Abstract
BackgroundWith 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.ObjectiveThis 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.MethodsA 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.ResultsKey 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.ConclusionsInteractive 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.
Highlights
Low- and middle-income country populations suffer approximately 75% of all noncommunicable disease deaths annually [1,2]
A qualitative study design [24] was used to elicit the experiences of participants who had completed a structured interview on noncommunicable disease risk factors using an Interactive voice response (IVR) survey delivered to respondents who owned or had access to a mobile phone [16]
Limited clarity of survey questions was only consistently reported by participants who were in rural locations—either on the farm, in a University, or in homes that were more than 250 km distant from the Capital city
Summary
Low- and middle-income country populations suffer approximately 75% of all noncommunicable disease deaths annually (approximately 32 million deaths) [1,2]. Within high-income countries, IVR use is generally limited to exploring aspects of self-care [12,13], follow-up of patient care [7,14,15], and evaluating patient-provider interactions in clinical settings [9] but is rarely used for research or surveillance purposes [8,16,17]. Within sub-Saharan Africa, sectors other than health, such as agriculture and social development have successfully used IVR for surveillance and community engagement [6,23] It is unclear why some respondents complete surveillance questions using IVR and why some do not. We sought to explore user perceptions and experiences of receiving and responding to an interactive voice response mobile phone survey for noncommunicable disease risk factors, to inform the design and delivery of future surveys delivered using mobile phones
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