Tailored+interventions

Primary author: Megan Critser December 12, 2010

Definition: Tailored interventions are the process of developing specific, behavior- focused communication based on an assessment of individual characteristics (Kreuter, Strecher, & Glassman, 1999). Tailored interventions involve, “the use of communication, drugs, or other types of treatments that are specific for an individual or a group to improve health or change behavior (NCI, 2010). Interventions are used to modify and change behaviors, outcomes, or processes that can effect health and other types of systems issues (self definition). Tailored interventions have been used to address health disparities (Campbell & Quintiliani, 2006), cancer risk associated with tanning (Robinson, 2010), family centered communication between epileptic teens and parents (Carter, 2000), strengthening emotional self- regulation in school- aged children (Wyman, Cross, Hendricks- Brown, et al., 2010) and many other types of physical and mental health behavior change. They have also been used to assist with behavior changes related to financial health (Bach, 2002), adolescent issues related to violence in the media (Beresin, 2010), and with environmental waste reduction strategies (Tobias, 2010). Tailored interventions do not require stages or using stage theories, but are interventions tailored to an group or individual.

Types of tailored interventions Tailored interventions are derived from social, psychological, communication, and persuasive theories Campbell & Quintiliani, 2006). Tailored environmental interventions are interventions that include modification of environmental factors to effect change in the living environment of an individual or community and are based on environmental theories (self definition). Tailored environmental interventions have been used frequently in asthma research and education. In one asthma study, tailored environmental interventions resulted in a decrease in sleep disturbances and asthma related emergency room visits (Morgan et al., 2004). Some asthma models stage tailored environmental interventions and group them into education, sensitivity and exposure controls, counseling and intervention strategies ( Asthma Community Network, n. d.). Tailored risk assessments are specific individualized assessments used to evaluate health risks and quality of life. Risk assessments aim to assess the status of health, determine how likely an individual is to be at risk for a certain behavior or health problem, and instruct the individual or community on ways to decrease this risk (Baker, DeJoy, & Wilson, 2007). Another type of tailored intervention involves message tailoring, which is, “the process of developing a specific, behavior- focused communication based on an assessment of individual characteristics (Kreuter, Strecher, & Glassman, 1999). These various subtypes of tailored interventions are based upon social and communication theories and models as well as social theories that use behavioral constructs known to predict behavior change (Campbell & Quintiliani, 2006). Tailored interventions also include group targeting. These interventions specifically address communication and strategies within sub-groups. They combine assessment- based tailoring with groups and require extensive knowledge of these groups or communities ( Carbone, Campbell, & Honess- Morreale, 202).

Planning and preparations for the use of tailored interventions. Prior to the design and implementation of tailored interventions, individual stages of change must be identified (Weinstein, N. D., Sandman, P.M., & Blalock, S.J., 2008). When creating movement between stages, interventions should focus on increasing awareness, decreasing risk, and the benefits of long term change and risk reduction (Blalock et al., 1996). Information must be offered in an interesting and engaging manner, and focus must be shifted to identifying inhibiting beliefs and transitional skills (Weinstein, N.D., Sandman, P.M., & Blalock, S.J., 2008) for effective use of tailored interventions. Tailored interventions may not incorporate stages or stage theory. When tailored interventions are used to modify a single behavior or a behavior over a point period of time, knowledge of the associated or causal relationships between the behavior and the problem should be known to be able to provide tailored interventions.

Tailored interventions and their associated theoretical models Many models are associated with tailored interventions and have benefited from positive effectiveness by using this strategy. One model heavily linked to tailored interventions is the Precaution Adoption Process Model (Weinstein, Sandman, & Blalock, 2008). The PAPM involves identifying behaviors, classifying individuals and their current stages, understanding factors that influence stage change, and using intervention strategies to effect change within these stages. Tailored interventions are used in all stages from unawareness of the problem at hand, to acting decisions, decisions not to act and maintenance levels. Interventions are specific and measurable and incomplete progress made toward goals are not discounted as failure, but yet classified in a separate group from those who completely met stage changes. Interventions are then tailored accordingly (Weinstein, Sandman, & Blalock, 2008). These specific interventions have also been used with the Transtheoretical Model to effect change in mammogram awareness (Lin, Z. C., 2009) and with the Health Belief Model which looks at perceived risks and benefits and how they individually outweigh costs and barriers (Janz & Bevker, 1984). While many models have benefited from tailored interventions, some studies have not shown effective results from its use. In a study by Datta, Oddone, Olsen Orr et. al (2010) tailored behavioral interventions did not provide positive economical results in patients with blood pressure control issues. Nurses used tailored behavioral interventions to cause a decrease in health care related costs, but though the nursing costs used to institute the change were nominal, the results were not statistically significant and did not show a decrease in health care costs associated with the interventions. Poor study design, and lack of or misjudged planning and preparation prior to instituting the intervention may have been to blame for the studies lack of results.

Studies involving tailored interventions -Tuberculosis decline in the Inuit population of Quebec, Canada using targeted interventions. Incidence rates of active tuberculosis between 1970 and 1981 were 16 times higher among Indians and 24 times higher among Inuit populations in Canada than any other ethnic group. Prior to this time period the Inuit population had had the highest incidence of tuberculosis in the world. An intensive program including tailored interventions was implemented among the Inuit population and rates decrease significantly (Enarson & Grzybowski, 1986).

-Smoking cessation using targeted interventions in the USA. (Non-staged) This study looked at the impact of 3 tailored interventions focused on increasing smoking cessation rates among African- American smokers as part of a low- income and indigent person program. The tailoring included: tailored print communications, tailored telephone counseling, and tailored provider intervention. Smokers who received the tailored print materials were more likely to report having quit than smokers who did not receive the print material. However, smokers who received all 3 interventions were not more likely to report quitting at follow- up than those who only received the provider intervention (19.2% vs. 13.2%). (Lipkus, Lyna, & Rimer, 1999).

-HIV reduction in MSM (Staged) This study looked at the prevalence rates of HIV- related risk behaviors in a large cohort of MSM (Males having sex with males) enrolled in EXPLORE, a randomized clinical trial designed to evaluate the impact of a 10 session individually delivered cognitive behavior intervention program with quarterly maintenance sessions aimed at reducing risk behavior. Tailored interventions included: motivational interviewing, intervention-motivation-behavior model, and tailoring social learning theory focusing on normative components of behavior change. This model tailored interventions to the individual. This study focused on targeting risk factors and did not provide an analysis outcome of implementation, but rather offered baseline data that discussed issues with prevalence such as profound enjoyment of non protected anal sex, increasing risk factors over time, substance abuse relationships, and the link with poor communication skills increasing risk. The EXPLORE model used is a helpful tool to assess which tailored interventions may be appropriate to use depending on the statistical relationship between variables. ( Chesney et. al, 2003).

References

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Bach, D. (2002). Smart women finish rich. Broadway Publishing: USA.

Baker K, DeJoy D, and Wilson M. (2007). [|Using online health risk assessments], //The Journal of Employee Assistance//.

Beresin, E. V. (2010). The impact of media violence on children and adolescents: Opportunities for clinical intervention. American Academy of Child and Adolescent Psychiatry. Retrieved from [|www.aacap.org].

Blalock, S.K., and others. Osteoporosis prevention in premenopausal women: Using a stage model approach to examine the predictors of behavior. (1996). //Health Psychology//. 15; 84- 93.

Carbone, E., Campbell, M., & Honess- Morreale, L. (2002). Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low- income populations. Journal of the American Dietetic Association, 102(5): 690- 695.

Carter, C. B. (2000). The effects of targeted vs. non- specific interventions in family therapy for teens with epilepsy and their parents. //Dissertation Abstracts// International. 62- 11B.

Campbell, M. K & Quintiliani, L. M. (2006). Tailoring interventions in public health. Where does tailoring fit in interventions to reduce health desparities? American Behavioral Scientist. 49 (6): 775- 793. Chesney, M. A., Koblin, B. A., Barresi, P. J., Husnik, M. J., Celum, C. L. et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE study. American Journal of Public Health, 93 (5): 933- 939. Datta, S. K., Oddone, E. Z., Olsen, M. K., Orr, M., McCant, F., Genty, P., Bosworth, H. B., (2010). Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients. //American Heart Journal//. 160 (2); 257-63.

Enarson, D. A., & Grzybowski, S. (1986). Incidence of active tuberculosis in the native population of Canada. Canadian Medical Association Journal, 134: 1149- 1152.

Janz, N., & Becker, M. (1984). The health belief model: A decade later. //Health Education Quarterly,// 11 (1); 1- 47.

Kreuter, M. W., Strecher, V. J., & Glassman, B. (1999). One size does not fit all: The case for tailoring print materials. //Annals of Behavioral Medicine//, 21 (4); 276- 283.

Lin, Z. C. (2009). A tailored web- based intervention to promote women’s perceptions of and intentions for mammography. //Journal of Nursing Research//. 17 (4); 249- 260.

Lipkus, I. M., Lyna, P.R., & Rimer, B. K. (1999). Using tailored interventions to enhance smoking cessation among African- Americans at a community health center. Nictotine and Tobacco Research, 1(1):77- 85.

Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, Evans R III, et al. (2004). Results of a home-based environmental intervention among urban children with asthma. //New England Journal of Medicine//. 351:1068–1080.

Robinson, J. K. (2010). Consider tanning motivations and counsel accordingly. //Journal of the American Medical Association//. 30(20); 2074- 5.

Weinstein, N.D., Sandman, P. M., Blalock, S.J., (2008). The precaution adoption process model in Behavior and Health Education: Theory Research and Practice 4th ed. Jossey Bass: San Francisco.

Wyman, P. A., Cross, W., Hendricks- Brown, C., Yu, Q., Tu, X., & Eberly, S. (2010). Intervention to strengthen emotional self- regulation in children with emerging mental health problems: Proximal impact on school behavior. //Journal of Abnormal Child Psychology//. 38, 5, 707- 20.