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International Collaboration Publishes Updated Cochrane Review on Tailored Interventions to Improve Clinical Practice
A collaboration among members of the Health Implementation Research Hub, led by Sheena McHugh, and international implementation scientists has resulted in the publication of an updated Cochrane systematic review entitled “Tailored interventions to address determinants of practice” in the Cochrane Database of Systematic Reviews.
The authorship team included two of the authors Michel Wensing and Signe Flottorp, in collaboration with leading implementation scientists, including Byron Powell, Cara Lewis and Luke Wolfenden, alongside a multidisciplinary team of researchers from 10 different institutions.
This publication provides comprehensive and up-to-date evidence on the effectiveness of tailored interventions compared with non-tailored interventions or no intervention. Tailored interventions comprise bundles of activities (implementation strategies) chosen to address the specific challenges (determinants of practice) faced by healthcare professionals in a given setting. The aim is to make it easier for healthcare professionals to follow the guidelines consistently over time. For example, if nurses in a busy clinic find a guideline too long to use during short appointments, a tailored strategy might provide a short visual summary or electronic prompts to remind the nurse about which actions to take. In contrast, a non-tailored strategy might be simply to distribute the full guideline without any consideration of the challenges faced by the nurses. By focusing on modifiable barriers within specific clinical contexts, tailoring aims to improve the uptake of evidence-based clinical guidelines and ultimately strengthen quality of care.
The updated review identified 79 studies published between 2014 and 2024. Across these studies, tailored interventions were found to be slightly more effective than non-tailored intervention or no intervention in improving professional practice. Most tailored approaches were multifaceted, combining several implementation activities. The most frequently used components included distribution of educational materials, educational meetings or training sessions for healthcare professionals, and audit and feedback interventions providing performance data.
The certainty of the evidence ranged from low to moderate, reflecting variability in study design, intervention components, and outcome measurement. While results suggest modest improvements, effects were generally small, and the optimal methods for identifying determinants and matching them to strategies remain uncertain. This underscores the need for more rigorous research to strengthen methodological approaches to tailoring.
Most included studies were conducted in high-income countries. There was limited evidence from low- and middle-income settings, indicating a gap in the global evidence base and the need for increased investment in implementation research in under-resourced health systems.
Dr McHugh received funding from the Health Research Board (HRB-RL-2020-004), which supported the conduct of this review.