Summer 2007 Edition

August 15, 2007

Many Americans do not meet national goals for dietary intake. Low-income, low literate and/or ethnic minority individuals are often further from dietary goals and suffer a disproportionate burden of diet-related chronic diseases.(1-4) There is a critical need for low-cost, accessible, effective nutrition education interventions that reach large and varied population segments.

Computerized tailoring, which combines the effectiveness of personalized communication with the efficiency of mass-mediated communication, is a promising approach. Computerized tailoring is a process whereby individuals complete a survey and their answers are entered into a computer program, which uses a series of “if-then” statements to generate individually tailored education materials with the appropriate content based on their responses.(5) Many studies have found that tailored interventions aimed at changing diet (and other health behaviors) are effective,(5-7) but continued research is needed. Especially needed are tailoring studies with low income, low literate and/or ethnic minority audiences that address literacy and language issues, and studies on the most cost-effective methods for implementing tailored interventions.(5, 8) In addition, the majority of computerized tailoring has been done using print materials; however, given the large number of lower literate individuals in the US and other countries, tailoring studies are needed with alternative delivery channels.

We are currently completing two National Cancer Institute-funded studies using computerized tailoring with diverse populations to lower fat and increase fruit and vegetable (F&V) intake. The first project, Your Healthy Life/Su Vida Saludable, studied the cost-effectiveness of different methods of delivering tailored written nutrition materials for low-income consumers.(9) Study groups were: non-tailored materials (NT) vs. tailored materials delivered in a single dose (ST) vs. tailored materials delivered in multiple (4) installments (MT) vs. MT with interactive retailoring by phone in between each mailing. All tailored intervention participants also received a motivational/instructional video. All materials had a reading level of sixth grade or less and were tailored to the participant’s ethnicity and language (Spanish or English) in addition to their survey answers. A total of 1874 participants (including 54% Latinos and 80% with household incomes below $41K) were randomized. Process evaluation data demonstrates high use of and satisfaction with the program materials. Preliminary study results indicate that the ST and/or MT materials were more effective than NT materials and that interactive “retailoring” did not improve effectiveness. Thus, tailoring can be effective for low income, ethnically diverse populations.

Our second project entitled Good for You! compared the cost-effectiveness of written tailored nutrition education materials (TW) plus tailored videos (TV) vs. TW materials alone vs. non-tailored materials (NT) with 2567 employees from over 40 worksites. Participants received individually tailored written materials and/or videos/DVDs based on their answers to a baseline and two later surveys. Process evaluation data indicate high levels of use and satisfaction with the program materials. From preliminary data, TV and TW appear to be superior to NT for changing both F&V and fat intake, and TV appears to be more effective than TW alone for changing F&V intake. Cost effectiveness analyses for both studies are pending.

Because DVDs cost less than 60 cents to reproduce, tailored video can be an effective, inexpensive, accessible method of delivering health education. The vast majority of U.S. households have a TV and a VCR or DVD player, while only 41% of low income households (<$25,000/yr) had a personal computer and less than 31% had internet access in 2003.(10, 11) In addition, Whites are significantly more likely than both African-Americans and Hispanics to have Internet access at home.(12) Tailored video interventions can be easily be translated to newer media/technologies such as E-mail, cell phones, PDAs, MP-3 players, handheld games, and the internet as these become more accessible to diverse segments of the population.

Effective tailored interventions need to be translated for dissemination through a variety of delivery channels and media to diverse population segments. Many of our effective interventions are in the process of being disseminated to diverse audiences through channels such as health insurers, churches, low income health clinics, state health departments, and mass media. We are also involving health care providers in delivering tailored interventions in practical ways. Tailored interventions can augment costly face-to-face interactions with providers and reach more people. Computerized tailoring has widespread future applicability in public health and patient education.

Kim M. Gans, PhD, MPH, LDN
Brown University, Institute for Community Health Promotion

Reference List

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3. Sharma S, Malarcher AM, Giles WH, Myers G. Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors. Ethn Dis. Winter 2004;14(1):43-48.
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9. Strolla LO, Gans K, Risica PM. Using Qualitative and Quantitative Formative Research to Develop Tailored Nutrition Intervention Materials for a Diverse Low-Income Audience. Health Educ Res. 2006.
10. U.S. Census Bureau. Statistical Abstract of the United States:2003. No. 1126. http://www.census.gov/prod/www/statistical-abstract-03.html.
11. U.S. Department of Commerce Economics and Statistics Administration. Computers and Internet Use in the United States: 2003. 2005.
12. Rideout V RD, Foehr UG. Generation M: Media in the Lives of 8 - 18 Year-olds. 2005.

The views expressed in this article are those of the author and do not imply endorsement by The Robert Wood Johnson Foundation or the Health e-Technologies Initiative.