Academic journal article Research and Theory for Nursing Practice

Tailored Biobehavioral Interventions: A Literature Review and Synthesis

Academic journal article Research and Theory for Nursing Practice

Tailored Biobehavioral Interventions: A Literature Review and Synthesis

Article excerpt

This article presents a metasynthesis of the literature from 1996 through 2005 on randomized clinical or controlled trials comparing effects of tailored interventions to those of control conditions or other interventions. A search was conducted for publications written in English using the terms "patient-centered interventions," "tailored interventions," and "individualized interventions," using Ovid and Elton B. Stephens Company (EBSCO) Host databases. A total of 245 publications were located after deleting duplicates. An additional six studies were identified from two syntheses of intervention research. A total of 63 studies met the inclusion criteria, and 49 of these reported that tailored interventions were superior to control conditions for one or more of the main outcomes. The evidence strongly supports the efficacy of tailored behavioral interventions and provides beginning support for the efficacy of tailored psychosocial and biological interventions.

Keywords: patient-centered interventions; tailored interventions; individualized interventions; metasynthesis

Since the time of Florence Nightingale, nurses have valued tailored interventions that take into account the unique characteristics of the person receiving care, including affective state, biological state, cognition, ethnicity, beliefs, goals, needs, preferences, and resources (Evans, 1996; Happ, Williams, Strumpf, & Burger, 1996; Nightingale, 1969; van Servellen, 1988). For example, nurses have used a standardized assessment of pressure ulcer risk to develop an individualized turning schedule that balances patient needs for sleep with needs for tissue integrity. Nurses then monitor patient skin integrity to evaluate the effectiveness of the intervention (Hammer , 2002). Studies have shown that patients also value care tailored to their individual characteristics and needs (Evans, 1996; Radwin & Alster, 2002; Ryan & Lauver, 2002; Whittemore, 2000). However, most clinical trials by nurse researchers have tested standardized interventions, that is, interventions provided in the same way for all patients. Further, nursing textbooks frequently prescribe standardized care: "turn every two hours to relieve pressure" for persons with decreased mobility. Many of these interventions have failed to show efficacy or have shown significant improvements but with effect sizes so small as to have little clinical significance (Lauver et al., 2002). Even clinically significant standardized interventions have often failed in clinical practice. The failure may have occurred in part because standardized interventions do not systematically address patients' individual needs, preferences for care, and goals, and thus patients were nonadherent.

Unfortunately, we have little unequivocal evidence of the efficacy of tailored interventions. A metasynthesis of 20 published experimental and quasi-experimental studies that examined at least one behavioral outcome found tailored interventions more effective than standardized interventions in only 50% of the cases. Thus, even though the superiority of tailored interventions remains undetermined, authors reported that participants preferred tailored interventions, perceived them as personal, and read and remembered more tailored information (Ryan & Lauver, 2002).

Beginning to develop the science of tailored care is important and necessary, as evidence is needed to justify this approach in clinical practice. A first step in this development, this article reports a review and synthesis of published randomized controlled trials of interventions tailored to patients' unique characteristics; the trials compared the effects of these interventions to those of standardized interventions, control interventions, usual care, or other tailored interventions. The article summarizes the conceptual models and theories that guided the studies of tailored interventions, the methods and processes used in studies of tailored interventions, and the outcomes of trials testing their efficacy and effectiveness. …

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