Objectives 1. Summarize the efficacy of tailored interventions compared to standardized interventions. 2. Summarize implications for future research on tailored interventions.
Objective: Tailored interventions (TI) are one type of patient-centered interventions (PCIs). Definition and components of interventions labeled TI vary considerably in the literature. Because of this variation, the efficacy of TIs has not been clear. After defining and describing TIs, and clarifying similarities and differences of TIs to other types of PCIs, it was possible to determine the efficacy of TIs. The purposes of this paper are to present the results of an integrative literature review on the efficacy of TIs in comparison with SIs and to identify directions for future research related to TIs. Future directions for research will be presented in general and with a particular example.
Design: Cooper’s Method of Literature Integration (1989, Cooper & Hedges, 1994) was used. Population, Sample, Years: The target population consisted of all articles submitted for publication between 1990 and 2000 containing the terms TI, tailoring, patient centered, interventions, matching, personalized, and individualized within the title or abstract. The search yielded 85 articles and one book. A final sample of 20 articles was used to determine the efficacy of TIs in comparison with SIs. These articles were selected if researchers met the following criteria: (a) used an experimental or quasi-experimental design, (b) had at least two groups with one group receiving a TI and one group receiving a SI, (c) randomly assigned individuals to group, (d) based customized content on an initial assessment, and (e) measured at least one health behavior outcome.
Concepts: Tailoring, targeting, personalized, individualized, patient-centered, feedback. Method: A worksheet was developed to evaluate each article. This worksheet contained information pertaining to the type of behavior studied, conceptual framework used, and description of the intervention, method, type of variables measured, and analysis and results. Authors worked to reach consensus about definition of terms, criteria to select articles, review, and interpretation of articles, and evaluation of findings. Based on these findings implications for future research were developed. Findings: Studies were designed to change health behaviors related to nutrition (30%), smoking cessation (30%), mammography use (25%), or exercise/activity (15%). Personal characteristics used to tailor the information included stage of change (71%), specific type or level of behavior of behavior (e.g., fat consumption or exercise, 57%), person’s behavior specific efficacy (43%), and barriers (38%). More than one characteristic was used to tailor interventions in all of the studies. Participants preferred TIs to SIs, believed messages were directed to them personally, and read and remembered more information from TIs. TIs were more effective than SIs in promoting health behavior outcomes in only 43% of studies reviewed. The efficacy of TIs differed across types of behavior. TIs had greater effect when ipsative feedback (comparison of current with past behavior) was provided. There was no evidence that repeated doses (singular vs. repeated exposures) of TIs influenced the effect of TIs on behavioral outcomes. There was some evidence that the effects of TIs changed over time but the pattern of change was not consistent. Although the differences between TIs and SIs were positive in 43% of the studies the effect sizes and estimated impact were small.
Conclusions: TIs hold considerable promise as a means of providing PCIs. The challenges are to increase the efficacy of tailored interventions and to identify situations in which TIs are most effective.
Implications: More research in needed prior to widespread adoption of TIs in clinical practice. Future researchers can contribute by (a) identifying the most salient characteristics on which to tailor, (b) further delineating essential components of TIs, (c) assessing determining the efficacy of different delivery channels, (d) determining factors that moderate effects of TIs, and (e) clarifying whether the efficacy of TIs change over time. A pilot study will be presented as an example of how research can be used to further delineate the essential components of TIs. In this pilot study ipsative feedback was used in an intervention to prevent osteoporosis.
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