Interactive Voice Response Intervention Research Articles

A REVIEW OF INTERACTIVE VOICE RESPONSE SYSTEM FOR ENTERPRISE EDUCATION

This article reviews the use of the Interactive Voice Response (IVR) mechanism in delivering enterprise education to the Micro, Small and Medium Enterprises (MSMEs) sector in Nigeria. Using desk research and review of system performance report, the suitability of the IVR mechanism as an alternative approach towards ensuring inclusiveness in entrepreneurship education is highlighted. The review revealed that deploying learning systems that take into considerations geographical locations without internet infrastructure and also socio-economic factors of intending and existing entrepreneurs for enterprise education is crucial and equally promising. The challenges and opportunities of online and continuing education during the COVID-19 pandemic are summarized. There is the need for further exploration of IVR interventions to make them more effective and policy interventions on affordable online teaching and learning platforms accessible to persons of varied economic divide.

Cancer as a death sentence: developing an initial program theory for an IVR intervention.

To address current trends in poor health-seeking behaviour and late cancer diagnosis in many low- and middle-income countries, like Uganda, it is important to explore innovative awareness building interventions. One possible intervention is a common digital format, an interactive voice response (IVR) system, which is suitable for individuals with low technological and reading literacy. It is increasingly acknowledged that developing digital interventions requires co-creation with relevant stakeholders and explication of program developers’ assumptions, to make them effective, sustainable, and scalable. To this end, we sought to develop an initial program theory for a co-created IVR system for cancer awareness in Uganda. Utilising principles of the realist approach, a qualitative exploratory study was conducted through seven focus group discussions (FGDs) with people living with cancer (PLWC), health workers, and policy makers. Thematic analysis of the transcripts resulted in the emergence of four major themes. Through all themes the most consistent finding was that myths, misconceptions, and misinformation about cancer were related to every aspect of the cancer journey and influenced the experiences and lives of PLWC and their caregivers. Participants were positive about the potential of an IVR system but also had reservations about the design and reach of the system. The resulting initial program theory proposes that a context-specific IVR system has the potential to improve awareness on cancer, provided attention is given to aspects such as language, message framing, and accuracy.

A pilot randomized controlled trial (RCT) of daily versus weekly interactive voice response calls to support adherence among antiretroviral treatment patients in India.

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. 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%). 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. 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. ClinicalTrials.gov registration #NCT02118454.

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.

BackgroundThe 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.ObjectiveThis 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.MethodsThis 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.ResultsA 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.ConclusionsOur 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 RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149.

Interactive voice response interventions targeting behaviour change: a systematic literature review

Interactive voice response interventions targeting behaviour change: a systematic literature review

Interactive voice response interventions targeting behaviour change: a systematic literature review

Interactive voice response interventions targeting behaviour change: a systematic literature review

Interactive voice response interventions targeting behaviour change: a systematic literature review with meta-analysis and meta-regression

ObjectiveA 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...

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

ObjectivesThis 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...

Misuse of Pediatric Medications and Parent-Physician Communication: An Interactive Voice Response Intervention.

Children take 1 medication each week on average at home. Better communication between parents and providers could support safer home medication use and prevent misuse of pediatric medications, such as intentional underdosing or overdosing. Our primary objective was to assess the impact of an interactive voice response system on parent-provider communication about medications. Parents of children 4 months to 11 years of age with upcoming well child visits were invited to call our interactive voice response system, called Personal Health Partner (PHP), which asked questions about the child's health and medication use. Responding parents were randomized to either PHP (interview and counseling) or control (injury prevention survey). Parents' responses were embedded in the electronic health record. After the physical visit, research assistants performed a phone follow-up survey. Of 475 parents, including 293 PHPs and 182 controls, 93% were women. We found a high prevalence of misuse of medications: 14% reported underdosing (n = 63) fever-reducer medications and 3% reported overdosing (n = 13). Twenty percent (n = 37) of the 190 children younger than 3 years had received cold medication. Thirty-three percent (n = 19) of 62 PHP parents of children on prescription medications reported nonadherence. Among children on prescription medications, PHP significantly increased discussion of medications at the physical, but not the number who brought medications to the visit; it had no impact on those not on prescription medications. Pediatric medication misuse was common in this study. Use of a previsit interactive voice response system increased medication-related communication during visits and supports the need for systems that better prepare patients for visits and improve medication-related patient-physician communication.

A Randomized Controlled Trial of Brief Intervention by Interactive Voice Response.

To determine the effect of an Interactive Voice Response (IVR) brief intervention (BI) to reduce alcohol consumption among adults seeking primary care. Patients (N = 1855) with unhealthy drinking were recruited from eight academic internal medicine and family medicine clinics and randomized to IVR-BI (n = 938) versus No IVR-BI control (n = 917). Daily alcohol consumption was assessed at baseline, 3- and 6-months using the Timeline Followback. The IVR-BI was completed by 95% of the 938 patients randomized to that condition, and 62% of them indicated a willingness to consider a change in their drinking. Participants in both conditions significantly reduced consumption over time, but changes were not different between groups. Regardless of condition, participants with alcohol use disorder (AUD) showed significant decreases in drinking outcomes. No significant changes were observed in patients without AUD, regardless of condition. Although the IVR intervention was well accepted by patients, there was no evidence that IVR-BI was superior to No IVR-BI for reducing drinking in the subsequent 6 months. Because both the design and the intervention tested were novel, we cannot say definitively why this particular eHealth treatment lacked efficacy. It could be useful to evaluate the effect of the pre-randomization assessment alone on change in drinking. The high treatment engagement rate and successful implementation protocol are strengths, and can be adopted for future trials. We examined the efficacy of a novel BI for patient self-administration by automated telephone. Alcohol consumption decreased over time but there were no between-group changes in consumption. Regardless of treatment condition, participants with alcohol use disorder (AUD) showed significant reduction in drinking but participants without AUD showed no change.

Comparison of WEB and Interactive Voice Response (IVR) Methods for Delivering Brief Alcohol Interventions to Hazardous-Drinking University Students: A Randomized Controlled Trial

This study evaluated automated techniques including personalized normative feedback and protective behavioral strategies, for brief interventions intended to reduce peak alcohol concentrations in university students. After completing baseline assessment, a total of 1,678 hazardous-drinking consumers were randomized to a single or a repeated Internet (WEB) or Interactive Voice Response (IVR) intervention, or to a control group (Single WEB: 323; Single IVR: 329; Repeated WEB: 318; Repeated IVR: 334; Control group: 374). At follow-up, six weeks after baseline, questionnaires were returned by 1,422 participants (Single WEB: 277; Single IVR: 286; Repeated WEB: 259; Repeated IVR: 279; Control group: 321). It was found that peak estimated BAC was reduced in the total group (b -0.14, 95% confidence interval (CI) -0.023; -0.005), in the total (b -0.17, 95% CI -0.027; -0.007) and single (b -0.021, 95% CI -0.032; -0.011) WEB group, and in the total (b -0.011, 95% CI -0.021; -0.015) and repeated (b -0.012, 95% CI -0.023; -0.000) IVR groups, compared to controls. The reduction in peak estimated BAC was greater in the single WEB group compared to the single IVR group (b -0.011, 95% CI -0.022; -0.000). This study concluded that both WEB and IVR interventions have a small but significant effect in reducing heavy episodic drinking, which may be due to the relatively large sample size. Repeated intervention may be needed if delivered by IVR.

Automated pain intervention for underserved minority women with breast cancer.

Minority patients with breast cancer are at risk for undertreatment of cancer-related pain. The authors evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer. Sixty low-income African American and Latina women with breast cancer and cancer-related pain were enrolled in a pilot study of an automated, telephone-based, interactive voice response (IVR) intervention. Women in the intervention group were called twice weekly by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients' oncologists received e-mail alerts if the reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles. The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention also was associated with improvements in other cancer-related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists who were treating the patients rated the intervention as only somewhat useful for improving symptom management. The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed.

Use of Interactive Voice Response to Improve Colorectal Cancer Screening

Only 63% of the US population aged 50-75 years is adherent with recommended colorectal cancer (CRC) screening guidelines. Efforts are needed to increase screening for CRC. We evaluated a quality improvement intervention conducted in 2010 at Group Health in Washington State to assess the use of interactive voice response (IVR) systems to improve CRC screening. Eligible members were aged 50-81 years, received primary care from a contracted physician, and were due for CRC screening. A total of 13,279 members were identified and randomly assigned to either: (1) an intervention with IVR to encourage CRC screening (n=10,000), or (2) usual care (n=3279). The primary outcome was receipt of any recommended CRC screening test at 6 months postintervention or index date. We used Cox proportional hazards to model time until receipt of CRC screening at 6 months. Adherence to CRC screening was 10.0% in the intervention arm and 7.8% in the usual care arm at 6 months. Randomization to the IVR intervention arm was associated with a 32% increased likelihood of receiving CRC screening (hazard ratio=1.32; 95% confidence interval, 1.14, 1.52) compared with usual care. The difference in CRC screening uptake was apparent by 3 months and persisted for 12 months postintervention (log-rank test, P=0.0012). Our analysis provides "real-world" evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.

Development and Feasibility of a Text Messaging and Interactive Voice Response Intervention for Low-Income, Diverse Adults with Type 2 Diabetes Mellitus

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.

Overcoming challenges to screening and brief intervention implementation with technology: the promise of interactive voice response systems

While the efficacy of screening and brief intervention (SBI) is supported by multiple clinical trials, routine delivery of SBI is hampered by complex factors, both individual and systemic. An alternative to the traditional in-office approach to SBI holds promise as a way of broadening its reach. The purpose of this study is to share our experience using interactive voice response (IVR) technology to deliver and augment SBI in primary care. We draw on experience from a 12-year program of research in this area, summarizing results from prior studies and describing a new trial currently underway. Questions regarding the nature of IVR; how it works; why it might be a helpful modality for fostering, delivering, and/or augmenting SBI; and how others can embark on IVR research are addressed. We provide a brief overview of the IVR applications we have employed in alcohol research, a description of some methodological challenges we encountered in a prior SBI trial, and how these experiences led us to develop our current IVR-based SBI program. We cover technicalities of developing IVR applications and issues of their implementation in research. Interactive voice response is a feasible modality for delivering assessment and advice about drinking. The technology required for implementation is accessible to researchers and clinicians who do not necessarily have specialized training or expertise. Although this technology offers several advantages, including patient comfort with disclosure of personal information and widespread access and availability, it has downsides as well. For example, refusal and noncompliance can be higher than in other modalities. A small body of research suggests that process variables such as interviewer voice characteristics, survey length, and questionnaire-item format may influence consent to participate and compliance with IVR surveys and interventions.

Reaching out, inviting back: using Interactive voice response (IVR) technology to recycle relapsed smokers back to Quitline treatment – a randomized controlled trial

BackgroundTobacco dependence is a chronic, relapsing condition that typically requires multiple quit attempts and extended treatment. When offered the opportunity, relapsed smokers are interested in recycling back into treatment for a new, assisted quit attempt. This manuscript presents the results of a randomized controlled trial testing the efficacy of interactive voice response (IVR) in recycling low income smokers who had previously used quitline (QL) support back to QL support for a new quit attempt.MethodsA sample of 2985 previous QL callers were randomized to either receive IVR screening for current smoking (control group) or IVR screening plus an IVR intervention. The IVR intervention consists of automated questions to identify and address barriers to re-cycling in QL support, followed by an offer to be transferred to the QL and reinitiate treatment. Re-enrollment in QL services for both groups was documented.ResultsThe IVR system successfully reached 715 (23.9%) former QL participants. Of those, 27% (194/715) reported to the IVR system that they had quit smoking and were therefore excluded from the study and analysis. The trial’s final sample was composed of 521 current smokers. The re-enrollment rate was 3.3% for the control group and 28.2% for the intervention group (p < .001). Logistic regression results indicated an 11.2 times higher odds for re-enrollment of the intervention group than the control group (p < .001). Results did not vary by gender, race, ethnicity, or level of education, however recycled smokers were older (Mean =45.2; SD = 11.7) than smokers who declined a new treatment cycle (Mean = 41.8; SD = 13.2); (p = 0.013). The main barriers reported for not engaging in a new treatment cycle were low self-efficacy and lack of interest in quitting. After delivering IVR messages targeting these reported barriers, 32% of the smokers reporting low self-efficacy and 4.8% of those reporting lack of interest in quitting re-engaged in a new QL treatment cycle.ConclusionProactive IVR outreach is a promising tool to engage low income, relapsed smokers back into a new cycle of treatment. Integration of IVR intervention for recycling smokers with previous QL treatment has the potential to decrease tobacco-related disparities.Trial registrationClinicalTrials.gov Identifier: NCT01260597

Test of an Interactive Voice Response Intervention to Improve Adherence to Controller Medications in Adults with Asthma

This study was conducted to test the effectiveness of a theory-based interactive voice response (IVR) intervention to improve adherence to controller medications among adults with asthma. Fifty participants aged 18 to 65 years who had a physician diagnosis of asthma and a prescription for a daily inhaled corticosteroid, attended a baseline visit and a final visit 10 weeks later. Participants randomized to the intervention group received 2 automated IVR telephone calls separated by one month, with one additional call if they reported recent symptoms of poorly controlled disease or failure to fill a prescription. Calls were completed in less than 5 minutes and included content designed to inquire about asthma symptoms, deliver core educational messages, encourage refilling of inhaled corticosteroid prescriptions, and increase communication with providers. Adherence was tracked during 10 weeks, with objective measures that included either electronic monitors or calculation of canister weight. Participants completed the Asthma Quality of Life Questionnaire, the Asthma Control Test, and the Beliefs in Medications Questionnaire (BMQ) during both visits. Adherence was 32% higher among patients in the IVR group than those in the control group (P = .003). A more favorable shift in perception of inhaled corticosteroids was seen on BMQ scores of patients in the IVR group (P = .003), which in turn correlated with degree of adherence change (r = 0.342; P = .0152). No differences emerged for the Asthma Quality of Life Questionnaire or Asthma Control Test. The IVR intervention resulted in a significant increase in adherence to inhaled corticosteroid treatment and improved BMQ scores during the study interval. The association of increased adherence with increased BMQ scores suggests that the intervention succeeded in helping participants adopt a more favorable perception of their controller medication, leading in turn to improved adherence.

Interactive Voice Response Reminder Effects on Preventive Service Utilization

This study evaluated the effects of interactive voice response (IVR) system reminders to managed care organization (MCO) members to obtain mammograms, Papanicolaou (Pap) tests, and influenza immunizations. The MCO identified 3 member cohorts and sent IVR reminders to get preventive services. Analyses employed claims data to examine relationships between IVR reminders and preventive service use 5 to 9 months post-intervention among members without prior utilization. Multivariate logistic regressions controlling for age, gender (for influenza immunizations), and risk stratum confirmed hypothesized relationships between intervention and preventive services: mammograms, odds ratio (OR) = 1.263 (95% confidence interval [CI] = 1.104, 1.444); Pap tests, OR = 1.241 (1.107, 1.391); influenza immunizations, OR = 2.072 (1.665, 2.580). IVR reminders are associated with higher rates of mammograms, Pap tests, and influenza immunizations. Study limitations include unknown generalizability of results and possible self-selection. There is justification for more IVR interventions and research to enhance MCO members' preventive service utilization.