Tailored interventions to address determinants of practice

Area of Science:

• Healthcare Implementation Science
• Clinical Practice Improvement
• Evidence-Based Medicine

Background:

• Tailored implementation strategies are recommended to enhance healthcare professional practice by addressing specific barriers.
• This review is an update of a 2015 publication, focusing on the effectiveness of tailoring strategies.

Purpose of the Study:

• To evaluate the impact of tailored implementation strategies versus non-tailored or no strategies on healthcare professional practice.
• To explore secondary objectives regarding the influence of theory, evidence, stakeholder input, and country income level on tailoring effectiveness.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, Embase) and trials registers from 2014 to March 2024.
• Included randomized controlled trials (RCTs) comparing tailored and non-tailored strategies, excluding patient-only behavior change studies.
• Performed meta-analyses using random-effects models and assessed risk of bias using Cochrane RoB 2 tool.

Main Results:

• Included 79 studies (52 new), with 35 comparing tailored vs. non-tailored strategies (5015 professionals) and 44 comparing tailored vs. no strategy (20,615 professionals).
• Tailored strategies likely result in a slight improvement in professional practice compared to non-tailored strategies (OR 1.49, 95% CI 1.26 to 1.75; moderate-certainty evidence).
• Tailored strategies showed a pooled odds ratio of 1.34 (95% CI 1.17 to 1.53) compared to no strategy.

Conclusions:

• Despite an increase in included studies, the main finding aligns with previous reviews.
• Tailored implementation strategies are likely to yield a slight improvement in healthcare professional practice.
• Further research may refine understanding of factors influencing tailoring effectiveness across diverse settings.