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We investigated the feasibility of an interactive voice response (IVR) survey in Tanzania and compared its prevalence estimates for tobacco use to the estimates of the 'Global Adult Tobacco Survey (GATS) 2018′. IVR participants were enrolled by random digit dialing. Quota sampling was employed to achieve the required sample sizes of age-sex strata: sex (male/female) and age (18–29-, 30–44-, 45–59-, and ≥60-year-olds). GATS was a nationally representative survey and used a multistage stratified cluster sampling design. The IVR sample’s weights were generated using the inverse proportional weighting (IPW) method with a logit model and the standard age-sex distribution of Tanzania. The IVR and GATS had 2362 and 4555 participants, respectively. Compared to GATS, the unweighted IVR sample had a higher proportion of males (58.7 % vs. 43.2 %), educated people (secondary/above education: 43.3 % vs. 21.1 %), and urban residents (56.5 % vs. 40 %). The weighted prevalence (95 % confidence interval (CI)) of current smoking was 4.99 % (4.11–6.04), 5.22 % (4.36–6.24), and 7.36 % (6.51–8.31) among IVR (IPW), IVR (age-sex standard), and GATS samples, respectively; the weighted prevalence (95 % CI) of smokeless tobacco use was similar: 3.54 % (2.73–4.57), 3.58 % (2.80–4.56), and 2.43 % (1.98–2.98), respectively. Most differences in point estimates for tobacco indicators were small (

BackgroundDaily use of home telehealth (HT) technologies decreases over time. Barriers to continued use are unclear.PurposeTo examine predictors of drop-out from HT in Veterans with heart failure.MethodsData for Veterans with heart failure enrolled in the Veterans Affairs HT Program were analyzed using a mixed effects Cox regression model to determine risk of dropping-out over a 1-year period.FindingsOlder (hazard ratio [HR] 1.01), sicker (prior hospital readmission [HR 1.39]), higher probability of hospital admission/death [HR 1.23], functional impairments [1.14]) and white Veterans (compared to black; HR 1.41) had higher risk of drop-out in HT Programs. Users of VA's online patient portal (HR 0.90) had lower risk of drop-out.DiscussionOlder and sicker patients are at most risk of stopping HT use, yet use of a patient portal shows promise in improving continued use. Interventions targeting patients at high risk for HT discontinuation are needed to promote ongoing engagement.

BackgroundThere 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.MethodsART 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%).ResultsIntention-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.ConclusionsHigh 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.Trial registrationClinicalTrials.gov registration #NCT02118454.

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.

Human interaction in natural language with computer systems has been a prime focus of research, and the field of conversational agents (including chatbots and Interactive Voice Response (IVR) systems) has evolved significantly since 2009, with a major boost in 2016, especially for industrial solutions. Emergency systems are crucial elements of today's societies that can benefit from the advantages of intelligent human–computer interaction systems. In this paper, we present two solutions for human-to-computer emergency systems with critical deadlines that use a multi-layer FreeSwitch IVR solution and the Botpress chatbot platform. We are the pioneers in Romania who designed and implemented such a solution, which was evaluated in terms of performance and resource management concerning Quality of Service (QoS). Additionally, we assessed our Proof of Concept (PoC) with real data as part of the system for real-time Romanian transcription of speech and recognition of emotional states within emergency calls. Based on our feasibility research, we concluded that the telephony IVR best fits the requirements and specifications of the national 112 system, with the presented PoC ready to be integrated into the Romanian emergency system. [ABSTRACT FROM AUTHOR]

Background: Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone-based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level., Objective: This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia., Methods: In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey., Results: For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female., Conclusions: In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method., (©Andres I Vecino-Ortiz, Deivis Nicolas Guzman-Tordecilla, Vidhi Maniar, Sandra Agudelo-Londoño, Oscar Franco-Suarez, Nathaly Aya Pastrana, Mariana Rodríguez-Patarroyo, Marino Mejía-Rocha, Jaime Cardona, Mariangela Chavez Chamorro, Dustin Gibson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.10.2024.)

The increased use of interactive voice response (IVR) in assessing patient and family experience should be paired with evidence-based practices on how to obtain the most accurate information via this survey mode. We added a brief clarification sentence of the survey scale at the start of the IVR call to improve our experience data both qualitatively and quantitatively. Our setting was an urban pediatric hospital. We gathered lived experiences from our patients, families, and providers to understand and design a change to the IVR survey mode that would reduce survey inaccuracies. Outcome measures were assessed by baseline measurement and post-intervention statistical analysis. Outcome measures were the percent of family comments related to survey errors and the discrepancy in scores for the first question of the survey between the two survey modes, IVR and email. One Plan-Do-Study-Act (PDSA) cycle was used to improve the accuracy of the IVR survey mode. The family survey comments expressing errors made on the first question of the IVR survey were reduced by 92% from a 2.5% (N=3,344 comments) error rate to a 0.2% (N=3,373) error rate. The discrepancy between the first question scores for IVR vs. email reduced by an average of 76.8% change (17.4 vs. 3.8) over a 20-month study period. Our initiative exceeded our goal by statistically significantly reducing the percent of comments expressing errors and the gap in survey mode first question scores. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

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. [ABSTRACT FROM AUTHOR]

Abstract Background Throughout the last decade, tuberculosis (TB) treatment success has not surpassed 90%, the global target. The impact of mobile health interventions (MHIs) on TB treatment outcomes is unknown, especially in low- and middle-income countries (LMICs). MHIs, including interactive voice response technology (IVRT), may enhance adherence and retention in the care of patients with tuberculosis and improve TB treatment outcomes. This study seeks to determine the impact of IVRT-based MHI on TB treatment success (treatment completion and cure rates) in patients with TB receiving care at five public health facilities in Uganda. Methods We used a theory-based and human-centered design (HCD) to adapt an already piloted software to design “Call for life-TB” (CFL-TB), an MHI that utilizes IVRT to deliver adherence and appointment reminders and allows remote symptom reporting. This open-label, multicenter, randomized controlled trial (RCT), with nested qualitative and economic evaluation studies, will determine the impact of CFL-TB on TB treatment success in patients with drug-susceptible TB in Uganda. Participants (n = 274) at the five study sites will be randomized (1:1 ratio) to either control (standard of care) or intervention (adherence and appointment reminders, and health tips) arms. Multivariable regression models will be used to compare treatment success, adherence to treatment and clinic appointments, and treatment completion at 6 months post-enrolment. Additionally, we will determine the cost-effectiveness, acceptability, and perceptions of stakeholders. The study received national ethical approval and was conducted in accordance with the international ethical guidelines. Discussion This randomized controlled trial aims to evaluate interactive voice response technology in the context of resource-limited settings with a high burden of TB and high illiteracy rates. The software to be evaluated was developed using HCD and the intervention was based on the IMB model. The software is tailored to the local context and is interoperable with the MHI ecosystem. The HCD approach ensures higher usability of the MHI by integrating human factors in the prototype development. This research will contribute towards the understanding of the implementation and impact of the MHI on TB treatment outcomes and the health system, especially in LMICs. Trial registration ClinicalTrials.gov NCT04709159 . Registered on January 14, 2021.

Background: Atrial fibrillation (AF) is an increasingly common chronic health condition for which integrated care that is multidisciplinary and patient-centric is recommended yet challenging to implement. Objective: The aim of Coordinating Health Care With Artificial Intelligence-Supported Technology in AF is to evaluate the feasibility and potential efficacy of a digital intervention (AF-Support) comprising preprogrammed automated telephone calls (artificial intelligence conversational technology), SMS text messages, and emails, as well as an educational website, to support patients with AF in self-managing their condition and coordinate primary and secondary care follow-up. Methods: Coordinating Health Care With Artificial Intelligence-Supported Technology in AF is a 6-month randomized controlled trial of adult patients with AF (n=385), who will be allocated in a ratio of 4:1 to AF-Support or usual care, with postintervention semistructured interviews. The primary outcome is AF-related quality of life, and the secondary outcomes include cardiovascular risk factors, outcomes, and health care use. The 4:1 allocation design enables a detailed examination of the feasibility, uptake, and process of the implementation of AF-Support. Participants with new or ongoing AF will be recruited from hospitals and specialist-led clinics in Sydney, New South Wales, Australia. AF-Support has been co-designed with clinicians, researchers, information technologists, and patients. Automated telephone calls will occur 7 times, with the first call triggered to commence 24 to 48 hours after enrollment. Calls follow a standard flow but are customized to vary depending on patients' responses. Calls assess AF symptoms, and participants' responses will trigger different system responses based on prespecified protocols, including the identification of red flags requiring escalation. Randomization will be performed electronically, and allocation concealment will be ensured. Because of the nature of this trial, only outcome assessors and data analysts will be blinded. For the primary outcome, groups will be compared using an analysis of covariance adjusted for corresponding baseline values. Randomized trial data analysis will be performed according to the intention-to-treat principle, and qualitative data will be thematically analyzed. Results: Ethics approval was granted by the Western Sydney Local Health District Human Ethics Research Committee, and recruitment started in December 2020. As of December 2021, a total of 103 patients had been recruited. Conclusions: This study will address the gap in knowledge with respect to the role of postdischarge digital care models for supporting patients with AF. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000174886; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12621000174886 International Registered Report Identifier (IRRID): DERR1-10.2196/34470 [ABSTRACT FROM AUTHOR]

Telephone-based interactive voice response (IVR) systems could be an effective tool for promotion of physical activity among older women. To test IVR feasibility, we enrolled 30 older women in a 10-week physical activity intervention designed around National Institute on Aging (NIA) Go4Life® educational materials with IVR coaching. Participants (mean age = 76 years) significantly increased physical activity by a mean 79 ± 116 (SD) minutes/week (p

Background: Cholera-like diarrheal disease (CLDD) outbreaks are complex and influenced by environmental factors, socioeconomic conditions, and population dynamics, leading to limitations in traditional surveillance methods. In Malawi, cholera is considered an endemic disease. Its epidemiological profile is characterized by seasonal patterns, often coinciding with the rainy season when contamination of water sources is more likely. However, the outbreak that began in March 2022 has extended to the dry season, with deaths reported in all 29 districts. It is considered the worst outbreak in the past 10 years., Objective: This study aims to evaluate the feasibility and outcomes of participatory surveillance (PS) using interactive voice response (IVR) technology for the early detection of CLDD outbreaks in Malawi., Methods: This longitudinal cohort study followed 740 households in rural settings in Malawi for 24 weeks. The survey tool was designed to have 10 symptom questions collected every week. The proxies' rationale was related to exanthematic, ictero-hemorragica for endemic diseases or events, diarrhea and respiratory/targeting acute diseases or events, and diarrhea and respiratory/targeting seasonal diseases or events. This work will focus only on the CLDD as a proxy for gastroenteritis and cholera. In this study, CLDD was defined as cases where reports indicated diarrhea combined with either fever or vomiting/nausea., Results: During the study period, our data comprised 16,280 observations, with an average weekly participation rate of 35%. Maganga TA had the highest average of completed calls, at 144.83 (SD 10.587), while Ndindi TA had an average of 123.66 (SD 13.176) completed calls. Our findings demonstrate that this method might be effective in identifying CLDD with a notable and consistent signal captured over time (R 2 =0.681404). Participation rates were slightly higher at the beginning of the study and decreased over time, thanks to the sensitization activities rolled out at the CBCCs level. In terms of the attack rates for CLDD, we observed similar rates between Maganga TA and Ndindi TA, at 16% and 15%, respectively., Conclusions: PS has proven to be valuable for the early detection of epidemics. IVR technology is a promising approach for disease surveillance in rural villages in Africa, where access to health care and traditional disease surveillance methods may be limited. This study highlights the feasibility and potential of IVR technology for the timely and comprehensive reporting of disease incidence, symptoms, and behaviors in resource-limited settings., (©Mariana Gasparoto Pereira Valerio, Beverly Laher, John Phuka, Guilherme Lichand, Daniela Paolotti, Onicio Leal Neto. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 16.07.2024.)

Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media--only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This two-phase pilot study aimed to design, pilot, and refine an automated interactive voice response (IVR) intervention to support antiretroviral adherence for people living with HIV (PLH), in Kolkata, India. Mixed-methods formative research included a community advisory board for IVR message development, 1-month pre-post pilot, post-pilot focus groups, and further message development. Two IVR calls are made daily, timed to patients' dosing schedules, with brief messages (

Agricultural development projects often struggle to show impact because they lack agile and cost-effective data collection tools and approaches. Due to the lack of real-time feedback data, they are not responsive to emerging opportunities during project implementation and often miss the needs of beneficiaries. This study evaluates the application of the 5Q approach (5Q). It shows findings from analyzing more than 37,000 call log records from studies among five countries. Results show that response rate and completion status for interactive voice response (IVR) surveys vary between countries, survey types, and survey topics. The complexity of question trees, the number of question blocks in a tree, and the total call duration are relevant parameters to improve response and survey completion rate. One of the main advantages of IVR surveys is low cost and time efficiency. The total cost for operating 1,000 calls of 5 min each in five countries was 1,600 USD. To take full advantage of 5Q, questions and question-logic trees must follow the principle of keeping surveys smart and simple and aligned to the project's theory of change and research questions. Lessons learned from operating the IVR surveys in five countries show that the response rate improves through quality control of the phone contact database, using a larger pool of phone numbers to reach the desired target response rate, and using project communication channels to announce the IVR surveys. Among other things, the respondent's first impression is decisive. Thus, the introduction and the consent request largely determine the response and completion rate.

Human interaction in natural language with computer systems has been a prime focus of research, and the field of conversational agents (including chatbots and Interactive Voice Response (IVR) systems) has evolved significantly since 2009, with a major boost in 2016, especially for industrial solutions. Emergency systems are crucial elements of today’s societies that can benefit from the advantages of intelligent human–computer interaction systems. In this paper, we present two solutions for human-to-computer emergency systems with critical deadlines that use a multi-layer FreeSwitch IVR solution and the Botpress chatbot platform. We are the pioneers in Romania who designed and implemented such a solution, which was evaluated in terms of performance and resource management concerning Quality of Service (QoS). Additionally, we assessed our Proof of Concept (PoC) with real data as part of the system for real-time Romanian transcription of speech and recognition of emotional states within emergency calls. Based on our feasibility research, we concluded that the telephony IVR best fits the requirements and specifications of the national 112 system, with the presented PoC ready to be integrated into the Romanian emergency system.

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.

Background: Throughout the last decade, tuberculosis (TB) treatment success has not surpassed 90%, the global target. The impact of mobile health interventions (MHIs) on TB treatment outcomes is unknown, especially in low- and middle-income countries (LMICs). MHIs, including interactive voice response technology (IVRT), may enhance adherence and retention in the care of patients with tuberculosis and improve TB treatment outcomes. This study seeks to determine the impact of IVRT-based MHI on TB treatment success (treatment completion and cure rates) in patients with TB receiving care at five public health facilities in Uganda.Methods: We used a theory-based and human-centered design (HCD) to adapt an already piloted software to design "Call for life-TB" (CFL-TB), an MHI that utilizes IVRT to deliver adherence and appointment reminders and allows remote symptom reporting. This open-label, multicenter, randomized controlled trial (RCT), with nested qualitative and economic evaluation studies, will determine the impact of CFL-TB on TB treatment success in patients with drug-susceptible TB in Uganda. Participants (n = 274) at the five study sites will be randomized (1:1 ratio) to either control (standard of care) or intervention (adherence and appointment reminders, and health tips) arms. Multivariable regression models will be used to compare treatment success, adherence to treatment and clinic appointments, and treatment completion at 6 months post-enrolment. Additionally, we will determine the cost-effectiveness, acceptability, and perceptions of stakeholders. The study received national ethical approval and was conducted in accordance with the international ethical guidelines.Discussion: This randomized controlled trial aims to evaluate interactive voice response technology in the context of resource-limited settings with a high burden of TB and high illiteracy rates. The software to be evaluated was developed using HCD and the intervention was based on the IMB model. The software is tailored to the local context and is interoperable with the MHI ecosystem. The HCD approach ensures higher usability of the MHI by integrating human factors in the prototype development. This research will contribute towards the understanding of the implementation and impact of the MHI on TB treatment outcomes and the health system, especially in LMICs.Trial Registration: ClinicalTrials.gov NCT04709159 . Registered on January 14, 2021. [ABSTRACT FROM AUTHOR]

Agricultural advisory services generally rely on interpersonal knowledge transfers by agricultural extension agents who visit farmers to provide information. This approach is not always effective and has proved hard to scale sustainably, particularly in highly dispersed smallholder farming systems. Information and communication technologies (ICTs) have been advanced as a promising way to overcome many of the problems associated with conventional agricultural extension. We evaluate the effectiveness of an ICT‐mediated approach to deliver agricultural information in a field experiment conducted among small‐scale maize farmers in eastern Uganda. Three complementary technologies designed to address both informational and behavioral constraints to technical change are considered. First, we investigate the effectiveness of audiovisual messages (video) as a means of delivering information on input use and improved maize management practices to farmers. Second, we quantify the additional impact of complementing video with an interactive voice response (IVR) service. Third, we estimate the incremental effect of time‐sensitive short message services (SMS) messages designed to remind farmers about applying key practices at specific points during the season. We find that households that were shown a short video on how to become better maize farmers were performing significantly better on a knowledge test, more likely to apply recommended practices, and more likely to use fertilizer than households that did not view the video. These same households also reported maize yields about 10.5% higher than those that did not view the video. We find little evidence of an incremental effect of the IVR service or SMS reminders. [ABSTRACT FROM AUTHOR]

Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their "business case" and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers., Competing Interests: Two of the authors (HS and EM) have current affiliation with the University of Ottawa Heart Institute. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Jaana, MacPhee, Sherrard and Walker.)

Background Given access barriers to cognitive behavioral therapy for chronic pain (CBT-CP), this pragmatic superiority trial will determine whether a remotely delivered CBT-CP intervention that addresses these barriers outperforms in-person and other synchronous forms of CBT-CP for veterans with musculoskeletal pain. Design This pragmatic trial compares an asynchronous form of CBT-CP that uses interactive voice response (IVR) to allow patients to participate from their home (IVR CBT-CP) with synchronous CBT-CP delivered by a Department of Veterans Affairs (VA) clinician. Veterans (n=764; 50% male) with chronic musculoskeletal pain throughout nine VA medical centers will participate. The primary outcome is pain interference after treatment (4 months). Secondary outcomes, including pain intensity, depression symptom severity, sleep, self-efficacy, and global impression of change, are also measured after treatment. Where possible, outcomes are collected via electronic health record extraction, with remaining measures collected via IVR calls to maintain blinding. Quantitative and qualitative process evaluation metrics will be collected to evaluate factors related to implementation. A budget impact analysis will be performed. Summary This pragmatic trial compares the outcomes, cost, and implementation of two forms of CBT-CP as delivered in the real-world setting. Findings from the trial can be used to guide future policy and implementation efforts related to these interventions and their use in the health system. If one of the interventions emerges as superior, resources can be directed to this modality. If both treatments are effective, patient preferences and health care system factors will take precedence when making referrals. Implications of COVID-19 on treatment provision and trial outcomes are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was the development and evaluation of an algorithm-based diagnosis-tool, applicable on mobile phones, to support guardians in providing appropriate care to sick children. Methods The algorithm was developed on the basis of the Integrated Management of Childhood Illness (IMCI) guidelines and evaluated at a hospital in Ghana. Two hundred and thirty-seven guardians applied the tool to assess their child’s symptoms. Data recorded by the tool and health records completed by a physician were compared in terms of symptom detection, disease assessment and treatment recommendation. To compare both assessments, Kappa statistics and predictive values were calculated. Results The tool detected the symptoms of cough, fever, diarrhoea and vomiting with good agreement to the physicians’ findings (kappa = 0.64; 0.59; 0.57 and 0.42 respectively). The disease assessment barely coincided with the physicians’ findings. The tool’s treatment recommendation correlated with the physicians’ assessments in 93 out of 237 cases (39.2% agreement, kappa = 0.11), but underestimated a child’s condition in only seven cases (3.0%). Conclusions The algorithm-based tool achieved reliable symptom detection and treatment recommendations were administered conformably to the physicians’ assessment. Testing in domestic environment is envisaged.

We investigated the feasibility of an interactive voice response (IVR) survey in Tanzania and compared its prevalence estimates for tobacco use to the estimates of the 'Global Adult Tobacco Survey (GATS) 2018'. IVR participants were enrolled by random digit dialing. Quota sampling was employed to achieve the required sample sizes of age-sex strata: sex (male/female) and age (18-29-, 30-44-, 45-59-, and ≥60-year-olds). GATS was a nationally representative survey and used a multistage stratified cluster sampling design. The IVR sample's weights were generated using the inverse proportional weighting (IPW) method with a logit model and the standard age-sex distribution of Tanzania. The IVR and GATS had 2362 and 4555 participants, respectively. Compared to GATS, the unweighted IVR sample had a higher proportion of males (58.7 % vs. 43.2 %), educated people (secondary/above education: 43.3 % vs. 21.1 %), and urban residents (56.5 % vs. 40 %). The weighted prevalence (95 % confidence interval (CI)) of current smoking was 4.99 % (4.11-6.04), 5.22 % (4.36-6.24), and 7.36 % (6.51-8.31) among IVR (IPW), IVR (age-sex standard), and GATS samples, respectively; the weighted prevalence (95 % CI) of smokeless tobacco use was similar: 3.54 % (2.73-4.57), 3.58 % (2.80-4.56), and 2.43 % (1.98-2.98), respectively. Most differences in point estimates for tobacco indicators were small (<2%). Overall, the odds of tobacco smoking indicators were lower in IVR than in GATS; however, the odds of smokeless tobacco use were reversed. Although we found under-/over-estimation of the prevalence of tobacco use in IVR than GATS, the estimates were close. Further research is required to increase the representativeness of IVR., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction Interactive Voice Response (IVR) technology has become an increasingly popular and valid method for collecting Ecological Momentary Assessment (EMA) data on a variety of health-risk behaviors, including daily alcohol use and cigarette smoking, and for stimulating behavior change. However, very little research has evaluated the parameters of IVR compliance and reactivity in respondents who may have greater problem severity than samples previously examined in published IVR studies. This study examined the prevalence and correlates of use, receptivity and reactivity to IVR monitoring in 77 untreated risky drinking smokers who were motivated to quit within the next 6 months. Methods Respondents completed twice daily IVR assessments for 28 days and were re-assessed immediately after IVR to measure receptivity and reactivity to daily monitoring and six months post-baseline. Results Mean compliance rate was 70.6%, with a morning rate of 72.4% and an evening compliance rate of 68.9% out of all possible surveys. IVR assessments of drinking and smoking were significantly associated with baseline paper-pencil reports of the same. African-American participants and those who reported more daily stressful events were more compliant. Between the baseline session and the 6-month follow-up, 68% of the sample reported engaging in some form of smoking behavior change (50% reduction in CPD, a quit attempt, pastmonth continuous abstinence). Nearly 80% reported increased awareness of their behavior due to the IVR and 40% reported intentional behavior change from IVR monitoring. The odds of making a quit attempt at the 6-month follow-up were significantly higher among respondents who reported making purposeful changes to their smoking as a result of IVR monitoring (AOR=3.25, p

The last twenty years of computer integration significantly changed the process of service in a call center service systems. Basic building modules of classical call centers – a switching system and a group of humans agents – was extended with other special modules such as skills-based routing module, automatic call distribution module, interactive voice response module and others to minimize the customer waiting time and wage costs. A calling customer of a modern call center is served in the first stage by the interactive voice response module without any human interaction. If the customer requirements are not satisfied in the first stage, the service continues to the second stage realized by the group of human agents. The service time of second stage – the average handle time – is divided into a conversation time and wrap-up time. During the conversation time, the agent answers customer questions and collects its requirements and during the wrap-up time (administrative time) the agent completes the task without any customer interaction. The analytical model presented in this contribution is solved under the condition of statistical equilibrium and takes into account the interactive voice response module service time, the conversation time and the wrap-up time.

Background: Hospitalization offers smokers an opportunity to quit smoking. Starting cessation treatment in hospital is effective, but sustaining treatment after discharge is a challenge. Automated telephone calls with interactive voice response (IVR) technology could support treatment continuance after discharge.Objective: To assess smokers' use of and satisfaction with an IVR-facilitated intervention and to test the relationship between intervention dose and smoking cessation.Design: Analysis of pooled quantitative and qualitative data from the intervention groups of two similar randomized controlled trials with 6-month follow-up.Participants: A total of 878 smokers admitted to three hospitals. All received cessation counseling in hospital and planned to stop smoking after discharge.Intervention: After discharge, participants received free cessation medication and five automated IVR calls over 3 months. Calls delivered messages promoting smoking cessation and medication adherence, offered medication refills, and triaged smokers to additional telephone counseling.Main Measures: Number of IVR calls answered, patient satisfaction, biochemically validated tobacco abstinence 6 months after discharge.Key Results: Participants answered a median of three of five IVR calls; 70% rated the calls as helpful, citing the social support, access to counseling and medication, and reminders to quit as positive factors. Older smokers (OR 1.36, 95% CI 1.20-1.54 per decade) and smokers hospitalized for a smoking-related disease (OR 1.65, 95% CI 1.21-2.23) completed more calls. Smokers who completed more calls had higher quit rates at 6-month follow-up (OR 1.49, 95% CI 1.30-1.70, for each additional call) after multivariable adjustment for age, sex, education, discharge diagnosis, nicotine dependence, duration of medication use, and perceived importance of and confidence in quitting.Conclusions: Automated IVR calls to support smoking cessation after hospital discharge were viewed favorably by patients. Higher IVR utilization was associated with higher odds of tobacco abstinence at 6-month follow-up. IVR technology offers health care systems a potentially scalable means of sustaining tobacco cessation interventions after hospital discharge.Clinical Trial Registration: ClinicalTrials.gov Identifiers NCT01177176, NCT01714323. [ABSTRACT FROM AUTHOR]

Objectives: To investigate and determine the factors that enhanced or constituted barriers to the acceptance of an mHealth system which was piloted in Asante-Akim North District of Ghana to support healthcare of children.Methods: Four semi-structured focus group discussions were conducted with a total of 37 mothers. Participants were selected from a study population of mothers who subscribed to a pilot mHealth system which used an interactive voice response (IVR) for its operations. Data were evaluated using qualitative content analysis methods. In addition, a short quantitative questionnaire assessed system's usability (SUS).Results: Results revealed 10 categories of factors that facilitated user acceptance of the IVR system including quality-of-care experience, health education and empowerment of women. The eight categories of factors identified as barriers to user acceptance included the lack of human interaction, lack of update and training on the electronic advices provided and lack of social integration of the system into the community. The usability (SUS median: 79.3; range: 65-97.5) of the system was rated acceptable.Conclusions: The principles of the tested mHealth system could be of interest during infectious disease outbreaks, such as Ebola or Lassa fever, when there might be a special need for disease-specific health information within populations. [ABSTRACT FROM AUTHOR]

Objectives: Our study objective was to compare the equivalence of a new version of the electronic Columbia-Suicide Severity Rating Scale that was administered on a tablet device with the existing interactive voice response version in order to support the prospective monitoring of suicidal ideation and behavior in clinical trials and clinical practice. Design: This was a randomized, crossover-equivalence study with no treatment intervention. Setting: The study setting was a psychiatric hospital. Participants: Fifty-eight recently admitted psychiatric inpatients and 28 employees of the hospital site were included in the study. Mean age was 41.0 years (standard deviation=12.5), and 59 percent were female. Measurements: Participants completed both tablet and interactive voice response versions in randomized order, with a 25-minute break between administrations. Finally, participants completed a second administration of the first administered version. Intraclass correlation coefficients (ICCs) and Kappa coefficients were used to evaluate agreement across modalities. Results: High levels of agreement were observed for most severe lifetime (ICC=0.88) and recent (ICC=0.79) ideation, occurrence of actual lifetime (Kappa=0.81) and recent (Kappa=0.73) suicide attempts, and occurrence of lifetime interrupted attempts (Kappa=0.78), aborted attempts (Kappa=0.54), and preparatory behaviors (Kappa=0.77), as well as non-suicidal selfinjurious behavior (Kappa=0.73). Scores from both modes significantly differentiated psychiatric patients and hospital employee controls, and the testretest reliability of both modes was excellent. Conclusions: These results support the validity and reliability of the new tabletbased electronic Columbia-Suicide Severity Rating Scale. This will allow the inclusion of the electronic Columbia-Suicide Severity Rating Scale in a wider range of clinical studies, particularly where a tablet is also being used to collect other study data. [ABSTRACT FROM AUTHOR]

Background: Brief interventions for unhealthy drinking in primary care settings are efficacious, but underutilized. Efforts to improve rates of brief intervention though provider education and office systems redesign have had limited impact. Our novel brief intervention uses interactive voice response (IVR) to provide information and advice directly to unhealthy drinkers before a physician office visit, with the goals of stimulating in-office dialogue about drinking and decreasing unhealthy drinking. This automated approach is potentially scalable for wide application.Objective: We aimed to examine the effect of a pre-visit IVR-delivered brief alcohol intervention (IVR-BI) on patient-provider discussions of alcohol during the visit.Design: This was a parallel group randomized controlled trial with two treatment arms: 1) IVR-BI or 2) usual care (no IVR-BI).Participants: In all, 1,567 patients were recruited from eight university medical center-affiliated internal medicine and family medicine clinics.Interventions: IVR-BI is a brief alcohol intervention delivered by automated telephone. It has four components, based on the intervention steps outlined in the National Institute of Alcohol Abuse and Alcoholism guidelines for clinicians: 1) ask about alcohol use, 2) assess for alcohol use disorders, 3) advise patient to cut down or quit drinking, and 4) follow up at subsequent visits.Main Measures: Outcomes were patient reported: patient-provider discussion of alcohol during the visit; patient initiation of the discussion; and provider's recommendation about the patient's alcohol use.Key Results: Patients randomized to IVR-BI were more likely to have reported discussing alcohol with their provider (52 % vs. 44 %, p = 0.003), bringing up the topic themselves (20 % vs. 12 %, p < 0.001), and receiving a recommendation (20 % vs. 14 %, p < 0.001). Other predictors of outcome included baseline consumption, education, age, and alcohol use disorder diagnosis.Conclusions: Providing automated brief interventions to patients prior to a primary care visit promotes discussion about unhealthy drinking and increases specific professional advice regarding changing drinking behavior. [ABSTRACT FROM AUTHOR]

The last twenty years of computer integration significantly changed the process of service in a call center service systems. Basic building modules of classical call centers - a switching system and a group of humans agents - was extended with other special modules such as skills-based routing module, automatic call distribution module, interactive voice response module and others to minimize the customer waiting time and wage costs. A calling customer of a modern call center is served in the first stage by the interactive voice response module without any human interaction. If the customer requirements are not satisfied in the first stage, the service continues to the second stage realized by the group of human agents. The service time of second stage - the average handle time - is divided into a conversation time and wrap-up time. During the conversation time, the agent answers customer questions and collects its requirements and during the wrapup time (administrative time) the agent completes the task without any customer interaction. The analytical model presented in this contribution is solved under the condition of statistical equilibrium and takes into account the interactive voice response module service time, the conversation time and the wrap-up time. [ABSTRACT FROM AUTHOR]