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Votaw VR, Witkiewitz K, Van Horn ML, Crist RC, Pond T, Kranzler HR. An intensive longitudinal examination of topiramate treatment for alcohol use disorder: a secondary analysis of data from a randomized controlled trial. Addiction 2023; 118:1040-1052. [PMID: 36606295 PMCID: PMC10175136 DOI: 10.1111/add.16126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Previous findings have been equivocal as to whether a single-nucleotide polymorphism (rs2832407) in GRIK1, which encodes a glutamate receptor subunit, moderates the effects of topiramate treatment for drinking reduction. We leveraged intensive longitudinal data to provide greater precision and allow an examination of intermediate outcomes addressing this question. We used data from a randomized controlled trial (RCT) to test the hypotheses that topiramate treatment reduces daily heavy drinking, desire to drink and positive alcohol expectancies and that these effects are stronger in rs2832407*C-allele homozygotes. DESIGN Secondary data analysis of a randomized controlled trial. SETTING University of Pennsylvania Treatment Research Center in the United States. PARTICIPANTS/CASES Participants were 164 individuals (70.1% male, mean age = 51.42, 36.0% rs2832407*C-allele homozygotes) who sought to reduce or stop drinking. INTERVENTION AND COMPARATOR Participants were assigned to medication (topiramate or placebo), with stratification by genotype group (CC versus AA/AC) and treatment goal (reduce versus abstain). MEASUREMENTS During the 12-week treatment period, participants completed daily interactive voice response (IVR) surveys. FINDINGS On any given day during treatment, participants who received topiramate had lower odds of IVR-reported heavy drinking [odds ratio (OR) = 0.259, b (standard error, SE) = -1.351 (0.334), P < 0.001] and lower levels of desire to drink [b (SE) = -0.323 (0.122), P = 0.009] and positive alcohol expectancies [b (SE) = -0.347 (0.138), P = 0.013] than those who received placebo. Participants who received topiramate also reported greater reductions in positive alcohol expectancies during the first 2 weeks of treatment than those who received placebo [b (SE) = -0.028 (0.008), P = 0.001], but topiramate did not impact the daily rate of change in heavy drinking or desire to drink. Genotype did not moderate the effects of topiramate on any outcomes examined (P > 0.05). CONCLUSIONS Topiramate is an effective medication for individuals seeking to reduce heavy drinking. The effects are not moderated by the single-nucleotide polymorphism rs2832407.
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Affiliation(s)
- Victoria R Votaw
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
| | - M Lee Van Horn
- Department of Individual, Family and Community Education, Educational Psychology Program, University of New Mexico, Albuquerque, NM, USA
| | - Richard C Crist
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Timothy Pond
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Chukwu E, Gilroy S, Addaquay K, Jones NN, Karimu VG, Garg L, Dickson KE. Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey. JMIR Form Res 2021; 5:e23874. [PMID: 34766908 PMCID: PMC8663572 DOI: 10.2196/23874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/26/2020] [Accepted: 04/13/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. OBJECTIVE The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. METHODS This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. RESULTS Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media-only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). CONCLUSIONS mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale.
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Affiliation(s)
- Emeka Chukwu
- Department of Computer Information System, Faculty of Information and Communications Technology (ICT), Msida, Malta.,United Nations Population Fund Country Office, Freetown, Sierra Leone
| | - Sonia Gilroy
- United Nations Population Fund Country Office, Freetown, Sierra Leone
| | - Kojo Addaquay
- United Nations Population Fund Country Office, Freetown, Sierra Leone
| | - Nki Nafisa Jones
- United Nations Population Fund Country Office, Freetown, Sierra Leone
| | - Victor Gbadia Karimu
- National Secretariat for the Reduction of Teenage Pregnancy, New England, Freetown, Sierra Leone
| | - Lalit Garg
- Department of Computer Information System, Faculty of Information and Communications Technology (ICT), Msida, Malta
| | - Kim Eva Dickson
- United Nations Population Fund Country Office, Freetown, Sierra Leone
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Dione M, Kangethe E, Poole EJ, Ndiwa N, Ouma E, Dror I. Digital Extension Interactive Voice Response (IVR) mLearning: Lessons Learnt From Uganda Pig Value Chain. Front Vet Sci 2021; 8:611263. [PMID: 34262959 PMCID: PMC8273433 DOI: 10.3389/fvets.2021.611263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
We assessed the effectiveness of Interactive Voice Response (IVR) technology in delivering biosecurity messages for the control of African swine fever (ASF) in Uganda using a randomized controlled trial (RCT) with 408 smallholder pig farmers. Our results show that IVR technology significantly improved knowledge of farmers who had not been exposed to training on biosecurity. Furthermore, it enhanced knowledge for farmers who had received face-to-face (f2f) training in biosecurity. This group of farmers recorded the highest knowledge gain following IVR training compared to farmers who did not receive f2f training. IVR technology was perceived by farmers as a new technology capable of transforming their lives because it is time efficient, has high potential for resource saving and flexibility. IVR also seems to be gender sensitive as it addresses some of the constraints women face in accessing conventional extension services such as time. IVR is an innovative way for delivery of advisory information to pig farmers. The scalability of IVR technology could further be explored and its feasibility assessed for wider use by the extension systems in Uganda and elsewhere.
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Affiliation(s)
- Michel Dione
- International Livestock Research Institute, Dakar, Senegal
| | - Edwin Kangethe
- International Livestock Research Institute, Nairobi, Kenya
| | | | - Nicholas Ndiwa
- International Livestock Research Institute, Nairobi, Kenya
| | - Emily Ouma
- International Livestock Research Institute, Kampala, Uganda
| | - Iddo Dror
- International Livestock Research Institute, Addis Ababa, Ethiopia
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Byonanebye DM, Nabaggala MS, Naggirinya AB, Lamorde M, Oseku E, King R, Owarwo N, Laker E, Orama R, Castelnuovo B, Kiragga A, Parkes-Ratanshi R. An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e22229. [PMID: 33570497 PMCID: PMC7906832 DOI: 10.2196/22229] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/15/2020] [Accepted: 01/08/2021] [Indexed: 01/03/2023] Open
Abstract
Background Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings. Objective The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively. Methods Within the Call for Life study, ART-experienced and ART-naïve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4. Results Overall, 600 participants (413 female, 68.8%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3%) opted for IVR and 2 (0.7%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4%) active participants had picked up at least 50% of the calls. In the active intervention participants, high users (received >75% of reminders) had overall higher QoL compared to low users (received <25% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51%-75%) had better viral suppression at 12 months (80/94, 85% versus 11/19, 58%, P=.006). Conclusions Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic. Trial Registration ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080
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Affiliation(s)
- Dathan Mirembe Byonanebye
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Makerere University, Kampala, Uganda.,The Academy for Health Innovations, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Maria S Nabaggala
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Bwanika Naggirinya
- The Academy for Health Innovations, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Oseku
- The Academy for Health Innovations, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Rachel King
- The Academy for Health Innovations, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Noela Owarwo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eva Laker
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Orama
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosalind Parkes-Ratanshi
- The Academy for Health Innovations, Infectious Diseases Institute, Makerere University, Kampala, Uganda.,Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Tweheyo R, Selig H, Gibson DG, Pariyo GW, Rutebemberwa E. User Perceptions and Experiences of an Interactive Voice Response Mobile Phone Survey Pilot in Uganda: Qualitative Study. JMIR Form Res 2020; 4:e21671. [PMID: 33270037 PMCID: PMC7746503 DOI: 10.2196/21671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/11/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background With the growing burden of noncommunicable diseases in low- and middle- income countries, the World Health Organization recommended a stepwise approach of surveillance for noncommunicable diseases. This is expensive to conduct on a frequent basis and using interactive voice response mobile phone surveys has been put forth as an alternative. However, there is limited evidence on how to design and deliver interactive voice response calls that are robust and acceptable to respondents. Objective This study aimed to explore user perceptions and experiences of receiving and responding to an interactive voice response call in Uganda in order to adapt and refine the instrument prior to national deployment. Methods A qualitative study design was used and comprised a locally translated audiorecorded interactive voice response survey delivered in 4 languages to 59 purposively selected participants' mobile phones in 5 survey rounds guided by data saturation. The interactive voice response survey had modules on sociodemographic characteristics, physical activity, fruit and vegetable consumption, diabetes, and hypertension. After the interactive voice response survey, study staff called participants back and used a semistructured interview to collect information on the participant’s perceptions of interactive voice response call audibility, instruction clarity, interview pace, language courtesy and appropriateness, the validity of questions, and the lottery incentive. Descriptive statistics were used for the interactive voice response survey, while a framework analysis was used to analyze qualitative data. Results Key findings that favored interactive voice response survey participation or completion included preference for brief surveys of 10 minutes or shorter, preference for evening calls between 6 PM and 10 PM, preference for courteous language, and favorable perceptions of the lottery-type incentive. While key findings curtailing participation were suspicion about the caller’s identity, unclear voice, confusing skip patterns, difficulty with the phone interface such as for selecting inappropriate digits for both ordinary and smartphones, and poor network connectivity for remote and rural participants. Conclusions Interactive voice response surveys should be as brief as possible and considerate of local preferences to increase completion rates. Caller credibility needs to be enhanced through either masking the caller or prior community mobilization. There is need to evaluate the preferred timing of interactive voice response calls, as the finding of evening call preference is inconclusive and might be contextual.
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Affiliation(s)
- Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health, Lira University, Lira, Uganda
| | - Hannah Selig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George William Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizeus Rutebemberwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Swendeman D, Fehrenbacher AE, Roy S, Ray P, Sumstine S, Scheffler A, Das R, Jana S. A pilot randomized controlled trial (RCT) of daily versus weekly interactive voice response calls to support adherence among antiretroviral treatment patients in India. Mhealth 2020; 6:35. [PMID: 33437832 PMCID: PMC7793015 DOI: 10.21037/mhealth-19-248a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/21/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There are more than two million people living with HIV (PLH) in India, with more than 30% on antiretroviral treatment (ART) estimated to be non-adherent. This study aimed to (I) document adherence rates and related factors among ART patients in a large ART clinic in India, and (II) pilot test daily and weekly interactive voice response (IVR) calls to improve ART adherence and related outcomes. METHODS ART patients reporting missing at least one dose in prior 6 months (N=362) were enrolled and assessed via self-report and medical record review. Participants were randomized to one of two conditions: (I) twice-daily IVR call reminders with self-management support messaging, plus a weekly IVR adherence assessment; or (II) an attention control, with only weekly IVR adherence assessment. Participants completed study assessments at baseline, 2-, 4-, and 6-months with high retention (88% to 96%). RESULTS Intention-to-treat analyses found limited support for intervention effects for improving or maintaining ART adherence or CD4 counts between the two study arms over 6-months follow-up. Adherence increased significantly in the six months prior to baseline from about 65% to >95% with perfect adherence based on pill counts from medical records and consistent with patient self-report measures, which presented ceiling effects for detecting improvements in ART adherence in response to IVR intervention exposure. There was also limited support for intervention effects on secondary, self-management outcomes. CONCLUSIONS High levels of adherence were sustained throughout the 6-month RCT. IVR regulation changes in India delayed study launch for 6 months, which likely allowed mobilization of improved adherence at the clinic, provider and patient levels in anticipation of the study launch. Therefore, ceiling effects limited inferences on intervention effects to improve adherence. Results suggest that clinic-level adherence monitoring may be sufficient to mobilize adherence improvements by providers and patients. TRIAL REGISTRATION ClinicalTrials.gov registration #NCT02118454.
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Affiliation(s)
- Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA 90024, USA
| | - Anne E. Fehrenbacher
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA 90024, USA
| | - Soma Roy
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India
| | - Protim Ray
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India
| | - Stephanie Sumstine
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Aaron Scheffler
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Rishi Das
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Smaraijt Jana
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India
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Kassavou A, Mirzaei V, Brimicombe J, Edwards S, Massou E, Prevost AT, Griffin S, Sutton S. A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness. J Med Internet Res 2020; 22:e16629. [PMID: 32427113 PMCID: PMC7267991 DOI: 10.2196/16629] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/04/2020] [Accepted: 02/01/2020] [Indexed: 12/20/2022] Open
Abstract
Background The efficacy of a highly tailored digital intervention to support medication adherence and feasibility to support clinical effectiveness as an adjunct to the primary care setting has not been evaluated. Objective This trial aimed to assess the behavioral efficacy of a highly tailored digital intervention to support medication adherence and to evaluate the feasibility of its clinical effectiveness, in patients with either or both hypertension and type 2 diabetes. We also examined quality of life and mechanisms of behavior change. Intervention fidelity, engagement, and satisfaction were also explored. Methods This was a multicenter, individually randomized controlled trial of 2 parallel groups: an intervention group that received a highly tailored text message and interactive voice response intervention for 12 weeks, and a control group that received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of a repeat prescription. Systolic blood pressure and glucose levels were assessed by nurses blinded to group allocation during practice visits at 3 months follow-up. Questionnaires obtained data to assess intervention mechanisms of action and satisfaction and digital log files captured data to evaluate fidelity and engagement. Results A total of 135 nonadherent patients (62/135, 46% female; 122/135, 90.3%; aged above 50 years) were randomly allocated in the intervention (n=79) or in the control group (n=56); of whom 13% (18/135) were lost at follow-up. Medication adherence was significantly improved in the intervention group compared with the control group (t116=2.27; P=.02, 2-tailed). Systolic blood pressure was 0.6 mmHg (95% CI −7.423 to 6.301), and hemoglobin A1c was 4.5 mmol/mol (95% CI −13.099 to 4.710) lower in the intervention group compared with the control group. Changes in intentional nonadherence and nonintentional nonadherence explained the improvements in medication adherence in the intervention group (beta=.074, SE=0.464; P=.04), but not in the control group (beta=.00, SE 1.35; P=.37). The intervention had 100% fidelity, a median of 12 days of engagement, and 76% overall satisfaction. Conclusions Our trial is the first that has been conducted in the United Kingdom and showed that among nonadherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was effective at improving treatment adherence and feasible to obtain clinically meaningful outcomes. Changes in intentional and nonintentional nonadherence predicted the improvements in medication adherence. The intervention had high fidelity, engagement, and satisfaction. Future research using a rigorous design is needed to evaluate the clinical effectiveness and cost-effectiveness of the intervention in primary care. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149.
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Affiliation(s)
| | - Venus Mirzaei
- The University of Cambridge, Cambridge, United Kingdom
| | | | - Simon Edwards
- The University of Cambridge, Cambridge, United Kingdom
| | | | | | - Simon Griffin
- The University of Cambridge, Cambridge, United Kingdom
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Ssemugabo C, Rutebemberwa E, Kajungu D, Pariyo GW, Hyder AA, Gibson DG. Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study. JMIR Form Res 2019; 3:e15000. [PMID: 31793889 PMCID: PMC6918213 DOI: 10.2196/15000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap. Objective This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda. Methods This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis. Results Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey. Conclusions Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Makerere University College of Health Science, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Makerere University College of Health Science, Kampala, Uganda
| | - Dan Kajungu
- Iganga Mayuge Health and Demographic Surveillance Site, Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Gibson DG, Wosu AC, Pariyo GW, Ahmed S, Ali J, Labrique AB, Khan IA, Rutebemberwa E, Flora MS, Hyder AA. Effect of airtime incentives on response and cooperation rates in non-communicable disease interactive voice response surveys: randomised controlled trials in Bangladesh and Uganda. BMJ Glob Health 2019; 4:e001604. [PMID: 31565406 PMCID: PMC6747927 DOI: 10.1136/bmjgh-2019-001604] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 12/31/2022] Open
Abstract
Background The global proliferation of mobile phones offers opportunity for improved non-communicable disease (NCD) data collection by interviewing participants using interactive voice response (IVR) surveys. We assessed whether airtime incentives can improve cooperation and response rates for an NCD IVR survey in Bangladesh and Uganda. Methods Participants were randomised to three arms: a) no incentive, b) 1X incentive or c) 2X incentive, where X was set to airtime of 50 Bangladesh Taka (US$0.60) and 5000 Ugandan Shillings (UGX; US$1.35). Adults aged 18 years and older who had a working mobile phone were sampled using random digit dialling. The primary outcomes, cooperation and response rates as defined by the American Association of Public Opinion Research, were analysed using log-binomial regression model. Results Between 14 June and 14 July 2017, 440 262 phone calls were made in Bangladesh. The cooperation and response rates were, respectively, 28.8% (353/1227) and 19.2% (580/3016) in control, 39.2% (370/945) and 23.9% (507/2120) in 50 Taka and 40.0% (362/906) and 24.8% (532/2148) in 100 Taka incentive groups. Cooperation and response rates, respectively, were significantly higher in both the 50 Taka (risk ratio (RR) 1.36, 95% CI 1.21 to 1.53) and (RR 1.24, 95% CI 1.12 to 1.38), and 100 Taka groups (RR 1.39, 95% CI 1.23 to 1.56) and (RR 1.29, 95% CI 1.16 to 1.43), as compared with the controls. In Uganda, 174 157 phone calls were made from 26 March to 22 April 2017. The cooperation and response rates were, respectively, 44.7% (377/844) and 35.2% (552/1570) in control, 57.6% (404/701) and 39.3% (508/1293) in 5000 UGX and 58.8% (421/716) and 40.3% (535/1328) in 10 000 UGX groups. Cooperation and response rates were significantly higher, respectively in the 5000 UGX (RR 1.29, 95% CI 1.17 to 1.42) and (RR 1.12, 95% CI 1.02 to 1.23), and 10 000 UGX groups (RR 1.32, 95% CI 1.19 to 1.45) and (RR 1.15, 95% CI 1.04 to 1.26), as compared with the control group. Conclusion In two diverse settings, the provision of an airtime incentive significantly improved both the cooperation and response rates of an IVR survey, with no significant difference between the two incentive amounts. Trial registration number NCT03768323.
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Affiliation(s)
- Dustin G Gibson
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaeze C Wosu
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - George William Pariyo
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saifuddin Ahmed
- Population, Family And Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph Ali
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins University Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Alain B Labrique
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Iqbal Ansary Khan
- Institute of Epidemiology Disease Control and Research, Dhaka, Dhaka District, Bangladesh
| | | | - Meerjady Sabrina Flora
- Institute of Epidemiology Disease Control and Research, Dhaka, Dhaka District, Bangladesh
| | - Adnan A Hyder
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Raebel MA, Shetterly SM, Bhardwaja B, Sterrett AT, Schroeder EB, Chorny J, Hagen TP, Silverman DJ, Astles R, Lubin IM. Technology-Enabled Outreach to Patients Taking High-Risk Medications Reduces a Quality Gap in Completion of Clinical Laboratory Testing. Popul Health Manag 2019; 23:3-11. [PMID: 31107176 DOI: 10.1089/pop.2019.0033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clinical laboratory quality improvement (QI) efforts can include population test utilization. The authors used a health care organization's Medical Data Warehouse (MDW) to characterize a gap in guideline-concordant laboratory testing recommended for safe use of antirheumatic agents, then tested the effectiveness of laboratory-led, technology-enabled outreach to patients at reducing this gap. Data linkages available through the Kaiser Permanente Colorado MDW and electronic health record were used to identify ambulatory adults taking antirheumatic agents who were due/overdue for alanine aminotransferase (ALT), aspartate aminotransferase (AST), complete blood count (CBC), or serum creatinine (SCr) testing. Outreach was implemented using an interactive voice response system to send patients text or phone call reminders. Interrupted time series analysis was used to estimate reminder effectiveness. Rates of guideline-concordant testing and testing timeliness in baseline vs. intervention periods were determined using generalized linear models for repeated measures. Results revealed a decrease in percentage of 3763 patients taking antirheumatic agents due/overdue for testing at any given time: baseline 24.3% vs. intervention 17.5% (P < 0.001). Among 3205 patients taking conventional antirheumatic agents, concordance for all ALT testing was baseline 52.8% vs. intervention 65.4% (P < 0.001) among patients chronically using these agents and baseline 20.6% vs. intervention 26.1% (P < 0.001) among patients newly starting these agents. The 95th percentiles for days to ALT testing were baseline 149 vs. intervention 117 among chronic users and baseline 134 vs. intervention 92 among new starts. AST, CBC, and SCr findings were similar. Technology-enabled outreach reminding patients to obtain laboratory testing improves health care system outcomes.
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Affiliation(s)
- Marsha A Raebel
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Susan M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Bharati Bhardwaja
- Department of Pharmacy, Kaiser Permanente Colorado, Denver, Colorado
| | - Andrew T Sterrett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Emily B Schroeder
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Joseph Chorny
- Regional Laboratory, Colorado Permanente Medical Group, Denver, Colorado
| | - Tyson P Hagen
- Department of Rheumatology, Colorado Permanente Medical Group, Lafayette, Colorado
| | - David J Silverman
- Department of Rheumatology, Colorado Permanente Medical Group, Lafayette, Colorado
| | - Rex Astles
- Quality and Safety Systems Branch, Division of Laboratory Systems, Centers for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ira M Lubin
- Quality and Safety Systems Branch, Division of Laboratory Systems, Centers for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Fomby P, Sastry N. Data Collection on Sensitive Topics with Adolescents Using Interactive Voice Response Technology. Methoden Daten Anal 2019; 13:91-110. [PMID: 31031869 DOI: 10.12758/mda.2018.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe the development and implementation of a survey administered using interactive voice response (IVR) technology to collect information on sensitive topics in a US national sample of adolescents age 12-17. Respondents were participants in the Panel Study of Income Dynamics 2014 Child Development Supplement (N=1,098). We review questionnaire design, fieldwork protocols, data quality and completeness, and respondent burden. We find that in the context of research on sensitive topics with adolescents, IVR is a cost-efficient and flexible method of data collection that yields high survey response rates and low item nonresponse rates with distributions on key variables that are comparable to other national studies.
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12
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Saarela AL, Walzer A, Juppo AM. Use of telephone and web interfaces of interactive response technology at clinical investigator sites in clinical trials. Clin Trials 2019; 16:297-305. [PMID: 30813773 DOI: 10.1177/1740774519832329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Interactive response technologies are used in clinical trials to provide services such as automated randomization and medication logistics management. The objective of this article is to investigate the usage of telephone (Interactive Voice Response) and web (Interactive Web Response) interfaces of interactive response technologies at clinical investigator sites in clinical trials, to obtain information about the preferences of interactive response technology end users between the telephone and web interfaces, and to explore the relevance of the telephone interface in this setting. METHODS The data consist of an online survey conducted in spring 2016 with clinical investigators, study nurses, and pharmacists in 13 countries. RESULTS Ninety-eight percent of survey respondents preferred the web interface over the telephone interface, the most important reason being superior usability. However, the respondents indicated the usability of interactive response technology interfaces is not optimal, and lack of integration and consistency across systems is common. A vast majority of interactive response technology end users at clinical sites prefer to use the web interface over the telephone interface, but most also feel there would need to be a back-up system. CONCLUSIONS Based on the results, it would be beneficial to improve the usability of the interactive response technology interfaces, and to increase consistency across systems from the current level. Support to and training of the users, as well as clarifying the responsibilities between sites and the sponsor should also be a focal point. Study sponsors should explore with interactive response technology service providers how removing the telephone interface would impact future studies, and whether there could be a more efficient means to achieve a reliable back-up to the web interface instead of a dedicated telephone interface.
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Affiliation(s)
- Anna-Leena Saarela
- 1 Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, Formulation and Industrial Pharmacy Unit, University of Helsinki, Helsinki, Finland.,2 Crown CRO Oy, Espoo, Finland
| | - Anja Walzer
- 3 Bayer AG, Development, Pharmaceuticals, Berlin, Germany
| | - Anne Mari Juppo
- 1 Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, Formulation and Industrial Pharmacy Unit, University of Helsinki, Helsinki, Finland
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13
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Kassavou A, Houghton V, Edwards S, Brimicombe J, Sutton S. Development and piloting of a highly tailored digital intervention to support adherence to antihypertensive medications as an adjunct to primary care consultations. BMJ Open 2019; 9:e024121. [PMID: 30613027 PMCID: PMC6326276 DOI: 10.1136/bmjopen-2018-024121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This paper describes the systematic development and piloting of a highly tailored text and voice message intervention to increase adherence to medication in primary care. METHODS Following the Medical Research Council guidance, this paper describes (a) the systematic development of the theoretical framework, based on review of theories and meta-analyses of effectiveness; (b) the systematic development of the delivery mode, intervention content and implementation procedures, based on consultations, face-to-face interviews, think-aloud protocols, focus groups, systematic reviews, patient and public involvement/engagement input, intervention pre-test; and (c) the piloting of the intervention, based on a 1-month intervention; and follow-up assessment including interviews and questionnaires. The mixed-methods analysis combined findings from the parallel studies complementarily. RESULTS intervention development suggested the target behaviour of the intervention should be the tablets taken at a regular time of the day. It recommended that patients could be more receptive to intervention content when they initiate medication taking or they change prescription plan; and more emphasis is needed to patients' consent process. Intervention piloting suggested high intervention engagement with, and fidelity of, the intervention content; which included a combination of behaviour change techniques, and was highly tailored to patients' beliefs and prescription plan. Patients reported that the intervention content increased awareness about the necessity to take and maintain adherent to medication, reinforced social support and habit formation, and reminded them to take medication as prescribed. CONCLUSION Tailored automated text and voice message interventions are feasible ways to improve medication adherence as an adjunct to primary care. TRIAL REGISTRATION NUMBER ISRCTN10668149.
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Affiliation(s)
- Aikaterini Kassavou
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Vikki Houghton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Simon Edwards
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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14
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Cohn AM, Elmasry H, Ehlke SJ. Utilization, receptivity and reactivity to Interactive Voice Response daily monitoring in risky drinking smokers who are motivated to quit. Tob Induc Dis 2018; 16:25. [PMID: 31516425 PMCID: PMC6659485 DOI: 10.18332/tid/84972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, United States
| | - Hoda Elmasry
- Hoda Elmasry was at the Schroeder Institute for Tobacco Research and Policies Studies, Washington, United States at the time of data analysis and when the manuscript was submitted
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15
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Abstract
OBJECTIVE A number of promising automated behaviour change interventions have been developed using advanced phone technology. This paper reviewed the effectiveness of interactive voice response (IVR)-based interventions designed to promote changes in specific health behaviours. METHODS A systematic literature review of papers published between January 1990 and September 2017 in MEDLINE, CINAHL, Embase, PsycINFO, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. From the total of 2546 papers identified, 15 randomised control trials (RCTs) met the eligibility criteria and were included in a random effects meta-analysis. Meta-regression analysis was used to explore whether behaviour change techniques (BCTs) that were used in the interventions were associated with intervention effectiveness. RESULTS Meta-analysis of 15 RCTs showed that IVR-based interventions had small but significant effects on promoting medication adherence (OR=1.527, 95% CI 1.207 to 1.932, k=9, p=0.000) and physical activity (Hedges' g=0.254, 95% CI 0.068 to 0.439, k=3, p=0.007). No effects were found for alcohol (Hedges' g=-0.077, 95% CI -0.162 to 0.007, k=4, p=0.073) or diet (Hedges' g=0.130, 95% CI -0.088 to 0.347, k=2, p=0.242). In the medication adherence studies, multivariable meta-regression including six BCTs explained 100% of the observed variance in effect size, but only the BCT 'information about health consequences' was significantly associated with effect size (β=0.690, SE=0.199, 95% CI 0.29 to 1.08, p=0.000). CONCLUSION IVR-based interventions appear promising in changing specific health behaviours, such as medication adherence and physical activity. However, more studies are needed to elucidate further the combination of active components of IVR interventions that make them effective and test their feasibility and effectiveness using robust designs and objective outcome measures.
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Affiliation(s)
- Stergiani Tsoli
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Primary Care Unit, Behavioural Science Group, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aikaterini Kassavou
- Primary Care Unit, Behavioural Science Group, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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16
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Kassavou A, Sutton S. Automated telecommunication interventions to promote adherence to cardio-metabolic medications: meta-analysis of effectiveness and meta-regression of behaviour change techniques. Health Psychol Rev 2017; 12:25-42. [PMID: 28805162 DOI: 10.1080/17437199.2017.1365617] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Automated telecommunication interventions, including short message service and interactive voice response, are increasingly being used to promote adherence to medications prescribed for cardio-metabolic conditions. This systematic review aimed to comprehensively assess the effectiveness of such interventions to support medication adherence, and to identify the behaviour change techniques (BCTs) and other intervention characteristics that are positively associated with greater intervention effectiveness. Meta-analysis of 17 randomised controlled trials showed a small but statistically significant effect on medication adherence, OR = 1.89, 95% CI [1.51, 2.36], I2 = 89%, N = 25,101. Multivariable meta-regression analysis including eight BCTs explained 88% of the observed variance in effect size (ES). The BCTs 'tailored' and 'information about health consequences' were positively and significantly associated with ES. Future studies could explore whether the inclusion of these and/or additional techniques (e.g., 'implementation intentions') would increase the effect of automated telecommunication interventions, using rigorous designs and objective outcome measures.
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Affiliation(s)
| | - Stephen Sutton
- a Behavioural Science Group , University of Cambridge , Cambridge , UK
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17
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Rigotti NA, Chang Y, Rosenfeld LC, Japuntich SJ, Park ER, Tindle HA, Levy DE, Reid ZZ, Streck J, Gomperts T, Kelley JHK, Singer DE. Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials. J Gen Intern Med 2017; 32:1005-1013. [PMID: 28616847 PMCID: PMC5570745 DOI: 10.1007/s11606-017-4085-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/31/2017] [Accepted: 05/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospitalization offers smokers an opportunity to quit smoking. Starting cessation treatment in hospital is effective, but sustaining treatment after discharge is a challenge. Automated telephone calls with interactive voice response (IVR) technology could support treatment continuance after discharge. OBJECTIVE To assess smokers' use of and satisfaction with an IVR-facilitated intervention and to test the relationship between intervention dose and smoking cessation. DESIGN Analysis of pooled quantitative and qualitative data from the intervention groups of two similar randomized controlled trials with 6-month follow-up. PARTICIPANTS A total of 878 smokers admitted to three hospitals. All received cessation counseling in hospital and planned to stop smoking after discharge. INTERVENTION After discharge, participants received free cessation medication and five automated IVR calls over 3 months. Calls delivered messages promoting smoking cessation and medication adherence, offered medication refills, and triaged smokers to additional telephone counseling. MAIN MEASURES Number of IVR calls answered, patient satisfaction, biochemically validated tobacco abstinence 6 months after discharge. KEY RESULTS Participants answered a median of three of five IVR calls; 70% rated the calls as helpful, citing the social support, access to counseling and medication, and reminders to quit as positive factors. Older smokers (OR 1.36, 95% CI 1.20-1.54 per decade) and smokers hospitalized for a smoking-related disease (OR 1.65, 95% CI 1.21-2.23) completed more calls. Smokers who completed more calls had higher quit rates at 6-month follow-up (OR 1.49, 95% CI 1.30-1.70, for each additional call) after multivariable adjustment for age, sex, education, discharge diagnosis, nicotine dependence, duration of medication use, and perceived importance of and confidence in quitting. CONCLUSIONS Automated IVR calls to support smoking cessation after hospital discharge were viewed favorably by patients. Higher IVR utilization was associated with higher odds of tobacco abstinence at 6-month follow-up. IVR technology offers health care systems a potentially scalable means of sustaining tobacco cessation interventions after hospital discharge. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT01177176, NCT01714323.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa C Rosenfeld
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Providence, RI, USA
| | - Sandra J Japuntich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Providence, RI, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Zachary Z Reid
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
| | - Joanna Streck
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Timothy Gomperts
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Kassavou A, Sutton S. Reasons for non-adherence to cardiometabolic medications, and acceptability of an interactive voice response intervention in patients with hypertension and type 2 diabetes in primary care: a qualitative study. BMJ Open 2017; 7:e015597. [PMID: 28801402 PMCID: PMC5724082 DOI: 10.1136/bmjopen-2016-015597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study explored the reasons for patients' non-adherence to cardiometabolic medications, and tested the acceptability of the interactive voice response (IVR) as a way to address these reasons, and support patients, between primary care consultations. DESIGN, METHOD, PARTICIPANTS AND SETTING The study included face-to-face interviews with 19 patients with hypertension and/or type 2 diabetes mellitus, selected from primary care databases, and presumed to be non-adherent. Thirteen of these patients pretested elements of the IVR intervention few months later, using a think-aloud protocol. Five practice nurses were interviewed. Data were analysed using multiperspective, and longitudinalthematic analysis. RESULTS Negative beliefs about taking medications, the complexity of prescribed medication regimens, and the limited ability to cope with the underlying affective state, within challenging contexts, were mentioned as important reasons for non-adherence. Nurses reported time constraints to address each patient's different reasons for non-adherence, and limited efficacy to support patients, between primary care consultations. Patients gave positive experiential feedback about the IVR messages as a way to support them take their medicines, and provided recommendations for intervention content and delivery mode. Specifically, they liked the voice delivering the messages and the voice recognition software. For intervention content, they preferred messages that were tailored, and included messages with 'information about health consequences', 'action plans', or simple reminders for performing the behaviour. CONCLUSIONS Patients with hypertension and/or type 2 diabetes, and practice nurses, suggested messages tailored to each patient's reasons for non-adherence. Participants recommended IVR as an acceptable platform to support adherence to cardiometabolic medications between primary care consultations. Future studies could usefully test the acceptability, and feasibility, of tailored IVR interventions to support medication adherence, as an adjunct to primary care.
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Affiliation(s)
- Aikaterini Kassavou
- Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
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Gibson DG, Farrenkopf BA, Pereira A, Labrique AB, Pariyo GW. The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing. J Med Internet Res 2017; 19:e112. [PMID: 28476724 PMCID: PMC5438455 DOI: 10.2196/jmir.7340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/17/2017] [Accepted: 02/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background The rise in mobile phone ownership in low- and middle-income countries (LMICs) presents an opportunity to transform existing data collection and surveillance methods. Administering surveys via interactive voice response (IVR) technology—a mobile phone survey (MPS) method—has potential to expand the current surveillance coverage and data collection, but formative work to contextualize the survey for LMIC deployment is needed. Objective The primary objectives of this study were to (1) cognitively test and identify challenging questions in a noncommunicable disease (NCD) risk factor questionnaire administered via an IVR platform and (2) assess the usability of the IVR platform. Methods We conducted two rounds of pilot testing the IVR survey in Baltimore, MD. Participants were included in the study if they identified as being from an LMIC. The first round included individual interviews to cognitively test the participant’s understanding of the questions. In the second round, participants unique from those in round 1 were placed in focus groups and were asked to comment on the usability of the IVR platform. Results A total of 12 participants from LMICs were cognitively tested in round 1 to assess their understanding and comprehension of questions in an IVR-administered survey. Overall, the participants found that the majority of the questions were easy to understand and did not have difficulty recording most answers. The most frequent recommendation was to use country-specific examples and units of measurement. In round 2, a separate set of 12 participants assessed the usability of the IVR platform. Overall, participants felt that the length of the survey was appropriate (average: 18 min and 31 s), but the majority reported fatigue in answering questions that had a similar question structure. Almost all participants commented that they thought an IVR survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. Conclusions Overall, the participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Formative research and cognitive testing of the questionnaire is needed for further adaptation before deploying in an LMIC.
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Affiliation(s)
- Dustin G Gibson
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Brooke A Farrenkopf
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Amanda Pereira
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Alain B Labrique
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - George William Pariyo
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
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Gibson DG, Pereira A, Farrenkopf BA, Labrique AB, Pariyo GW, Hyder AA. Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review. J Med Internet Res 2017; 19:e139. [PMID: 28476725 PMCID: PMC5438460 DOI: 10.2196/jmir.7428] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/11/2017] [Accepted: 03/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey.
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Affiliation(s)
- Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Pereira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brooke A Farrenkopf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
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Brinkel J, May J, Krumkamp R, Lamshöft M, Kreuels B, Owusu-Dabo E, Mohammed A, Bonacic Marinovic A, Dako-Gyeke P, Krämer A, Fobil JN. Mobile phone-based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana - an evaluation of user experiences. Trop Med Int Health 2017; 22:622-630. [PMID: 28278352 DOI: 10.1111/tmi.12864] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate and determine the factors that enhanced or constituted barriers to the acceptance of an mHealth system which was piloted in Asante-Akim North District of Ghana to support healthcare of children. METHODS Four semi-structured focus group discussions were conducted with a total of 37 mothers. Participants were selected from a study population of mothers who subscribed to a pilot mHealth system which used an interactive voice response (IVR) for its operations. Data were evaluated using qualitative content analysis methods. In addition, a short quantitative questionnaire assessed system's usability (SUS). RESULTS Results revealed 10 categories of factors that facilitated user acceptance of the IVR system including quality-of-care experience, health education and empowerment of women. The eight categories of factors identified as barriers to user acceptance included the lack of human interaction, lack of update and training on the electronic advices provided and lack of social integration of the system into the community. The usability (SUS median: 79.3; range: 65-97.5) of the system was rated acceptable. CONCLUSIONS The principles of the tested mHealth system could be of interest during infectious disease outbreaks, such as Ebola or Lassa fever, when there might be a special need for disease-specific health information within populations.
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Affiliation(s)
- J Brinkel
- School of Public Health, University of Bielefeld, Bielefeld, Germany.,Department of Biological, Environmental, Occupational Health Sciences, University of Ghana, Accra, Ghana
| | - J May
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - R Krumkamp
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - M Lamshöft
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - B Kreuels
- Medical Clinic I, University Clinic Hamburg Eppendorf, Hamburg, Germany
| | - E Owusu-Dabo
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
| | - A Mohammed
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
| | - A Bonacic Marinovic
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - P Dako-Gyeke
- Department of Social and Behavioural Sciences, University of Ghana, Accra, Ghana
| | - A Krämer
- School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - J N Fobil
- Department of Biological, Environmental, Occupational Health Sciences, University of Ghana, Accra, Ghana
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Gwaltney C, Mundt JC, Greist JH, Paty J, Tiplady B. Interactive Voice Response and Text-based Self-report Versions of the Electronic Columbia-Suicide Severity Rating Scale Are Equivalent. Innov Clin Neurosci 2017; 14:17-23. [PMID: 28584693 PMCID: PMC5451034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectives: Our study objective was to compare the equivalence of a new version of the electronic Columbia-Suicide Severity Rating Scale that was administered on a tablet device with the existing interactive voice response version in order to support the prospective monitoring of suicidal ideation and behavior in clinical trials and clinical practice. Design: This was a randomized, crossover-equivalence study with no treatment intervention. Setting: The study setting was a psychiatric hospital. Participants: Fifty-eight recently admitted psychiatric inpatients and 28 employees of the hospital site were included in the study. Mean age was 41.0 years (standard deviation=12.5), and 59 percent were female. Measurements: Participants completed both tablet and interactive voice response versions in randomized order, with a 25-minute break between administrations. Finally, participants completed a second administration of the first administered version. Intraclass correlation coefficients (ICCs) and Kappa coefficients were used to evaluate agreement across modalities. Results: High levels of agreement were observed for most severe lifetime (ICC=0.88) and recent (ICC=0.79) ideation, occurrence of actual lifetime (Kappa=0.81) and recent (Kappa=0.73) suicide attempts, and occurrence of lifetime interrupted attempts (Kappa=0.78), aborted attempts (Kappa=0.54), and preparatory behaviors (Kappa=0.77), as well as non-suicidal self-injurious behavior (Kappa=0.73). Scores from both modes significantly differentiated psychiatric patients and hospital employee controls, and the test-retest reliability of both modes was excellent. Conclusions: These results support the validity and reliability of the new tablet-based electronic Columbia-Suicide Severity Rating Scale. This will allow the inclusion of the electronic Columbia-Suicide Severity Rating Scale in a wider range of clinical studies, particularly where a tablet is also being used to collect other study data.
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Affiliation(s)
- Chad Gwaltney
- Dr. Gwaltney is with Gwaltney Consulting, Westerly, Rhode Island (with ERT Inc. during the time of this study); Dr. Mundt is with ePRO Research Consulting, LLC, Sauk City, Wisconsin; Dr. Greist is Professor Emeritus of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Dr. Paty is with Quintiles Advisory Services at QuintilesIMS, Pittsburgh, Pennsylvania; and Dr. Tiplady is an honorary fellow at Edinburgh University Medical School, Scotland, UK (with ERT Inc. during the time of this study)
| | - James C Mundt
- Dr. Gwaltney is with Gwaltney Consulting, Westerly, Rhode Island (with ERT Inc. during the time of this study); Dr. Mundt is with ePRO Research Consulting, LLC, Sauk City, Wisconsin; Dr. Greist is Professor Emeritus of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Dr. Paty is with Quintiles Advisory Services at QuintilesIMS, Pittsburgh, Pennsylvania; and Dr. Tiplady is an honorary fellow at Edinburgh University Medical School, Scotland, UK (with ERT Inc. during the time of this study)
| | - John H Greist
- Dr. Gwaltney is with Gwaltney Consulting, Westerly, Rhode Island (with ERT Inc. during the time of this study); Dr. Mundt is with ePRO Research Consulting, LLC, Sauk City, Wisconsin; Dr. Greist is Professor Emeritus of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Dr. Paty is with Quintiles Advisory Services at QuintilesIMS, Pittsburgh, Pennsylvania; and Dr. Tiplady is an honorary fellow at Edinburgh University Medical School, Scotland, UK (with ERT Inc. during the time of this study)
| | - Jean Paty
- Dr. Gwaltney is with Gwaltney Consulting, Westerly, Rhode Island (with ERT Inc. during the time of this study); Dr. Mundt is with ePRO Research Consulting, LLC, Sauk City, Wisconsin; Dr. Greist is Professor Emeritus of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Dr. Paty is with Quintiles Advisory Services at QuintilesIMS, Pittsburgh, Pennsylvania; and Dr. Tiplady is an honorary fellow at Edinburgh University Medical School, Scotland, UK (with ERT Inc. during the time of this study)
| | - Brian Tiplady
- Dr. Gwaltney is with Gwaltney Consulting, Westerly, Rhode Island (with ERT Inc. during the time of this study); Dr. Mundt is with ePRO Research Consulting, LLC, Sauk City, Wisconsin; Dr. Greist is Professor Emeritus of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Dr. Paty is with Quintiles Advisory Services at QuintilesIMS, Pittsburgh, Pennsylvania; and Dr. Tiplady is an honorary fellow at Edinburgh University Medical School, Scotland, UK (with ERT Inc. during the time of this study)
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Rose GL, Badger GJ, Skelly JM, Ferraro TA, MacLean CD, Helzer JE. A Randomized Controlled Trial of IVR-Based Alcohol Brief Intervention to Promote Patient-Provider Communication in Primary Care. J Gen Intern Med 2016; 31:996-1003. [PMID: 27206539 DOI: 10.1007/s11606-016-3692-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/23/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Brief interventions for unhealthy drinking in primary care settings are efficacious, but underutilized. Efforts to improve rates of brief intervention though provider education and office systems redesign have had limited impact. Our novel brief intervention uses interactive voice response (IVR) to provide information and advice directly to unhealthy drinkers before a physician office visit, with the goals of stimulating in-office dialogue about drinking and decreasing unhealthy drinking. This automated approach is potentially scalable for wide application. OBJECTIVE We aimed to examine the effect of a pre-visit IVR-delivered brief alcohol intervention (IVR-BI) on patient-provider discussions of alcohol during the visit. DESIGN This was a parallel group randomized controlled trial with two treatment arms: 1) IVR-BI or 2) usual care (no IVR-BI). PARTICIPANTS In all, 1,567 patients were recruited from eight university medical center-affiliated internal medicine and family medicine clinics. INTERVENTIONS IVR-BI is a brief alcohol intervention delivered by automated telephone. It has four components, based on the intervention steps outlined in the National Institute of Alcohol Abuse and Alcoholism guidelines for clinicians: 1) ask about alcohol use, 2) assess for alcohol use disorders, 3) advise patient to cut down or quit drinking, and 4) follow up at subsequent visits. MAIN MEASURES Outcomes were patient reported: patient-provider discussion of alcohol during the visit; patient initiation of the discussion; and provider's recommendation about the patient's alcohol use. KEY RESULTS Patients randomized to IVR-BI were more likely to have reported discussing alcohol with their provider (52 % vs. 44 %, p = 0.003), bringing up the topic themselves (20 % vs. 12 %, p < 0.001), and receiving a recommendation (20 % vs. 14 %, p < 0.001). Other predictors of outcome included baseline consumption, education, age, and alcohol use disorder diagnosis. CONCLUSIONS Providing automated brief interventions to patients prior to a primary care visit promotes discussion about unhealthy drinking and increases specific professional advice regarding changing drinking behavior.
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Saquib J, King AC, Castro CM, Tinker LF, Sims S, Shikany JM, Bea JW, Lacroix AZ, Van Horn L, Stefanick ML. A pilot study combining Go4Life® materials with an interactive voice response system to promote physical activity in older women. J Women Aging 2016; 28:454-62. [PMID: 27387264 DOI: 10.1080/08952841.2015.1018065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Telephone-based interactive voice response (IVR) systems could be an effective tool for promotion of physical activity among older women. To test IVR feasibility, we enrolled 30 older women in a 10-week physical activity intervention designed around National Institute on Aging (NIA) Go4Life® educational materials with IVR coaching. Participants (mean age = 76 years) significantly increased physical activity by a mean 79 ± 116 (SD) minutes/week (p < .001). Participants reported that the Go4Life® materials, pedometer, and IVR coaching (70% reported easy technology) were useful tools for change. This pilot study demonstrates IVR acceptability as an evidence-based physical activity program for older women.
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Affiliation(s)
- Juliann Saquib
- a Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , California , USA
| | - Abby C King
- a Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , California , USA
| | - Cynthia M Castro
- a Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , California , USA
| | - Lesley F Tinker
- b Fred Hutchinson Cancer Research Center , Division of Public Health Sciences , Seattle , Washington , USA
| | - Stacy Sims
- a Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , California , USA
| | - James M Shikany
- c Division of Preventive Medicine , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Jennifer W Bea
- d University of Arizona Cancer Center, School of Medicine , University of Arizona , Tucson , Arizona , USA
| | - Andrea Z Lacroix
- b Fred Hutchinson Cancer Research Center , Division of Public Health Sciences , Seattle , Washington , USA.,e School of Public Health , University of Washington , Seattle , Washington , USA
| | - Linda Van Horn
- f Department of Preventive Medicine, School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - Marcia L Stefanick
- a Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , California , USA
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Strid C, Andersson C, Forsell Y, Öjehagen A, Lundh LG. Internet-based cognitive behaviour therapy and physical exercise - Effects studied by automated telephone assessments in mental ill-health patients; a randomized controlled trial. Br J Clin Psychol 2016; 55:414-428. [PMID: 27059176 DOI: 10.1111/bjc.12111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/04/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Mental ill-health has become a large health problem and it is important for caregivers to provide effective treatment alternatives. REGASSA is a randomized controlled study performed in primary care to study the effects of 12 weeks of Internet-based cognitive behaviour therapy (ICBT) and physical exercise (PE) compared with treatment as usual (TAU) in patients with mild-to-moderate mental ill-health. The present study aimed to examine the results of these treatment alternatives on psychological functioning, stress, and sleep disturbances. METHODS The study comprised 879 patients with mental ill-health taking part in the REGASSA study. Data were collected by Interactive Voice Response (IVR), a computerized, automated telephone technique. The treatments were compared at baseline, twice during treatment, at the end of treatment and at three follow-ups after treatment. Measures used were the Outcome Questionnaire-45, the short versions of the Perceived Stress Scale, and the Karolinska Sleep Questionnaire. RESULTS Linear mixed models showed that the patients in ICBT and PE had better results than in TAU on psychological functioning and sleep disturbances, p < .001, with weak-to-moderate effect sizes. On stress there were no differences; all groups made improvements. Women had stronger effects than men. More patients recovered on psychological functioning (OQ-45) in ICBT and PE than in TAU. CONCLUSIONS Internet-based cognitive behaviour therapy and PE proved to be effective treatment alternatives for patients with mild-to-moderate mental ill-health in improving psychological functioning, stress, and sleep disturbances and could be useful alternatives in primary care. PRACTITIONER POINTS Internet-based cognitive behaviour therapy and physical exercise proved to be effective treatment alternatives for mental ill-health patients in primary care. Automated techniques (Interactive Voice Response) could be useful for following treatment course in large groups of patients in the health care. It is important to use measures that capture different aspects of patients' health problems. The recruitment of participants was based on patients' interest and inclusion criteria which may have affect the generalizability.
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Affiliation(s)
| | | | - Yvonne Forsell
- Section for Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Öjehagen
- Department of Clinical Sciences, Lund, Psychiatry, Lund, Sweden
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Falconi M, Johnston S, Hogg W. A scoping review to explore the suitability of interactive voice response to conduct automated performance measurement of the patient's experience in primary care. Prim Health Care Res Dev 2016; 17:209-25. [PMID: 26242171 DOI: 10.1017/S1463423615000407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Practice-based performance measurement is fundamental for improvement and accountability in primary care. Traditional performance measurement of the patient's experience is often too costly and cumbersome for most practices. OBJECTIVE/METHODS This scoping review explores the literature on the use of interactive voice response (IVR) telephone surveys to identify lessons for its use for collecting data on patient-reported outcome measures at the primary care practice level. RESULTS The literature suggests IVR could potentially increase the capacity to reach more representative patient samples and those traditionally most difficult to engage. There is potential for long-term cost effectiveness and significant decrease of the burden on practices involved in collecting patient survey data. Challenges such as low response rates, mode effects, high initial set-up costs and maintenance fees, are also reported and require careful attention. CONCLUSION This review suggests IVR may be a feasible alternative to traditional patient data collection methods, which should be further explored.
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Abstract
OBJECTIVES To develop an interactive voice response (IVR) version of the Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) and to evaluate its reliability and acceptability in older adults. DESIGN The IVR system was embedded within the LLFDI-CAT program. To test the test-retest reliability and concordance of the IVR version of LLFDI-CAT with the telephone interviewer form (TIF), participants received the two versions of the LLFDI at baseline and at 1-week follow-up. SETTING Community. PARTICIPANTS Community-dwelling adults aged 65 and older (N = 50). MEASUREMENTS The LLFDI is a self-reported outcome measure developed to assess function and disability in older adults. RESULTS The IVR version of the LLFDI-CAT showed acceptable overall test-retest reliability (intraclass correlation coefficient (ICC) = 0.79-0.80) and concordance (ICC = 0.74-0.97) with the TIF. Although most participants preferred the TIF, the majority did not find the IVR version more difficult to use. CONCLUSION The IVR version of the LLFDI-CAT achieved reliability levels that were comparable with those of the TIF version. Future work is needed to improve the IVR design to better fit older adults' needs and preferences.
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Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan; Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
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Adams WG, Phillips BD, Bacic JD, Walsh KE, Shanahan CW, Paasche-Orlow MK. Automated conversation system before pediatric primary care visits: a randomized trial. Pediatrics 2014; 134:e691-9. [PMID: 25092938 DOI: 10.1542/peds.2013-3759] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical settings via spoken language. The objective of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians. METHODS English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were randomly assigned to groups by the system at the time of the call. Parents' spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit. Data were transferred to the electronic health records for review during visits. The study occurred in an urban hospital-based pediatric primary care center. Participants were called after the visit to assess (1) comprehensiveness of screening and counseling, (2) assessment of medications and their management, and (3) parent and clinician satisfaction. RESULTS PHP was able to identify and counsel in multiple areas. A total of 9.7% of parents responded to the mailed invitation. Intervention parents were more likely to report discussing important issues such as depression (42.6% vs 25.4%; P < .01) and prescription medication use (85.7% vs 72.6%; P = .04) and to report being better prepared for visits. One hundred percent of clinicians reported that PHP improved the quality of their care. CONCLUSIONS Systems like PHP have the potential to improve clinical screening, counseling, and medication management.
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Affiliation(s)
| | - Barrett D Phillips
- Research Department, VA Central Western Massachusetts, Leeds, Massachusetts; and
| | | | - Kathleen E Walsh
- Anderson Center and General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher W Shanahan
- General Internal Medicine, Boston University/Boston Medical Center, Boston, Massachusetts
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Rigotti NA, Regan S, Levy DE, Japuntich S, Chang Y, Park ER, Viana JC, Kelley JHK, Reyen M, Singer DE. Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial. JAMA 2014; 312:719-28. [PMID: 25138333 PMCID: PMC4507269 DOI: 10.1001/jama.2014.9237] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Health care systems need effective models to manage chronic diseases like tobacco dependence across transitions in care. Hospitalizations provide opportunities for smokers to quit, but research suggests that hospital-delivered interventions are effective only if treatment continues after discharge. OBJECTIVE To determine whether an intervention to sustain tobacco treatment after hospital discharge increases smoking cessation rates compared with standard care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial compared sustained care (a postdischarge tobacco cessation intervention) with standard care among 397 hospitalized daily smokers (mean age, 53 years; 48% were males; 81% were non-Hispanic whites) who wanted to quit smoking after discharge and received a tobacco dependence intervention in the hospital; 92% of eligible patients and 44% of screened patients enrolled. The study was conducted from August 2010 through November 2012 at Massachusetts General Hospital. INTERVENTIONS Sustained care participants received automated interactive voice response telephone calls and their choice of free smoking cessation medication (any type approved by the US Food and Drug Administration) for up to 90 days. The automated telephone calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard care participants received recommendations for postdischarge pharmacotherapy and counseling. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically confirmed past 7-day tobacco abstinence at 6-month follow-up after discharge from the hospital; secondary outcomes included self-reported tobacco abstinence. RESULTS Smokers randomly assigned to sustained care (n = 198) used more counseling and more pharmacotherapy at each follow-up assessment than those assigned to standard care (n = 199). Biochemically validated 7-day tobacco abstinence at 6 months was higher with sustained care (26%) than with standard care (15%) (relative risk [RR], 1.71 [95% CI, 1.14-2.56], P = .009; number needed to treat, 9.4 [95% CI, 5.4-35.5]). Using multiple imputation for missing outcomes, the RR for 7-day tobacco abstinence was 1.55 (95% CI, 1.03-2.21; P = .04). Sustained care also resulted in higher self-reported continuous abstinence rates for 6 months after discharge (27% vs 16% for standard care; RR, 1.70 [95% CI, 1.15-2.51]; P = .007). CONCLUSIONS AND RELEVANCE Among hospitalized adult smokers who wanted to quit smoking, a postdischarge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01177176.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Sandra Japuntich
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R. Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joseph C. Viana
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, CA
| | - Jennifer H. K. Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
| | - Michele Reyen
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
| | - Daniel E. Singer
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Abstract
The widespread availability of high speed, mobile cellular telephones and other advances in communication technology have the potential to change the way that interventions for substance use disorders (SUD) are delivered and how progress is monitored. This article reviews recent research on the use of new technology to monitor progress and deliver interventions for SUD. Several studies of telephone-based interventions show positive effects, but sometimes only in certain subgroups. However, other studies produced negative results. Studies support the use of interactive voice response (IVR) and personal digital assistants (PDAs) to conduct assessments, but there is little data on whether IVR- or PDA-based interventions improve outcomes. Text messaging has received comparatively little research, but appears promising as a means to conduct assessments and deliver automated interventions. Finally, smartphone technology provides the widest range of features and interventions and the greatest flexibility, but few intervention studies that use them have been conducted.
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Affiliation(s)
- James R McKay
- Perelman School of Medicine, University of Pennsylvania, And Philadelphia Veterans Affairs Medical Center
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31
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Steinberg DM, Levine EL, Lane I, Askew S, Foley PB, Puleo E, Bennett GG. Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial. J Med Internet Res 2014; 16:e114. [PMID: 24780934 PMCID: PMC4019773 DOI: 10.2196/jmir.2996] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND eHealth interventions are effective for weight control and have the potential for broad reach. Little is known about the use of interactive voice response (IVR) technology for self-monitoring in weight control interventions, particularly among populations disproportionately affected by obesity. OBJECTIVE This analysis sought to examine patterns and predictors of IVR self-monitoring adherence and the association between adherence and weight change among low-income black women enrolled in a weight gain prevention intervention. METHODS The Shape Program was a randomized controlled trial comparing a 12-month eHealth behavioral weight gain prevention intervention to usual care among overweight and obese black women in the primary care setting. Intervention participants (n=91) used IVR technology to self-monitor behavior change goals (eg, no sugary drinks, 10,000 steps per day) via weekly IVR calls. Weight data were collected in clinic at baseline, 6, and 12 months. Self-monitoring data was stored in a study database and adherence was operationalized as the percent of weeks with a successful IVR call. RESULTS Over 12 months, the average IVR completion rate was 71.6% (SD 28.1) and 52% (47/91) had an IVR completion rate ≥80%. At 12 months, IVR call completion was significantly correlated with weight loss (r =-.22; P=.04) and participants with an IVR completion rate ≥80% had significantly greater weight loss compared to those with an IVR completion rate <80% (-1.97 kg, SE 0.67 vs 0.48 kg, SE 0.69; P=.01). Similar outcomes were found for change in body mass index (BMI; mean difference -0.94 kg, 95% CI -1.64 to -0.24; P=.009). Older, more educated participants were more likely to achieve high IVR call completion. Participants reported positive attitudes toward IVR self-monitoring. CONCLUSIONS Adherence to IVR self-monitoring was high among socioeconomically disadvantaged black women enrolled in a weight gain prevention intervention. Higher adherence to IVR self-monitoring was also associated with greater weight change. IVR is an effective and useful tool to promote self-monitoring and has the potential for widespread use and long-term sustainability. TRIAL REGISTRATION Clinicaltrials.gov NCT00938535; http://www.clinicaltrials.gov/ct2/show/NCT00938535.
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Affiliation(s)
- Dori M Steinberg
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, NC, United States.
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32
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Hekler EB, Buman MP, Otten J, Castro CM, Grieco L, Marcus B, Friedman RH, Napolitano MA, King AC. Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial. Int J Behav Nutr Phys Act 2013; 10:109. [PMID: 24053756 PMCID: PMC3849440 DOI: 10.1186/1479-5868-10-109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor. METHODS Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions. RESULTS Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12). CONCLUSIONS Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.
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Affiliation(s)
- Eric B Hekler
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004, USA
- School of Medicine, Stanford University, Stanford, USA
| | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004, USA
- School of Medicine, Stanford University, Stanford, USA
| | - Jennifer Otten
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004, USA
| | - Cynthia M Castro
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004, USA
| | - Lauren Grieco
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004, USA
| | - Bess Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
| | - Robert H Friedman
- School of Medicine, Boston University and Boston Medical Center, Boston, USA
| | | | - Abby C King
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004, USA
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Hasin DS, Aharonovich E, O’Leary A, Greenstein E, Pavlicova M, Arunajadai S, Waxman R, Wainberg M, Helzer J, Johnston B. Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement. Addiction 2013; 108:1230-40. [PMID: 23432593 PMCID: PMC3755729 DOI: 10.1111/add.12127] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 12/21/2012] [Accepted: 01/17/2013] [Indexed: 12/13/2022]
Abstract
AIMS In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients. DESIGN Parallel random assignment to control (n = 88), MI-only (n = 82) or MI+HealthCall (n = 88). Counselors provided advice/education (control) or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment), counselors briefly discussed drinking with patients, using HealthCall graphs with MI+HealthCall patients. SETTING Large urban HIV primary care clinic. PARTICIPANTS Patients consuming ≥4 drinks at least once in prior 30 days. MEASUREMENTS Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days. FINDINGS End-of-treatment number of drinks per drinking day (NumDD) means were 4.75, 3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model χ(2) , d.f. = 9.11,2, P = 0.01). For contrasts of NumDD, P = 0.01 for MI+HealthCall versus control; P = 0.07 for MI-only versus control; and P = 0.24 for MI+HealthCall versus MI-only. Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients. However, for contrasts of NumDD among alcohol-dependent patients, P < 0.01 for MI+HealthCall versus control; P = 0.09 for MI-only versus control; and P = 0.03 for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others, effects were no longer significant. CONCLUSIONS For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.
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Affiliation(s)
- Deborah S. Hasin
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Ann O’Leary
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Rachel Waxman
- New York State Psychiatric Institute, New York, NY, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - John Helzer
- Department of Psychiatry, University ofVermont, Burlington, VT, USA
| | - Barbara Johnston
- Mount Sinai Hospital, New York, NY, USA,Mount Sinai School of Medicine, New York, NY, USA
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Osborn CY, Mulvaney SA. Development and feasibility of a text messaging and interactive voice response intervention for low-income, diverse adults with type 2 diabetes mellitus. J Diabetes Sci Technol 2013; 7:612-22. [PMID: 23759393 PMCID: PMC3869128 DOI: 10.1177/193229681300700305] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Low-income, racial/ethnic minorities are often nonadherent to diabetes medications, have uncontrolled glycemia, and have high rates of diabetes-related morbidity. Cell phones provide a viable modality to support medication adherence, but few cell phone-based interventions have been designed for low-income persons, a population with more feature phone penetration than smartphone penetration. In an effort to reach the broadest range of patients, we leveraged the voice and text messaging capabilities shared by all cell phones to design the MEssaging for Diabetes intervention. We specifically advanced and adapted an existing tailored text messaging system to include interactive voice response functionality and support the medication adherence barriers of low-income, diverse adults with type 2 diabetes mellitus. We report on the design process and feasibility testing results (i.e., technical use patterns and subjective user experiences) from patients from the target population who used the intervention in one of three user-centered design iterations. The types of challenges encountered in design were related to providing text message content with valued information and support that engages patients. The design process also highlighted the value of obtaining mixed methods data to provide insight into legitimate versus illegitimate missing data, patterns of use, and subjective user experiences. The iterative testing process and results outlined here provide a potential template for other teams seeking to design technology-based self-care support solutions for comparable patient populations.
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Affiliation(s)
- Chandra Y Osborn
- Vanderbilt University Medical Center, 1215 Twenty-First Ave. South, Nashville, TN 37232-8300, USA.
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Houser SH, Ray MN, Maisiak R, Panjamapirom A, Willig J, Schiff GD, English T, Nevin C, Berner ES. Telephone follow-up in primary care: can interactive voice response calls work? Stud Health Technol Inform 2013; 192:112-116. [PMID: 23920526 PMCID: PMC4117224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Follow-up calls after ambulatory visits are not routinely done, yet they can potentially detect and mitigate unresolved problems. Automated calls via an Interactive Voice Response System (IVRS) are an innovative way to conduct follow-up, but patients' attitudes toward follow-up calls are unknown. This study assessed 1) patient perceptions about follow-up calls after visits; 2) differences in perceptions between human and IVRS calls; and 3) association between follow-up calls and patient satisfaction with care. Post-visit follow-up calls in two ambulatory care setting were done in two phases. Phase 1 used a human caller and phase 2 used IVRS. Patient satisfaction questionnaires were completed after each phase. Results showed that 88% of patients favor the idea of the calls and those receiving them found them helpful. There were no differences in attitudes between patients receiving calls from clinic staff or from an IVRS. Patients receiving calls had higher patient satisfaction scores than those not called. CONCLUSION Patients value follow-up calls and they are associated with patient satisfaction with care. IVRS is an innovative way to conduct post-visit follow-up.
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Affiliation(s)
- Shannon H. Houser
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N. Ray
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - James Willig
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Thomas English
- The University of Massachusetts Medical School, Worcester, MA, USA
| | - Christa Nevin
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eta S. Berner
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
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Simpson CA, Huang J, Roth DL, Chandler SD, Tucker JA. Predictors of utilization of an IVR self-monitoring program by problem drinkers with recent natural resolutions. Drug Alcohol Depend 2012; 126:111-7. [PMID: 22682100 PMCID: PMC4477637 DOI: 10.1016/j.drugalcdep.2012.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND As part of a randomized controlled trial, problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response (IVR) self-monitoring (SM) system as a sobriety maintenance tool during early recovery when relapse risk is high. Because observed IVR utilization was variable, predictors of utilization were evaluated to inform knowledge of populations likely to access and use IVR services. METHODS Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longstanding high-risk drinking practices and alcohol-related problems (M=16.58 years, SD=10.95). Baseline interviews assessed pre-resolution drinking practices and problems, and behavioral economic (BE) measures of reward preferences (delay discounting, pre-resolution monetary allocation). Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages. RESULTS IVR use ranged from 0 to 100%. Frequent (n=28), infrequent (n=42), and non-caller (n=17) groups were identified. Non-callers tended to be younger and to report heavier pre-resolution drinking. Frequent callers (≥70% of IVR days) tended to be older, male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers. Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking. CONCLUSIONS Characteristics common in the untreated problem drinker population were associated with higher IVR utilization. This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform.
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Affiliation(s)
- Cathy A. Simpson
- University of Alabama at Birmingham School of Public Health Department of Health Behavior, Birmingham, AL
| | - Jin Huang
- University of Alabama at Birmingham School of Public Health Department of Biostatistics, Birmingham, AL
| | - David L. Roth
- University of Alabama at Birmingham School of Public Health Department of Biostatistics, Birmingham, AL
| | - Susan D. Chandler
- University of Alabama at Birmingham School of Public Health Department of Health Behavior, Birmingham, AL
| | - Jalie A. Tucker
- University of Alabama at Birmingham School of Public Health Department of Health Behavior, Birmingham, AL
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Naylor MR, Krauthamer GM, Naud S, Keefe FJ, Helzer JE. Predictive relationships between chronic pain and negative emotions: a 4-month daily process study using Therapeutic Interactive Voice Response (TIVR). Compr Psychiatry 2011; 52:731-6. [PMID: 21349510 PMCID: PMC3136612 DOI: 10.1016/j.comppsych.2010.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 11/19/2022] Open
Abstract
This article examines temporal relationships between negative emotions and pain in a cohort of 33 patients with chronic musculoskeletal pain enrolled in a telephone-based relapse prevention program (Therapeutic Interactive Voice Response [TIVR]), after 11 weeks of group cognitive behavioral therapy (CBT). Patients were asked to make daily reports to the TIVR system for 4 months after CBT. Patients' daily reports were analyzed with path analysis to examine temporal relationships between 3 emotion variables (anger, sadness, and stress) and 2 pain variables (pain and pain control). As expected, same-day correlations were significant between emotion variables and both pain and pain control. The lagged associations revealed unidirectional relationships between pain and next-day emotions: increased pain predicted higher reports of sadness the following day (P < .05). Conversely, increased pain control predicted decreased sadness and anger the following day (P < .05). Unlike some previous studies, this study did not reveal that an increase of negative emotions predicted increased next-day pain. We speculate that CBT treatment followed by the relapse prevention program teaches patients how to modulate negative emotions such that they no longer have a negative impact on next-day pain perception. The clinical implications of our findings are discussed.
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Affiliation(s)
- Magdalena R Naylor
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT 05401, USA.
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Toll BA, Cooney NL, McKee SA, O'Malley SS. Correspondence between Interactive Voice Response (IVR) and Timeline Followback (TLFB) reports of drinking behavior. Addict Behav 2006; 31:726-31. [PMID: 15975732 PMCID: PMC2527735 DOI: 10.1016/j.addbeh.2005.05.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 05/25/2005] [Accepted: 05/26/2005] [Indexed: 11/24/2022]
Abstract
This study compared reports of alcohol consumption using an Interactive Voice Response (IVR) system and the Timeline Followback (TLFB). One hundred eighty-two daily smokers who were not alcohol dependent provided once daily reports of alcohol consumption using an IVR system and participated in a weekly TLFB interview. The reporting time period was 7 days after participants attempted to quit smoking as part of participation in a smoking cessation clinical trial. The results revealed moderate to high correlations between reports of drinking behavior as assessed by IVR and TLFB. Reporting biases for both IVR and TLFB were approximately equal, with a slight trend toward underreporting drinking on the TLFB. Compliance with the IVR system was poor. This study provides preliminary evidence that it is possible to use an IVR system for the assessment of alcohol use in smokers participating in a clinical trial, and IVR seems to adequately assess drinking behavior in those that use the system. However, future studies should focus on improving compliance with IVR in this population.
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Affiliation(s)
- Benjamin A Toll
- Yale University School of Medicine, Department of Psychiatry, 1 Long Wharf Drive, Box 18, New Haven, CT 06511, and VA Connecticut Healthcare System, USA.
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