Tailoring interventions: examining the evidence and identifying gaps.

INTRODUCTION

Numerous population-based studies highlight the need to improve health care delivery and outcomes. Many single and combined interventions are available but their impact is limited and inconsistent. Tailoring may enhance their impact, but the best way to do so remains unclear. The purpose of this exploratory analysis was to identify potential ways to tailor these interventions that could enhance their effectiveness.

METHODS

Interventions were chosen according to those included in a recent systematic review, which found that their impact was enhanced through tailoring. The most recent syntheses of research on the effectiveness of these interventions were identified in MEDLINE and examined for details of intervention design or delivery that influenced impact.

RESULTS

Possible tailoring mechanisms were identified for 2 interventions. The impact of educational meetings could be enhanced by focusing on topics involving less complex behavior, offering a series of events, and including interactive components. The impact of audit and feedback could be enhanced by offering a series of events. Recent systematic reviews on the effectiveness of 3 interventions-self-assessment, public reporting of performance data, and opinion leaders-did not identify factors influencing their impact that could be used for tailoring.

DISCUSSION

This exploratory review revealed few ways to potentially improve the effectiveness of interventions among the plethora of available trials. Nontraditional systematic reviews that consider research from different disciplines and featuring a variety of designs are recommended. More immediately, educators, professional associations, and health care managers could use this information to structure, implement, and support interventions that improve health care delivery and outcomes.