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Objective The aim of this study is to review the evidence for tailored eHealth weight-loss interventions, describing in detail: 1. how tailoring was implemented in these studies and 2. whether these tailored approaches were effective in producing weight loss compared with generic or inactive controls. Methods A systematic review was carried out. Five databases were searched up until 15 March, 2018, including: EBSCO, Science Direct, Pubmed, EMBASE and Web of Science, using combinations of the concepts ‘tailoring’, ‘eHealth’ and ‘overweight’. Results Eight articles relating to six interventions were accepted. Tailoring was carried out in a number of ways, based on, for example, anthropometric data, health-related behaviours (e.g. dietary intake, physical activity), goals (e.g. weight goal), theoretical determinants (e.g. confidence/willingness to change behaviours), psychosocial factors (e.g. social support) and participant location. Systems acquired data using strategies that ranged from online questionnaire administration, to the dynamic gathering of data from web-based diaries, websites, mobile applications and SMS messaging. Tailored interventions were more effective in supporting weight loss than generic or waitlist controls in four of the six articles. Effect sizes were very small to moderate, with evidence for fluctuations in effect sizes and differences of effect between tailoring and non-tailoring interventions, and between tailoring types, over time. Conclusions We contribute an enhanced understanding of the variety of methods used for the tailoring of eHealth interventions for weight loss and propose a model for categorising tailoring approaches.

Legislators claim that how they explain their votes matters as much as or more than the roll calls themselves. However, few studies have systematically examined legislators' explanations and citizen attitudes in response to these explanations. We theorize that legislators strategically tailor explanations to constituents in order to compensate for policy choices that are incongruent with constituent preferences, and to reinforce policy choices that are congruent. We conduct a within-subjects field experiment using U.S. senators as subjects to test this hypothesis. We then conduct a between-subjects survey experiment of ordinary people to see how they react to the explanatory strategies used by senators in the field experiment. We find that most senators tailor their explanations to their audiences, and that these tailored explanations are effective at currying support—especially among people who disagree with the legislators' roll-call positions.

Background Implementation strategies are methods or techniques to improve the adoption, implementation, sustainment, and scale-up of evidence-based interventions. Limited guidance exists on feasible processes for selecting and tailoring implementation strategies in community (non-clinical) settings. The Implementation Strategies Applied in Communities (ISAC) compilation includes a pragmatic matching process to accompany the compilation (ISAC Match). This study expands on ISAC Match by providing additional detail and potential approaches to complete the four-step matching process, including a case study from work in a state Cooperative Extension System. Implementation Strategies Applied in Communities Matching Process (ISAC Match) ISAC Match is intended to be applied within integrated research-practice partnerships or similar models. Before beginning the ISAC Match process, participants should have identified a new or existing evidence-based intervention they are interested in integrating (or improving the integration of) and have the power and scope to influence implementation. ISAC Match includes four steps: 1) reviewing available information on evidence-based intervention integration and conducting contextual inquiry, if needed, to understand barriers and facilitators; 2) identifying existing implementation strategies used in the implementing organization, 3) using recommended guidance tools to select relevant implementation strategies to overcome barriers and capitalize on facilitators; and 4) tailoring strategies to fit within the setting they will be used in. These steps are completed with health equity considerations in mind to ensure that implementation strategies are designed to improve adoption, implementation, and maintenance in ways that seek to narrow existing health disparities. To illustrate the use of ISAC Match, this study applied the four-step ISAC Match process to select and tailor implementation strategies to increase Montana State University Extension Agents’ adoption of built environment approaches that facilitate physical activity. Conclusions The ISAC match process was developed to apply to community settings because of a lack of guidance on rapid, relevant methods for selecting and tailoring implementation strategies to overcome barriers and capitalize on facilitators. Future work is needed to determine whether the ISAC match process is more efficient and whether results are more impactful than other matching processes that are less specific to community settings.

Background Pain affects an estimated 1.5 billion people globally. Cultural factors strongly influence how pain is perceived, communicated, and managed. However, it remains unclear to what extent, how, and for whom pain management approaches have been culturally tailored, and whether these adaptations have been evaluated to ensure cultural relevance and effectiveness. This scoping review addresses this gap. Methods We searched six electronic databases for peer-reviewed articles and grey literature, combining terms for pain and cultural tailoring. We included empirical studies (including protocols), published in English, that reported on the cultural tailoring of pain management approaches for adults (≥18 years). At least two reviewers independently screened titles and abstracts, followed by full text assessment. We charted data on study characteristics, cultural tailoring methods, and evaluation strategies, and synthesised results narratively. Results Our search identified 4,551 unique studies, of which we included 38. Of these, 32 (84%) were published after 2016, with 26 (68%) focusing on musculoskeletal pain. They reported the cultural tailoring of 27 unique pain management intervention approaches, of which 19 (70%) focused on racial and ethnic minorities mainly in high-income countries. Educational interventions were most commonly tailored ( n  = 9, 33%). Only four (15%) tailored approaches were delivered digitally. Most ( n  = 25, 93%) approaches underwent content adaptation through including culturally relevant language, metaphors, and gender considerations. Most employed early tailoring steps, such as information gathering (85%) and preliminary adaptation design (93%). Only six (22%) approaches used frameworks to guide the adaptation such as Intervention Mapping-Adapt, FRAME, and ADAPT-IT. The effectiveness of cultural tailoring was evaluated for 11 (41%) approaches, mainly through randomised controlled trials ( n  = 7, 26%). Conclusion This review identified several efforts to culturally tailor pain management approaches, particularly for racial and ethnic minorities with musculoskeletal pain in high-income countries. Most tailoring focused on content adaptation for in-person formats, with limited use of contextual modifications, digital delivery, or adaptation frameworks. Future research should broaden tailoring beyond content changes, make greater use of digital tools, and prioritise adaptations in low- and middle-income countries. Evaluation strategies should also expand to assess real-world implementation, and long-term outcomes.

Australia’s welfare-to-work system has been subject to ongoing political contestation and policy reform since the 1990s. In this paper we take a big picture look at the Australian system over time, re-visiting our earlier analysis of the impact of marketisation on flexibility at the frontline over the first ten years of the Australian market in employment services. That analysis demonstrated that marketisation had failed to deliver the service flexibility intended through contracting-out, and had instead produced market herding around a common set of standardised frontline practices. In the interim, there have been two further major redesigns of the Australian system at considerable expense to taxpayers. Re-introducing greater flexibility and service tailoring into the market has been a key aim of these reforms. Calling on evidence from an original, longitudinal survey of frontline employment service staff run in 2008, 2012 and 2016, this paper considers how the Australian market has evolved over its second decade. We find remarkable consistency over time and, indeed, evidence of deepening organisational convergence. We conclude that, once in motion, isomorphic pressures towards standardisation quickly get locked into quasi-market regimes; at least when these pressures occur in low-trust contracting environments.

Background The process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial. Methods Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews ( n  = 55) with implementation team members ( n  = 30) and observations of support calls ( n  = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach. Results Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members’ ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, ‘time’, both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success. Conclusion This study responds directly to McHugh et al.’s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested.

Objective Tailored digital health programs can promote positive health-related lifestyle changes and have been shown to be (cost) effective in trials. However, such programs are used suboptimally. New approaches are needed to optimise the use of these programs. This paper illustrates the potential of recommender systems to support and enhance computer-tailored digital health interventions. The aim is threefold, to explore: (1) how recommender systems provide health recommendations, (2) to what extent recommender systems incorporate theoretical models and (3) how the use of recommender systems may enhance the usage of computer-tailored interventions. Methods A scoping review was conducted, using MEDLINE and ScienceDirect, to identify health recommender systems reported in studies between January 2007 and December 2017. Information was subsequently extracted to understand the potential benefits of recommender systems for computer-tailored digital health programs. Titles and abstracts of 1184 studies were screened for the full-text screening, in which two reviewers independently selected articles and systematically extracted data using a predefined extraction form. Results A total of 26 articles were included for data extraction. General characteristics were reported, with eight studies reporting hybrid filtering. A description of how each recommender system provides a recommendation is described; the majority of recommender systems used messages as recommendation. We identified the potential effects of recommender systems on efficiency, effectiveness, trustworthiness and enjoyment of the digital health program. Conclusions Incorporating a collaborative method with demographic filtering as a second step to knowledge-based filtering could potentially add value to traditional tailoring with regard to enhancing the user experience. This study illustrates how recommender systems, especially hybrid programs, may have the potential to bring tailored digital health forward.

Background Antibiotic overuse at hospital discharge is common, costly, and harmful. While discharge-specific antibiotic stewardship interventions are effective, they are resource-intensive and often infeasible for hospitals with resource constraints. This weakness impacts generalizability of stewardship interventions and has health equity implications as not all patients have access to the benefits of stewardship based on where they receive care. There may be different pathways to improve discharge antibiotic prescribing that vary widely in feasibility. Supporting hospitals in selecting interventions tailored to their context may be an effective approach to feasibly reduce antibiotic overuse at discharge across diverse hospitals. The objective of this study is to evaluate the effectiveness of the Reducing Overuse of Antibiotics at Discharge Home multicomponent implementation strategy (“ROAD Home”) on antibiotic overuse at discharge for community-acquired pneumonia and urinary tract infection. Methods This 4-year two-arm parallel cluster-randomized trial will include three phases: baseline (23 months), intervention (12 months), and postintervention (12 months). Forty hospitals recruited from the Michigan Hospital Medicine Safety Consortium will undergo covariate-constrained randomization with half randomized to the ROAD Home implementation strategy and half to a “stewardship as usual” control. ROAD Home is informed by the integrated-Promoting Action on Research Implementation in Health Services Framework and includes (1) a baseline needs assessment to create a tailored suite of potential stewardship interventions, (2) supported decision-making in selecting interventions to implement, and (3) external facilitation following an implementation blueprint. The primary outcome is baseline-adjusted days of antibiotic overuse at discharge. Secondary outcomes include 30-day patient outcomes and antibiotic-associated adverse events. A mixed-methods concurrent process evaluation will identify contextual factors influencing the implementation of tailored interventions, and assess implementation outcomes including acceptability, feasibility, fidelity, and sustainment. Discussion Reducing antibiotic overuse at discharge across hospitals with varied resources requires tailoring of interventions. This trial will assess whether a multicomponent implementation strategy that supports hospitals in selecting evidence-based stewardship interventions tailored to local context leads to reduced overuse of antibiotics at discharge. Knowledge gained during this study could inform future efforts to implement stewardship in diverse hospitals and promote equity in access to the benefits of quality improvement initiatives. Trial registration Clinicaltrials.gov NCT06106204 on 10/30/23

Background In regions with weak healthcare systems, critical shortages of the healthcare workforce, and increasing prevalence of dual disease burdens, there is an urgent need for the implementation of proven effective interventions and strategies to address these challenges. Our mixed-methods hybrid type II effectiveness-implementation study is designed to fill this evidence-to-practice gap. This study protocol describes a cluster randomized controlled trial which evaluates the effectiveness of an implementation strategy, practice facilitation (PF), on the integration, adoption, and sustainability of a task-strengthening strategy for hypertension control (TASSH) intervention within primary healthcare centers (PHCs) in Lagos State, Nigeria. Design Guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM), this study tests the impact of a proven effective implementation strategy to integrate hypertension management into the HIV care cascade, across 30 PHCs. The study will be conducted in three phases: (1) a pre-implementation phase that will use CFIR to develop a tailored PF intervention for integrating TASSH into HIV clinics; (2) an implementation phase that will use RE-AIM to compare the clinical effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without PF) on BP reduction; and (3) a post-implementation phase that will use RE-AIM to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention components comprise (a) an advisory board to provide leadership support for implementing TASSH in PHCs; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice facilitators, who will serve as coaches, provide support, and performance feedback to the HIV nurses. Discussion This study is one of few, if any trials, to evaluate the impact of an implementation strategy for integrating hypertension management into HIV care, on clinical and implementation outcomes. Findings from this study will advance implementation science research on the effectiveness of tailoring an implementation strategy for the integration of an evidence-based, system-level hypertension control intervention into HIV care and treatment. Trial registration ClinicalTrials.gov ( NCT04704336 ). Registered on 11 January 2021.