Tailored approaches to behavior change have been applied in numerous settings and focused on many different health issues including smoking cessation, weight loss, nutrition, physical activity, breast cancer screening, skin cancer prevention, and various disease management programs. Research comparing tailored and untailored materials generally shows dramatic differences on the impact of behavior change.

• Providing tailored feedback to a group of 1,546 smokers resulted in a 3.4 times greater likelihood of continuous abstinence from cigarettes at 14 months than not providing tailored information. (Dijkstra, 1998)
• In a study of smokers visiting family practice sites, 31% of those who received tailored smoking cessation materials were successful at quitting smoking after 4 months compared with 7% who did not receive the materials. (Strecher, 1994)
• A study of the effects of tailored materials on dietary behavior showed significant differences across several nutrition measures in a sample of 315 subjects. After receiving materials tailored on both consumption patterns and psychosocial variables, participants showed a 70% increase in fruit consumption, a 13% increase in vegetable consumption, and a 6% reduction in fat consumption. (Brug, 1999).
• Providing tailored information on passive detection and help-seeking intentions related to the early detection of cancer resulted in significant differences in subjects' intentions and behaviors compared to the control group, both immediately preceding the intervention and at a six month follow-up. (de Nooijer et al, 2002)
• Smokers receiving a tailored, stage-matched smoking cessation program were 2.6 times more likely to have quit smoking than those receiving no program. In addition, the tailored materials were found to produce a significant difference in smoking cessation among those who initially reported no intention to quit smoking at the beginning of the program (3.8% vs. 0.8%). (Etter & Perneger, 2001)
• 581 women between the ages of 45 to 54 were randomized to receive a tailored decision aid about hormone replacement therapy. Women receiving the decision aid were more likely to be confident about their decision at both one and nine months, more accurately perceived their level of risk for breast cancer at one and nine months, and were more likely to report satisfaction with their decision at one month. (McBride et al, 2002)
• Smokers were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. (Prochaska et al, 1993)
• 1,574 urban low-income and minority women were randomized to receive either a tailored letter or a generic letter of cancer information to test the effects of this information on their rates of screening for breast and cervical cancer. The tailored intervention group was significantly more likely to have undergone both a Pap smear and a mammogram within one year after the intervention than the generic letter group. (Jibaja-Weiss et al, 2003)
• Women who had not had a mammogram within the last 13 months were significantly more likely to undergo a mammogram after receiving a tailored intervention than those women who received either no message or generic information about the screening. Those women who reported the most external barriers to mammography at the baseline and who were randomized to the tailored condition had the highest mammography rates of all groups at the one-year follow up. (Lauver et al, 2003)
• Women randomized to five different tailored interventions were all significantly more likely to increase their mammography adherence compared to women receiving the usual care intervention. Of those women not thinking about getting a mammogram at baseline, 30% of those receiving any tailored interventions had received a mammogram compared to only 13% of those in the usual care group. (Champion, 2003)
• A tailored asthma self-management program showed an increase in satisfaction and reduction in need for information among participants, as compared to their baseline scores and a usual care group. The tailored program was also shown to improve the participant's interactions with their physician. (Thoonen et al, 2002)
• A study was conducted in which patients of family medicine practices were randomly assigned to one of three intervention groups designed to reduce dietary fat intake: (1) a tailored dietary intervention, (2) an untailored dietary intervention, and (3) no intervention. Results clearly indicated a superiority of the tailored intervention in reducing dietary fat intake. Total fat intake decreased by 23% in the tailored group compared to 9% and 3% in the untailored and no message groups, respectively. (Campbell, 1994)
• Four different studies have demonstrated the efficacy of The Pathways to Change intervention in a general population, with cessation rates of 22 to 26%. Furthermore, the difference between the groups was larger at each follow-up assessment point, indicating that the effects of the treatment increased long after the end of treatment. (Velicer & Prochaska, 1999)
• A three year trial involving 1099 women aged 50 and over recruited from an HMO compared the efficacy of tailored print materials in promoting mammography screening. The percentage of women on schedule to receive their mammograms increased 17% after receipt of the tailored materials while the number of women who obtained their mammogram increased 6% over the usual care group. (Lipkus, 2000)
• Patients involved in a study with primary care physicians appeared to be more likely to increase their physical activity with tailored materials than were patients in the personalized, general, and control groups (65% vs. 46% vs. 56% vs. 54% respectively). Those who received tailored materials were also less likely to report doing less activity at follow-up (18% vs. 38% for all other groups). (Bull, 1999)

Health enhancement, disease prevention, and disease management will continue to evolve and incorporate technology both in academic and practical settings. The question before us is how to focus our efforts to ensure that we are getting the most we can from new approaches. Although a solid body of research on tailoring exists, there are many questions yet to be answered. Now that technology has advanced to allow us to tailor at a very complex level, we need to be diligent in determining how best to use this technology.

Further research needs to be done to identify not only which constructs are most critical for behavior change, given varied populations and behaviors, but also the degree of tailoring that is most beneficial.

• Does tailoring need to exist at the DNA level or is it comparably effective to tailor at a lower degree of specificity?
• On what constructs within a cultural context should tailoring efforts focus?
• How much should learning styles and other variables influence and modify the content?
• Are tailored materials on the Internet as effective as tailored print materials?
• Is technology both available and accessible enough to reach the populations that need these kinds of programs the most?

These are the kinds of questions the Center for Health Communications Research is asking itself and taking steps forward to explore. Stay tuned.

References:

Bull, F.C., Kreuter, M.W., and Scharff, D.P. (1999), Effects of tailored, personalized and general health messages on physical activity. Patient Education and Counseling. 36, 181-192.

Brug, J., Steenhuis, I., van Assema, P., Glanz, K., and De Vries, H. (1999), Computer-tailored nutrition education: differences between two interventions. Health Education Research. 14(2), 249-256.

Campbell M.K., DeVellis B.M., Strecher V.J., Ammerman A.S., DeVellis R.F. and Sandler R.S. (1994), The impact of message tailoring on dietary behavior change for disease prevention in primary care settings. American Journal of Public Health. 84(5), 783-787.

Champion, V., Maraj, M., Hui, S., Perkins, A.J., Tierney, W., Menon, U., and Skinner, C.S. (2003). Comparison of tailored interventions to increase mammography screening in nonadherent older women. Preventive Medicine, 36(2):150-8.

de Nooijer, J., Lechner, L., Candel, M., and de Vries, H. (2002). A randomized controlled study of short-term and long-term effects of tailored information versus general information on intention and behavior related to early detection of cancer. Cancer Epidemiology, Biomarkers & Prevention, 11(11): 1489-91.

Dijkstra, A, De Vries, H., and Roijackers, J. (1998), Long-term effectiveness of computer-generated tailored feedback in smoking cessation. Health Education Research. 30(2), 207-214.

Etter, J.F. and Perneger, T.V. (2001). Effectiveness of a computer-tailored smoking cessation program: a randomized trial. Archives of Internal Medicine, 161(21): 2596-601.

Jibaja-Weiss, M.L., Volk, R.J., Kingery, P., Smith, Q.W., and Holcomb, J.D. (2003). Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data. Patient Education and Couseling, 50(2):123-32.

Lauver, D.R., Settersten, L., Kane, J.H., and Henriques, J.B. (2003). Tailored messages, external barriers, and women’s utilization of professional breast cancer screening over time. Cancer, 97(11): 2724-35.

Lipkus, I.M., Rimer, B.K., Halabi, S., and Strigo, T.S. (2000), Can tailored interventions increase mammography use among HMO women? American Journal of Preventive Medicine. 18(1), 1-10.

McBride, C.M., Bastian, L.A., Halabi, S., Fish, L., Lipkus, I.M., Bosworth, H.B., Rimer, B.K., and Siegler, I.C. (2002). A tailored intervention to aid decision making about hormone replacement therapy. American Journal of Public Health. 92(7): 1112-1114.

Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. (1993) Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychology. (12): 399-405.

Strecher, V.J., Kreuter, M.W., Den Boer, D.J.,Kobrin, S., Hospers, H.J., and Skinner, C.S. (1994), The effects of computer-tailored smoking cessation messages in family practice settings. Journal of Family Practice. 39(3), 262-269.

Thoonen, B.P., Schermer, T.R., Jansen, M., Smeele, I., Jacobs, A.J., Grol, R., and van Schayck, O.C. (2002). Asthma education tailored to individual patient needs can optimize partnerships in asthma self-management. Patient Education & Counseling. 47(4):355-60.

Velicer WF, Prochaska JO. (1999) An expert system intervention for smoking cessation. Patient Education and Counseling;36(2):119-29.