Targeted and Tailored Health Messages: What’s the better value?

Madeleine J. Kerr, RN, PhD, Karen A. Monsen, RN, PhD(c), Kay Savik MS

School of Nursing

Acknowledgements

National Institute for Occupational Safety and Health (NIOSH RO1CCR 513049) M. Kerr, PI.

Predictors of Use of Hearing Protection Model Sally L. Lusk PhD, RN, FAAN & team

University of Michigan

Purpose of follow-up study

To discover the “better value” between tailoring and targeting health messages.

Tailoring vs. Targeting

Individually tailoredCustomized to a population

Specific Aims

• Determine if content of tailored interventions differed from the targeted interventions

• Describe unique characteristics of participants for whom the tailored intervention was effective in improving outcomes

Background for follow-up study

• Study of construction workers’ use of hearing protection devices (HPD)

• Randomized trial of tailored versus targeted computer-based educational messages.

Results

• Overall participants improved use of HPD from baseline (42%) to post-intervention (50%), (p<.001)

Results

• No significant difference in the effect of tailored and non-tailored computer-based instruction (p=.51, Mann-Whitney U Test) Tailored participants improved use of

HPD by 8.3% (30.2)

Non-tailored participants improved use of HPD by 6.1% (29.8)

Intervention Description

Interactive multimedia game-like format

Intervention Description

Applied concepts from the Predictors of Use of Hearing Protection Model e.g health messages designed to

decrease perceptions of barriers to use, increase self-efficacy in using HPDs.

Intervention Description

Sequence 8-minute introduction & consent 15-minute survey 40- to 50- minute educational program

11 tailoring points5 tailored vs. no message6 tailored vs targeted message

Tailored vs. no message1. benefits of using HPDs2. social models for HPD use3. access to HPDs4. noise annoyance5. organizational support for HPD use

e.g. If perceived employer support is low.“View the agent hall of fame for finding

ways to seek out support.”

Tailored vs. targeted message

1. Noise exposure2. Use of HPDs3. Hearing ability4. Comfort communicating while using

HPDs5. Barriers6. Fit of HPDs (example follows)

Fit of HPDs exampleYou’re progressing very well, but…• (Tailored) …I see from your record that you

are unhappy with the way your anti-noise weapon fits.

• (Targeted) …you need some more details on getting the most out of your anti-noise weapon.

The computer will now guide you through some basic tips that will help you get the right fit.

Aim 1: Method

• Tailored and targeted intervention content was matched, quantified and match scores described, following Ryan et al. methodology1.

1. Ryan GL, Skinner CS, Farrell D, Champion VL. Examining the boundaries of tailoring: the utility of tailoring versus targeting mammography interventions for two distinct populations. Health Educ.Res. 2001 Oct;16(5):555-566.

Aim 1: Method

• Match score sums were computed for each participant in the tailoring group (n=163)

• Match score sums represented the fit of their individually tailored message combination with the targeted message combination.

Aim 1: Match score method

Two content experts • independently compared messages at

each of 11 tailoring points to the corresponding targeted message

• rated their judgments of similarity using a match score of 0 (poor fit), 0.5 (close fit), or 1point (nearly exact fit).

• compared their ratings• reached consensus through

discussion

Aim 1: Results

• Match scores demonstrated that tailored interventions differed from the targeted intervention for this study.

• The perfect match score was 11; scores for the tailored messages ranged from 2 to 9, with a mean of 5.5 (bar chart follows)

Aim 1: Results

• Among tailoring group subjects, a higher match score correlated positively with a change in hearing protection use (r=.17, p=.03).

• This suggests that the researchers successfully created an effective targeted message intervention for construction workers.

Aim 2: Method

• Background data on subjects who improved their use of hearing protection were compared to those who did not.

Aim 2: Results

• About half of subjects who received tailored interventions showed improvement in use of hearing protection.

• These subjects were not significantly different in background characteristics from those not showing improvement in use of hearing protection.

Conclusions

• The control intervention had been well-targeted to address the overall responses of construction workers

• No differences were found between background characteristics of subjects related to the effectiveness of tailoring

• Thus targeted interventions were the better value.

Discussion

• Evidence is needed to promote optimal use of resources in health promotion.

• Future studies should consider using tailoring as a tool to develop well-targeted interventions.

“Our challenge is to be able to develop parsimonious theoretical models outlining what is worth tailoring for what types of people and in what sociocultural contexts” (Ryan et al.,2001).