Defining what works in tailoring: A meta-analysis of computer-tailored interventions for health behavior change

Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Preventive Medicine (Impact Factor: 3.09). 09/2010; 51(3-4):214-21. DOI: 10.1016/j.ypmed.2010.06.004
Source: PubMed


Computer-tailored interventions have become increasingly common for facilitating improvement in behaviors related to chronic disease and health promotion. A sufficient number of outcome studies from these interventions are now available to facilitate the quantitative analysis of effect sizes, permitting moderator analyses that were not possible with previous systematic reviews.
The present study employs meta-analytic techniques to assess the mean effect for 88 computer-tailored interventions published between 1988 and 2009 focusing on four health behaviors: smoking cessation, physical activity, eating a healthy diet, and receiving regular mammography screening. Effect sizes were calculated using Hedges g. Study, tailoring, and demographic moderators were examined by analyzing between-group variance and meta-regression.
Clinically and statistically significant overall effect sizes were found across each of the four behaviors. While effect sizes decreased after intervention completion, dynamically tailored interventions were found to have increased efficacy over time as compared with tailored interventions based on one assessment only. Study effects did not differ across communication channels nor decline when up to three behaviors were identified for intervention simultaneously.
This study demonstrates that computer-tailored interventions have the potential to improve health behaviors and suggests strategies that may lead to greater effectiveness of these techniques.

Download full-text


Available from: Paul Krebs, Mar 18, 2014
35 Reads
  • Source
    • "The core constructs of the TTM include stages of change, processes of change, decisional balance, and self-efficacy. Tailored, computerized interventions based on the TTM have been empirically validated and effective for a wide variety of behaviors [9] [10] [11], including sun protection behaviors [12] [13] [14] [15] [16]. The self-efficacy component of the TTM assesses an individual's perceived ability to perform healthy behaviors in difficult situations [17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Self-Efficacy Scale for Sun Protection consists of two correlated factors with three items each for Sunscreen Use and Avoidance. This study evaluated two crucial psychometric assumptions, factorial invariance and scale reliability, with a sample of adults ( N = 1356 ) participating in a computer-tailored, population-based intervention study. A measure has factorial invariance when the model is the same across subgroups. Three levels of invariance were tested, from least to most restrictive: (1) Configural Invariance (nonzero factor loadings unconstrained); (2) Pattern Identity Invariance (equal factor loadings); and (3) Strong Factorial Invariance (equal factor loadings and measurement errors). Strong Factorial Invariance was a good fit for the model across seven grouping variables: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Internal consistency coefficient Alpha and factor rho scale reliability, respectively, were .84 and .86 for Sunscreen Use, .68 and .70 for Avoidance, and .78 and .78 for the global (total) scale. The psychometric evidence demonstrates strong empirical support that the scale is consistent, has internal validity, and can be used to assess population-based adult samples.
    08/2015; 2015:862732. DOI:10.1155/2015/862732
  • Source
    • "Exemplary intervention paths for two participants partaking in the same intervention are indicated. Meta-analyses by Krebs et al. (2010) and Lustria et al. (2013) point out effects of different modes of tailored interventions and their advantages compared A stitch in time saves nine: Things to consider when tailoring your online "
    [Show abstract] [Hide abstract]
    ABSTRACT: Internet based interventions promoting healthy lifestyle changes are well documented within the last years, especially using online platforms as well as applications for mobile devices. They are used in primary, secondary as well as tertiary prevention to support people in leading a healthier lifestyle and adhering to medication. To communicate relevant messages and information for the user without involving personal counseling, the content is often personalized. These so called tailored eHealth or online interventions are a promising approach to improve intervention effects and adherence. Increasing the level of tailoring of the intervention seems to be beneficial for intervention effects when considering each participant. But this practice also leads to methodological issues concerning the general comparability of the results. This is a direct consequence of tailored content based on prior assessments and indications instead of providing one intervention for all. We discuss pros and cons of such interventions as well as ways to increase the comparability of different tailored interventions. The discussion tries to advance the research field by critically appraising this approach and providing suggestions to tackle the addressed problems. These include the use of standardized taxonomies as well as adjusting the sample size or study design to adequately reflect the research goal and planned analysis of subgroups or individuals.
  • Source
    • "According to surveys published by the European Commission, > 70% of people in the Netherlands, Southeastern Europe, and Denmark are reported to have searched the Internet for health-specific information during the past year [17]. Interventions encompassing more readily available ICTs enable efficient delivery of authoritative educational resources , individually tailored health and wellness programs in addition to time-unlimited feedback, coaching, and support [18] [19] [20]. Furthermore, there is growing evidence that healthrelated social media channels and similar online communications are useful in helping to promote health literacy, thereby fostering improvements in self-efficacy, self-care behaviors, and health status [16] [21]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide yet the majority of related risk factors are largely preventable (primary prevention [PP]) and effectively treatable (secondary prevention [SP]) with healthy lifestyle behaviors. The use of information and communication technology (ICT) offers a unique approach to personal health and CVD prevention, as these mediums are relatively affordable, approachable, and accessible. The purpose of this review is to provide an overview of ICT-driven personal health technologies and their potential role in promoting and supporting self-care behaviors for PP and SP of CVD. In this review, we focus on technological interventions that have been successful at supporting positive behavior change in order to determine which tools, resources, and methods are most appropriate for delivering interventions geared towards CVD prevention. We conducted a literature search from a range of sources including scholarly, peer-reviewed journal articles indexed in PubMed and CINAHL, gray literature, and reputable websites and other Internet-based media. A synthesis of existing literature indicates that the overall efficacy of ICT-driven personal health technologies is largely determined by: 1) the educational resources provided and the extent to which the relayed information is customized or individually tailored; and 2) the degree of self-monitoring and levels of personalized feedback or other interactions (e.g. interpersonal communications). We conclude that virtually all the technological tools and resources identified (e.g. Internet-based communications including websites, weblogs and wikis, mobile devices and applications, social media, and wearable monitors) can be strategically leveraged to enhance self-care behaviors for CVD risk reduction and SP but further research is needed to evaluate their efficacy, cost-effectiveness, and long-term maintainability.
    Postgraduate Medicine 02/2015; 127(2):1-9. DOI:10.1080/00325481.2015.1015396 · 1.70 Impact Factor
Show more