TAILORING OF INTERVENTIONS
A general principle guiding the development of interventions is that effective interventions are tailored/customized to the key risks, needs, and specific profiles of target populations and contexts (Chapter 1). A growing body of literature indicates that tailoring health information is more efficacious than a “one-size-fits-all approach” (e.g., Caiata Zufferey & Schulz, 2009; Noar, Benac, & Harris, 2007). A distinction can be made between targeted intervention strategies and tailored intervention strategies (Beck et al., 2010). Targeting intervention strategies refer to developing aspects of the intervention or intervention components to address certain characteristics of the population such as age, gender, or ethnicity. In intervention research, cultural adaptation, which refers to the systematic modifications of an intervention to consider language, culture, and context to be compatible with an individual’s background and values (Barrera, Castro, Strycker, & Toobert, 2013), is common. This helps to reduce disparities in intervention access, facilitates recruitment of cultural minorities, and helps to ensure that interventions reach diverse subgroups and populations. An example is designing recruitment materials differently for different ethnic groups (Figure 6.1). This might include presenting the material in different languages and using different graphics and images. Other examples include using bicultural staff and incorporating familiar cultural traditions into intervention materials (Barrera et al., 2013).
Tailoring intervention strategies refers to modifying elements of an intervention so that they are uniquely individualized for an individual on the basis of some assessment. For example, in the REACH II trial, a questionnaire was used, referred to as the “risk appraisal,” which identified areas that caregivers were at risk for, such as home hazards, lack of skills managing behaviors, or depressive symptoms. The risk appraisal was administered during the baseline assessment and then used to “tailor” the intervention to the specific needs of the caregiver.
Tailoring can also involve modifying the content according to the skill level or knowledge of the individual. The initial step in tailoring is selecting the
Figure 6.1 Example of targeted recruitment material.
characteristics on which the intervention will be tailored. As noted by Beck et al. (2010), this should be driven by theories or prior research that demonstrates the association between these characteristics and study outcomes. Tailoring of an intervention might also involve modifying the intervention schedule or location of intervention delivery to correspond to an individual’s needs. Adjusting the delivery of an intervention to accommodate an individual (within reason, of course) may help offset potential problems with attrition or delays in assessments.
So what are the implications of targeting and tailoring with respect to standardization? In short, the goals of standardization can still be achieved even if targeting or tailoring is part of the intervention protocol. The important consideration is planning and systematizing the strategies for targeting/tailoring the intervention materials or protocol. This cannot be done on an ad hoc basis. The plan for target- ing/tailoring interventions needs to clearly articulate which aspects of the intervention can be modified, the boundaries of modifications, and who on the team can make decisions with respect to modifications. It must also include when modifications can occur and a systematic plan for making modifications. Of course, the essence or core elements of an intervention must be maintained. In addition, the cost and effort involved in targeting or tailoring an intervention must also be considered. For example, although it may be more convenient for a small group of participants to attend support group sessions on a Saturday evening, this might entail hiring an additional person on the research team who would be willing to adhere to this schedule. In this case, the benefits of maintaining a small number of participants would need to be carefully weighed against hiring an additional staff person.