Health education to improve repeat participation in the Dutch breast cancer screening programme: evaluation of a leaflet tailored to previous participants

Mass behaviour change amid COVID-19: How public health information and social norms explain the transformation

COVID-19 is a severe and ongoing threat globally, with the spread disrupting lives and society. Despite the developments of vaccines, the key measure to reduce the transmission of variants has stemmed from mass changes to personal behaviours. COVID-19 pandemic offers a unique context, where the protection behaviours enacted by an individual are necessary to keep the community safe. A social psychological perspective can be used to understand the reasons for adherence to policies and determine what other factors can shape preventive behaviours. To resolve this, in partnership with health consumers we use an online survey, with the findings substantiating preventive behaviours are positively related to COVID-19 information access and descriptive norms. Additionally, findings demonstrate the mediating role of injunctive norms on preventive behaviour suggesting that policy makers can influence decision-making by promoting health information that provides guidance on acceptable behaviours, but also demonstrates subsequent success. The integrity of the model is substantiated by partial least squares (PLS) testing.

A systematic review of decision aids for mammography screening: Focus on outcomes and characteristics

PURPOSE

Decision Aid systems (DAs) provide information on the pros and cons of mammography. This study aimed to review the research on mammography DAs, synthesize the findings related to their outcomes and characteristics, and address the existed research gap.

METHODS

Relevant studies were identified through a comprehensive search on some e-databases, including PubMed, EMBASE, Scopus, and Web of Science in August 2020; by searching the keywords of "Breast cancer", "Screening", and "Decision aid systems" as well as their synonyms in the titles and abstracts of the papers with no time limits. Among the selected English journal papers with the interventional study design, those measuring outcome values of using mammography DAs were recognized as eligible for being included in this review.

RESULTS

The systematic search results in 16 DAs regarding mammography that were designed and then evaluated from 18 selected studies. The results showed that DAs provide improvements in knowledge and informed choice, the decreased decisional conflicts and decisional confidence, almost without changing any attitude towards mammography, mammography participation rates, psychological issues, anticipated regret, and perceived risk of breast cancer. The DAs' effects on women's inclination to screening were divergent. In other words, the DAs affect individuals' inclination in rare cases; however, on occasion, they could affect women's decision to undergo screening.

CONCLUSION

DAs could correct the bias attached to the existing knowledge on mammography and breast cancer in women so that they are more likely to make a precise decision. Additionally, it might be of central importance in shared decision-making and assisting health providers, in order to promote the quality of care. Accordingly, performing more studies is needed to develop more professional DAs in various countries with different facilities, cultures, and languages.

Measuring Consumer Willingness to Pay to Reduce Health Risks of Contracting Dengue Fever

Located in the subtropics, Taiwan is one of the major epidemic areas for dengue fever, with severe epidemics occurring in recent years. Dengue fever has become a serious health threat to Taiwan’s residents and a potentially serious economic cost to society. This study recruited 730 random participants and adopted the contingent valuation method to understand the factors influencing the populace’s willingness to pay (WTP) to reduce the health risk of dengue fever. The results show that high-income women with children and people with higher preventive perceptions and behavior are more willing to invest in preventive measures against dengue fever. In the evaluation of WTP for preventive treatment for health risks, each person was willing to pay on average NT$751 annually to lower psychological health risks, NT$793 annually to lower the risk of illness, and NT$1086 annually to lower the risk of death.

Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation

BACKGROUND

In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years.

PURPOSE

To review studies of screening in average-risk women with mammography, magnetic resonance imaging, or ultrasonography that reported on false-positive results, overdiagnosis, anxiety, pain, and radiation exposure.

DATA SOURCES

MEDLINE and Cochrane databases through December 2014.

STUDY SELECTION

English-language systematic reviews, randomized trials, and observational studies of screening.

DATA EXTRACTION

Investigators extracted and confirmed data from studies and dual-rated study quality. Discrepancies were resolved through consensus.

DATA SYNTHESIS

Based on 2 studies of U.S. data, 10-year cumulative rates of false-positive mammography results and biopsies were higher with annual than biennial screening (61% vs. 42% and 7% vs. 5%, respectively) and for women aged 40 to 49 years, those with dense breasts, and those using combination hormone therapy. Twenty-nine studies using different methods reported overdiagnosis rates of 0% to 54%; rates from randomized trials were 11% to 22%. Women with false-positive results reported more anxiety, distress, and breast cancer-specific worry, although results varied across 80 observational studies. Thirty-nine observational studies indicated that some women reported pain during mammography (1% to 77%); of these, 11% to 46% declined future screening. Models estimated 2 to 11 screening-related deaths from radiation-induced cancer per 100,000 women using digital mammography, depending on age and screening interval. Five observational studies of tomosynthesis and mammography indicated increased biopsies but reduced recalls compared with mammography alone.

LIMITATIONS

Studies of overdiagnosis were highly heterogeneous, and estimates varied depending on the analytic approach. Studies of anxiety and pain used different outcome measures. Radiation exposure was based on models.

CONCLUSION

False-positive results are common and are higher for annual screening, younger women, and women with dense breasts. Although overdiagnosis, anxiety, pain, and radiation exposure may cause harm, their effects on individual women are difficult to estimate and vary widely.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

Cultural aspects of ageing and health promotion

The emphasis of Australian Government policy is on the promotion of good health in later life and positive experiences with ageing. Conceptually, a new gerontology framework has replaced the study of disease, decline, loss and disability. Within this framework, health promotion offers a mechanism by which individuals can be assisted to create environments that offer better opportunities for continued participation in society and improved quality of health and self-care. Oral health is instrumental to older people's health, life satisfaction, quality of life and perception of self. Australia is culturally diverse, composed of numerous ethno-cultural groups coexisting within a larger, predominant culture, creating a multicultural and multiracial society. However, despite this cultural diversity, the well documented ageing profile of the Australian population and repeated calls for comprehensive geriatric assessment, the oral health of older adults remains a challenge for oral health providers and for society. A major challenge will be to translate existing knowledge and experience of disease prevention and health promotion into appropriate programmes for older adults. Health promotion is the key to improving oral health in later life as it encourages older adults to be proactive in regard to their health. Therefore, increased efforts should be directed towards identifying opportunities for health promotion activities and the development of community based models that encourage older people to improve and maintain their oral health. Ignoring opportunities for health promotion may increase inequalities in oral health and may lead to even greater demands for curative and oral rehabilitative services from these groups This article firstly provides a brief rationale for oral health promotion. Its second part explores the influence of culture on health beliefs, behaviours and outcomes in older adults and how oral health can relate to cultural background. The last section presents the results of an oral health promotion programme for older adults.

Educational effects of a tailored leaflet addressing drinking during pregnancy

OBJECTIVE

To examine the educational effects of a tailored leaflet on current drinking behavior, thoughts about drinking alcohol during pregnancy, and knowledge of fetal alcohol syndrome (FAS) among pregnant women.

DESIGN

Intervention.

PARTICIPANTS

We recruited pregnant women who were participating in maternity classes held at five municipal health centers in Saitama Prefecture and Tokyo in Japan.

METHODS

Questionnaires were administered before and after distribution of either a tailored or a non-tailored leaflet and again after the women delivered their babies.

RESULTS

More women read the non-tailored leaflet than the tailored one; this was because they felt they could read the non-tailored leaflet immediately. As for educational effects, the tailored leaflet was not superior to the non-tailored one in changing the women’s behavior, thoughts, or knowledge.

CONCLUSION

It is more important for health education leaflets to seem easy to read in terms of volume than to be tailored.

Cancer risk comparative perception and overscreening behaviours of non-carriers from BRCA1/2 families

Cancer-free women who are from families with an inherited form of breast and/or ovarian cancer (BRCA1/2) are referred to as 'unaffected non-carriers' when the results of genetic testing for the inherited gene are negative. Recent studies have identified overscreening behaviours (undergoing more screening tests for cancer than are medically warranted) among these women, even though they do not require specific cancer monitoring. Overscreening behaviours deserve particular attention due to their potential psychological drivers and implications. The principal objective of this study was to examine the factors, including state anxiety, feelings of self-vulnerability, and the comparative perception of cancer risk that might explain these overscreening behaviours. Unaffected non-carriers women (n = 77) were asked about these different variables. Overscreening was associated with and determined by feelings of self-vulnerability and the comparative perception of cancer risk, but was not associated with anxiety. An increase in feelings of self-vulnerability or elevated comparative pessimism (CP) was related to the participants' decision to be frequently screened. Patients' perceptions of the risk should be considered in measures or information aimed at preventing inappropriate overscreening behaviours.

Effectiveness of interventions to increase the participation rate of gastric cancer screening in the Republic of Korea: a pilot study

This study assessed the effectiveness of three intervention strategies to improve the participation rate of gastric cancer screening among people who had never undergone such screening, and those who had been screened for the disease, but not recently. It was conducted in the Ilsandong-gu District of Goyang City, Korea. The population for the current study was restricted to male residents, aged 40-65 years, who received an invitation letter to undergo gastric cancer screening from the National Health Insurance (NHI) Corporation at the beginning of 2010. The subjects were divided into two categories according to their screening history: never-screened, and ever-screened. A total of 2,065 men were eligible: 803 never-screened and 1,262 ever-screened. In each screening category they were randomly assigned to one of three intervention groups: 1) tailored telephone counseling; 2) tailored postcard reminder after tailored telephone counseling;and 3) tailored telephone counseling after tailored postcard reminder. At 3 months post-intervention, never- screened men with any intervention were more likely to undergo gastric cancer screening (OR=2.75, 95% CI: 1.22-6.18) compared to those in the reference group (no intervention). However, there was no statistically significant intervention effect in ever-screened men (OR=1.21, 95% CI: 0.65-2.27). Examination of the intervention effects by intervention group among never-screened men showed that those in the postcard reminder after telephone counseling group to be statistically significantly more likely to undergo gastric cancer screening (OR=4.49, 95% CI: 1.79-11.29) than the reference group (no intervention). Our results highlight that use of tailored postcard reminders after tailored telephone counseling is an effective method to increase participation in gastric cancer screening among men who had never been screened.

Characteristics of Educational Leaflets that Attract Pregnant Women

Background

Many health service sectors produce leaflets for health education, but specific issues such as their overall content and design (layout, graphics, illustrations) are seldom discussed. Important features contributing to the effectiveness of any leaflet is the extent to which it is read by its target audience. The purpose of this study was to examine the acceptability of two different leaflets on abstinence from alcohol during pregnancy.

Methods

Four semistructured group discussions were conducted among 33 pregnant women. They were asked if they would take, read, and save the leaflets, and to give a reason for their decision. The reasons were discussed according to the components of the leaflet, including its front cover, content, and illustrations.

Results

The design of a leaflet's front cover plays a key role in attracting pregnant women, and, in the event that readers are interested in the topic, they prefer a leaflet with detailed content, and a real-life example, eg, a photograph of a child with fetal alcohol syndrome.

Conclusion

Positive key characteristics should be incorporated into educational leaflets to enhance the attention given to the material by pregnant women, as well as to facilitate retention of the information.

Interventions to promote repeat breast cancer screening with mammography: a systematic review and meta-analysis

BACKGROUND

Various interventions to promote repeat use of mammography have been evaluated, but the efficacy of such interventions is not well understood.

METHODS

We searched electronic databases through August 15, 2009, and extracted data to calculate unadjusted effect estimates (odds ratios [ORs] and 95% confidence intervals [CIs]). Eligible studies were those that reported estimates of repeat screening for intervention and control groups. We tested homogeneity and computed summary odds ratios. To explore possible causes of heterogeneity, we performed stratified analyses, examined meta-regression models for 15 a priori explanatory variables, and conducted influence analyses. We used funnel plots and asymmetry tests to assess publication bias. Statistical tests were two-sided.

RESULTS

The 25 eligible studies (27 effect estimates) were statistically significantly heterogeneous (Q = 69.5, I(2) = 63%, P < .001). Although there were homogeneous subgroups in some categories of the 15 explanatory variables, heterogeneity persisted after stratification. For all but one explanatory variable, subgroup summary odds ratios were similar with overlapping confidence intervals. The summary odds ratio for the eight heterogeneous reminder-only studies was the largest observed (OR = 1.79, 95% CI = 1.41 to 2.29) and was statistically significantly greater than the summary odds ratio (P(diff) = .008) for the homogeneous group of 17 studies that used the more intensive strategies of education/motivation or counseling (OR = 1.27, 95% CI = 1.17 to 1.37). However, reminder-only studies remained statistically significantly heterogeneous, whereas the studies classified as education/motivation or counseling were homogeneous. Similarly, in meta-regression modeling, the only statistically significant predictor of the intervention effect size was intervention strategy (reminder-only vs the other two combined as the referent). Publication bias was not apparent.

CONCLUSIONS

The observed heterogeneity precludes a summary effect estimate. We also cannot conclude that reminder-only intervention strategies are more effective than alternate strategies. Additional studies are needed to identify methods or strategies that could increase repeat mammography.

Longitudinal predictors of nonadherence to maintenance of mammography

BACKGROUND

Regular adherence to screening mammography, also known as maintenance of mammography, reduces breast cancer morbidity and mortality. However, mammography maintenance is uncommon and little is known about why women do not maintain regular screening schedules. We investigated longitudinal predictors of women not maintaining adherence.

METHODS

Participants were insured women enrolled in an intervention trial who had screening mammograms 8 to 9 months before study enrollment (n = 1,493). Data were collected from 2003 to 2008. We used discrete event history analysis to model nonadherence to mammography maintenance over three successive annual screening intervals (+ 2 months).

RESULTS

Most (54%) women did not maintain screening adherence over 3 years. Women who did not maintain adherence were more likely to be ages 40 to 49 years, rate their health fair or poor, be less satisfied with their last mammography experiences, report one or more barriers to getting mammograms, be less than completely confident about getting their next mammograms (lower self-efficacy), or have weaker behavioral intentions. The odds of not maintaining adherence decreased over time.

DISCUSSION

Although great strides have been achieved in increasing the proportion of women who have received mammograms, most women still are not maintaining regular mammography use over time. Our findings provide insights into targets for future mammography maintenance interventions.

Matching health messages to monitor-blunter coping styles to motivate screening mammography

This study examined whether providing messages matched to women's monitor-blunter coping styles is effective in encouraging mammography utilization. Female callers to a cancer information hotline were assessed at the end of their regular telephone call and classified as monitors or blunters. A randomly assigned message promoting mammography utilization, tailored for monitors or blunters, was delivered on the telephone, and a similarly tailored brochure and refrigerator magnet were mailed to participants immediately after their call. Women were telephoned 6 and 12 months later to determine whether they had obtained a mammogram. Messages matched to a woman's monitor-blunter coping style encouraged mammography after 6 months more effectively than mismatched messages and were significantly more effective for blunters but not for monitors.

The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute's Cancer Information Service

In this large randomized trial among callers to the Cancer Information Service (CIS), tailored print materials were tested for efficacy in promoting colorectal cancer (CRC) screening (fecal occult blood test [FOBT], flexible sigmoidoscopy, or colonoscopy). All participants completed baseline interviews at the end of their usual service calls to the CIS, as well as short-term (6-month) and longer-term (14-month) telephone follow-up interviews. The study sample (n = 4,014) was restricted to English-speaking CIS callers 50 + years of age, who would be eligible for CRC screening at 14 months follow-up and did not call the CIS about CRC or CRC screening. Four experimental conditions were compared: a single untailored (SU) mailout of print material (the control condition); a single tailored (ST) mailout of print material; four (multiple) tailored (MT) mailouts of print materials spanning 12 months, all of which were tailored to information obtained at baseline; and four (multiple) retailored (MRT) mailouts also spanning 12 months, with retailoring of the print materials (mailouts 2, 3, and 4) based on updated information obtained from the 6-month follow-up interviews. Consistent with the main hypothesis of this trial, a significant linear trend across the SU, ST, MT, and MRT groups was found at 14 months (42%, 44%, 51%, and 48%, respectively, p = 0.05). Only for MT was there a significant difference compared with SU (p = 0.03) for the sample as a whole, while no differences were found for MT vs. MRT at 14 months. Significant moderator effects in the predicted direction were found among females, younger participants, and among those with a history of CRC screening, all of which involved the SU vs. MT MRT comparisons. Only among younger participants (ages 50-59) was there a difference between SU vs. ST at 14 months. Given these results, we conclude from this trial the following: (1) the MRT intervention failed to show added benefit beyond the MT intervention, (2) the significant intervention effects involving the MT and MRT conditions can be explained by tailoring and/or the longitudinal nature of both interventions, and (3) the most compelling evidence in support of tailoring was found for the ST condition among younger participants, where a significant need for interventions exists at the national level. Directions for future research are discussed in light of the results summarized above.

Comunicação instrumental, diretiva e afetiva em impressos hospitalares

Este trabalho se ocupa dos típicos sistemas semânticos extraídos dos recursos comunicativos de equipes hospitalares, que tentam validar informações como um "objeto" a ser transferido aos pacientes. Descrevemos modelos de comunicação textual em 58 impressos de orientações aos pacientes de cinco unidades hospitalares, coletados de 1996 a 2002. Identificamos três categorias fundamentadas na teoria dos atos de fala (Austin, Searle e Habermas): (1) Proferimentos cognitivo-instrumentais - descrições por meio de termos técnicos validados por argumentação auto-referente, incompleta ou inacessível; função educativa implícita. (2) Proferimentos técnico-diretivos - auto-referentes (contexto dos setores de origem); deslocamento freqüente de atos cotidianos para o terreno técnico com função disciplinadora; impessoalidade. (3) Modulações expressivas: necessidade de conexões intersubjetivas para fortalecer laços de confiança; tendência à infantilização. Concluímos que as categorias estudadas expõem: base em origens fragmentárias; pressupostos de univocidade de mensagens e consumo invariante da informação (motivações e interesses idealizados, alheios às perspectivas individuais); pressuposto de interesses universais como geradores de conhecimento.

[Communication prostheses and behavioral alignment in hospital leaflets]

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

Matching health messages to information-processing styles: need for cognition and mammography utilization

The use of tailored health communications has become a favored technique for persuading individuals to engage in health behaviors, such as screening mammography. This experiment examined the impact of tailoring persuasive health communications to one aspect of individuals' information-processing styles, that of the need for cognition (NFC), the enjoyment of thinking deeply about issues. To determine whether messages matched to an individual's NFC are more influential than mismatched messages, 602 women who called the Cancer Information Service (CIS) of the National Cancer Institute were asked to participate in an experiment at the end of their service call. They were assigned randomly to receive 1 of 2 phone messages promoting mammography use and a similarly tailored pamphlet 1 month later. Messages matched to an individual's NFC were better at motivating mammography 6 months later among high-NFC women. After controlling for prior mammography utilization, age, worry, intentions, perceived norms, suggestions to get a mammogram, and marital status, the interaction between participant NFC and message type also approached statistical significance. The differential influence of these brief, tailored communications diminished after 12 months, however.

The effects of mailed reminders and tailored messages on mammography screening

A mail campaign to promote mammography screening was tested with 3,887 Medicare recipients in North Dakota who had not had a mammogram in 2 1/2 years. Three types of mailings were compared: (1) a simple reminder message, (2) a reminder accompanied by a persuasive communication emphasizing personal risk, and (3) a reminder accompanied by a message tailored to the participants' chief barrier to having a mammogram. Overall, subsequent mammography rates for women in these conditions did not differ from the rate observed among women who did not receive any mailing. However, post-hoc analyses suggested that women who reported a barrier to having a mammogram were more likely to have a mammogram. Population-wide mail campaigns of the kinds tested here may be generally ineffective for Medicare recipients who are obtaining screenings infrequently. Tailoring messages may be one potentially effective intervention, if investigators can develop ways to increase responses to inquiries about barriers.

The effect of a stage-matched and tailored intervention on repeat mammography(1)

BACKGROUND

Our objective was to determine whether a tailored, stage-matched educational intervention, guided by the transtheoretical model (TTM), would increase rates of repeat-screening mammography. DESIGN SETTING/PARTICIPANTS: A total of 1324 women (N=1026 after attrition) aged 50 to 74 years were recruited from a staff-model health maintenance organization. Some of the women were not due for mammograms at the time of recruitment.

INTERVENTION

Women were randomly assigned to one of three intervention conditions: Group 1, no educational materials (usual care); Group 2, standard materials; and Group 3, stage-matched/tailored materials. Women in Groups 2 and 3 received a mailed education packet after both a baseline and a follow-up telephone interview. All women in Group 2 received the same materials regardless of differences in baseline mammography-related attitudes and behaviors. Each woman in Group 3 received materials based on her stage of adoption for mammography and TTM constructs.

MAIN OUTCOME

Using clinical records, repeat screening was defined as receipt of a second mammogram within 14 months after obtaining an initial postbaseline mammogram.

RESULTS

Women in Group 3 were more likely to obtain repeat-screening mammograms than women in Group 1 (44.2% vs 35.8%; adjusted rate ratio = 1.29, 95% confidence interval [CI]=1.11-1.46; adjusted rate difference = 0.06, 95% CI=-0.01-0.13). The screening percentage in Group 2 was intermediate (39.3%), and did not differ from either Group 3 or Group 1.

CONCLUSIONS

The effect of the stage-matched/tailored intervention was sustained for repeat screening, although no educational materials were delivered to coincide with the timing for a second mammogram. However, the stage-matched/tailored intervention was not sufficient to have a substantial impact on screening beyond the effect of standard educational materials. Future interventions may need to administer "booster" sessions to increase repeat screenings.

Is there a use for tailored print communications in cancer risk communication?

The manner of presentation of cancer risk information is critical to its understanding and acceptance by the individual recipient. Optimal communication of cancer risk information must effectively translate the technical meaning and subtleties of risk and its associated factors to a conceptual level understandable by the recipient. Tailored print communications (TPCs) may be an appropriate medium for cancer risk communication (CRC). TPCs are more refined than targeted communication materials. They are print materials created especially for an individual on the basis of knowledge about that person. The goal is to provide individually relevant and appropriate information. This review examines the nature of TPCs, assesses the use and potential of TPCs for the purpose of CRC, and highlights new directions in CRC. Articles dealing with TPCs were located by searching the MEDLINE(R) and PsychInfo(R) databases and seeking in-press articles. TPCs were identified for several areas of CRC, including dietary change, smoking cessation, mammography use, hormone replacement therapy, health risk appraisal, and genetic susceptibility to cancer. Although TPCs have been used in a number of different behavioral areas, they have not yet achieved their potential for CRC. The use of TPCs in the communication of cancer risk shows great promise, however, particularly as knowledge evolves regarding both the nature of risk and the most effective tailoring of health communication messages.

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 collected 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 delivering 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.

How effective is tailored print communication?

This article reviews the "first generation" of tailored print communications studies in the published literature, describing the purpose, theoretical framework, sample, research design, message type and source, outcomes measured, and findings of each. Eight studies compared tailored versus similar nontailored print; one compared tailored print versus an alternate intervention, and three included tailored print as one of several intervention components. Although studies varied by behavioral topic, type of tailoring, and measurement of behavioral outcomes, several themes persist. Compared to their nontailored counterparts, tailored print communications have been consistently better remembered, read, and perceived as relevant and/or credible. There is also evidence that tailored print communications are more effective for influencing health behaviors. Six of the eight tailored/nontailored comparisons found more behavior change among tailored than nontailored recipients. Tailored print communications have also demonstrated effectiveness as an adjunct to other intervention components such as self-help smoking cessation manuals. However, studies comparing tailored print communications with tailoring via other media such as telephone counseling have shown mixed results. Additional research is needed to assess whether the behavioral topic itself may make a difference in whether tailoring is appropriate and effective.