Tailored messages are formal individual messages in which the content and/or style of the materials have been created based on data specific to the individual. Tailoring is distinguished from targeting, in that targeting refers to audience segmentation and development of group-specific messages, whereas tailoring involves individual-specific assessment and feedback driven by that assessment. Individual computerized tailoring for health promotion typically combines health behavior change theory, communication theory, social marketing principles, and computer-based programs and algorithms, in order to produce personally relevant health messages for each project participant. Information obtained from each individual is accessed and assembled using specially created software to generate customized messages for each person that are designed to promote healthy behavior changes (Campbell et al. 1994; Kreuter et al. 2000a). Providing individualized messages means the information can be tailored so that it is particularly relevant, interesting, culturally appropriate, and credible to the message recipient (Skinner et al. 1999).
In tailoring, appropriate messages for an individual are drawn from a “library” of precreated messages, which can include text, graphics, photographs, audio or video information, or other types of message files. Each message is developed to address the demographic, health, behavioral, psychosocial, and/or cultural characteristics and determinants considered important for promoting change in a specific behavior or combination of behaviors. The messages are then turned into a single coherent communication by use of computer software that searches, selects, and assembles the messages on the basis of matching rules (algorithms). The development of tailored messages can be resource intensive; however, once developed, the production and delivery are usually of relatively low cost and the messages can be widely disseminated on a population basis.
The development of tailored messages typically involves a number of steps, beginning with identification of the target population, epidemiologic and/or clinical assessment of health risks and targets for change, and formative research to identify salient issues, barriers, preferences, beliefs, and other determinants of behavior change. Next, an assessment tool is developed that measures the tailoring variables validly and reliably and provides finite data points that determine the range of participant responses for which tailored feedback elements should be created. Typically, “macro-tailoring” involves tailoring a section or block of feedback, such as a page of a newsletter or website, to a particular variable, such as stage of readiness to change or barriers to change. “Micro-tailoring,” on the other hand, usually involves smaller variations of the feedback that are determined by additional variables relevant within a larger tailored section. For example, a tailored feedback segment might be macro-tailored to the participant’s level of perceived social support for increasing physical activity, and then micro-tailored to participant responses to one or more other questions, such as the person who would be most useful to provide that support (spouse/ partner, family member, friend, co-worker, etc.). In creating tailored feedback, a parsimonious approach is recommended that focuses on a subset of key variables for which evidence indicates tailoring will make a difference. Once the survey and the message library are created, pre-testing is recommended by members of the target audience in order to assess factors such as acceptability, usability, and comprehension. Algorithms or instructions are then written by the research team and programmed, using computer-based software, to select the appropriate message files and tailored elements for each individual from the overall message library, and incorporate them into a pre-determined format, layout, or sequence, depending upon the medium of delivery (print, web, video, etc.; Kreuter et al. 2000a).
Research and theory suggest that tailored messages are more likely to be effective than generic materials because they provide personally relevant information that meets the exact information needs of readers and excludes irrelevant or superfluous facts (Brug et al. 2003; Skinner et al. 1994). It follows that when these needs are more closely met, an individual will be more likely to make the desired changes in knowledge, belief, and attitudes, and to move toward the action and maintenance stages of behavior change. A number of recent reviews have concluded that tailored messages are effective in promoting a variety of health behavior changes including diet, physical activity, smoking cessation, and cancer screening (Skinner et al. 1999; Brug et al. 2003). The strongest effects are seen when tailoring is compared to a no-intervention control condition; smaller effects are found when tailored messages are compared to non-tailored or targeted health information on the same topic. Receiving multiple tailored messages versus one dose of tailored feedback has been shown to produce more effect in promoting dietary change (Heimendinger et al. 2005). In addition, tailored messages have shown promise for addressing health disparities among minority and underserved populations (Skinner et al. 1994, Campbell & Quintiliani 2006). Tailored print messages have been most widely studied; however; tailored health behavior feedback systems also have been developed and delivered via the telephone, Internet, CD-ROM, and other media. Evidence suggests that short-term effects of tailoring via these media are comparable to print; however, longer-term studies seem to favor print over electronic media for maintenance of change (Kroeze et al. 2006).
Refining the theoretical basis of tailoring and choices of variables, media, channels, and other variances of tailored messages will be important for increasing effectiveness and cost-effectiveness. Research is ongoing to investigate issues such as theoretical models and pathways through which tailored messages exert their effects, innovative variables and algorithms for determining tailored feedback, optimal amounts and timing of tailoring, combining tailoring with other intervention modalities, and effective dissemination of evidence-based tailored messages to achieve broad public health impact.
- Brug, J., Oenema, A., & Campbell, M. (2003). Past, present, and future of computer-tailored nutrition education. American Journal of Clinical Nutrition, 77(S4), 1028S–1034S.
- Campbell, M. K., & Quintiliani, L. (2006). Tailored interventions in public health: Where does tailoring fit in interventions to reduce health disparities? American Behavioral Scientist, 49, 779–793. Campbell, M. K., DeVellis, B. M., Strecher, V. J., Ammerman, A. S., DeVellis, R. F., & Sandler, R. S. (1994). Improving dietary behavior: The effectiveness of tailored messages in primary care settings. American Journal of Public Health, 84(5), 783–787.
- Heimendinger, J., O’Neill, C., Marcus, A. C., et al. (2005). Multiple tailored messages are effective in increasing fruit and vegetable consumption among callers to the cancer information service. Journal of Health Communication, 10(S1), 65–82.
- Kreuter, M. W., Brennan, L. K., Farrell, D. W., & Olevitch, L. R (2000a). Tailoring health messages: Customizing communication with computer technology. Mahwah, NJ: Lawrence Erlbaum.
- Kreuter, M. W., Oswald, D. L., Bull, F. C., & Clark, E. M. (2000b). Are tailored health education materials always more effective than non-tailored materials? Health Education Research, 15(3), 305–315.
- Kroeze, W., Werkman, A., & Brug, J. (2006). A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Annals of Behavioral Medicine, 31(3), 205–223.
- Skinner, C. S., Strecher, V. J., & Hospers, H. (1994). Physicians’ recommendations for mammography: Do tailored messages make a difference? American Journal of Public Health, 84, 43–49.
- Skinner, C. S., Campbell, M. K., Rimer, B. K., Curry, S., & Prochaska, J. O. (1999). How effective is tailored print communication? Annals of Behavioral Medicine, 21(4), 290–298.
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