If you were able to attend the Diffusion of Innovations book club in September, you will remember one of the questions: Should we be tailoring implementation strategies to the different “types” along the diffusion of innovations continuum—from innovator to laggard? In many ways it makes sense. You really don’t need strategies to get the innovators to adopt an evidence-based intervention—and maybe not even the early adopters—but the early majority likely need different strategies than the laggards.

Interestingly, a little over a week later, Jonathan Purtle, an implementation scientist who focuses on policy, asked his audience at the Society for Implementation Research Collaboration (SIRC) if we should be developing different implementation strategies based on the political affiliations of our target groups. In his keynote address on September 26th in Minneapolis, he presented on the growing polarization of the United States and the spread of political party affiliations by medical specialty. Although Dr. Purtle was neutral and inviting in his presentation, it felt more like a thought experiment. People in the audience were hesitant to respond. From a logical perspective, I wasn’t quite sure how to think about political affiliation tailoring in practice. From an emotional perspective, I was taught politics and religion are not to be discussed in polite conversation.

As I’ve thought about both examples, precision medicine also surfaced for me. In precision medicine, treatments are specifically designed and prescribed based on your own genetic make-up or even your environment and lifestyle. Most medical and public health evidence-based practices are based on probabilities among the general population—not an individual’s whole genome sequence. 

I’ll stop here because my math and statistics knowledge are enough to get me in trouble in these spaces. However, what is interesting to me is that all of these examples are about tailoring, a fundamental concept in implementation science. Implementation scientists accept that tailoring of an intervention and/or the implementation strategies to context is often required for successful implementation. Yet, I often assume this is tailoring to organizational level context (e.g., at the unit level in the hospital). Even for patients, the interventions and implementation strategies are designed with a population in mind (e.g.,  how do we get evidence-based psychotherapy to more rural Veterans with PTSD?)

What would change if implementation was tailored to individual characteristics? Can we imagine it or would we be stymied like those of us in the audience when Dr. Purtle asked us to think about tailoring implementation to political affiliation? I likely will continue to be stymied because my perspective is solidly in organizational level context and tailoring; however, these questions about assessing individual characteristics and using those to tailor implementation came right in a row and forced me to take pause. Each time I’m reintroduced to precision medicine, I go through a similar thought experiment. These questions remind me of the importance of socioecological models in implementation science—and they remind me that we need to go beyond classifying determinants into their micro, meso, or macro level. Should we be asking: When is it most impactful to focus on the individual? And balancing that question, what are the consequences and costs?

Please send me examples of tailoring to the individual – where you’ve seen it successfully done, where there are challenges. I need more fuel for continued discussion of this fascinating but perplexing topic.