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Individual Tailoring and Community Targeting of Behavioral and Social Interventions to Improve Oral Health

Behavioral and Social Sciences Research Branch
Division of Extramural Research
 

OBJECTIVE:

The broad purpose of this initiative is to increase the efficacy of behavioral and social interventions in improving oral health, and to increase the efficiency of behavioral and social intervention research. The specific purpose of this initiative is to support research that identifies aspects of behavioral and social interventions that require tailoring for individuals, or targeting for communities or populations.  

BACKGROUND:

Health behaviors play an important role in oral and craniofacial diseases and conditions, and behavioral and social interventions can improve these health behaviors. One widely-held belief in behavioral and social intervention research is that interventions need to be tailored to meet individuals’ specific needs, or targeted to meet the needs of communities or populations. This belief has led to the development of hundreds of behavioral or social interventions aimed at improving dozens of health behaviors. A major challenge in behavioral and social research has been the absence of an empirical basis for deciding when tailoring is needed, and what aspects of the intervention need to be tailored. An excerpt from a 2008 article by Alan Kazdin, during his Presidency of the American Psychological Association, illustrates this nicely: 

We know from everyday life that when we are told “one size fits all,” the garment in question tends not to fit anybody very well. One assumes this is true of therapy too, but how to individualize therapy for each person and how to show that doing so makes a difference are topics researchers have still not helped elaborate and that are difficult to defend. 

A related aspect of the tailoring challenge is the need to identify principles of behavior change that may apply to multiple individuals and/or populations, across multiple settings, or to multiple oral health conditions. Assuming that certain aspects of behavioral or social interventions need to be tailored to address unique needs of the target population, might there be general principles of behavior change that can be harnessed across populations? A trans-NIH group of behavioral and social scientists recently highlighted the importance and timeliness of this question by developing a Funding Opportunity Announcement entitled, “Science of Behavior Change: Finding Mechanisms of Change in the Laboratory and the Field (R01)."  

Behavioral and social sciences research has generated a large body of evidence about individual differences between patients, and cultural and social differences between communities and populations. Infant feeding practices, parental attitudes toward oral health, access to and use of fluoride, tobacco use, injury-risk behaviors, access to and utilization of professional oral health care, and dental anxiety are just some of the differences between individuals or populations that have been associated with differential oral health. 

Despite a large body of evidence suggesting that characteristics of individuals and communities are associated with differential oral health, there is little empirical data about how best to target behavioral or social interventions to the needs of various individuals and communities. Behavioral and social interventions tend to be developed anew, for each new health concern, for each new population, in each new setting. This process is inefficient, missing opportunities to draw on and contribute to an empirical basis for behavior change, and more importantly, slows progress in meeting the needs of our populations. Developing an empirical basis to guide the tailoring or targeting of behavioral and social interventions is a major gap in our knowledge.

 

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This page last updated: February 26, 2014