A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans.

BACKGROUND: Colorectal cancer (CRC) screening (CRCS) facilitates early detection and lowers CRC mortality. OBJECTIVES: To increase CRCS in a randomized trial of stepped interventions. Step 1 compared three modes of delivery of theory-informed minimal cue interventions. Step 2 was designed to more intensively engage those not completing CRCS after Step 1. METHODS: Recruitment packets (60,332) were mailed to a random sample of individuals with a record of U.S. military service during the Vietnam-era. Respondents not up-to-date with CRCS were randomized to one of four Step 1 groups: automated telephone, telephone, letter, or survey-only control. Those not completing screening after Step 1 were randomized to one of three Step 2 groups: automated motivational interviewing (MI) call, counselor-delivered MI call, or Step 2 control. Intention-to-treat (ITT) analyses assessed CRCS on follow-up surveys mailed after each step. RESULTS: After Step 1 (n = 1784), CRCS was higher in the letter, telephone, and automated telephone groups (by 1%, 5%, 7%) than in survey-only controls (43%), although differences were not statistically significant. After Step 2 (n = 516), there were nonsignificant increases in CRCS in the two intervention groups compared with the controls. CRCS following any combination of stepped interventions overall was 7% higher (P = 0.024) than in survey-only controls (55.6%). CONCLUSIONS: In a nationwide study of Veterans, CRCS after each of two stepped interventions of varying modes of delivery did not differ significantly from that in controls. However, combined overall, the sequence of stepped interventions significantly increased CRCS.

Attitudes of Chinese health sciences postgraduate students' to the use of information and communication technology in global health research.

BACKGROUND: Information and communications technology (ICT) has been suggested as an important tool for improving global health education and building research capacity in developing countries. However, the existing curricula do not have adequate emphasis on global health research and training. This study was carried out to examine health sciences postgraduates' attitudes and practices regarding curriculum for ICT use in global health research and training in China. METHODS: A cross-sectional study was conducted among health sciences postgraduates from six universities in southern China, during December 2016 to March 2017. A self-administered online questionnaire was used to collect data through an online survey platform. Data were analyzed using SPSS for Windows 13.0. RESULTS: A total of 1065 participants successfully completed the questionnaires. More than 90% of the students have not had any training about ICT, three quarters have not taken an online course, and 31% of the students do not use ICT in their current research. More than 65% thought that, in an ICT research training curriculum, it was important to learn: ICT utilization related knowledge, ICT research methods/resources, knowledge of databases, ways of data use and acquisition, and informatics search methods (ICT users compared to non-users were more likely to agree to these learning components (all p <  0.05)). Many of the respondents used or planned to use mobile phones (80%), Internet (59%), use computer and WeChat (> 40%), and QQ (a popular chat tool in China) (30%) as ICT tools in research activities. ICT users compared to non-users were more likely to consider using ICT and/or biomedical informatics methods in decision-support or support for information seeking, healthcare delivering, academic research, data gathering, and facilitating collaboration (all p <  0.05). CONCLUSIONS: The findings of this study showed that ICT utilization was very important to health sciences postgraduates for their research activities in China, but they lacked ICT-related training. The results suggested the need for specialized curriculum related to ICT use in global health research for health sciences postgraduates in China.

A RCT to evaluate a totally automated, culturally-adapted telephone counselor for increasing physical activity among physically inactive individuals in China.

BACKGROUND: The prevalence of diabetes in China has rapidly increased in recent years. Family history and physical inactivity are known risk factors for developing diabetes. As automated telephone-based communication is recognized as a cost-effective health promoting device, the present study aims at evaluating the efficacy of an automated telephone counselor (TLC-PA-China) for promoting physical activity to the WHO-recommended level among physically inactive family members of diabetes patients. METHODS: This study employed a parallel, two-group, non-blinded, randomized controlled trial design with equal allocation to the intervention group (TLC-PA-China), and a control group. Voluntary participants with at least one first-degree relative diagnosed with diabetes mellitus were recruited through eight Community Health Centers in Shenzhen, China. The intervention group was requested to use the system once per week during a six-month period. The control group received an information pamphlet about the benefits of regular physical activity. RESULTS: Two hundred ten eligible participants were randomized to TLC-PA-China (n = 109) or Control (n = 101) groups. Using intention-to-treat analysis, the TLC-PA-China group was significantly more likely to meet the WHO physical activity recommendation than the control (GEE: OR = 6.37, p < 0.001). The number of physically inactive people to intervene upon for one to become active was 2.84 at 3 months and 3.31 at 6 months. CONCLUSIONS: TLC-PA-China increased physical activity levels among physically inactive adults in China who were at high risk of developing diabetes. This study lays the groundwork for application of behavioral informatics intervention in China. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-PRC-13003361 . Registered 15 May 2013 (Retrospectively registered).

Developing a Curriculum for Information and Communications Technology Use in Global Health Research and Training: A Qualitative Study Among Chinese Health Sciences Graduate Students.

BACKGROUND: Rapid development of information and communications technology (ICT) during the last decade has transformed biomedical and population-based research and has become an essential part of many types of research and educational programs. However, access to these ICT resources and the capacity to use them in global health research are often lacking in low- and middle-income country (LMIC) institutions. OBJECTIVE: The aim of our study was to assess the practical issues (ie, perceptions and learning needs) of ICT use among health sciences graduate students at 6 major medical universities of southern China. METHODS: Ten focus group discussions (FGDs) were conducted from December 2015 to March 2016, involving 74 health sciences graduate students studying at 6 major medical universities in southern China. The sampling method was opportunistic, accounting for the graduate program enrolled and the academic year. All FGDs were audio recorded and thematic content analysis was performed. RESULTS: Researchers had different views and arguments about the use of ICT which are summarized under six themes: (1) ICT use in routine research, (2) ICT-related training experiences, (3) understanding about the pros and cons of Web-based training, (4) attitudes toward the design of ICT training curriculum, (5) potential challenges to promoting ICT courses, and (6) related marketing strategies for ICT training curriculum. Many graduate students used ICT on a daily basis in their research to stay up-to-date on current development in their area of research or study or practice. The participants were very willing to participate in ICT courses that were relevant to their academic majors and would count credits. Suggestion for an ICT curriculum included (1) both organized training course or short lecture series, depending on the background and specialty of the students, (2) a mixture of lecture and Web-based activities, and (3) inclusion of topics that are career focused. CONCLUSIONS: The findings of this study suggest that a need exists for a specialized curriculum related to ICT use in health research for health sciences graduate students in China. The results have important implications for the design and implementation of ICT-related educational program in China or other developing countries.

Building capacity for information and communication technology use in global health research and training in China: a qualitative study among Chinese health sciences faculty members.

BACKGROUND: The demand to use information and communications technology (ICT) in education and research has grown fast among researchers and educators working in global health. However, access to ICT resources and the capacity to use them in global health research remains limited among developing country faculty members. In order to address the global health needs and to design an ICT-related training course, we herein explored the Chinese health science faculty members' perceptions and learning needs for ICT use. METHODS: Nine focus groups discussions (FGDs) were conducted during December 2015 to March 2016, involving 63 faculty members working in areas of health sciences from six universities in China. All FGDs were audio recorded and analysed thematically. RESULTS: The findings suggest that the understandings of ICT were not clear among many researchers; some thought that the concept of ICT was too wide and ambiguous. Most participants were able to cite examples of ICT application in their research and teaching activities. Positive attitudes and high needs of ICT use and training were common among most participants. Recommendations for ICT training included customised training programmes focusing on a specific specialty, maintaining a balance between theories and practical applications, more emphasis on the application of ICT, and skills in finding the required information from the bulk information available in the internet. Suggestions regarding the format and offering of training included short training programmes, flexible timing, lectures with practicum opportunities, and free of charge or with very minimal cost to the participants. Two participants suggested the linking of ICT-related training courses with faculty members' year-end assessment and promotion. CONCLUSIONS: This study among health sciences faculty members in China demonstrated a high level of need and interest in learning about ICT use in research and training. The results have important implications for the design and implementation of ICT-related educational programmes in China and other developing countries.

Interactive voice response version of the late-life function and disability instrument.

OBJECTIVES: To develop an interactive voice response (IVR) version of the Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) and to evaluate its reliability and acceptability in older adults. DESIGN: The IVR system was embedded within the LLFDI-CAT program. To test the test-retest reliability and concordance of the IVR version of LLFDI-CAT with the telephone interviewer form (TIF), participants received the two versions of the LLFDI at baseline and at 1-week follow-up. SETTING: Community. PARTICIPANTS: Community-dwelling adults aged 65 and older (N = 50). MEASUREMENTS: The LLFDI is a self-reported outcome measure developed to assess function and disability in older adults. RESULTS: The IVR version of the LLFDI-CAT showed acceptable overall test-retest reliability (intraclass correlation coefficient (ICC) = 0.79-0.80) and concordance (ICC = 0.74-0.97) with the TIF. Although most participants preferred the TIF, the majority did not find the IVR version more difficult to use. CONCLUSION: The IVR version of the LLFDI-CAT achieved reliability levels that were comparable with those of the TIF version. Future work is needed to improve the IVR design to better fit older adults' needs and preferences.

Validation of 5 stage-of-change measures for parental support of healthy eating and activity.

OBJECTIVE: To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d of fruits and vegetables (FV), (2) limiting television (TV) to 2 h/d, (3) helping children achieve 1 h/d physical activity (PA), (4) limiting sugary drinks (SD) to 1 serving/wk, and (5) limiting fruit juice (FJ) to 4-6 oz/d. DESIGN: Cross-sectional instrument development study. Construct validity was evaluated by examining whether parental self-efficacy, parental readiness ladder (ladder), and child's behavioral levels (eg, FV consumption) exhibited a theoretically consistent pattern across the SOC. SETTING/PARTICIPANTS: Convenience sample (n = 283) of parents of children aged 4-10 years. MEASURES: Survey assessed SOC, ladder, and child's behavioral level score for each topic (FV, TV, PA, SD, and FJ), and parental self-efficacy for measure except TV. ANALYSIS: Analysis of variance with Tukey-Kramer post hoc tests examined whether variables differed by SOC. RESULTS: Percentages of parents in the pre-action SOC were 34% (PA), 39% (FV), 42% (SD), 45% (TV), and 63% (FJ). Parental self-efficacy, ladder, and child's behavioral level differed significantly by SOC for each topic area (P < .001). Maintenance SOC was significantly higher than pre-action SOC. CONCLUSIONS AND IMPLICATIONS: Measured variables exhibited a theoretically consistent pattern across SOC, suggesting construct validity and potential usefulness for obesity prevention efforts.

Comparison of two theory-based, fully automated telephone interventions designed to maintain dietary change in healthy adults: study protocol of a three-arm randomized controlled trial.

BACKGROUND: Health behavior change interventions have focused on obtaining short-term intervention effects; few studies have evaluated mid-term and long-term outcomes, and even fewer have evaluated interventions that are designed to maintain and enhance initial intervention effects. Moreover, behavior theory has not been developed for maintenance or applied to maintenance intervention design to the degree that it has for behavior change initiation. OBJECTIVE: The objective of this paper is to describe a study that compared two theory-based interventions (social cognitive theory [SCT] vs goal systems theory [GST]) designed to maintain previously achieved improvements in fruit and vegetable (F&V) consumption. METHODS: The interventions used tailored, interactive conversations delivered by a fully automated telephony system (Telephone-Linked Care [TLC]) over a 6-month period. TLC maintenance intervention based on SCT used a skills-based approach to build self-efficacy. It assessed confidence in and barriers to eating F&V, provided feedback on how to overcome barriers, plan ahead, and set goals. The TLC maintenance intervention based on GST used a cognitive-based approach. Conversations trained participants in goal management to help them integrate their newly acquired dietary behavior into their hierarchical system of goals. Content included goal facilitation, conflict, shielding, and redundancy, and reflection on personal goals and priorities. To evaluate and compare the two approaches, a sample of adults whose F&V consumption was below public health goal levels were recruited from a large urban area to participate in a fully automated telephony intervention (TLC-EAT) for 3-6 months. Participants who increase their daily intake of F&V by ≥1 serving/day will be eligible for the three-arm randomized controlled trial. A sample of 405 participants will be randomized to one of three arms: (1) an assessment-only control, (2) TLC-SCT, and (3) TLC-GST. The maintenance interventions are 6 months. All 405 participants who qualify for the trial will complete surveys administered by blinded interviewers at baseline (randomization), 6, 12, 18, and 24 months. RESULTS: Data analysis is not yet complete, but we hypothesize that (1) TLC-GST > TLC-SCT > control at all follow-up time points for F&V consumption, and (2) intervention effects will be mediated by the theoretical constructs (eg, self-efficacy, goal pursuit, conflict, shielding, and facilitation). CONCLUSIONS: This study used a novel study design to initiate and then promote the maintenance of dietary behavior change through the use of an evidence-based fully automated telephony intervention. After the first 6 months (the acquisition phase), we will examine whether two telephony interventions built using different underlying behavioral theories were more successful than an assessment-only control group in helping participants maintain their newly acquired health behavior change. TRIAL REGISTRATION: Clinicaltrials.gov NCT00148525; http://clinicaltrials.gov/ct2/show/NCT00148525 (Archived by Webcite at http://www.webcitation.org/6TiRriJOs).

Assessing parental self-efficacy for obesity prevention related behaviors.

BACKGROUND: Reliable, valid and theoretically consistent measures that assess a parent's self-efficacy for helping a child with obesity prevention behaviors are lacking. OBJECTIVES: To develop measures of parental self-efficacy for four behaviors: 1) helping their child get at least 60 minutes of moderate intensity physical activity every day, 2) helping one's child consume five servings of fruits and vegetables each day, 3) limiting sugary drinks to once a week, and 4) limiting consumption of fruit juice to 6 ounces every day. METHODS: Sequential methods of scale development were used. An item pool was generated based on theory and qualitative interviews, and reviewed by content experts. Scales were administered to parents or legal guardians of children 4-10 years old. The item pool was reduced using principal component analysis. Confirmatory factor analysis tested the resulting models in a separate sample. SUBJECTS: 304 parents, majority were women (88%), low-income (61%) and single parents (61%). Ethnic distribution was 40% Black and 37% white. RESULTS: All scales had excellent fit indices: Comparative fit index> .98 and chi-squares (Pediatrics 120 Suppl 4:S229-253, 2007) = .85 - 7.82. Alphas and one-week test-retest ICC's were ≥.80. Significant correlations between self-efficacy scale scores and their corresponding behaviors ranged from .13-.29 (all p < 0.03). CONCLUSIONS: We developed four, four-item self-efficacy scales with excellent psychometric properties and construct validity using diverse samples of parents. CLINICAL TRIAL REGISTRATION: NCT01768533.

Automated monitoring of symptoms during ambulatory chemotherapy and oncology providers' use of the information: a randomized controlled clinical trial.

PURPOSE: Monitoring patient-reported symptoms is necessary to adjust and improve supportive care during chemotherapy. Continuing advances in computerized approaches to symptom monitoring can enhance communication about unrelieved symptoms between patients and oncology providers and may facilitate intensified symptom treatment. METHODS: An automated IT-based telephone monitoring system was developed to enable oncology providers to receive and act on alert reports from patients about unrelieved symptoms during chemotherapy treatment. Daily, 250 participants (randomized to treatment or attentional control) were asked to call the automated system to report presence, severity, and distress for common chemotherapy-related symptoms (1-10 scale if present). For the treatment group, symptoms exceeding preset thresholds for moderate-to-severe intensity levels generated emailed alert reports to both the patient's oncologist and oncology nurse. RESULTS: Patients reported high satisfaction and ease of use of the automated system. Over 80 % of providers reported usefulness of the symptom alert reports. Ten monitored symptoms resulted in, on average, nine moderate-to-severe intensity alerts per patient over 45 study days. However, providers rarely contacted patients after receiving alerts. There were no significant differences in change of symptom severity between the two groups (mean difference = 0.06, p = 0.58). CONCLUSION: Despite patients' use of a daily symptom monitoring system and providers' receipt of information about unrelieved symptoms of moderate-to-severe intensity, oncology physicians and nurses did not contact patients to intensify symptom treatment nor did symptoms improve. Further research is indicated to determine if oncology providers initiated follow-up to intensify symptom treatment, whether symptom outcomes would improve.

Exercise advice by humans versus computers: maintenance effects at 18 months.

OBJECTIVE: An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors. METHODS: Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry. RESULTS: The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months. CONCLUSIONS: The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation.

The interaction between dietary and life goals: using goal systems theory to explore healthy diet and life goals.

Objective: To examine the types of life and dietary goals individuals report and how these goal domains interact as framed by goal systems theory. Methods: This work is a cross-sectional survey study. Measures included the incidence of common life and dietary goals and how these goals interact with and facilitate each other. Results: The results of a quantitative survey (n = 46 participants), which was informed by two focus groups (n = 17 participants), showed that participants are trying to achieve several different life (e.g. achieving financial success) and dietary goals (e.g. eating more fruits and vegetables, drinking more water, and losing weight) and that these two types of goals interact to both facilitate and conflict with each other. Having a life goal of exercising was significantly associated with healthy eating goals when compared with other life goals (p's < .05), suggesting these goals may be linked and help to facilitate one another. Being in the maintenance phase with the goal of healthy eating was associated with participants feeling like they were more successful in their other non-diet-related health goals (p < .05), suggesting maintenance of goals can facilitate success in achieving other goals. Conclusions: Life goals can have an impact on a person's ability to achieve and maintain dietary and other health goals. Health educators may help to facilitate long-term behavior change by examining a person's life goals as well as dietary goals.

Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial.

BACKGROUND: Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor. METHODS: Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions. RESULTS: Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12). CONCLUSIONS: Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: a randomized controlled trial.

BACKGROUND: Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking. PURPOSE: We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity. METHODS: We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling. RESULTS: The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p < 0.03) and in energy expenditure (+80 kcal/day, p < 0.03). A decrease in systolic BP between groups was not statistically significant (-2.3 mmHg, p = 0.25). CONCLUSIONS: Given their convenience, scalability, and ability to deliver tailored messages, automated telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.

Design and development of a Telephone-Linked Care (TLC) system to reduce impulsivity among violent forensic outpatients and probationers.

Forensic services face the challenge of reducing relapse among clients with a history of violent crime. An automated interactive voice response (IVR) service of the complex Telephone-Linked Care (TLC) type, with a focus on reducing impulsivity, could improve the adequacy of service responses to client needs. Theoretically based in Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and Motivational Interviewing (MI), the forensic TLC system offers interactive conversations on coping with the emotions of anger, shame and loneliness; activities of daily life such as getting out of bed, asking for help, visiting social services and taking medication; and other areas such as hearing voices, drinking alcohol and self-critical thoughts. We describe the user's flow through the system, with an in-depth synopsis of the hearing voices intervention. Issues regarding voluntary versus mandatory use of the system are addressed in connection with prospective introduction of the system in forensic settings.

A telerehabilitation intervention for persons with spinal cord dysfunction.

Pressure ulcers and depression are common preventable conditions secondary to a spinal cord dysfunction. However, few successful, low-cost preventive approaches have been identified. We have developed a dynamic automated telephone calling system, termed Care Call, to empower and motivate people with spinal cord dysfunction to improve their skin care, seek treatment for depression, and appropriately use the healthcare system. Herein, we describe the design and development of Care Call, its novel features, and promising preliminary results of our pilot testing. Voice quality testing showed that Care Call was able to understand all voice characteristics except very soft-spoken speech. Importantly, pilot study subjects felt Care Call could be particularly useful for people who are depressed, those with acute injury, and those without access to quality care. The results of a randomized controlled trial currently underway to evaluate Care Call will be available in 2011.

Workplace telecommunications technology to identify mental health disorders and facilitate self-help or professional referrals.

PURPOSE: Test the feasibility and impact of an automated workplace mental health assessment and intervention. DESIGN: Efficacy was evaluated in a randomized control trial comparing employees who received screening and intervention with those who received only screening. SETTING: Workplace. SUBJECTS: 463 volunteers from Boston Medical Center, Boston University, and EMC and other employed adults, among whom 164 were randomized to the intervention (N  =  87) and control (N  =  77) groups. INTERVENTION: The system administers a panel of telephonic assessment instruments followed by tailored information, education, and referrals. MEASURES: The Work Limitation Questionnaire, the Medical Outcomes Questionnaire Short Form-12, the Patient Health Questionnaire-9, question 10 from the Patient Health Questionnaire to measure functional impairment, and the Perceived Stress Scale-4 and questions written by study psychiatrists to measure emotional distress and social support respectively. The WHO-Five Well-being Index was administered to measure overall well-being. ANALYSIS: Independent sample t-tests and χ(2) tests as well as mean change were used to compare the data. RESULTS: No significant differences on 16 of the 20 comparisons at 3- and 6-month time points. The intervention group showed a significant improvement in depression (p ≤ .05) at 3 months and on two Work Limitation Questionnaire subscales, the Mental-Interpersonal Scale (p ≤ .05) and the Time and Scheduling Scale (p ≤ .05), at 3 and 6 months respectively with a suggestive improvement in mental health at 6 months (p ≤ .10). CONCLUSIONS: This is a potentially fruitful area for research with important implications for workplace behavioral interventions.

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project): study protocol.

BACKGROUND: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. METHODS/DESIGN: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned. DISCUSSION: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally. TRIAL REGISTRATION NUMBER: ACTRN12607000594426.

Usability testing of an electronic health record form to support physician-based counseling and self-management of overweight children.

Overweight management is challenging due to time constraints and minimal training in nutrition, physical activity and brief counseling. The Telephone-linked Care for Healthy Eating and Activity Today system may help physicians counsel by providing home data and effective behavioral theory-based counseling. Incorporating Goal Directed Task Analysis, Display Task Description and usability testing helped align the interface with the user's needs and workflow. We recommend routine use of these approaches to improve interface quality and usability.

TLC-HEAT: Telephony-based self-care for overweight children.

Efforts to use information technology (IT) to link pediatric primary care patients in the home with their clinicians have been rudimentary to date. We have developed a model information system that uses a ubiquitous user-interface, the telephone, and the electronic health record (EHR) to support health behavior change and weight loss for overweight urban children and their parents. In this paper, we present the technical architecture and underlying psychological theories used to build the system.