Targeted and Tailored Health Messages: Whats the better value

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Targeted and Tailored Health Messages Whats
the better value?

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

School of Nursing
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Acknowledgements
Predictors of Use of Hearing Protection Model
Sally L. Lusk PhD, RN, FAAN team University of
Michigan
National Institute for Occupational Safety and
Health (NIOSH RO1CCR 513049) M. Kerr, PI.
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Purpose of follow-up study

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

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Tailoring vs. Targeting
Customized to a population
Individually tailored
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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

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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.

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Results

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

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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)

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Intervention Description
Interactive multimedia game-like format
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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.

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Intervention Description

• Sequence
• 8-minute introduction consent
• 15-minute survey
• 40- to 50- minute educational program
• 11 tailoring points
• 5 tailored vs. no message
• 6 tailored vs targeted message

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Tailored vs. no message

• benefits of using HPDs
• social models for HPD use
• access to HPDs
• noise annoyance
• 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.

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Tailored vs. targeted message

• Noise exposure
• Use of HPDs
• Hearing ability
• Comfort communicating while using HPDs
• Barriers
• Fit of HPDs (example follows)

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Fit of HPDs example

• Youre 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.

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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 Oct16(5)555-566.

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Aim 1 Method

• Match score sums were computed for each
  participant in the tailoring group (n163)
• Match score sums represented the fit of their
  individually tailored message combination with
  the targeted message combination.

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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

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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)

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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.

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Aim 2 Method

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

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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.

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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.

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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.

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• 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).