Health Education Research, Vol. 16, No. 4, 507-508,
August 2001
© 2001 Oxford University Press
LETTERS TO THE EDITOR |
Response to Pasick
Health Communication Research Laboratory, School of Public Health, St Louis University, St Louis, MO 63108 and
1 Department of Surgery, Duke University Medical Center and Prevention and Control Program, Duke University Comprehensive Cancer Center, Durham, NC 27710, USA
We appreciate Dr Pasick's and others' (Rimer, 2000
) thoughtful responses to our Editorial (Kreuter and Skinner, 2000), and shared interest in arriving at common definitions for tailoring and targeting. Before addressing Dr Pasick's concerns specifically, we would like to call attention to the considerable common ground in our perspectives, as well as that shared with Dr Rimer. First, implicit in our Editorial and in the responses from Pasick and Rimer is endorsement of the health education truism that any program or educational materials will be more effective when audience characteristics are taken into account in the development process. Second, we each recognize the important—and to date underutilized—role of culture as one such audience characteristic. Third, we all agree that customization based on group-level variables differs from customization based on individual-level variables. Finally, we concur that our field needs to move towards clear and consistent use of key terminology.
Our differences with Dr Pasick on definitions of tailoring and targeting are semantic, not conceptual. Her inclusion of the American Heritage Dictionary's definition of `targeting' is helpful in illustrating this point. The definition includes two components—establishing a target and aiming for the target. Whereas Dr Pasick and colleagues' definition of `targeting' speaks more to identifying or establishing the target group, our use of the term is more closely associated with the process of aiming at or for something. Importantly, both are consistent with the dictionary definition. For example, health educators may target a group by selecting it to receive some program or intervention, but also subsequently target specific messages to address the unique characteristics of that group.
Dr Pasick also offers a dictionary definition of `tailoring' as a process of alteration or adaptation for a particular purpose. We agree that by this definition a message can be `tailored' to better fit a group or an individual. However, we see a clarity and parallelism in calling a message `targeted' when it is aimed toward a `target group' and `tailored' as in the case of a tailor-made suit—when it is aimed toward an individual. Dr Pasick suggests using the term `individual tailoring' to distinguish between approaches aimed at individuals versus groups. We, too, have used this term and its derivatives (e.g. `individually tailored'), but have recently discontinued this usage due to another problem. Rather than being interpreted as `for individuals' as we and Pasick intended it to be, the term connotes to some a process of creating intervention materials one at a time, rather than mass-producing them. Indeed, there are differences in the ways tailored messages can be produced. Whereas some programmers `hand-finish' each individual piece—and we have done this ourselves—others produce tailored messages en mass using fully automated computer programs. Titling the latter process as `individually tailored' is problematic in that it may imply a manual process that is neither efficient nor practical on a large-scale or population basis.
We agree with Dr Passick (and Dr Rimer) that the issue of culture and cultural tailoring is especially salient in this debate. In fact, it is on this point that we believe our suggested definitions of `targeting' and `tailoring' are most appropriate. Although culture and cultural traits are clearly shared, few would argue that culture is monolithic. For example, collectivism may be a value in a particular cultural group, but that does not mean collectivism is valued equally among all members of that group. Thus, while various members of a cultural group might recognize and respond to a single health appeal that integrated and reflected collectivist values, we would never expect that response to be uniform across all members of the group. One reason is, as Dr Pasick acknowledges in her letter, different individuals will have varying levels of endorsement of certain cultural beliefs. Whenever there is individual-level variation like this on a belief or construct that influences health or behavior, there is at least the possibility of enhancing communication effectiveness by customizing appeals to each individual accordingly. We believe the important question is not whether treating cultural variables in this way is appropriate, but rather can it enhance effectiveness of our programs and materials, and make them more acceptable to cultural groups. The latter is an empirical question that seems to us worth pursuing.
Finally, the assertion that tailored communication does not provide `different content for each person' is not supported by data. In fact, just the opposite appears to be true. In evaluating the `uniqueness' of different tailored communications within a given population, we have demonstrated that using even simple tailoring algorithms, 78–98% of study participants would receive a completely unique combination of messages that no other person received [(Kreuter, 2000), pp. 30–33]. Do higher rates of uniqueness lead to greater effectiveness? Is tailoring more effective than targeting? We know of few data answering either question and hope to soon see studies addressing these important issues. Our purpose is not to advocate for tailoring or targeting, but for a clarification of the meaning of these terms. We believe our definitions will facilitate researchers and practitioners making a clear distinction between the two.
References
Rimer, B. K. (2000) Response to Kreuter and Skinner. Health Education Research, 15, 503.
Kreuter, M. W. and Skinner, C. S. (2000) Tailoring, what's in a name? Health Education Research, 15, 1–4.
Kreuter, M. W., Farrell, D., Olevitch, L. and Brennan, L. (2000) Tailoring Health Messages: Customizing Communication Using Computer Technology. Lawrence Erlbaum, Mahwah, NJ.
Pasick, R. J. (2001) Response to Kreuter and Skinner. Health Education Research, 16, 503–505.
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