Matthew W. Kreuter

Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches

It is a truism of health education that programs and interventions will be more effective when they are culturally appropriate for the populations they serve. In practice, however, the strategies used to achieve cultural appropriateness vary widely. This article briefly describes five strategies commonly used to target programs to culturally defined groups. It then explains how a sixth approach, cultural tailoring, might extend these strategies and enhance our ability to develop effective programs for cultural groups. The authors illustrate this new approach with an example of cultural tailoring for cancer prevention in a population of lower income urban African American women.

How We Design Feasibility Studies

Public health is moving toward the goal of implementing evidence-based interventions. To accomplish this, there is a need to select, adapt, and evaluate intervention studies. Such selection relies, in part, on making judgments about the feasibility of possible interventions and determining whether comprehensive and multilevel evaluations are justified. There exist few published standards and guides to aid these judgments. This article describes the diverse types of feasibility studies conducted in the field of cancer prevention, using a group of recently funded grants from the National Cancer Institute. The grants were submitted in response to a request for applications proposing research to identify feasible interventions for increasing the utilization of the Cancer Information Service among underserved populations.

One size does not fit all: The case for tailoring print materials

Printed health education materials frequently consist of mass-produced brochures, booklets, or pamphlets designed for a general population audience. Although this one-size-fits-all approach might be appropriate under certain circumstances and even produce small changes at relatively modest costs, it cannot address the unique needs, interests, and concerns of different individuals. With the advent and dissemination of new communication technologies, our ability to collect information from individuals and provide feedback tailored to the specific information cellected is not only possible, but practical. The purpose of this article is to: (a) distinguish between tailored print communication and other common communication-based approaches to health education and behavior change; (b) present a theoretical and public health rationale for tailoring health information; and (c) describe the steps involved in creating and deliverin tailored print communication programs. Studies suggest computer tailoring is a promising strategy for health education and behavior change. Practitioners and researchers should understand the approach and consider the possibilities it presents for enhancing their work in disease prevention.

Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview

Narrative is the basic mode of human interaction and a fundamental way of acquiring knowledge. In the rapidly growing field of health communication, narrative approaches are emerging as a promising set of tools for motivating and supporting health-behavior change. This article defines narrative communication and describes the rationale for using it in health-promotion programs, reviews theoretical explanations of narrative effects and research comparing narrative and nonnarrative approaches to persuasion, and makes recommendations for future research needs in narrative health communication.

Tailoring Health Messages: Customizing Communication with Computer Technology

Through the use of new technologies researchers and practitioners in health education and health communication can now provide health information and behavior change strategies that are customized based on the unique needs interests and concerns of different individuals. These are examples of tailored health messages which can be highly effective in assisting individuals in understanding and responding to health concerns. This book discusses the process of tailoring and its use in health communication programs. Moreover it presents a theoretical and public health rationale for tailoring and supports its position with empirical evidence. It is noted that tailored health promotion messages are any combination of information and behavior change strategies intended to reach one specific person based on characteristics that are unique to that person related to the outcome of interest and derived from an individual assessment. Hence it measures a participants needs interests and concerns and uses that information to create health messages and materials to fit that person. The step-by-step approach in creating tailoring programs is described in this book.

Narrative communication in cancer prevention and control: a framework to guide research and application.

Narrative forms of communication—including entertainment education, journalism, literature, testimonials, and storytelling—are emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose a typology of narrative application in cancer control. We assert that narrative has four distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. We further assert that different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship). This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way. Future research needs based on these propositions are outlined and encouraged.

A glossary for dissemination and implementation research in health.

Dissemination and implementation (D&I) Research is increasingly Recognized as an important function of academia and is a growing priority for major health-related funders. Because D&I Research in the health field has emerged from Research traditions in diverse disciplines Ranging from agriculture to education, there are inconsistencies in the use and meaning of terms and main concepts. This glossary provides definitions for the key concepts and terms of D&I Research in health (in both public health and clinical settings). Definitions are organized under five major sections: (1) foundation concepts; (2) types of Research; (3) models, theories, and frameworks; (4) factors influencing the D&I processes; and (5) measurement/evaluation of the D&I process. The aim of this glossary is to aid in the development of more standardized and established terminology for D&I Research, facilitate the communication across different stakeholders, and ultimately contribute to higher-quality D&I Research.

Effects of tailored, personalized and general health messages on physical activity

Physical inactivity is a major public health problem. Patient education programs and materials that are customized to address the unique needs and concerns of specific patients have shown promise in changing a range of health related behavior, although findings to date for physical activity have been equivocal. In this study a randomized controlled trial was conducted among 272 adult primary care patients to compare the effectiveness of tailored, personalized and general health messages, and usual medical care in promoting leisure time physical activity (LTA) and physical activities of daily living (PADLs). Patients in the tailored group were more likely to increase PADLs than were patients in the personalized, general and control groups (65% vs. 46% vs. 56% vs. 54%) and less likely to being doing fewer PADLs at follow-up (18% vs. 38% vs. 38% vs. 38%; chi 2 = 12.2, df = 6, p = 0.056). There were no significant differences for LTAs. To help maximize the effectiveness of future tailored interventions on physical activity, studies should seek to identify the social, psychological and environmental variables that are most important to include in tailored materials.

Comparing narrative and informational videos to increase mammography in low-income African American women

OBJECTIVE Compare effects of narrative and informational videos on use of mammography, cancer-related beliefs, recall of core content and a range of reactions to the videos. METHOD African American women (n=489) ages 40 and older were recruited from low-income neighborhoods in St. Louis, MO and randomly assigned to watch a narrative video comprised of stories from African American breast cancer survivors (Living Proof) or a content-equivalent informational video using a more expository and didactic approach (Facts for Life). Effects were measured immediately post-exposure and at 3- and 6-month follow-up. RESULTS The narrative video was better liked, enhanced recall, reduced counterarguing, increased breast cancer discussions with family members and was perceived as more novel. Women who watched the narrative video also reported fewer barriers to mammography, more confidence that mammograms work, and were more likely to perceive cancer as an important problem affecting African Americans. Use of mammography at 6-month follow-up did not differ for the narrative vs. informational groups overall (49% vs. 40%, p=.20), but did among women with less than a high school education (65% vs. 32%, p<.01), and trended in the same direction for those who had no close friends or family with breast cancer (49% vs. 31%, p=.06) and those who were less trusting of traditional cancer information sources (48% vs. 30%, p=.06). CONCLUSIONS Narrative forms of communication may increase the effectiveness of interventions to reduce cancer health disparities. PRACTICE IMPLICATIONS Narratives appear to have particular value in certain population sub-groups; identifying these groups and matching them to specific communication approaches may increase effectiveness.

Development and validation of brief scales to measure collectivism, religiosity, racial pride, and time orientation in urban African American women.

This article describes the development and pilot-testing of brief scales to measure four cultural constructs prevalent in urban African American women. Internal consistency and temporal stability were assessed in two convenience samples (n = 47 and n = 25) of primarily lower-income African American women. All scales performed well: collectivism (α = .93, r = .85, p < .001); religiosity (α = .88, r = .89, p < .001); racial pride (α = .84, r = .52, p < .001); present time orientation (α = .73, r = .52, p < .01) and future time orientation (α = .72, r = .54, p = .07).