Pilot of a novel cervical screening intervention: interactive voice response

Designing audience-centered interactive voice response messages to promote cancer screenings among low-income Latinas

INTRODUCTION

Cancer screening rates among Latinas are suboptimal. The objective of this study was to explore how Latinas perceive cancer screening and the use and design of interactive voice response (IVR) messages to prompt scheduling of 1 or more needed screenings.

METHODS

Seven focus groups were conducted with Latina community health center patients (n = 40) in need of 1 or more cancer screenings: 5 groups were of women in need of 1 cancer screening (breast, cervical, or colorectal), and 2 groups were of women in need of multiple screenings. A bilingual researcher conducted all focus groups in Spanish using a semistructured guide. Focus groups were recorded, transcribed, and translated into English for analysis. Emergent themes were identified by using thematic content analysis.

RESULTS

Participants were familiar with cancer screening and viewed it positively, although barriers to screening were identified (unaware overdue for screening, lack of physician referral, lack of insurance or insufficient insurance coverage, embarrassment or fear of screening procedures, fear of screening outcomes). Women needing multiple screenings voiced more concern about screening procedures, whereas women in need of a single screening expressed greater worry about the screening outcome. Participants were receptive to receiving IVR messages and believed that culturally appropriate messages that specified needed screenings while emphasizing the benefit of preventive screening would motivate them to schedule needed screenings.

CONCLUSION

Participants' receptiveness to IVR messages suggests that these messages may be an acceptable strategy to promote cancer screening among underserved Latina patients. Additional research is needed to determine the effectiveness of IVR messages in promoting completion of cancer screening.

Formative evaluation of the accuracy of a clinical decision support system for cervical cancer screening

Objectives

We previously developed and reported on a prototype clinical decision support system (CDSS) for cervical cancer screening. However, the system is complex as it is based on multiple guidelines and free-text processing. Therefore, the system is susceptible to failures. This report describes a formative evaluation of the system, which is a necessary step to ensure deployment readiness of the system.

Materials and methods

Care providers who are potential end-users of the CDSS were invited to provide their recommendations for a random set of patients that represented diverse decision scenarios. The recommendations of the care providers and those generated by the CDSS were compared. Mismatched recommendations were reviewed by two independent experts.

Results

A total of 25 users participated in this study and provided recommendations for 175 cases. The CDSS had an accuracy of 87% and 12 types of CDSS errors were identified, which were mainly due to deficiencies in the system's guideline rules. When the deficiencies were rectified, the CDSS generated optimal recommendations for all failure cases, except one with incomplete documentation.

Discussion and conclusions

The crowd-sourcing approach for construction of the reference set, coupled with the expert review of mismatched recommendations, facilitated an effective evaluation and enhancement of the system, by identifying decision scenarios that were missed by the system's developers. The described methodology will be useful for other researchers who seek rapidly to evaluate and enhance the deployment readiness of complex decision support systems.

Predictors of successful communication with interactive voice response systems in older people

OBJECTIVES

Interactive voice response (IVR) systems are computer programs that can interact with people to provide a number of services from business to health care. However, surveys examining people's attitudes toward these systems have consistently found that people in general and older people in particular strongly dislike these systems. We wanted to determine the memory and cognitive abilities that predict successful IVR interactions for older people.

METHOD

We compared the performance of 185 older adults (aged 65 and older) on normed cognitive tests (the Wechsler Adult Intelligence Scale fourth edition and the Wechsler Memory Scale fourth edition) with their performance on 4 real-life IVR systems that included fact-finding at governmental agencies and plane ticket reservation.

RESULTS

The results indicated that adults aged 65 and older experience significant difficulties in interacting with IVR systems. A significant number of people (20.5%) could not complete any of the tasks. Participants who could not complete any task were older and had the lowest full-scale IQ. However, there was little difference between the age of participants who completed 1, 2, 3, or 4 tasks. Rather, auditory memory and working memory were the best overall predictors for success in IVR tasks.

DISCUSSION

The impact of poorer auditory memory and working memory is compounded by programming practices that increase the demand on these abilities and create unnecessary difficulties. Successful use of IVR systems could eventually complement in person health services.

Participation in an ambulatory e-pharmacovigilance system

PURPOSE

There is growing concern about whether passive surveillance can detect adverse drug events (ADEs). Our objective was to demonstrate the reach of an interactive voice response system (IVRS) to systematically monitor symptoms experienced by ambulatory patients prescribed one of 31 medications, and to document whether there were differences in our ability to contact certain populations.

METHODS

Patients receiving a prescription for a target medication at one of 11 clinics were eligible for a cross-sectional IVRS survey, "e-pharmacovigilance," with a follow-up survey done 3 months later if the target medication was still listed on the patient's active medication list.

RESULTS

902 patients participated, representing 43.3% of contacted and 25.7% of potentially eligible patients with a working phone. After adjustment for demographics and drug class, patients >66 years were more likely to participate than those 56-65 years (odds ratio 1.47; 95% confidence interval 1.19-1.81). Hispanics were less likely than whites (0.56; 0.42-0.76), and those in low-income communities less likely to participate than those in high-income communities (0.69; 0.58-0.82). Patients prescribed asthma, or seizure medications were more likely to participate than those prescribed medications for insomnia. Of patients reached by the system, those prescribed medications were erectile dysfunction and smoking cessation were less likely, and those prescribed seizure medication were more likely to participate.

CONCLUSIONS

IVRS technology can be used to perform ambulatory e-pharmacovigilance for a broad spectrum of patients, particularly older individuals who may at particular risk for ADEs.

Technology and quality of life outcomes

OBJECTIVES

To discuss recent technological advances in quality of life (QOL) data collection and guidance for use in research and clinical practice. The use of telephone-, computer-, and web/internet-based technologies to collect QOL data, reliability and validity issues, and cost will be discussed, along with the potential pitfalls associated with these technologies.

DATA SOURCES

Health care literature and web resources.

CONCLUSION

Technology has provided researchers and clinicians with an opportunity to collect QOL data from patients that were previously not accessible. Most technologies offer a variety of options, such as language choice, formatting options for the delivery of questions, and data management services. Choosing the appropriate technology for use in research and/or clinical practice primarily depends on the purpose for QOL data collection.

IMPLICATIONS FOR NURSING PRACTICE

Technology is changing the way nurses assess QOL in patients with cancer and provide care. As stakeholders in the health care delivery system and patient advocates, nurses must be intimately involved in the evaluation and use of new technologies that impact QOL and/or the delivery of care.

Data equivalency of an interactive voice response system for home assessment of back pain and function

BACKGROUND

Interactive voice response (IVR) systems that collect survey data using automated, push-button telephone responses may be useful to monitor patients' pain and function at home; however, its equivalency to other data collection methods has not been studied.

OBJECTIVES

To study the data equivalency of IVR measurement of pain and function to live telephone interviewing.

METHODS

In a prospective cohort study, 547 working adults (66% male) with acute back pain were recruited at an initial outpatient visit and completed telephone assessments one month later to track outcomes of pain, function, treatment helpfulness and return to work. An IVR system was introduced partway through the study (after the first 227 participants) to reduce the staff time necessary to contact participants by telephone during nonworking hours.

RESULTS

Of 368 participants who were subsequently recruited and offered the IVR option, 131 (36%) used IVR, 189 (51%) were contacted by a telephone interviewer after no IVR attempt was made within five days, and 48 (13%) were lost to follow-up. Those with lower income were more likely to use IVR. Analysis of outcome measures showed that IVR respondents reported comparatively lower levels of function and less effective treatment, but not after controlling for differences due to the delay in reaching non-IVR users by telephone (mean: 35.4 versus 29.2 days).

CONCLUSIONS

The results provided no evidence of information or selection bias associated with IVR use; however, IVR must be supplemented with other data collection options to maintain high response rates.