Received Telephone Counseling Research Articles

Effectiveness of Psychotherapy for Community-Dwelling Vulnerable Older Adults with Depression and Care Needs: Findings from the PSY-CARE Trial

ABSTRACT Background For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce. Methods In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4). Results There was a significant decrease in depressive symptoms across both arms with Cohen’s d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations. Conclusions Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs. Clinical implications Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations. Trial registration The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).

The effect of discharge training and telephone counseling service on patients’ functional status and caregiver burden after stroke: A randomized controlled trial

Objective: This study aimed to determine the effect of discharge training and telephone counseling service on patients’ functional status and caregiver burden after stroke. Methods: This study was conducted as a randomized controlled trial in 69 stroke patients and their caregivers. Discharge training and telephone counseling were given to the caregivers in the intervention group. Caregivers also received telephone counseling by calling researcher when needed. Information form for participants, Modified Rankin Scale, Barthel Index and The Zarit Caregiver Burden Scale were used for data collection. Pre-tests were applied to the intervention and control groups before discharge. Three months after discharge post-tests were performed for the two groups. Results: Three months after discharge, caregivers’ burden was significantly lower in the intervention group compared to the control group. The mean Modified Rankin Scale score of the patients in the intervention group was significantly lower than the control group three months after discharge. Although the mean Barthel Index score of the patients in the intervention group was statistically significant higher than before discharge, but the difference between the groups was not statistically significant. Conclusion: Discharge training and telephone counseling provided to the caregivers of stroke patients reduced the caregiver burden and had a positive effect on the improvement of the functional status of the patients.

Cancer Screening Program Delivered by Community Health Workers for Chinese Married Immigrant Women in Korea.

This quasi-experimental study used a cancer prevention program delivered by community health workers (CHWs) as an intervention to improve health literacy and increase screening uptake. The intervention group was educated by trained CHWs and received information about the nearby hospitals. After education, participants received telephone counseling once a month for 6 months. In the intervention group, CHWs met the participants individually and delivered the CD-ROM containing conversation scenarios with voice during the cancer screening test. The control group was provided educational materials related to breast and cervical cancers and a booklet containing information on mammography and Pap test. This study assessed the difference in mammography and Pap tests between the intervention and control groups. The results showed that the participants’ knowledge improved, and the rate of cancer screening tests did not decrease in the intervention group. Therefore, it is necessary to develop and apply various programs that train CHWs and apply them to immigrant women to promote health-related behaviors under the health system that they are not familiar with while living in another country.

Telephone-Supported Internet-Based Cognitive Behavioral Therapy for People With Depression: Users’ Perspective

Background Little is known from the perspective of service users on the quality and benefits of receiving telephone counseling in a guided Internet-based Cognitive Behavioral Therapy (iCBT). Purpose This study aimed to investigate, from the user’s perspective, the feasibility, quality, and benefits of a telephone-supported iCBT which provided eight self-learned online modules and weekly telephone counseling from a social worker for people with depression. Research design This study adopted interpretive qualitative research, involving semi-structural in-depth individual interviews with participants. Study sample Purposive sampling method was adopted, involving ten adults receiving a diagnosis of depression and completing the telephone-supported iCBT. Data collection and/or analysis Qualitative content analysis was adopted, involving coding data and identifying themes. Results The telephone-supported iCBT was appreciated by service users by offering convenience, efficiency, anonymity, privacy, synchronous and asynchronous support. Additionally, the counselor demonstrated competence in counseling via telephone, and provided various support, including: delivering CBT, handling personal issues outside the scope of iCBT, encouragement, guiding & monitoring learning progress, and solving technical difficulties. Perceived outcomes included improved abilities in cognitive restructuring, emotion regulation, and self-awareness. Conclusions The guided iCBT with telephone-supported is a feasible, effective, and preferable intervention for people with depression in Chinese societies.

Comparing the Effectiveness of a Wearable Activity Tracker in Addition to Counseling and Counseling Only to Reinforce Leisure-Time Physical Activity among Breast Cancer Patients: A Randomized Controlled Trial.

Simple SummaryMany interventions have been introduced to promote PA among patients with breast cancer. While patients have become active and their PA levels have improved during interventions, they discontinued their PA and became inactive once the study ended. Recently, interventions that use new technologies, such as wearable activity trackers (WATs) or smartphones, have become popular and replaced traditional face-to-face interventions emphasizing its efficiency. However, the use of wearable devices would not be sufficient for intervening in PA among patients with breast cancer, as each patient has different physical conditions, baseline PA levels, and clinical characteristics requiring individual counseling. Therefore, we conducted a randomized controlled trial to evaluate whether WAT in addition to counseling would reinforce leisure-time PA (LTPA) among patients with breast cancer under radiation therapy (RT) in comparison with counseling only. We found that the counseling with WAT application group had increased LTPAs immediately after the intervention and they were more likely to maintain long-term LTPAs (6 months after the intervention). We also found that patients who did not perform regular PAs before cancer diagnosis had significantly increased step counts (steps/day) compared with those who did perform regular PAs before cancer diagnosis.This randomized controlled trial aimed to compare the effectiveness of a wearable activity tracker (WAT) in addition to counseling (WAT+counseling) and counseling only for reinforcing leisure-time physical activity (LTPA) among breast cancer patients during radiotherapy (RT). A total of 152 breast cancer patients who were planning to undergo radiation therapy (RT) after surgery participated in the study. The WAT+counseling group (n = 76) underwent physical activity (PA) self-monitoring using a WAT and participated in counseling. The counseling-only group (n = 76) received telephone counseling once a week during RT and did not receive WAT. The WAT+counseling group had increased relative change in self-reported LTPA (102.8) compared with the counseling-only group (57.8) immediately after RT compared to baseline. Although the relative changes of self-reported LTPA of the WAT+counseling group were higher at three and six months after the end of RT compared to in the counseling-only group, the results were not significant. The mean average daily step count of the WAT+counseling group was 9351.7, which increased to 11,592.2 during RT and 12,240.1 after RT. In the subgroup analysis, patients who did not perform regular PA before cancer diagnosis had significantly increased step counts. This study shows the feasibility of WAT with counseling to reinforce PA among breast cancer patients.

Effect of Empowerment Program with and without Telenursing on Self-efficacy and Glycosylated Hemoglobin Index of Patients with Type-2 Diabetes: A Randomized Clinical Trial.

Introduction: Developing new training methods for improving the health of diabetic patients has always been a concern for nurses. The present study aims to investigate the effects of empowerment-based interventions with or without telenursing on self-efficacy and HbA1c level in diabetic patients.Methods: In this randomized clinical trial, 156 patients with type-2 diabetes were randomly assigned into two intervention groups (empowerment with/without telenursing) and one control group. All subjects in the intervention groups participated in two sessions of the empowerment program. However, only the group of empowerment with telenursing received telephone counseling for 12 weeks. The patients in the control group did not receive any intervention programs. Self-efficacy was measured by diabetes-specific self-efficacy scale. The HbA1c level was measured using Bionic kit. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, Ill., USA).Results: After 14 weeks, while the changes in self-efficacy scores of the control group were not statistically significant, they were significant in the two intervention groups. Comparison of the two intervention groups showed that self-efficacy was higher in the group of empowerment with telenursing. It was only in the empowerment with telenursing group that the reduction of HbA1 c was significant.Conclusion: Training based on empowerment models and emphasis on the strengths of clients in solving their own problems can play a major role in increasing self-efficacy and reduction of HbA1c level. In addition, a continuous training program, along with telephone follow-ups can result in higher self-efficacy and lower HbA1c level.

Evaluating the Effect of Telephone Counseling during the Postpartum Period on Exclusive Breastfeeding

Background The most common type of feeding for infants is breastfeeding. Since breastfeeding mothers have low levels of breastfeeding knowledge, proper Health workers' support can play an effective role in raising mother's awareness and enhancing exclusive nutrition. This study aimed to evaluate the effect of telephone counseling during the postpartum period on exclusive breastfeeding. Materials and Methods: This quasi-experimental study was conducted on 170 breastfed women referred to the 2 selected health centers of Mazandaran University of Medical Sciences in 2018. The participants were randomly allocated into two equal groups (75 individuals each). The participants in the intervention group received telephone counseling by one midwifery expert. The control group received routine care. Data were collected using a questionnaire including demographic characteristics and a breastfeeding check-list. Exclusive breastfeeding rates were recorded two and six months after childbirth in both groups. Data were analyzed using SPSS software version 24.0. Results: A total of 165 mothers participants in this study. Based on the results, exclusive breastfeeding rate was 61% in treatment group and 39.8% in control group which was statistically significant (p=0.006). In addition, 24 neonates (28.9%) of the newborns in the control group and 19 (23.2%) in the intervention group were fed to the breastfeeding. This difference was statistically significant and indicates that the intervention Telephone counseling in postpartum period has a positive effect on exclusive breastfeeding (p = 0.027). Conclusion Based on the results, using a counseling program in this study led to an increase in exclusive breastfeeding in newborns. Pre and postpartum and lactation care for both mother and infant can increase health and exclusive breastfeeding.

A Mixed Methods Study on Engagement and Satisfaction with a Digitally-Enhanced Pilot Intervention Among African American and Hispanic Women.

African American and Hispanic women report less physical activity (PA) than non-Hispanic White women. As such, a digitally-enhanced 16-week social support pilot intervention was conducted to promote PA among African American and Hispanic women dyads. This study quantitatively and qualitatively examined the engagement and satisfaction of participants (N = 30; 15 dyads) assigned to the intervention. Intervention participants received telephone counseling calls based on motivational interviewing and a Jawbone UP activity monitor. Intervention engagement and satisfaction data were collected from the Jawbone UP, call logs, self-report questionnaires conducted at the 16-week follow-up, and two post-intervention focus groups. Nonparametric tests assessed group differences across engagement and satisfaction measures, and a manually-driven coding scheme was used to evaluate emerging themes from qualitative text. Participants demonstrated high engagement in the telephone counseling sessions and moderate engagement with the Jawbone UP. Friend/co-worker dyads and participants who were 45years and older were more likely to use the device. Qualitative results emphasized participants' appreciation for the counseling calls, the Jawbone UP, and the overall dyadic framework of the study to collectively nurture social support and accountability for PA. Overall, the intervention group reacted positively to study components. Additional research is needed to understand the role of technology in facilitating long-lasting PA change via social support in minority populations.

Automated Mobile Delivery of Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: Feasibility Study.

BackgroundSocioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment among socioeconomically disadvantaged adults.ObjectiveThis study aimed to evaluate the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation.MethodsSocioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from 1 week before a scheduled quit attempt through 26 weeks after the quit date. Participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified 5 times per week via smartphone prompts to self-report smoking status and submit a breath sample via a portable carbon monoxide (CO) monitor that was connected with participants’ smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first 4 weeks after the scheduled quit date, with additional incentives offered during postquit weeks 8 and 12. In total, participants had the opportunity to earn up to US $250 in abstinence-contingent incentives over the first 12 weeks of the quit attempt.ResultsParticipants (N=16) were predominantly female (12/16, 75%) and non-Hispanic white (11/16, 69%), black (4/16, 25%), or Hispanic of any race (1/16, 6%). Most participants (9/16, 56%) reported an annual household income of <US $11,000. During the first 4 weeks after the scheduled quit date, participants completed a median of 16 (out of 21; range 1-21) mobile smoking status assessments, and they earned a median of US $28 in abstinence-contingent incentives (out of a possible US $150; range US $0-US $135). Median earnings did not change during the 8- and 12-week incentivized follow-up periods (total median earnings over 12 weeks=US $28; range US $0-US $167). During the first 4 weeks after the scheduled quit date, participants abstained from smoking on a median of 5 (out of 21) assessment days (range 0-20). At the in-person follow-up visits, the expired CO-confirmed 7-day point prevalence abstinence rates were 19% (3/16) and 13% (2/16) at 12 and 26 weeks postquit, respectively. Overall, most participants reported that the system was easy to use and that they would recommend this treatment to their friends and family.ConclusionsPreliminary data suggest that this smartphone-based approach to verifying identity and smoking status and automating the delivery of abstinence-contingent incentives to a credit card is feasible for use among socioeconomically disadvantaged adults. However, continued refinement is warranted.

Proactive Telephone Smoking Cessation Counseling Tailored to Parents: Results of a Randomized Controlled Effectiveness Trial.

A recent Dutch efficacy trial showed the efficacy of a telephone smoking cessation counseling tailored to smoking parents. Currently, it is unknown whether such telephone counseling would be effective under more real-world conditions. This study aimed to examine the effectiveness of parent-tailored telephone smoking cessation counseling in a two-arm randomized controlled effectiveness trial and whether the effectiveness depended on the recruitment approaches that were used to recruit parents (mass media vs. health care). In total, 87 parents received either telephone counseling (intervention) or a self-help brochure (control). Parents were asked to complete questionnaires at baseline and three months post-intervention. Results showed that the odds of reporting 7-day point-prevalence abstinence at three months post-intervention was 7.54 higher for parents who received telephone counseling than for parents in the control condition (53.3% vs. 13.2%, 95% CI = 2.49–22.84). Because inclusion was lower than anticipated, interaction-effects of condition and recruitment approach could not be interpreted. The present study demonstrates that the parent-tailored smoking cessation telephone counseling is effective in helping parents to quit smoking. Yet, before large-scale implementation, future research should focus on how recruitment of parents via the recruitment approaches could be improved.

Counseling intervention to improve quality of life in patients with pre-existing acute myocardial infarction (AMI) or chronic obstructive pulmonary disease (COPD): a pilot study.

In the light of diagnostic and therapeutic advances, patients with a previous myocardial infarction or with a diagnosis of chronic obstructive pulmonary disease are vulnerable and need continuous monitoring over time. These pathological frameworks have a strong impact on the economy and on the status of the population and require effective and low-cost solutions. The objective of this clinical trial is to evaluate the efficacy in the short term of a telephone counseling intervention to modify the lifestyles of these two patient populations. In May 2015, all the patients included in the study underwent a questionnaire to evaluate their eating and smoking habits and their quality of life. After randomization in two groups, the intervention group received telephone counseling related to the correct lifestyles. The control group did not undergo any intervention. In September-October 2015, the same initial questionnaire was administered to evaluate changes in patients' behavior. 64 patients were included in the study: 34 were assigned to the intervention group and 30 to the control group. The outcomes evaluated were: quality of life, assessment of eating habits and smoking status. After the telephone counseling, the intervention group (34 persons) showed a significant improvement in the score of adherence to the Mediterranean diet (p = 0.01) and a significant reduction in the percentage of smokers (p = 0.01) compared to the population that did not receive any intervention (30 persons). On the other hand, the changes related to the quality of life questionnaire were not significant. A single telephone counseling intervention is effective in modifying the lifestyles of patients with a previous myocardial infarction or diagnosed with chronic obstructive pulmonary disease in the short term, reducing their risk profile.

Comparing the effects of nicotine replacement therapy and nursing counseling on smoking cessation among the candidates for coronary artery bypass graft surgery: A clinical trial

Background: There is limited data about the effects of smoking cessation (SC) strategies among the candidates for coronary artery bypass graft (CABG) surgery. Objectives: This study aimed to compare the effects of nicotine replacement therapy (NRT) and nursing counseling (NC) on SC among the candidates for CABG. Methods: This randomized controlled trial was made in the heart center of Afshar hospital, Yazd, Iran. Sixty candidates for elective bypass graft were recruited and were randomly allocated either to a NC or a NRT group. Study interventions were implemented from 3 weeks before to 3 weeks after the surgery. Before and after hospitalization for the surgery, patients in the counseling group received telephone counseling while during their 1-week hospital stay, they received face-to-face counseling. Patients in the NRT group received nicotine gums before and after hospitalization and were treated with nicotine patches during their 1-week hospital stay. Data were collected through three questionnaires. The Chi-square and the independent-sample t tests were run to analyze the data. Results: SC rate in the counseling group was significantly higher than the NRT group (63.3% vs. 33.3%; P = 0.038). Moreover, cessation rate among the participants with lower nicotine dependency was significantly greater than those with moderate-to-severe dependency (P = 0.01). Conclusion: NC is more effective than NRT in improving SC rate among the candidates for CABG.

A Randomized Clinical Trial of a Tailored Lifestyle Intervention for Obese, Sedentary, Primary Care Patients.

The aim of the study was to test a tailored lifestyle intervention for helping obese primary care patients achieve weight loss and increase physical activity. We conducted a 24-month randomized clinical trial in Rhode Island. Primary care physicians identified obese, sedentary patients motivated to lose weight and increase their moderate to vigorous physical activity. These patients were randomized to 1 of 2 experimental groups: enhanced intervention (EI) or standard intervention (SI). Both groups received 3 face-to-face weight loss meetings. The enhanced intervention group also received telephone counseling calls, individually tailored print materials, and DVDs focused on diet and physical activity. Active intervention occurred in year 1 with a tapered maintenance phase in year 2. Two hundred eleven obese, sedentary patients were recruited from 24 primary care practices. Participants were 79% women and 16% minorities. They averaged 48.6 years of age, with a mean body mass index (BMI) of 37.8 kg/m(2), and 21.2 minutes/week of moderate to vigorous physical activity. Significantly more EI participants lost 5% of their baseline weight than SI participants (group by visit, P <.001). The difference was significant during active treatment at 6 months (37.2% EI vs 12.9% SI) and 12 months (47.8% vs 11.6%), but was no longer significant during the maintenance phase at 18 months (31.4% vs 26.7%,) or 24 months (33.3% vs 24.6%). The EI group reported significantly more minutes of moderate to vigorous physical activity over time than the SI group (group by visit, P = 0.04). The differences in minutes per week at 6 months was 95.7 for the EI group vs 68.3 minutes for the SI group; at 12 months, it was 126.1 vs 73.7; at 18 months, 103.7 vs 63.7, and at 24 months, 101.3 vs 75.4. Similar trends were found for absolute weight loss and the percentage reaching national guidelines for physical activity. A home-based tailored lifestyle intervention in obese, sedentary primary care patients was effective in promoting weight loss and increasing moderate to vigorous physical activity, with the effects peaking at 12 months but waning at 24 months.

Efficacy and Satisfaction of a Smoking Cessation Telephone Counseling Service Provided by Pharmacy Students

Objective: This was a prospective, research survey assessing patient satisfaction and efficacy of the smoking cessation telephone counseling service provided by pharmacy students at the University of Illinois Hospital.&#x0D; Methods: From September 2012 through May 2013, 82 patients received telephone counseling post hospital discharge and were followed up at 30 days for a telephone survey. Primary outcomes included improvement in stages of change, motivation and confidence levels in quitting tobacco, as well as patient satisfaction of the service. Secondary outcomes included self-reported continuous and point prevalence abstinence rates at 30 days.&#x0D; Results: Eighteen patients completed the survey. There was no significant difference before and after the service with regards to the stage of change (p = 0.14), motivation levels (p = 0.80) nor confidence levels (p = 0.89) to quit tobacco. Majority of patients felt the duration of the call was just nice (83.3%), but having only one call was too little (77.8%). Overall satisfaction of the service was 83.1%. Self-reported continuous and point prevalence abstinence rates at 30 days were 16.7% and 22.2%, respectively.&#x0D; Conclusion: Although there was no statistically significant improvement in the stages of change, motivation and confidence levels to quit smoking, patients were highly satisfied with the telephone counseling service provided by pharmacy students.&#x0D; &#x0D; Type: Clinical Experience

Efficacy of a tobacco quitline among adult survivors of childhood cancer.

The purpose of this investigation was to determine the efficacy of two evidence-based tobacco quitlines in adult survivors of childhood cancer who regularly smoke cigarettes. A total of 519 adult survivors of childhood cancer were randomized to either Proactive + 4 weeks of medication (Counselor-initiated intervention, n = 260) or a Reactive + 2 weeks of medication (Participant-initiated intervention, n = 259) condition. Both conditions received telephone counseling to quit smoking as well as nicotine replacement therapy. The primary outcome was biochemically verified (i.e. cotinine) point prevalence smoking cessation at 12 months follow-up. Participants randomized to the Proactive + 4 weeks of medication condition self-reported a higher rate of cessation than those survivors in the Reactive + 2 weeks of medication condition at 8 weeks (33.2% vs. 17.0%, p < .001), but cessation rates were not significantly different at 12 months (23.0% vs. 18.7%, p = .29). However, 80% of participants claiming abstinence failed biochemical verification, indicating marked falsification of self-reported smoking status. Adjusted cessation rates were less than 2% in both intervention conditions. Our results indicate that neither a Proactive + 4 weeks of medication or Reactive + 2 weeks of medication quitline significantly impacted long-term smoking cessation rates. Our results further indicate that self-reports of smoking status are unreliable in survivors of childhood cancer, a population in considerable need of tobacco abstinence. Rates of smoking cessation may be markedly overestimated in studies of childhood cancer survivors that rely on self-reports of tobacco abstinence, and future studies need to include biochemical verification of tobacco status in this population.

Disparities in uptake of BRCA1/2 genetic testing in a randomized trial of telephone counseling

PurposeAs genetic counseling and testing become more fully-integrated into clinical care, alternative delivery models are increasingly prominent. This study examines predictors of genetic testing for hereditary breast/ovarian cancer among high-risk women in a randomized trial of in-person vs. telephone-based genetic counseling.MethodsMethods include multivariable logistic regression and interaction analyses.ResultsOf the 669 participants, 600 completed counseling and 523 received test results. As previously reported, participants randomized to telephone counseling were significantly less likely to be tested. In intention to treat analyses, completion of counseling and testing was associated with: race/ethnicity (OR = 1.96, 95% CI: 1.20-3.20), , perceived stress (OR = 0.89, 95% CI: 0.81-0.98, knowledge (OR=1.12, 95% CI: 1.02-1.23), and randomization group (OR = 1.48, 95% CI: 1.01-2.16).. Further, race/ethnicity moderated the association between randomization group and testing, where minority women receiving telephone counseling were least likely to complete testing.ConclusionEvidence for logistical and communication-based explanations for this interaction are presented. The overall increased access made possible with telephone genetic counseling should be considered in light of the possibility that this may also lead to lower rates of testing among high-risk minority women. Additional care should be taken to assess and address potential barriers when services are delivered by phone.

A Pilot Study for Using Fecal Immunochemical Testing to Increase Colorectal Cancer Screening in Appalachia, 2008-2009

The Appalachian region of the United States has disproportionately high colorectal cancer (CRC) death rates and low screening rates. The purpose of this pilot study was to assess acceptability of a take-home fecal immunochemical test (FIT) and the effect of follow-up telephone counseling for increasing CRC screening in rural Appalachia. We used a prospective, single-group, multiple-site design, with centralized laboratory reports of screening adherence and baseline and 3-month questionnaires. Successive patients, aged 50 or older, at average CRC risk and due for screening were enrolled during a routine visit to 3 primary care practices in rural Appalachian Pennsylvania and received a free take-home FIT and educational brochure. Those who had not returned the test 2 weeks later were referred for telephone counseling. Of 232 patients approached, 200 (86.2%) agreed to participate. Of these, 145 (72.5%) completed the FIT as recommended (adherent) and 55 (27.5%) were referred for telephone counseling (nonadherent), of whom 23 (41.8%) became adherent after 1 to 2 counseling sessions, an 11.5 percentage-point increase in screening after telephone counseling and 84% FIT adherence overall. Lack of CRC-related knowledge and perceived CRC risk were the screening barriers most highly associated with nonadherence. Although not statistically significant, the rate of conversion to screening adherence was higher among participants who received telephone counseling compared to an answering machine reminder. If confirmed in future randomized trials, provider-recommended take-home FIT and follow-up telephone counseling may be methods to increase CRC screening in Appalachia.

Increasing the Reach of Quitlines Through Active Telephone Recruitment: Do Cold-Called Smokers Differ From Quitline Callers?

Only 1%-7% of smokers use quitlines annually. Active telephone recruitment ("cold calling") can enroll about 50% of community smokers to quitline services. However, whether cold-called smokers' characteristics differ from traditional quitline clients is unknown. To assess whether active telephone recruitment reaches new groups of smokers, New South Wales (NSW) Quitline callers were compared with cold-called smokers who received telephone counseling as part of a randomized controlled trial. Data were extracted from the NSW Quitline database from September 13, 2005, to April 10, 2007, to coincide with the trial's recruitment period. Records (n = 18,584) of first-time quitline callers, who smoked daily, resided in NSW, Australia, and received telephone counseling were included. Cold-called participants who received telephone counseling (n = 695) were recruited by telephone from the electronic NSW telephone directory. Eligibility requirements were daily tobacco use, aged 18 or older, NSW resident, and English speaking. Smokers were eligible regardless of their quitting intention. Male smokers, older age groups, those living in nonmetropolitan areas, smokers who took longer to smoke their first cigarette after waking, consumed fewer cigarettes per day, and were less motivated to quit had greater odds of being referred to the quitline through cold calling. Active telephone recruitment enrolls new groups of smokers to quitlines. The reach of quitlines could be improved if quitlines incorporated cold calling into their recruitment strategies.

Pilot study to develop telehealth tinnitus management for persons with and without traumatic brain injury

Tinnitus, or "ringing in the ears," affects 10%-15% of adults; cases can be problematic and require lifelong management. Many people who have experienced traumatic brain injury (TBI) also experience tinnitus. We developed Progressive Tinnitus Management (PTM), which uses education and counseling to help patients learn how to self-manage their reactions to tinnitus. We adapted PTM by delivering the intervention via telephone and by adding cognitive-behavioral therapy. A pilot study was conducted to evaluate the feasibility and potential efficacy of this approach for individuals with and without TBI. Participants with clinically significant tinnitus were recruited into three groups: probable symptomatic mild TBI (n = 15), moderate to severe TBI (n = 9), and no symptomatic TBI (n = 12). Participants received telephone counseling (six sessions over 6 months) by an audiologist and a psychologist. Questionnaires were completed at baseline, 12 weeks, and 24 weeks. All groups showed trends reflecting improvement in self-perceived functional limitations due to tinnitus. A follow-up randomized clinical study is underway.

Telephone Counseling and Attendance in a National Mammography-Screening Program: A Randomized Controlled Trial

In Germany, a mammography-screening program (MSP) was implemented on a national level. It complies with all criteria of the European guidelines for quality assurance in screening mammography; however, the attendance rate is 54%, falling short of the target attendance rate of 70%. The aim of this study was to investigate whether additional telephone counseling improves attendance among nonresponders and the level of satisfaction with telephone counseling. In a prospective RCT, women identified as nonresponders in the MSP were randomized to a control group that received written reminders or to an intervention group that additionally received telephone counseling. In a follow-up, a subset of the intervention group was contacted by telephone regarding their satisfaction with telephone counseling. In 2008, a total of 5477 women aged 50-69 years who were eligible for the German MSP but had not participated up to 6 weeks after the first invitation were included in the study. Individual telephone counseling consisted of scripted calls from a trained counselor who provided information on MSP and answered the woman's questions. Report of mammography use provided by the screening unit 3 months after the reminder was sent. Analysis was conducted in 2009. Comparison of screening attendance revealed a significantly higher attendance rate in the intervention group compared with controls (29.7% vs 26.1%, p=0.0035). When only women for whom telephone numbers were available were analyzed, attendance was even better (35.5% vs 29.7%, p=0.0004). In the follow-up, 278 of 404 women were actually surveyed. Of those, 33% stated that telephone counseling had influenced their decision, 56% stated that they had undergone screening mammography, and 77% agreed that personal telephone counseling should be used routinely to encourage nonresponders to go for screening. Individual telephone counseling for nonresponders to a national program for breast cancer screening was well accepted by participants and effective. This study is registered at the Australian New Zealand Clinical Trials Registry ACTRN12611000645954.