Guide Tailoring health messages: customizing communication with computer technology

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  3. One size does not fit all: The case for tailoring print materials | SpringerLink

Alternative methods of assessing visit behaviors also have limitations. For example, clinician reports may also be biased, and observing or recording visits may change the behaviors. As a result, previsit imbalances favored the IMCP group for the knowledge of screening harms and inconveniences and self-efficacy measures Table 2 , leaving less room for improvement in these factors.

Because analyses of IMCP effects on these factors are biased toward the null, our estimates for these factors may be conservative. In conclusion, 1-time EHBM sociopsychological factor tailoring delivered by an IMCP was no more effective than nontailored information in encouraging objectively measured colorectal cancer screening in a multiethnic sample, despite salutary effects on sociopsychological factors and visit behaviors predictive of screening.

Furthermore, IMCP effects did not differ significantly among ethnicity and preferred language subgroups. The findings raise doubts regarding the utility of single-exposure sociopsychological factor tailoring in promoting and reducing ethnic disparities in colorectal cancer screening. Sanders, BA and Leticia E. We also wish to thank Robert Burnett, MA, for his programming contributions to the tailored software program.

Finally, we are indebted to all of the primary care offices and patients who participated. Disclaimer: The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. Search for Keyword: GO. User Name Password Sign In.

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Previous Section Next Section. Study Interventions We designed the study computer programs using standard software engineering principles. View larger version: In this window In a new window. Figure 1 Sequence and content of tailored IMCP and nontailored control interventions for colorectal screening. Note: shaded boxes indicate keying individually tailored modules of experimental IMCP. Measures EHBM sociopsychological factors were measured pre- and postvisit. Data Analysis Data were analyzed using Stata Figure 2 Flow of participants through the trial.

View this table: In this window In a new window. Table 1 Characteristics of the Participants by Study Group. Figure 3 Kaplan-Meier curve for receipt of colorectal cancer screening after intervention according to study group. Note: Screening was ascertained by medical record review. Previous Section. Trends in colorectal cancer test use among vulnerable populations in the United States.

Cancer Epidemiol Biomarkers Prev. Preventive Services Task Force. Screening for colorectal cancer: U. Preventive Services Task Force recommendation statement. Ann Intern Med. CrossRef Medline Google Scholar. J Gen Intern Med. Social learning theory and the health belief model. Health Educ Q. Community Preventive Services Task Force.

Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med. Empowerment through choice? A critical analysis of the effects of choice in organizations. Res Organ Behav. CrossRef Google Scholar. Understanding tailoring in communicating about health. Health Educ Res. Tailored interactive multimedia computer programs to reduce health disparities: opportunities and challenges. Patient Educ Couns. Google Scholar. Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: a randomized controlled pilot study in physician offices.

Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African-Americans. Mediators of physical activity behavior change: a multivariate approach. Health Psychol. Tailored computer-based cancer risk communication: correcting colorectal cancer risk perception. J Health Commun. Using tailored telephone counseling to accelerate the adoption of colorectal cancer screening. Cancer Detect Prev. Tailored navigation in colorectal cancer screening. Med Care.

Promoting colorectal cancer screening discussion: a randomized controlled trial. Changes in risk perceptions in relation to self-reported colorectal cancer screening among first-degree relatives of colorectal cancer cases enrolled in a randomized trial. Ruffin MT IV. Preference-based electronic decision aid to promote colorectal cancer screening: results of a randomized controlled trial. Prev Med. Miller DP Jr. Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population. A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives.

A meta-analysis of computer-tailored interventions for health behavior change. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. Healthy colon, healthy life: a novel colorectal cancer screening intervention. A randomized controlled trial of a tailored interactive computer-delivered intervention to promote colorectal cancer screening: sometimes more is just the same.

Ann Behav Med. A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening. A randomized trial of generic versus tailored interventions to increase colorectal cancer screening among intermediate risk siblings. The lowest-priced brand-new, unused, unopened, undamaged item in its original packaging where packaging is applicable. Packaging should be the same as what is found in a retail store, unless the item is handmade or was packaged by the manufacturer in non-retail packaging, such as an unprinted box or plastic bag.

See details for additional description. Skip to main content. We're sorry, something went wrong. Please try again. Olevitch, Matthew W. Kreuter, David W. Farrell and Laura K. Brennan , Paperback Be the first to write a review. About this product. Stock photo. Obtaining answers to this large and complex question may advance our understanding of tailored health communication and also inform the issue of the importance of personalization compared with tailoring.

Tailoring can be achieved on virtually any variable that is capable of assessment Rakowski, Thus, what variables should be tailored on to achieve the greatest intervention effects? Reviews of the tailoring literature demonstrate that, to date, a re- latively small set of behavioral theories has been widely used in tailored interventions see Kreuter et al. Tailored interventions typically customize content based upon these concepts in efforts to match the right messages to the right individuals and, ultimately, persuade individuals to change their health behavior.

This principle exemplifies one of the elegant features of tailored interventions.

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For a particular individual, theoretical mediators that do not need to change e. This standpoint, however, appears to be the minority view. Alternatively, other researchers suggest a process through which scholars select theoretical determinants on the basis of the empirical literature and subsequently use them in tailoring messages, regardless of theoretical origin Kreuter et al.

Indeed, some reviews of tailored interventions demonstrate that multiple theories are used in tailoring, and, at times, little correspondence emerges between theories applied and variables tailored upon e. This fact makes it difficult to test which theory provides the most fruitful basis for tailored interventions, although testing which theoretical concepts may be most effective can and has been examined see Noar et al. To date, tailoring has almost entirely been conceived of as a way to custom- ize intervention content based on these behavioral theories to individuals.

As a result, nearly all tailoring has focused on what scholars believe to be the behavioral determinants of tailoring, which come from the theories of behavior and behavior change listed above Kreuter et al. A broader perspective would be that variables related to intervention content represent just one domain of tailoring that is possible.

Indeed, Rimer and Kreuter argued that at least four approaches to tailor- ing can be used to enhance health communication and these approaches can be adapted to represent tailoring message domains. Table 6 lists these four domains, and includes possible theories and theoretical constructs that have been or could be applied in tailoring. As noted above, matching content to individuals has been the main emphasis of the tailoring literature to date.

Beyond manipulating content, placing information in a context meaning- ful to participants may be as important as the selection of particular theoretical determinants, especially in terms of the perceived relevance of the material see Dijkstra, ; Hawkins et al. For example, creating materials that are tailored on factors such as gender, age, race, and culture may make that information more meaningful and relevant to par- ticipants. In fact, in their meta-analysis of print tailored materials, Noar et al.

They also found an additive effect such that tailoring in more areas e. Similarly, Kreuter et al. These studies suggest that moving beyond the content domain to include demographic and cultural variables in tailoring may lead to more efficacious interventions. The third and fourth domains have to do with the design, structure, and type of messages. The third domain concentrates on gaining and keeping the attention of the participant and facilitating message processing. Finally, message structure and type in the delivery of tailored messages may also be important, particularly with regard to message processing.

For example, delivering tailored messages in forms other than didactic materials, such as through the use of narratives Kreuter, or tailoring message type based on preference for narrative or statistical presentation of information, comprise compelling avenues for research. Tailoring could also be conducted on preference for particular type of appeal, such as presenting information in the form of a fear appeal versus a guilt appeal. To be able to answer this question, we must begin with a clear understanding of the past. Although the literature has greatly progressed since the first tailoring studies were pub- lished, many basic questions about tailoring that were posed a decade ago remain unanswered Abrams et al.

Indeed, this review reveals that we know much more about whether tailored interventions work than we do why and under what conditions they work. This conclusion has been drawn by other recent reviewers of the literature on tailored health interventions e. We next discuss directions for future research in terms of 4 areas that may help advance a cumulative science of tailoring.

These include additional meta-analyses, new primary studies, message design research, and message effects perspectives in tailoring. Importance of Meta-Analyses While new studies can lend critical answers to such questions in tailoring, meta-analytic projects also hold the potential to be fruitful as conduits for cumulative knowledge. Two recent meta-analytic projects in the tailoring area Noar et al. Although narrative reviewers of the literature can report on the kinds of studies that have been conducted, meta-analytic studies can offer valuable insights in terms of answering questions involving study findings and outcomes Noar, b.

In this manner, such projects could facilitate reflection on the first decade and a half of tailoring research and help set the agenda for the future of tailoring studies. Advancing our understanding of how tailoring does and does not work across particular health behaviors, channels, and populations is critical in building a cumulative science of tailored health communication. We must also determine how the diversity of theoretical variables, constructs, and domains can be most fruitfully applied to tailored messages and interventions.

In addition, as tailored message researchers work to build this cumulative science, we strongly urge the adoption of clear and consistent reporting guidelines for publications, including clearly specifying features such as assessment strategies, tailoring variables what was tailored on and how it was achieved , and detail on intervention materials. New Primary Studies While meta-analyses are capable of examining the large number of studies that have already been conducted, new studies can test novel ideas in tailoring. A number of studies could be undertaken, however, that would help improve the knowledge base regarding what makes effective tailoring.

Such studies would encompass randomized trials that tease out various components of tailoring by comparing a variety of intervention conditions that incrementally add various tailoring compo- nents and examine their influence on outcomes e. Although scholars have long called for such studies in the tailored health literature, as Abrams et al. In addition, many of these studies could be driven by research questions aimed at testing tailoring variables beyond the content domain, as suggested in Table 6.

Newer studies, thus, can examine the unique role that each of these strategies plays in the efficacy of tailored messages. Indeed, not surprisingly, tailored interventions have mostly been tailored on content i. While behavioral theories tell us what theoretical content interventions should stress, they do not tell us how to design the intervention messages in ways that make them personally relevant and per- suasive Cappella, ; Near, a; Slater, For guidance on this question, communication theories related to message design and persuasion can be applied Cappella, ; Harrington et al.

This research should include testing basic design questions such as whether tailoring on visual elements increases the efficacy of tailored interventions, as implied by the findings of a recent meta-analysis Noar et al. Message Effects We also need to disentangle the process by which tailored messages exert their effects. Figure 1 presents one such hypothesized pathway.

If receivers rate relevance as low, then they pay little attention to that message and likely turn their atten- tion to something else. If receivers judge perceived relevance as moderate or high, they may instead attend more closely to that message and devote more cognitive resources to it. An interrelationship likely exists among these factors, such that processing of the message may ultimately lead to a judgment that the message is not relevant after all or that the arguments are not persuasive.

Conversely, the design of the message may not be stimulating enough to keep attention. If the message is sufficiently compelling, however, and convinces an indi- vidual of its personal relevance, keeps attention, and results in central pro- cessing, the message may ultimately lead to information seeking, persuasion e. Indeed, when we consider tailoring from a message effects perspective, the role of tailoring variables beyond the content domain becomes clearer. Other tailoring variables, however, may be more useful in garnering attention, fostering perceived relevance, or encouraging message proces- sing also see Hawkins et al.

For example, both Table 6 and Figure 1 suggest that tailoring ou demographic factors and contextual variables, and using personalization strategies may aid in raising the perceived relevance of the message; theoretical concepts such as message sensation value might be applied to garner and keep attention to the message, and approaches such as narratives and message appeals might be used to enhance message pro- cessing.

These assertions constitute empirically testable hypotheses that might be the subject of further tailoring research. Such work holds the potential to greatly advance our understanding of how tailored messages exert their effects and could provide guidance for the next generation of tailored health communication. Conclusion This chapter has provided an overview of the area of individually tailored com- munication, an exciting area of persuasive messaging in health communica- tion with strong possible implications for other areas of the communication discipline as well.

Its focus on matching messages to the unique beliefs, atti- tudes, needs, and preferences of individuals makes it fundamentally different from the common mass communication practices of audience segmentation and message targeting, which operate at the group level. The possibility of reaching entire populations with individually tailored messages is upon us, and opportunities to bring such messages to populations will only grow with the further advancement of new technologies.


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This chapter reveals the extraordinary breadth of the tailoring literature, yet it also reveals the limited depth with which we understand the effects of tailored communications. Future studies in this area could advance the science of tailored communication by studying the mechanisms and moderators of efficacious tailored interventions. While the roots of this literature lie in psychology and public health, communication researchers have a unique role to play by applying communication and persuasion theory to better inform this work from a theoretically-oriented, message-based perspective.

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    Using Technology as a Relationship Builder: The Computer in the Exam Room

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