Maybe we should get out there and sell something!

Maybe we should get out there and sell something!
19 March 2010

Cars are prototyped before they are put into mass production; they are rolled out to dealerships, where they are warrantied, repaired and part-exchanged. What is so different about public health programs, US researchers are asking – apart from the fact that they lack any marketing, distribution or servicing network?

Matthew W. Kreuter of Washington University, St. Louis, and Jay M. Bernhardt from the Centers for Disease Control and Prevention, Atlanta, see it as a fundamental shortcoming in the implementation of evidence-based interventions.

“The ultimate dissemination goal for public health program developers is to get their evidence-based products into use by organizations whose job it is to deliver effective public health programs,” they maintain.

“Marketing and distribution systems are designed to meet this need; they bring products and services from development to use through a system of intermediaries.”

“Collectively, this chain of intermediaries identifies potential users, promotes the product to them, provides them with easy access to the product through multiple channels, allows them to evaluate the product before acquiring it, helps them buy it, and supports the product after purchase.”

Kreuter and Bernhardt made their case at this week’s third annual National Institutes of Health conference in Bethesda, Maryland.

Marketing and distribution involved numerous critical functions that most program developers were ill-equipped to fulfill, they explained, including customer research and segmentation, packaging, distribution, training, technical assistance, customer service and product service.

Once the only equivalent in program implementation was to cajole scientists into increasing their dissemination efforts. “But asking them to be central players in dissemination is unrealistic and inefficient. Scientists lack the necessary training, just as automobile engineers lack the training to deliver, sell, and service the cars they design.”

Assembling inventories of effective programs was a step in the right direction but also limited, they said. “It is a passive approach to dissemination, which studies have shown to be ineffective. Awareness of these program registries among potential users is low.”

Yet another approach, involving attempts to increase the demand for evidence-based approaches through workshops and training courses could be plain counterproductive, they claimed.

“Consumers respond negatively when a desired product is not readily available. Therefore, encouraging or requiring the use of evidence-based programs that are not readily available may have the unintended effect of increasing frustration rather than implementation.”

Kreuter and Bernhardt recommended a sequence of steps toward establishing marketing and distribution infrastructure to disseminate evidence-based public health programs and policies.

First, they needed to be promoted strategically. “Audience research should be conducted to identify the universe of potential users for a product, understand their needs, create homogeneous user segments based on the types of programs they are likely to use, and target promotional activities.”

Having done this, it was vital to build distribution capacity.
“For each user segment, distinct systems (or linked subsystems) should be established to give its members convenient access to a range of proven programs that they want or need.

“For example, distribution of all evidence-based programs designed for use in school settings might be coordinated through a single system, rather than having some in tobacco-control, and some in alcohol-abuse prevention system.”

Next, research-tested interventions needed to be transformed into programs and products that were easy to adapt and use. “A team of seasoned marketers and public health practitioners should critically review and modify programs to maximize their readiness for use in practice settings," they said.

“Intervention materials developed by researchers – who are notorious for being aesthetically challenged – must also be given the polish and professionalism users expect from other consumer products, and they must be packaged and presented to facilitate ease of use.”

And a comprehensive system of user support needed to be established. “Program users should have easy access to knowledgeable (and ideally local) agents who can provide timely technical assistance and support for adapting and implementing programs.”

The two of them are in no doubt: “If the dissemination and implementation challenge is reframed to reflect the marketing and distribution perspective, and if investments are made in system infrastructure to execute our recommendations, public health practice could be transformed.”

Tell it to Detroit?

See also: Kreuter M W and Bernhardt J M, (2009) “Reframing the dissemination challenge: a marketing and distribution perspective,” American Journal of Public Health 99 (12), 2123-2127.

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