Effects of Interactive Voice Response (IVR) Counseling on Physical Activity Benefits and Barriers

BACKGROUND Physical inactivity and related cancer incidence and mortality rates are disproportionately high in the U.S. Deep South, a rural, medically underserved region with a large African American population compared to the rest of the nation. Given this region’s lower rates of literacy and Internet access, Interactive Voice Response (IVR)-automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs transportation) but have yet to be extended to rural, underserved populations, such as the Deep South. Thus, extensive formative research was conducted to develop, and beta test the Deep South Interactive Voice Response System Supported Active Lifestyle (DIAL) intervention in preparation for dissemination in rural Alabama counties OBJECTIVE To describe the design and rationale of the ongoing efficacy trial of the DIAL intervention. METHODS The 2-arm randomized controlled trial will compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The DIAL intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity phone counseling (daily in months 0-3, twice weekly in months 4-6 and weekly in months 7-12) and support from local rural county coordinators with the UAB O’Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate-to-vigorous intensity physical activity (7-Day PAR, accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, recreational amenities, and inform future environment/policy efforts. RESULTS Start up activities (hiring/training staff, purchasing supplies) were completed in 2019. Study recruitment and assessments began in September 2020 and are ongoing. CONCLUSIONS IVR-supported phone counseling has great potential for addressing physical activity barriers (e.g., culture, literacy, cost, transportation) and reducing related rural health disparities in this region. CLINICALTRIAL ClinicalTrials.gov NCT03903874

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Physical Activity and Related Psychosocial Outcomes From a Pilot Randomized Trial of an Interactive Voice Response System–Supported Intervention in the Deep South

Health Education & Behavior ◽

10.1177/1090198118775492 ◽

2018 ◽

Vol 45 (6) ◽

pp. 957-966 ◽

Cited By ~ 1

Author(s):

Dori Pekmezi ◽

Cole Ainsworth ◽

Taylor Holly ◽

Victoria Williams ◽

Rodney Joseph ◽

...

Keyword(s):

Physical Activity ◽

Physical Activity Intervention ◽

Interactive Voice Response ◽

Controlled Trial ◽

Self Regulation ◽

Deep South ◽

Protective Effects ◽

Wait List ◽

Wait List Control ◽

Voice Response

Background. Physical activity exerts cancer-protective effects, yet most Americans are inactive, especially in the South, where cancer incidence rates are generally higher. Telephone-based approaches can help overcome physical activity intervention barriers in this region (literacy, costs, lack of transportation/technology, distance from facilities) and can be automated via interactive voice response (IVR) systems for improved reach and cost-effectiveness. Aims. To evaluate the Deep South IVR-supported Active Lifestyle (DIAL) intervention. Method. A pilot randomized controlled trial was conducted among 63 underactive adults in Birmingham, Alabama, from 2015 to 2017. Results. Retention was 88.9% at 12 weeks, and ≥75% adherence (IVR contact on at least 63 out of 84 days) was noted among 62.5% of intervention participants. Intervention participants reported larger increases in self-reported minutes of moderate-to-vigorous intensity physical activity from baseline to 12 weeks than the wait-list control arm (median change = 47.5 vs. 5.0 minutes, respectively, p = .09). Moreover, the intervention produced significantly greater increases in physical activity self-regulation ( p < .001) and social support from family ( p = .001) and friends ( p = .009) from baseline to 12 weeks, compared with the wait-list control. Significant decreases in self-reported sleep disturbance also were found in the intervention arm but not among the controls, p < .05. Overall, intervention participants reported being satisfied with the DIAL program (71.4%) and would recommend it to friends (92.9%). Discussion. Findings support the feasibility, acceptability, and preliminary efficacy of the DIAL intervention. Conclusion. Next steps include intervention refinement in preparation for a fully powered efficacy trial and eventual dissemination to rural counties.

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An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study

JMIR Human Factors ◽

10.2196/29494 ◽

2022 ◽

Vol 9 (1) ◽

pp. e29494

Author(s):

Mohanraj Thirumalai ◽

Nashira Brown ◽

Soumya Niranjan ◽

Sh'Nese Townsend ◽

Mary Anne Powell ◽

...

Keyword(s):

Physical Activity ◽

Interactive Voice Response ◽

Usability Testing ◽

Black Belt ◽

Rural County ◽

Research Staff ◽

System Usability Scale ◽

System Usability ◽

Rural Alabama ◽

Voice Response

Background Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.

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An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study (Preprint)

10.2196/preprints.29494 ◽

2021 ◽

Author(s):

Mohanraj Thirumalai ◽

Nashira Brown ◽

Soumya Niranjan ◽

Sh'Nese Townsend ◽

Mary Anne Powell ◽

...

Keyword(s):

Physical Activity ◽

Interactive Voice Response ◽

Usability Testing ◽

Black Belt ◽

Rural County ◽

Research Staff ◽

System Usability Scale ◽

System Usability ◽

Rural Alabama ◽

Voice Response

BACKGROUND Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. OBJECTIVE The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. METHODS A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. RESULTS The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying <i>excellent</i> usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. CONCLUSIONS The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.

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