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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. [ABSTRACT FROM AUTHOR]

Phone surveys have increasingly become important data collection tools in developing countries, particularly in the context of sudden contact restrictions due to the COVID-19 pandemic. So far, there is limited evidence regarding the potential of the messenger service WhatsApp for remote data collection despite its large global coverage and expanding membership. WhatsApp may offer advantages in terms of reducing panel attrition and cutting survey costs. WhatsApp may offer additional benefits to migration scholars interested in cross-border migration behavior which is notoriously difficult to measure using conventional face-to-face surveys. In this field experiment, we compared the response rates between WhatsApp and interactive voice response (IVR) modes using a sample of 8446 contacts in Senegal and Guinea. At 12%, WhatsApp survey response rates were nearly eight percentage points lower than IVR survey response rates. However, WhatsApp offers higher survey completion rates, substantially lower costs and does not introduce more sample selection bias compared to IVR. We discuss the potential of WhatsApp surveys in low-income contexts and provide practical recommendations for field implementation. [ABSTRACT FROM AUTHOR]

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.

Background Cognitive behavioral therapy for chronic pain (CBT-CP) has a strong evidence base, but little is known about when treatment benefits are achieved. The present study is a secondary analysis of individuals with chronic back pain recruited for a noninferiority trial comparing interactive voice response (IVR) CBT-CP with in-person CBT-CP. Methods On the basis of data from daily IVR surveys, a clinically meaningful change was defined as a 30% reduction in pain intensity (n = 108) or a 45% increase in daily steps (n = 104) compared with the baseline week. We identified individuals who achieved a meaningful change at any point during treatment, and then we compared those who maintained a meaningful change in their final treatment week (i.e. responders) with those who did not or who achieved a meaningful change but lapsed (i.e. nonresponders). Results During treatment, 46% of participants achieved a clinically meaningful decrease in pain intensity, and 66% achieved a clinically significant increase in number of steps per day. A total of 54% of patients were classified as responders in terms of decreases in pain intensity, and 70% were responders in terms of increases in step count. Survival analyses found that 50% of responders first achieved a clinically meaningful change by week 4 for pain intensity and week 2 for daily steps. Dropout and demographic variables were unrelated to responder status, and there was low agreement between the two measures of treatment response. Conclusions Collectively, results suggest that most responders improve within 4 weeks. Evaluating treatment response is highly specific to the outcome measure, with little correlation across outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: Previous findings have been equivocal as to whether a single‐nucleotide polymorphism (rs2832407) in GRIK1, which encodes a glutamate receptor subunit, moderates the effects of topiramate treatment for drinking reduction. We leveraged intensive longitudinal data to provide greater precision and allow an examination of intermediate outcomes addressing this question. We used data from a randomized controlled trial (RCT) to test the hypotheses that topiramate treatment reduces daily heavy drinking, desire to drink and positive alcohol expectancies and that these effects are stronger in rs2832407*C‐allele homozygotes. Design: Secondary data analysis of a randomized controlled trial. Setting: University of Pennsylvania Treatment Research Center in the United States. Participants/Cases: Participants were 164 individuals (70.1% male, mean age = 51.42, 36.0% rs2832407*C‐allele homozygotes) who sought to reduce or stop drinking. Intervention and Comparator: Participants were assigned to medication (topiramate or placebo), with stratification by genotype group (CC versus AA/AC) and treatment goal (reduce versus abstain). Measurements During the 12‐week treatment period, participants completed daily interactive voice response (IVR) surveys. Findings On any given day during treatment, participants who received topiramate had lower odds of IVR‐reported heavy drinking [odds ratio (OR) = 0.259, b (standard error, SE) = −1.351 (0.334), P < 0.001] and lower levels of desire to drink [b (SE) = −0.323 (0.122), P = 0.009] and positive alcohol expectancies [b (SE) = −0.347 (0.138), P = 0.013] than those who received placebo. Participants who received topiramate also reported greater reductions in positive alcohol expectancies during the first 2 weeks of treatment than those who received placebo [b (SE) = −0.028 (0.008), P = 0.001], but topiramate did not impact the daily rate of change in heavy drinking or desire to drink. Genotype did not moderate the effects of topiramate on any outcomes examined (P > 0.05). Conclusions: Topiramate is an effective medication for individuals seeking to reduce heavy drinking. The effects are not moderated by the single‐nucleotide polymorphism rs2832407. [ABSTRACT FROM AUTHOR]

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]

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]

Mobile technology is widely used in healthcare. However, designers and developers in many cases have focused on developing solutions that are often tailored to highly literate people. While the advent of the pandemic has called for people to seek and use Covid-19 related information to adapt their behaviors, it is relatively difficult for low literate to get easily access to health information through digital technologies. In this study, we present a Mobile based Interactive Voice Response service designed particularly for low-literate people which provides validated Covid-19 related health information in local African languages. We conducted a field study, among high school students, through a usability study to assess users’ perception. The service received an excellent numerical usability score of 78.75. [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

This paper analyses the performance of different types of Deep Neural Networks to jointly estimate age and identify gender from speech, to be applied in Interactive Voice Response systems available in call centres. Deep Neural Networks are used, because they have recently demonstrated discriminative and representation capabilities in a wide range of applications, including speech processing problems based on feature extraction and selection. Networks with different sizes are analysed to obtain information on how performance depends on the network architecture and the number of free parameters. The speech corpus used for the experiments is Mozilla's Common Voice dataset, an open and crowdsourced speech corpus. The results are really good for gender classification, independently of the type of neural network, but improve with the network size. Regarding the classification by age groups, the combination of convolutional neural networks and temporal neural networks seems to be the best option among the analysed, and again, the larger the size of the network, the better the results. The results are promising for use in IVR systems, with the best systems achieving a gender identification error of less than 2% and a classification error by age group of less than 20%. [ABSTRACT FROM AUTHOR]

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]

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.

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: 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 (

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]

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]

This study developed a data collection method, combining (i) random‐digit dialling and interactive voice response to sample and screen respondents and (ii) computer‐assisted telephone interviewing, to survey 2265 respondents during the 2014 Ebola epidemic. The response, cooperation, refusal and contact rates computed according to the American Association for Public Opinion Research were 51.97, 52.62, 41.85 and 98.77 per cent, for interactive voice response and 91.10, 91.65, 8.30 and 99.40 per cent for computer‐assisted telephone interviewing. A comparison with Demographic and Health Surveys confirmed that the sample is not nationally representative. However, this method offers promise for data collection at a low cost ($24) and without any in‐person interaction. © 2020 John Wiley & Sons, Ltd. [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.

Objectives: In this study, we identify physical activity (PA) benefits and barriers and changes in response to a 12-week interactive voice response (IVR)-supported PA telephone counseling intervention. Methods: Participants (N = 63) completed the Exercise Benefits/Barriers Scale (EBBS) at baseline and post-intervention. Exit interview responses to benefits and barriers items were analyzed qualitatively. Results: High exercise benefits and moderate barriers were reported at baseline. The intervention arm experienced a statistically significant greater improvement in barriers (but not benefits) from baseline to week 12, compared to the control arm. These relationships held when we controlled for sex, age, ethnicity, baseline PA, baseline barriers, and baseline benefits. Themes from interviews corroborated the lack of change in PA benefits and decreases in PA barriers and emphasized that support and accountability helped address barriers related to time and motivation. Conclusions: IVR-supported interventions show promise for improving perceived exercise barriers and possibly exercise benefits. [ABSTRACT FROM AUTHOR]

Clinical laboratory quality improvement (QI) efforts can include population test utilization. The authors used a health care organization's Medical Data Warehouse (MDW) to characterize a gap in guideline-concordant laboratory testing recommended for safe use of antirheumatic agents, then tested the effectiveness of laboratory-led, technology-enabled outreach to patients at reducing this gap. Data linkages available through the Kaiser Permanente Colorado MDW and electronic health record were used to identify ambulatory adults taking antirheumatic agents who were due/overdue for alanine aminotransferase (ALT), aspartate aminotransferase (AST), complete blood count (CBC), or serum creatinine (SCr) testing. Outreach was implemented using an interactive voice response system to send patients text or phone call reminders. Interrupted time series analysis was used to estimate reminder effectiveness. Rates of guideline-concordant testing and testing timeliness in baseline vs. intervention periods were determined using generalized linear models for repeated measures. Results revealed a decrease in percentage of 3763 patients taking antirheumatic agents due/overdue for testing at any given time: baseline 24.3% vs. intervention 17.5% (P < 0.001). Among 3205 patients taking conventional antirheumatic agents, concordance for all ALT testing was baseline 52.8% vs. intervention 65.4% (P < 0.001) among patients chronically using these agents and baseline 20.6% vs. intervention 26.1% (P < 0.001) among patients newly starting these agents. The 95th percentiles for days to ALT testing were baseline 149 vs. intervention 117 among chronic users and baseline 134 vs. intervention 92 among new starts. AST, CBC, and SCr findings were similar. Technology-enabled outreach reminding patients to obtain laboratory testing improves health care system outcomes. [ABSTRACT FROM AUTHOR]

Background:  Health dialog systems have seen increased adoption by patients, hospitals, and universities due to the confluence of advancements in machine learning and the ubiquity of high-performance hardware that supports real-time speech recognition, high-fidelity text-to-speech, and semantic understanding of natural language.Objectives:  This review seeks to enumerate opportunities to apply dialog systems toward the improvement of health outcomes while identifying both gaps in the current literature that may impede their implementation and recommendations that may improve their success in medical practice.Methods:  A search over PubMed and the ACM Digital Library was conducted on September 12, 2017 to collect all articles related to dialog systems within the domain of health care. These results were screened for eligibility with the main criteria being a peer-reviewed study of a system that includes both a natural language interface and either end-user testing or practical implementation.Results:  Forty-six studies met the inclusion criteria including 24 quasi-experimental studies, 16 randomized control trials, 2 case-control studies, 2 prospective cohort studies, 1 system description, and 1 human-computer conversation analysis. These studies evaluated dialog systems in five application domains: medical education (n = 20), clinical processes (n = 14), mental health (n = 5), personal health agents (n = 5), and patient education (n = 2).Conclusion:  We found that dialog systems have been widely applied to health care; however, most studies are not reproducible making direct comparison between systems and independent confirmation of findings difficult. Widespread adoption will also require the adoption of standard evaluation and reporting methods for health dialog systems to demonstrate clinical significance. [ABSTRACT FROM AUTHOR]

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.)