CER studies offer the opportunity to evaluate social marketing under more rigorous conditions than are typically present in our applied work. Yet, one danger is that many policy staff, grant makers and investigators will mistakenly operationalize the term 'social marketing' to include interventions that only use communication strategies or only sell products to consumers. I hope funders of CER research, and the policy makers, will educate themselves that social marketing is more than either of those extremes, and that incentive systems coupled with better access and improved opportunities for more people to lead healthier lives are part of the social marketing mix and the CER that is eventually funded.
The Institute of Medicine (IOM) just released their list of the 100 national priority areas for CER. I have pulled from their list some examples where social marketing should be at the table.
1. Compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk.
2. Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others.
3. Compare the effectiveness and costs of alternative detection and management strategies (e.g., pharmacologic treatment, social/family support, combined pharmacologic and social/family support) for dementia in community-dwelling individuals and their caregivers.
4. Compare the effectiveness of school-based interventions involving meal programs, vending machines, and physical education, at different levels of intensity, in preventing and treating overweight and obesity in children and adolescents.
5. Compare the effectiveness of various strategies (e.g., clinical interventions, selected social interventions [such as improving the built environment in communities and making healthy foods more available], combined clinical and social interventions) to prevent obesity, hypertension, diabetes, and heart disease in at-risk populations such as the urban poor and American Indians.
6. Compare the effectiveness of the various delivery models (e.g., primary care, dental offices, schools, mobile vans) in preventing dental caries in children.
7. Compare the effectiveness of wraparound home and community-based services and residential treatment in managing serious emotional disorders in children and adults.
8. Compare the effectiveness of interventions (e.g., community-based multi-level interventions, simple health education, usual care) to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
9. Compare the effectiveness of literacy-sensitive disease management programs and usual care in reducing disparities in children and adults with low literacy and chronic disease (e.g., heart disease).
10. Compare the effectiveness of clinical interventions (e.g., prenatal care, nutritional counseling, smoking cessation, substance abuse treatment, and combinations of these interventions) to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African American women.
11. Compare the effectiveness of innovative strategies for preventing unintended pregnancies (e.g., over-the-counter access to oral contraceptives or other hormonal methods, expanding access to long-acting methods for young women, providing free contraceptive methods at public clinics, pharmacies, or other locations).
12. Compare the effectiveness of strategies for enhancing patients’ adherence to medication regimens.
13. Compare the effectiveness of patient decision support tools on informing diagnostic and treatment decisions (e.g., treatment choice, knowledge acquisition, treatment-preference concordance, decisional conflict) for elective surgical and nonsurgical procedures—especially in patients with limited English-language proficiency, limited education, hearing or visual impairments, or mental health problems.
And those are from just the first 30 or so top priorities - you get the idea.
I know that some social marketers will shudder at the idea of pigeon-holing social marketing programs into randomized clinical trials. For them, and other readers, I suggest you take a look at an article in the Annals of Internal Medicine (2009;151) by Luce et al Rethinking randomized clinical trials for comparative effectiveness research: The need for transformational change. Their thesis is:
…many RCTs as currently designed and conducted are ill suited to meet the evidentiary needs implicit in the IOM definition of CER: comparison of effective interventions among patients in typical patient care settings, with decisions tailored to individual patient needs. Without major changes in how we conceive, design, conduct, and analyze RCTs, the nation risks spending large sums of money inefficiently to answer the wrong questions—or the right questions too late.
My point is that there are many ways in which social marketing can be the subject of pragmatic research studies and applied to the solution of many challenges facing the health of Americans and the people who care about them. What are you doing to insure that society benefits from all that we have been learning in social marketing over the past 25 years (some references)?