Tailored interventions to address determinants of practice

Area of Science:

• Health Services Research
• Implementation Science
• Medical Education

Background:

• Health professional performance improvement often relies on tailored intervention strategies.
• Barriers to changing health professional behavior, termed determinants of practice, can impede implementation.
• Matching interventions to these determinants may increase the likelihood of successful change.

Purpose of the Study:

• To evaluate the effectiveness of tailored intervention strategies in enhancing professional practice and healthcare outcomes.
• This review compared interventions specifically designed to address identified practice determinants against non-tailored or no interventions.

Main Methods:

• A systematic search of multiple databases (Cochrane Library, MEDLINE, EMBASE, PubMed, CINAHL, BNI) was conducted up to May 2014, with a follow-up search in December 2014.
• Included were cluster-randomised controlled trials (RCTs) reporting objective practice or healthcare outcomes, where interventions were tailored to prospectively identified determinants of practice.
• Meta-regression and heterogeneity analyses were performed to assess intervention effectiveness and explore sources of variation.

Main Results:

• Thirty-two studies were included, with 15 contributing to quantitative analysis.
• Tailored interventions showed a pooled odds ratio of 1.56 (95% CI 1.27 to 1.93) for implementing recommended practice.
• Effectiveness varied across studies, consistent with meta-regression findings.

Conclusions:

• Tailored implementation strategies demonstrate effectiveness in improving health professional practice, though effects are variable and generally small to moderate.
• The number of high-quality studies remains limited, highlighting the need for more research.
• Further investigation is required to refine the methods for identifying determinants and selecting interventions for optimal tailoring.