Telephone-linked care for physical activity: A qualitative evaluation of the use patterns of an information technology program for patients

Abstract

Automated health behavior interventions that involve discretionary use by patients or consumers over extended periods of time are becoming more common and it is generally assumed that adherence to the recommended schedule is related to the impact of the system on users. Yet reasons for use or non-use of such systems have not been carefully explored. An understanding of factors that influence people to use, not use, or underutilize these automated behavioral change and self-care management systems can help in designing systems that are more effective and acceptable to users. Using qualitative research methods, this study explored the experiences of 45 users of a multiple-contact health promotion application with the goal of understanding the major factors that affect patterns of use (frequency of and duration of contact). The in-depth exploration of users' perceptions and views made possible by the qualitative research methods revealed a number of important themes. Reported reasons for underutilization or non-use were found to be both user-related and system-related. User-related reasons encompassed personal and individual events that prevented or impeded system utilization. System-related reasons included those that related to the medium itself as well as the content of the application. The qualitative methods employed in this study created a forum through which users' feedback could be fully explored and then synthesized to assist in the improvement of this and other automated health behavior interventions.

Review of spoken dialogue systems

“…During the last two decades, SDSs have been increasingly used in Ambient Assisted Living providing services such as interviews (Ghanem et al, 2005;, counseling (Hubal & Day, 2006), chronic symptoms monitoring (Black, McTear, Black, Harper, & Lemon, 2005;Migneault, Farzanfar, Wright, & Friedman, 2006), medication prescription assistance and adherence (Bickmore, Puskar, Schlenk, Pfeifer, & Sereika, 2010), changing dietary behaviour (Delichatsios et al, 2001), promoting physical activity (Farzanfar, Frishkopf, Migneault, & Friedman, 2005), helping cigarette smokers quit (Ramelson, Friedman, & Ockene, 1999), speech therapy (Saz et al, 2009), and prognosis and diagnosis using different techniques (Maglogiannis, Zafiropoulos, & Anagnostopoulos, 2009). …”

Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers

“…In a prestudy regarding a TLC-system for advice-giving to depressed patients regarding adherence to their medication regimen, most users preferred a female voice, considering it more nurturing, and advised us to make sure that the voice sounded compassionate and reassuring; we thus needed to enhance human-like attributes of the voice [49]. On the other hand, in two other studies of TLC, one a physical activity promotion program and the other a mental health assessment system, we were told by users that enhancing human-like characteristics in the voice should be avoided as users prefer to talk to a computer and not a human being and any similarities could be unsettling [51,52]. We have also learned that some users respond to a recorded digitized human voice largely in relation to the tone, pitch and delivery rather than gender of the voice [51].…”

“…On the other hand, in two other studies of TLC, one a physical activity promotion program and the other a mental health assessment system, we were told by users that enhancing human-like characteristics in the voice should be avoided as users prefer to talk to a computer and not a human being and any similarities could be unsettling [51,52]. We have also learned that some users respond to a recorded digitized human voice largely in relation to the tone, pitch and delivery rather than gender of the voice [51]. Indeed, in the mental health assessment study, the less human the voice sounded, the more users felt that they were talking to a computer and were thus less worried about confidentiality and privacy issues [52].…”

Relations between de-facto criteria in the evaluation of a spoken dialogue system

“…For example (Bickmore and Giorgino, 2006) report that individuals who intermittently use health dialogue systems on the telephone, compared to those who use them frequently and those who hardly use them at all, obtain the highest satisfaction levels and the best outcomes in terms of the perceived benefits. However, as discussed by Farzanfar et al (2004), this can be due to the stress that some users experience if they feel monitored.…”