Tailored health communication: Opportunities and challenges in the digital era

Tailoring health communication has proven to be an effective and cost-effective method for promoting health behavior change. This is illustrated by systematic reviews and meta-analyses as well as an abundance of individual research efforts. ‘Tailoring’ refers to the process of creating individualized communications, and typically starts with a theory-driven assessment of characteristics that are unique to an individual and are related to the outcome of interest. In contrast to generic forms of health communication (e.g., health brochures or information websites), tailored communications provide individuals with information that is relevant for them and that fits with their particular situation. As a result, this information is more likely to be considered as personally relevant and, consequently, to be read – findings which are in accordance with principles derived from the elaboration likelihood model. Increased perceived personal relevance is, in turn, expected to lead to increased user engagement, more in-depth processing of information, greater recall and, consequently greater intentions to engage in the desired health behaviour change. ‘Computer-tailoring’ refers to this process being automated, with the individual assessment being matched with relevant pieces of information using software algorithms. Early tailored interventions typically relied on print materials, e.g., paper-and-pencil questionnaires and printed tailored feedback letters, but advancements in computing soon provided health communication scholars and practitioners with more ways to offer tailored health communication. Web and mobile technologies have made it possible to scale up the production and delivery of tailored interventions and have helped improve the reach of effective behavior change interventions to potentially hard-to-reach populations. However, despite the many advantages afforded by tailored interventions (e.g., 24-7 accessibility, multiformat delivery modes, anonymity), high rates of attrition pose one of the main challenges to intervention effectiveness. Moreover, possibly in part caused by high attrition rates, the effect sizes of tailored interventions – albeit positive – remain rather small. It therefore seems that current tailoring efforts do not reach their full potential, which calls for identifying novel strategies that may increase the effectiveness and usage of tailored interventions. In this special issue, opportunities and challenges of tailored health communication are discussed. In the context of weight-loss e-health interventions, Ryan et al. acknowledged the problem of small effect sizes in tailored interventions. In their systematic review, four out of six studies showed small, but beneficial effects of tailored interventions on weight loss. In their systematic review and meta-analysis, Sahin et al. found that tailored text messaging interventions for type II diabetes self-management substantially contributed to effective glycemic control. The effectiveness of tailored text messaging depended on several intervention characteristics, such as message frequency, message delivery, and choice of modality. Both reviews acknowledged the heterogeneity in tailoring approaches and recognize the opportunities for tailoring health information that come with advances in technologies. A number of studies have also explored new ways of tailoring that go beyond ‘content-tailoring. ’ Content tailoring involves automatically adjusting intervention content to an individual’s present health behaviour and/or self-reported scores on known predictors of the desired health behaviour (change). This method,