Psychological performance assessment via interactive voice response systems

Utilization, receptivity and reactivity to Interactive Voice Response daily monitoring in risky drinking smokers who are motivated to quit

INTRODUCTION

Interactive Voice Response (IVR) technology has become an increasingly popular and valid method for collecting Ecological Momentary Assessment (EMA) data on a variety of health-risk behaviors, including daily alcohol use and cigarette smoking, and for stimulating behavior change. However, very little research has evaluated the parameters of IVR compliance and reactivity in respondents who may have greater problem severity than samples previously examined in published IVR studies. This study examined the prevalence and correlates of use, receptivity and reactivity to IVR monitoring in 77 untreated risky drinking smokers who were motivated to quit within the next 6 months.

METHODS

Respondents completed twice daily IVR assessments for 28 days and were re-assessed immediately after IVR to measure receptivity and reactivity to daily monitoring and six months post-baseline.

RESULTS

Mean compliance rate was 70.6%, with a morning rate of 72.4% and an evening compliance rate of 68.9% out of all possible surveys. IVR assessments of drinking and smoking were significantly associated with baseline paper-pencil reports of the same. African-American participants and those who reported more daily stressful events were more compliant. Between the baseline session and the 6-month follow-up, 68% of the sample reported engaging in some form of smoking behavior change (50% reduction in CPD, a quit attempt, past-month continuous abstinence). Nearly 80% reported increased awareness of their behavior due to the IVR and 40% reported intentional behavior change from IVR monitoring. The odds of making a quit attempt at the 6-month follow-up were significantly higher among respondents who reported making purposeful changes to their smoking as a result of IVR monitoring (AOR=3.25, p<0.05).

CONCLUSIONS

Reactivity was associated with behavior change outcomes. IVR may be a useful tool for motivating behavior change in smokers with alcohol-use problems.

Interactive voice response technology for symptom monitoring and as an adjunct to the treatment of chronic pain

Chronic pain is a medical condition that severely decreases the quality of life for those who struggle to cope with it. Interactive voice response (IVR) technology has the ability to track symptoms and disease progression, to investigate the relationships between symptom patterns and clinical outcomes, to assess the efficacy of ongoing treatments, and to directly serve as an adjunct to therapeutic treatment for chronic pain. While many approaches exist toward the management of chronic pain, all have their pitfalls and none work universally. Cognitive behavioral therapy (CBT) is one approach that has been shown to be fairly effective, and therapeutic interactive voice response technology provides a convenient and easy-to-use means of extending the therapeutic gains of CBT long after patients have discontinued clinical visitations. This review summarizes the advantages and disadvantages of IVR technology, provides evidence for the efficacy of the method in monitoring and managing chronic pain, and addresses potential future directions that the technology may take as a therapeutic intervention in its own right.

Telephonic Remote Evaluation of Neuropsychological Deficits (TREND): longitudinal monitoring of elderly community-dwelling volunteers using touch-tone telephones

Use of interactive voice response (IVR) technology to monitor cognitive functioning in cognitively normal (CN), mild cognitive impairment (MCI), and mild dementia (MD) participants was examined using 107 community-dwelling participants, 65 to 88 years old. Baseline Clinical Dementia Ratings identified 36 participants as CN, 37 with MCI, and 34 as MD. Alzheimer's Disease Assessment Scale (ADAS) and Mini-Mental State Examinations were administered during clinic visits at weeks 0, 8, 16, and 24. IVR cognitive testing was completed at each visit and from participants' homes at weeks 4, 12, and 20. Study partners provided dementia symptoms severity ratings via IVR. The assessment system received 719 participant and 723 partner calls. All calls initiated by CN participants, 99.2% by MCI participants, and 87.3% by MD participants were completed. Telephonic Remote Evaluation of Neuropsychological Deficit tasks showed significant performance differences between participant groups, good reliability, and convergent validity with Mini-Mental State Examinations and ADAS-Cog measures. Automated cognitive testing calls took about 18 minutes to complete, and informant calls took approximately 4 minutes. IVR informant data were convergent with the ADAS-Noncog measure. Computer-automated assessments of cognitive functioning via IVR provided reliable, valid data. Such assessments might benefit routine clinical care and large-scale, longitudinal research in the future, but will require additional research over longer periods.

Dial "T" for Testing: Technological Flexibility in Neuropsychological Assessment

Computer-automated neuropsychological testing can be conducted over the telephone via interactive voice response (IVR) technology by adapting cognitive measures traditionally administered by a clinician or in paper-and-pencil formats. By utilizing automated telephone interviews in neuropsychological research, time and money can be saved, and patients can be assessed remotely. This paper reviews the use of IVR to assess neuropsychological functioning in six studies that examined alcohol impairment of mental and physical functioning, cognitive and psychomotor recovery after surgery, and impairment resulting from central nervous system disease. Future directions for expanding application of cognitive performance assessment via IVR are discussed.

Capturing the Moment: Innovative Approaches to Daily Alcohol Assessment

This article is a summary of a symposium presented at the 2005 Research Society on Alcoholism annual conference organized by Dan J. Neal and chaired by William R. Corbin. Event-level data, wherein each "event" (e.g., day) is captured as its own data point, capture the complex patterns of drinking and other high-risk behaviors in ways that the typical aggregate approach cannot. Because of their richness, methodologies that incorporate event-level data are becoming more common in alcohol research. At least 3 distinct forms of event-level data can be gathered: retrospective data (those collected on a single occasion, using memory aids to help each participant reconstruct all drinking events over a specific period of time), daily monitoring data (reporting on all events for that day), and momentary assessment (those recorded immediately following a drinking event or in response to a prompt from researchers). The goal of this symposium was to address many issues associated with event-level methodology, as well as demonstrate projects that are currently implementing such innovative data collection. The 4 presentations included in this symposium were "Realizing the Promise and Avoiding the Pitfalls of Retrospective Daily Estimation Assessments of Alcohol Use" by Frances K. Del Boca; "Using Interactive Voice Response Technology to Assess the Alcohol-Victimization Link" by Kathleen Parks, Linda King, and Ann Pardi; "Methodological Issues in Using Personal Data Assistants to Self-monitor Alcohol Consumption" by R. Lorraine Collins, Mark Muraven, and Charlene Vetter; and "Collecting Event-level Data Using the World Wide Web" by Dan J. Neal and Kim Fromme.

A Novel Interactive Voice Response (IVR) System for Dementia Screening, Education, and Referral: One-Year Summary

This article summarizes the data collected from an interactive voice response (IVR) system for dementia screening, education, and referral during its first year of use. After its development and pilot testing, the system was made available to the public via a toll-free number and advertised in targeted, rural areas in the state of Wisconsin. After 1 year of availability, the data gathered by the system suggests that the majority of the callers remained in the system long enough to, at minimum, listen to educational information. The system received calls from both those concerned about themselves and those concerned about another person. The screening portions of the system received significant use, and most individuals receiving positive screens continued to explore the interactive voice response system, suggesting they sought additional information. Overall, the 1-year results support the need for accessible and anonymous resources for individuals concerned about dementia.

Interactive voice response: review of studies 1989-2000

A systematic review of the use of interactive voice response (IVR) was conducted. IVR is a telephone interviewing technique in which the human speaker is replaced by a high-quality recorded interactive script to which the respondent provides answers by pressing the keys of a touch telephone (touchphone). IVR has numerous advantages, including economy, autonomy, confidentiality, access to certain population groups, improved data quality, standardized interviewing, multilingual interfaces, and detailed longitudinal assessments. Despite this, there have been few applications of IVR. Previous studies have been in the areas of information services, reminder calls, monitoring, assessment, experimentation, interventions, and surveys. Areas that have received little attention have been the systematic evaluation of voice, multilingual interfaces, touchphone prevalence, survey response rates, use by the elderly, and acceptability.

Assessing cognitive function in clinical trials: latest developments and future directions

Properly developed automated test systems are of value for assessing changes in cognitive function in clinical trials. Besides the other advantages that automation brings to trials, such as increased reliability and utility, it is shown that such systems are also more sensitive to change in cognitive function than traditional nonautomated procedures. Data from a variety of topical areas in drug development are presented to illustrate the added value such techniques have brought. The latest developments in automation include remote testing via the Internet and telephone.

Meeting the need for public education about dementia

Research continues to advance the knowledge of pathophysiology and development of effective methods for treating patients with Alzheimer disease and other dementias. Dissemination of information is likely to be slowest among the general population, who may be the first to recognize dementia symptoms but may also be reticent to discuss concerns because of fear, embarrassment, and/or inadequate knowledge. The feasibility of providing public education and access to dementia resources was studied using a toll-free interactive voice response (IVR) telephone system. Public interest in this service and willingness to use this technology were evaluated in a 1-month study conducted in a predominantly rural upper Midwest county (population of 102,565). One hundred ninety-three calls were received during November 1999, with an average length of 9 minutes and 29 seconds. One in six calls lasted 15 minutes or longer. One third of the calls were received outside typical business hours (8:00 AM to 6:00 PM). Concern for a parent or grandparent was the most frequent reason (50.6%) given for the call. Self-concern was indicated by 24.7% of the callers. Callers provided positive feedback. Such IVR technology may provide a cost-effective bridge to the "digital divide" existing among elderly, lower socioeconomic status, and rural populations underrepresented as computer and Internet users.