundt等人，2015年）。的干预措施 增加创伤后应激障碍退伍军人EBP启动率可显著改善症状负担， 功能和生活质量（阿帕，2017）。直接面向消费者（DTC）的营销策略，其中服务 或产品直接向最终用户而不是医疗保健提供者做广告，经常使用， 在推动对精神药物的需求方面非常有效（例如，Avery等人，2012; Woloshin等人，2001年）。 DTC营销可能对EBP特别有效，因为广告可以直接针对一些 使用EBP的主要障碍。 然而，有限的现有研究DTC营销的心理健康集中在病人， 报告的参与治疗的意图，而不是实际的寻求治疗的行为（例如，布雷希特等人， 2017; Gallo等人，2013年）。其次，没有研究系统地比较不同的DTC营销 充分和传播这是一个重要的遗漏，因为并非所有消息类型都适用于所有产品和所有 消费者（Belch & Belch，2017; Ogivy，1985）。第三，大多数先前的研究DTC广告的心理治疗 向普通大众展示他们的信息，而不是选择需要的参与者， 心理治疗，这限制了他们的结论对目标人群的适用性，没有研究 专门针对退伍军人或创伤后应激障碍患者 在计划行为理论（TPB; Ajzen，1991）和退伍军人和供应商利益相关者的指导下， 反馈，目前的研究建议开发和测试不同版本的DTC广告信息 旨在增加对创伤后应激障碍EBP的参与。虽然在这方面投入了大量的资源， 心理健康，创伤后应激障碍教育和宣传材料的广告活动，没有研究检查 哪些策略对增加退伍军人开始心理治疗最有效。具有该 这些信息将有助于弗吉尼亚州将其有限的财政资源集中在最有效的DTC广告策略上 和信息，这有可能使更多的退伍军人参与最有效的治疗，并减少 未治疗的PTSD的负担（例如，Zatzick等人，1997; 2008; Kessler，2000）。该提案符合 2019年VA优先事项强调对高优先级心理健康状况的研究，如PTSD，以及 提高EBP培训的投资回报率，并通过促进大多数 PTSD的有效治疗方法 在试点工作中，退伍军人，家庭成员，供应商和退伍军人服务组织成员 提供了哪些DTC广告策略对他们最有吸引力的反馈。基于这些 早期的定性见解、初步工作、国家合作伙伴的投入以及我们的理论模型， 选定的广告策略，有资格进一步测试更大规模。其中包括见证 策略、效用策略和比较/对比策略。在建议的研究过程中，我们会 根据退伍军人、家庭成员和供应商的反复反馈，制作简短的广告视频 利益相关者，并测试这些DTC广告的有效性在一个随机对照试验与退伍军人谁筛选 创伤后应激障碍呈阳性但目前没有接受心理治疗主要结果将包括退伍军人的态度 关于心理治疗，寻求心理治疗的意图，以及开始转介心理治疗。的 这项研究的结果将提供宝贵的信息，以帮助退伍军人管理局针对其有限的广告和推广 为退伍军人提供最有效的战略和信息。

Evidence-based psychotherapies (EBP) are the most effective treatments for posttraumatic stress disorder (PTSD; APA, 2017; VA/DoD, 2017) and yet remain significantly underutilized (Hundt et al., 2017; Kehle-Forbes et al., 2016). Patient level barriers to EBP use including patient knowledge about EBPs, stigma, and concerns about treatment effectiveness or treatment demands (e.g., Hundt et al., 2015). Interventions that increase the rate of EBP initiation in Veterans with PTSD can substantially improve symptom burden, functioning, and quality of life (APA, 2017). Direct to consumer (DTC) marketing strategies, in which a service or product is advertised directly to the end user rather than a health care provider, are frequently used and highly effective at driving demand for psychotropic medications (e.g., Avery et al., 2012; Woloshin et al., 2001). DTC marketing may be particularly effective for EBPs because advertisements can directly target some of the primary barriers to EBP use. However, the limited existing studies on DTC marketing for mental health have focused on patient- reported intentions to engage in treatment, rather than actual therapy-seeking behaviors (e.g., Brecht et al., 2017; Gallo et al., 2013). Second, no studies have systematically compared different DTC marketing messages. This is an important omission because not all message types work for all products and for all consumers (Belch & Belch, 2017; Ogivy, 1985). Third, most prior studies of DTC advertising for psychotherapy have presented their messaging to the general population, rather than selecting for participants who need psychotherapy, which limits the applicability of their conclusions to target populations, and no studies have specifically focused on Veterans or those with PTSD. Guided by the Theory of Planned Behavior (TPB; Ajzen, 1991) and Veteran and provider stakeholder feedback, the current study proposes to develop and test different versions of DTC advertising messages aimed at increasing engagement in EBPs for PTSD. Although VA has invested considerable resources in advertising campaigns for mental health, PTSD education and outreach materials, no research has examined which strategies would be most effective at increasing Veteran initiation of psychotherapy. Having this information would help VA focus its limited financial resources on the most effective DTC advertising strategies and messages, which has the potential to engage more Veterans in the most effective treatments and reduce the burden of untreated PTSD (e.g., Zatzick et al., 1997; 2008; Kessler, 2000). This proposal aligns with the 2019 VA priorities emphasizing research on high priority mental health conditions, such as PTSD, and increasing return on investment in EBP training and increasing efficiency by facilitating uptake of the most effective treatments for PTSD. In pilot work, Veterans, family members, providers, and Veterans’ Service Organization members provided feedback on which DTC advertising strategies would be most compelling to them. Based upon these early qualitative insights, preliminary work, input from national partners, and our theoretical model, we have selected advertising strategies that qualified for further testing on a larger scale. These include the testimonial strategy, the utility strategy, and the compare/contrast strategy. In the course of the proposed study, we will develop brief advertising videos with iterative feedback from Veteran, family member, and provider stakeholders and test the effectiveness of these DTC advertisements in a RCT with Veterans who screened positive for PTSD but are not currently in psychotherapy. Primary outcomes will include Veteran attitudes about psychotherapy, intention to seek psychotherapy, and initiation of a referral for psychotherapy. The results of this study will provide invaluable information to help VA target its limited advertising and outreach budget to the most effective strategies and messages for Veterans.