Resnicow Ken, Davis Rachel E, Zhang Guangyu, Konkel Janine, Strecher Victor J, Shaikh Abdul R, Tolsma Dennis, Calvi Josephine, Alexander Gwen, Anderson Julia P, Wiese Cheryl
School of Public Health, Department of Health Behavior & Health Education, University of Michigan, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI 48109-2029, USA.
Ann Behav Med. 2008 Apr;35(2):159-69. doi: 10.1007/s12160-008-9028-9.
Tailored health communications to date have been based on a rather narrow set of theoretical constructs.
This study was designed to test whether tailoring a print-based fruit and vegetable (F & V) intervention on relatively novel constructs from self-determination theory (SDT) and motivational interviewing (MI) increases intervention impact, perceived relevance, and program satisfaction. The study also aimed to explore possible user characteristics that may moderate intervention response.
African American adults were recruited from two integrated health care delivery systems, one based in the Detroit Metro area and the other in the Atlanta Metro area, and then randomized to receive three tailored newsletters over 3 months. One set of newsletters was tailored only on demographic and social cognitive variables (control condition), whereas the other (experimental condition) was tailored on SDT and MI principles and strategies. The primary focus of the newsletters and the primary outcome for the study was fruit and vegetable intake assessed with two brief self-report measures. Preference for autonomy support was assessed at baseline with a single item: "In general, when it comes to my health I would rather an expert just tell me what I should do". Most between-group differences were examined using change scores.
A total of 512 (31%) eligible participants, of 1,650 invited, were enrolled, of which 423 provided complete 3-month follow-up data. Considering the entire sample, there were no significant between-group differences in daily F & V intake at 3 month follow-up. Both groups showed similar increases of around one serving per day of F & V on the short form and half a serving per day on the long form. There were, however, significant interactions of intervention group with preference for autonomy-supportive communication as well as with age. Specifically, individuals in the experimental intervention who, at baseline, preferred an autonomy-supportive style of communication increased their F & V intake by 1.07 servings compared to 0.43 servings among controls. Among younger controls, there was a larger change in F & V intake, 0.59 servings, than their experimental group counterparts, 0.29 servings. Conversely, older experimental group participants showed a larger change in F & V, 1.09 servings, than older controls, 0.48.
Our study confirms the importance of assessing individual differences as potential moderators of tailored health interventions. For those who prefer an autonomy-supportive style of communication, tailoring on values and other motivational constructs can enhance message impact and perceived relevance.
迄今为止，量身定制的健康传播一直基于一套相当狭隘的理论架构。
本研究旨在测试基于自我决定理论（SDT）和动机性访谈（MI）中相对新颖的架构，对以印刷品形式呈现的水果和蔬菜（F&V）干预措施进行量身定制，是否会增加干预效果、感知相关性和项目满意度。该研究还旨在探索可能调节干预反应的用户特征。
从两个综合医疗保健服务系统招募非裔美国成年人，一个位于底特律都会区，另一个位于亚特兰大都会区，然后随机分配，在3个月内接收三期量身定制的时事通讯。一组时事通讯仅根据人口统计学和社会认知变量进行量身定制（对照条件），而另一组（实验条件）则根据SDT和MI的原则及策略进行量身定制。时事通讯的主要重点以及该研究的主要结果是通过两项简短的自我报告测量来评估水果和蔬菜的摄入量。在基线时，用一个单项问题评估对自主性支持的偏好：“一般来说，在我的健康问题上，我宁愿专家直接告诉我该怎么做”。大多数组间差异使用变化分数进行检验。
在受邀的1650名参与者中，共有512名（31%）符合条件的参与者被纳入研究，其中423名提供了完整的3个月随访数据。考虑整个样本时，在3个月随访时，两组之间在每日F&V摄入量上没有显著差异。两组在简短形式上每天的F&V摄入量增加量相似，约为一份，在长形式上每天增加半份。然而，干预组与对自主性支持性沟通的偏好以及年龄之间存在显著的交互作用。具体而言，在基线时更喜欢自主性支持性沟通方式的实验干预组个体，其F&V摄入量增加了1.07份，而对照组为0.43份。在较年轻的对照组中，F&V摄入量的变化更大，为0.59份，而实验组对应变化为0.29份。相反，老年实验组参与者的F&V摄入量变化更大，为1.09份，而老年对照组为0.48份。
我们的研究证实了评估个体差异作为量身定制的健康干预潜在调节因素的重要性。对于那些更喜欢自主性支持性沟通方式的人，根据价值观和其他动机性架构进行量身定制可以增强信息影响和感知相关性。
