What We Have Learned: Pharmaceutical Wrap-Around Programs Victor J. Strecher, PhD, MPH Professor and Director Center for Health Communications Research

What We Have Learned:What We Have Learned:

Pharmaceutical Wrap-Around Programs

Victor J. Strecher, PhD, MPHProfessor and DirectorCenter for Health Communications

ResearchSchool of Public HealthUniversity of Michigan

Founder and ChairmanHealthMedia, Inc.

72%

7%

1%

11%

8%

1%

4%

6%

12%

8%

12%

25%

0% 10% 20% 30% 40% 50% 60% 70% 80%

No medication/ No

therapy

No medication/ Brief

therapy

No medication/

Intensive therapy

Medication*/ No therapy

Medication*/ Brief

therapy

Medication*/ Intensive

therapy

% Quit

% Use

* OTC use=85%; prescription use=15% of medication use

Percent of quitters who use each cessation therapy and long-term quit rates among those who use the therapy.

Hughes JR. Motivating and helping smokers to stop smoking. Journal of General Internal Medicine 2003; 18:1053-1057

crossing the chasm

-AIMRE-

crossing the chasm

AdoptionReach

Efficacy Maintenance

Implementation

crossing the chasm

DataProduction

Measures

Prototypes

AnalysisValidit

y Operations

Tech support

Design

Regulatory

Reach Efficacy Adoption Implementation Maintenance(ROI?) (turn-key?) (scalable?)

Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria).

Reach Efficacy Adoption Implementation Maintenance

Group counseling (ROI?) (turn-key?) (scalable?)



Untailored print

Group counseling (turn-key?) (scalable?)


(ROI?)


Untailored print

Group counseling

Clinician counseling

(turn-key?) (scalable?)


(ROI?)


Untailored print

Group counseling


Proactive telephonic



(ROI?)


Untailored print

Group counseling


Reactive telephonic




(ROI?)


Untailored print

Group counseling

Tailored print


Reactive telephonic




(ROI?)


Untailored print

IVR

Group counseling

Tailored print


Reactive telephonic




(ROI?)


Untailored print

IVR Public web

Group counseling

Tailored print


Reactive telephonic




(ROI?)


Untailored print

IVR Public web

Branded web

Group counseling

Tailored print


Reactive telephonic


(ROI?) (turn-key?) (scalable?)


0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.6 2.8 2.80.4

NRT+Tailored web (n=3501; Strecher et al, 2005) 3 mo (10wk ca): 23% vs 18%

NRT+Tailored print (n=3683; Shiffman et al, 2001) 3 mo (10wk ca): 18% vs 11%

NRT+Tailored print (n=2424; Shiffman et al, 2000) 3 mo (10wk ca): 28% vs 18%

NRT+Telecounseling (n=330; Solomon et al, 2005) 6 mo (7 day pp): 38% vs 30%

NRT+Telecounseling (n=214; Solomon et al, 2000) 6 mo (7 day pp): 23% vs 19%

NRT+Telecounseling (n=380; Ockene et al, 1991) 6 mo (7 day pp): 18% vs 15%

NRT+Telecounseling (n=336; Lando et al, 1997) 6 mo (7 day pp): 25% vs 23%

NRT+Untailored print (n=522; Fortmann & Killen, 1995) 6 mo (7 day pp): 28% vs 26%

NRT+Untailored print (n=303; Lando et al, 1988) 6 mo

NRT+Video (n=424; Killen et al, 1997) 6 mo 7 day pp): 16% vs 25%

Comparison of behavior adjuncts to nicotine replacement therapy (odds ratios):

2.04 [1.49-2.81]

1.78 [1.28-2.48]

1.14 [0.69-1.87]

1.01 [0.66-1.54]

0.82 [0.47-1.44]

0.60 [0.36-0.99]

1.23 [0.68-2.22]

1.29 [0.66-2.50]

1.42 [0.90-2.24]

Behavioral adjunct

1.34 [1.13-1.58]

Outcome expectations

Efficacy expectations

BEHAVIORPERSON OUTCOME

Perceived competence

• It is difficult for me to find effective solutions to the problems that come my way. (reversed)

• Typically, my plans don't work out well. (reversed)

• I succeed in the projects I undertake.

• I am able to do things as well as most other people.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Shallow Tailoring Deep Tailoring

High Competence

Low Competence

Abstinence at 6 month follow-up by shallow versus deeply tailored self-efficacy messages, stratified by perceived competence. Test of shallow tailoring sub-group: OR=1.66 (95% CI=1.07-2.60) p<.05. Test of interaction: OR=1.70 (95% CI=0.92-3.15) p<.10. PRELIMINARY DATA

Efficacy Expectation Messages

6-m

onth

abst

inence

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Shallow Tailoring Deep Tailoring

High Competence

Low Competence

Abstinence at 6 month follow-up by shallow versus deeply tailored outcome messages, stratified by perceived competence. Test of shallow tailoring sub-group: OR=1.87 (95% CI=1.19-2.97) p<.01. Test of interaction: OR=2.05 (95% CI=1.11-3.84) p<.05. PRELIMINARY DATA

Outcome Expectation Messages

6-m

onth

abst

inence

“The best way to predict the future is to invent it.”

Alan Kay

• Promote reach via media (e.g., inclusion in product advertising; periodically offering the program for free).

• Promote reach by creating stand-alone program that smokers pay for.

• Enhances perceived value.

• Increases ROI

• Improve the value of the program to the consumer through program enhancements.

Conclusions

Thank you

Victor J. Strecher, PhD, MPHProfessor and DirectorCenter for Health Communications

ResearchSchool of Public HealthUniversity of Michigan

Founder and ChairmanHealthMedia, Inc.

Documents

What We Have Learned: Pharmaceutical Wrap-Around Programs Victor J. Strecher, PhD, MPH Professor and Director Center for Health Communications Research