Treating chronic diseases can involve intensive programs designed to change people’s diet, exercise and other health behaviors.
But a typical program, while packed with information and advice, may overlook a fundamental reality: People’s lives can contain a variety of barriers to behaviors that can improve their health.
“The assumption is that if people follow these programs, their health will improve,” said Emily Fu, a clinical psychologist at the University of Chicago. “However, when you consider people’s real lives—busy schedules, different environments, mental health, social determinants of health and life circumstances—all of that affects whether they can engage in recommended behaviors.
“For example, you might recommend that someone walk for 30 minutes a day, but if they live somewhere without sidewalks or where they don’t feel safe walking, that’s not realistic.”
Fu, in her first year in the PITCH Fellowship at UChicago, studies how such real-world conditions influence long-term health. Yet while the importance of tailoring treatments to account for these factors is broadly accepted, it is neither a standardized practice nor well-understood.
“People often say they’re tailoring interventions, especially in behavioral medicine, but they rarely define what that means,” Fu said.
In a paper published in Prevention Science, she proposed a new way to measure whether health interventions are truly tailored to individuals—and showed that personalization can make a measurable difference in how people engage with treatment.
Scoring how well programs are tailored
The new framework describes tailoring as a structured process in which providers assess a participant’s health behaviors, mental health and social circumstances using validated questionnaires and discussions. Providers then work
collaboratively with participants to create a plan that addresses the most relevant barriers.
Fu applied her new Observational Assessment Tool for Tailoring (OATT) to data from two trials of the Family Check-Up 4® Health intervention, an adaptation of the internationally recognized Family Check-Up®, designed to support families to promote positive child outcomes. Families periodically met with a trained FCU4Health coordinator to develop strategies for improving health. At the beginning of the intervention and a year later, these families completed multiple surveys about family, parent and child health behaviors, mental health and social needs.
Using video recordings of feedback sessions with the FCU4Health coordinator and the parent, Fu and collaborators developed an observation-based scoring system to evaluate how well coordinators tailored their recommendations.
Coders watched nearly 200 recorded sessions across two trials, examining whether coordinators accurately identified the family’s needs and collaborated with them to develop personalized goals.
The scale ranged from zero to five, with higher scores reflecting stronger tailoring. A mid-range score indicated that the coordinator followed expected practices, while higher scores reflected especially thorough personalization and collaboration.
“Good tailoring means the coordinator accurately understands the family’s needs and collaborates with them to develop an appropriate plan,” she explains. “For example, if a parent says mental health is the main barrier and the coordinator connects them to a therapist, that’s good tailoring. If the parent says mental health is the issue but the coordinator focuses only on exercise, that’s poor tailoring.”
Personalized plans make a difference
The results showed that personalizing treatments made a difference.
“We found that better tailoring led to higher engagement during the intervention, which in turn predicted improvements in parents’ health behaviors after 12 months,” said Fu.
Moreover, the findings suggest that starting interventions on a strong personal note can help patients invest long-term in following the treatment.
“The tailoring session we analyzed was only the first session,” she said. “Even that initial session predicted later engagement. The key takeaway is the importance of thorough assessments and collaborative prioritization. Even if a program can’t perfectly tailor every element, focusing on participants’ main needs can improve engagement and outcomes.”
The work also addresses a practical challenge in health care—intensive programs can be expensive and difficult to implement widely. By identifying which elements of personalization matter most, Fu hopes future programs can deliver more efficient interventions that still maintain strong patient engagement.
In the future, she wants to adapt OATT into simpler checklists or self-assessment tools that clinicians can use in everyday practice.
Ultimately, her research aims to shift the focus of behavioral health interventions away from standardized prescriptions and toward a more collaborative model—one that recognizes that improving health behaviors often starts with understanding the complexities of people’s lives.
“Many health problems seen in primary care have behavioral components,” said Fu. “Clinicians and researchers work very hard to help patients change behaviors, often by adding more interventions. I’m interested in creating shorter, efficient, tailored behavioral interventions that fit into that setting.”
Citation: “Validation of the Observational Assessment Tool for Tailoring (OATT).” Fu et al, Prevention Science, Jan. 30, 2026.
Funding: Centers for Disease Control and Prevention, United States Department of Agriculture, National Heart, Lung, and Blood Institute, University of Chicago Primary Care Investigators Training in Chronic Disease & Health Disparities (PITCH) Fellowship.
—This article was originally published on the Biological Sciences Division website.