Computer-Tailored Interventions

More than half of the main causes of death and disability in the United States can be linked to a few individual health behaviors like diet and physical activity, and risky or unhealthy behaviors such as smoking, alcohol abuse, unsafe sex, use of firearms, and drug use. Avoiding these risky behaviors and adopting healthy behaviors can significantly lower one's risk for chronic illness, but persuading individuals to do so is easier said than done. This is because the factors that influence health behaviors vary greatly from one person to another. Individual differences in beliefs, values and attitudes, motives and expectations, circumstances, personality traits, mental and emotional states, patterns of action, and habits all play a large part in shaping health behaviors and decision making.

Tailoring is a health communication strategy that recognizes the complexity of health decision making and behavior change. Research has found that messages created based on an assessment and understanding of individual differences are more engaging and persuasive than generic or one-size-fits-all health messages. Moreover, several meta-analyses provide empirical evidence of the benefits of tailored versus nontailored interventions across a wide variety of health outcomes [Page 245]including smoking cessation, physical activity, diet and nutrition, and binge drinking.

Advances in computing have contributed significantly to the sophistication of tailored messaging and delivery. Computer-tailored interventions (CTIs) are behavior change interventions that use powerful expert systems to automate the collection of personal information and enable theory-based tailoring on a wide variety of psychosocial factors. Complex algorithms power the development of individualized messages or recommended actions from a content database—approaching a level of tailoring that, in the past, could only be achieved through interactions with experts or trained health care providers.

The efficacy of computer-tailored interventions is bolstered when assessment considers key determinants of the health behaviors being targeted as guided by research and health behavior theories and models. For example, James O. Prochaska's transtheoretical model has been used extensively in computer-tailored smoking cessation programs that base tailoring on an individual's readiness to quit. Motivational interviewing, a counseling technique used in clinical settings, has also been adapted into CTI systems to fine-tune assessment of individual motivations and enhance the “tailored” experience.

CTIs can range from simple, tailored risk assessments or tailored health messaging to more complex and highly individualized health programs, treatment plans, or recommended actions. Computer-automated assessments followed by tailored messaging has been used successfully for delivering short motivational interventions to encourage fruit and vegetable consumption and physical activity, and to discourage alcohol consumption and smoking. These types of brief CTIs typically involve single assessments at baseline, after which participants either immediately receive tailored advice via a Web page or print-out, or are scheduled to receive tailored messages via e-mail or snail mail.

When the goal of the CTI is to support more complex lifestyle changes or behavior modification, tailoring may be done iteratively or delivered in modules, and may be enhanced through interactive features such as goal setting, skills building, tracking and monitoring, and expert and social support tools to help participants achieve their goals. As an example, a CTI designed to help newly diagnosed diabetes patients manage their disease may include multiple assessments and tailored feedback as well as personalized dietary recommendations and meal plans, tailored exercise programs, and blood glucose monitoring and tracking tools. This approach has been used successfully in interventions focused on improving diet and nutrition, increasing physical activity, promoting quitting behaviors among smokers, and improving asthma self-management, among others.

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