BOX 7Exemplar study 2: comparison of adapted with adapted plus an additional component intervention

Resnicow et al. 2009.296 Tailoring a fruit and vegetable intervention on ethnic identity: results of a randomized study

Study design

This RCT was designed to test the addition of individual tailoring to an adapted intervention promoting fruit and vegetable intake in an African American adult population (n = 560)

Both the intervention and the control groups received a set of three newsletters over 3 months promoting behaviour change for improved nutrition. Topics addressed in the newsletters included food and vegetable preferences, social roles for shopping, barriers to fruit and vegetable intake and dietary limitations

Participants were recruited from two integrated health-care delivery systems, one in Detroit and one in Atlanta. Participants were randomly selected from health-care lists and health-care centre attendees in the two sites, respectively. One-third of the participants were randomised to the control group and two-thirds to the intervention. This 2 : 1 design was employed to ensure that enough people received all of the 16 types of newsletters that were developed for the intervention


The newsletters were tailored to demographic and social cognitive variables for both the intervention and the control groups. The control group newsletters were designed for a ‘general Black American audience with a slight Afrocentric focus’ and contained untailored ethnically neutral graphics that did not contain any people or other ethnic cues

The intervention group received additional individual tailoring to their ethnic identity. Ethnic identity was measured using an assessment of newsletter preference (e.g. would you prefer a newsletter designed for black people in America, black and white Americans, people of various races and cultures) and also through the Black Identity Classification Scale (BICS). The BICS assigned participants to 16 types of ethnic identity ranging, for example, from ‘Assimilated’ to ‘Afrocentric/Multicultural with Cultural Mistrust’. The adapted newsletters were therefore tailored to have messages and graphics (from a large database of images) that were appropriate to the 16 types of ethnic identity. For some participants this would mean that their newsletters were more adapted than the control newsletters, which were already targeted to a degree, and for others it would mean that they may be less adapted, that is, newsletters featuring both black and white Americans

Outcomes and insights

A follow-up survey was administered by telephone at approximately 3 months post intervention. A total of 468 participants (83.6%) provided 3-month follow-up data. The intervention group increased their fruit and vegetable intake by 1.1 servings per day compared with 0.8 servings for the control group. This difference was not statistically significant. A subsequent analysis compared only the participants assessed to be highly ‘Afrocentric’ in both the intervention and control groups and demonstrated a significant difference in intake of 1.4 servings per day compared with 0.43 servings per day, respectively (p < 0.05)

This was one of the few studies that measured ethnic identity and attempted to adapt according to this measure. Although overall there was no significant difference between groups, the subsequent analysis suggested that an adapted intervention was most successful for participants with strong cultural affiliations (the ‘Afrocentric’ group). It may be most beneficial to target adapted interventions to those who are most receptive to such an approach. Furthermore, the effects of the adaptation may have been diluted as the control newsletter was already adapted with a ‘slight Afrocentric focus’

From: 6, Systematic review of adapted health promotion interventions

Cover of Adapting Health Promotion Interventions to Meet the Needs of Ethnic Minority Groups: Mixed-Methods Evidence Synthesis
Adapting Health Promotion Interventions to Meet the Needs of Ethnic Minority Groups: Mixed-Methods Evidence Synthesis.
Health Technology Assessment, No. 16.44.
Liu JJ, Davidson E, Bhopal RS, et al.
© 2012, Crown Copyright.

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