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 ) 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 tailored Customized 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 points 5 tailored vs. no message 6 tailored vs targeted message

Tailored vs. no message 1. benefits of using HPDs 2. social models for HPD use 3. access to HPDs 4. noise annoyance 5. 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 exposure 2. Use of HPDs 3. Hearing ability 4. Comfort communicating while using HPDs 5. Barriers 6. Fit of HPDs (example follows)

Fit of HPDs example You’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. methodology 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 Oct;16(5):

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).