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

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.

Violence and sexual and reproductive health service disruption among girls and young women during COVID-19 pandemic in Nepal: A cross-sectional study using interactive voice response survey

Introduction There is a paucity of data on the impact of COVID-19 pandemic on girls and young women. The study examines the prevalence and correlates of violence and sexual and reproductive health (SRH) service disruption among girls and young women during COVID-19 restrictions and lockdown. Methods An interactive voice response survey was conducted among girls and women aged 18–24 years between 10th March to 24th April 2021. The survey enrolled 1314 participants. Descriptive analysis was used to assess prevalence of violence and SRH service disruption. Two sampled test of proportion was used to asses difference in prevalence of violence before and after the pandemic. Logistic regression was used to examine relationship between the outcome variables and socio demographic predictors. Results The study did not find significant difference in prevalence of violence before and after the pandemic. Education was found to be protective against experience of both physical and sexual violence after the pandemic. Dalit participants were four times more likely to report physical violence after the pandemic than Brahmin/Chhetri participants (OR:3.80; CI:1.41–10.24). Participants from 22-24-year age group were twice as likely to experience sexual violence compared to girls and participants from 18-21year age group (OR:2.25; CI:1.04–4.84). Participants from urban municipalities were 29% less likely to report SRH services disruption than participants from rural municipalities (OR-0.71, 95% CI: 0.55–0.91). Participants with disability were twice as likely to report disruption than participants without disability (OR-2.35, 95% CI: 1.45–3.82). Conclusions To reduce violence against girls and women due to the pandemic, interventions should focus on Dalit women and on preventing education discontinuation among girls and women. SRH service during the pandemic needs to be improved for girls and women with focus on girls and women from rural municipalities and girls and women with disability.

Digitization of agricultural extension system for effective management of emergency in Nigeria

This paper presents challenges facing agricultural extension system in Nigeria most especially, during crises and emergencies, which necessitate the adoption of digitizing extension systems as a basis for improving farmers’ access to extension services during emergencies. The emergence of ICTs has given rise to digitization, which is the delivery of agricultural advice via audiovisual messages (video), interactive voice response (IVR) and short message services (SMS) among others. Efforts should be made by the stakeholders in agricultural extension to digitize the country's extension system by capitalizing on the existing enthusiasm among extension practitioners, and farmers using lessons of best practices from elsewhere.

Score equivalence of paper-, tablet-, and interactive voice response system-based versions of PROMIS, PRO-CTCAE, and numerical rating scales among cancer patients

Background The study tests the effects of data collection modes on patient responses associated with the multi-item measures such as Patient-Reported Outcomes Measurement System (PROMIS®), and single-item measures such as Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), and Numerical Rating Scale (NRS) measures. Methods Adult cancer patients were recruited from five cancer centers and administered measures of anxiety, depression, fatigue, sleep disturbance, pain intensity, pain interference, ability to participate in social roles and activities, global mental and physical health, and physical function. Patients were randomized to complete the measures on paper (595), interactive voice response (IVR, 596) system, or tablet computer (589). We evaluated differential item functioning (DIF) by method of data collection using the R software package, lordif. For constructs that showed no DIF, we concluded equivalence across modes if the equivalence margin, defined as ± 0.20 × pooled SD, completely surrounds 95% confidence intervals (CI's) for difference in mean score. If the 95% CI fell totally outside the equivalence margin, we concluded systematic score difference by modes. If the 95% CI partly overlaps the equivalence margin, we concluded neither equivalence nor difference. Results For all constructs, no DIF of any kind was found for the three modes. The scores on paper and tablet were more comparable than between IVR and other modes but none of the 95% CI’s were completely outside the equivalence margins, in which we established neither equivalence nor difference. Percentages of missing values were comparable for paper and tablet modes. Percentages of missing values were higher for IVR (2.3% to 6.5% depending on measures) compared to paper and tablet modes (0.7% to 3.3% depending on measures and modes), which was attributed to random technical difficulties experienced in some centers. Conclusion Across all mode comparisons, there were some measures with CI’s not completely contained within the margin of small effect. Two visual modes agreed more than visual-auditory pairs. IVR may induce differences in scores unrelated to constructs being measured in comparison with paper and tablet. The users of the surveys should consider using IVR only when paper and computer administration is not feasible.

Commercial Voice Assistants’ Answers to Health-related Questions in Noncommunicable Disease Management: Factorial Experiment Assessing Response Rate and Source of Information (Preprint)

BACKGROUND Complications related to noncommunicable diseases are among the main causes of mortality. Fostering patients’ access to health-related information through efficient and accessible channels like commercial voice assistants (CVA) such as Amazon Alexa, Apple Siri, or Google Assistant, may support patients’ ability to make health-related decisions and manage their chronic conditions. OBJECTIVE This study aims to evaluate the ability of CVAs in providing expertise-based voice responses to questions related to noncommunicable disease management. METHODS We collected health-related frequently asked questions from health organizations, government, medical non-profit and popular websites about conditions associated with Alzheimer’s disease (AD), lung cancer (LC), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), cardiovascular disease (CVD), kidney disease (KD), and cerebrovascular disease (CV). The questions were then validated with practicing medical specialists and the most frequent ones selected, resulting in a pool of 144. We submitted the selected questions to CVAs in a 3x3 fractional factorial design experiment with three developers (ie, Amazon, Apple, and Google) and three modalities (ie, voice-only, voice-and-display, display-only). The condition Google display-only was operationalized with Google Search (our gold standard of information lookup). We assessed whether the CVA provided a voice response (ie, response rate) and what type of web source was used (ie, Expert, Commercial, Crowdsourced, or Not stated). RESULTS Amazon and Google showed a slightly higher voice response rate in voice-only (76.4% and 97.2%, respectively), compared to voice-and-display (74% and 92.4%, respectively). Apple showed the opposite (16% voice-only, 16.7% voice-and-display). Source type was mostly Expert in Amazon (77.3% voice-only, 76.6% voice-and-display) and Google (70.7% voice-only, 73.7% voice-and-display). Apple mostly used Commercial (30.4% voice-only, 29.2% voice-and-display), Crowdsourced (21.7% voice-only, 33.3% voice-and-display) sources, or stated no source (39.1% voice-only, 29.2% voice-and-display). Moreover, Amazon showed the highest response rate for LC (88%), while Apple did so for COPD (20%), and Google for AD (100%). Amazon and Google always used Expert sources for AD, while Apple never did so. However, Apple used the most Expert sources for CD (50%). CONCLUSIONS None of the tested CVAs was the absolute best in responding to questions about noncommunicable disease management. CVAs seem to perform differently depending on the noncommunicable disease in question. We urge health organizations to collaborate with Google, Amazon, and Apple to allow their CVAs consistently providing reliable answers to health-related questions on noncommunicable disease management.

Digital Extension Interactive Voice Response (IVR) mLearning: Lessons Learnt From Uganda Pig Value Chain

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.

An analysis of the impact of implementing a new interactive voice response system (IVR) on client experience in the Canadian banking industry

Banks are constantly competing to find new ways to satisfy clients and meet their growing, heterogenous needs. Clients can access round the clock banking services worldwide. One way to access information is through Interactive Voice Response (IVR) systems. This research is an analysis of the process of implementing an IVR system and the impact on client experience using the case study of a Canadian bank. The research question is: “What is the impact of an IVR system upgrade on client experience in the Canadian banking industry?” The Productivity Paradox and the Unified Theory of Acceptance and Use of Technology model (UTAUT) are leveraged and a thematic analysis of the feedback provided from Net Promoter Score (NPS) surveys is done. The results show that although the IVR system can be an attractive automation interface for clients, there are many unanswered concerns about customer satisfaction as demonstrated by NPS feedback.