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

循证心理疗法(EBP)是治疗创伤后应激障碍的最有效方法 精神障碍(PTSD；APA，2017；退伍军人事务部/国防部，2017)，但仍严重未得到充分利用(Hundt等人，2017； 凯尔-福布斯等人，2016)。患者层面使用EBP的障碍包括患者对EBPS的了解、耻辱、 以及对治疗效果或治疗需求的担忧(例如，Hundt等人，2015年)。干预措施 增加患有创伤后应激障碍的退伍军人的EBP起始率可以显著改善症状负担， 功能和生活质量(APA，2017)。直接面向消费者(DTC)营销策略，其中一项服务 或产品直接向最终用户而不是医疗保健提供者做广告，是经常使用的 在推动精神药物需求方面非常有效(例如，Avery等人，2012年；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 EBP使用的主要障碍。 然而，现有的针对精神健康的DTC营销的有限研究主要集中在患者身上。 报告的意图从事治疗，而不是实际寻求治疗的行为(例如，Brecht等人， 2017年；Gallo等人，2013年)。其次，没有研究对不同的DTC营销进行系统的比较 留言。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 消费者(Belch&Belch，2017；Ogivy，1985)。第三，之前大多数关于DTC心理治疗广告的研究 已经向普通民众展示了他们的信息，而不是为需要的参与者进行选择 心理疗法，这限制了他们的结论对目标人群的适用性，而且还没有研究 特别关注退伍军人或患有创伤后应激障碍的人。 在计划行为理论的指导下(TPB；阿杰森，1991)和资深人士和提供商利益相关者 反馈，目前的研究建议开发和测试不同版本的DTC广告信息 旨在提高对创伤后应激障碍的循证医学计划的参与度。尽管退伍军人事务部在以下方面投入了大量资源 心理健康、创伤后应激障碍教育和外展材料的广告宣传活动，没有进行过任何研究 在增加老兵开始心理治疗方面，哪种策略最有效。有了这个 信息将帮助退伍军人管理局将其有限的财政资源集中在最有效的DTC广告战略上 和信息，这有可能让更多的退伍军人参与到最有效的治疗中，并减少 未经治疗的创伤后应激障碍的负担(例如，Zatzick等人，1997；2008；Kessler，2000)。这项建议与 2019年退伍军人管理局的优先事项，强调对创伤后应激障碍等高度优先的精神健康状况的研究，以及 提高EBP培训的投资回报，并通过促进采用最 治疗创伤后应激障碍的有效方法。 在试点工作中，退伍军人、家属、提供者和退伍军人服务组织成员 就哪些DTC广告策略对他们最有吸引力提供了反馈。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，我们有 选定的广告策略有资格在更大范围内进行进一步测试。其中包括推荐信 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 制作简短的广告视频，反复听取资深人士、家庭成员和提供商的反馈 利益相关者并在RCT中测试这些DTC广告的有效性 创伤后应激障碍呈阳性，但目前未接受心理治疗。主要结果将包括退伍军人的态度 关于心理治疗，寻求心理治疗的意向，以及开始心理治疗的转介。这个 这项研究的结果将提供宝贵的信息，帮助退伍军人管理局瞄准其有限的广告和推广 预算用于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.