JMIR Publications

ABSTRACT

Background:

Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than recommended levels of physical activity. Using Interactive Voice Response (IVR) systems to provide personalized health education and counseling may represent a high reach low cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date.

Objective:

To design, develop and test the usability of an IVR system aimed at increasing physical activity levels in the rural Alabama Black Belt.

Methods:

A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed-method evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for two weeks and then completed System Usability Scale and qualitative semi-structured interviews.

Results:

The study sample was comprised of mostly African American female rural county coordinators and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD=5) on the System Usability Scale, implying “excellent” usability. Five overarching themes emerged from the qualitative interviews: likes/dislikes of the intervention, barriers/facilitators to physical activity; technical difficulties; quality of calls; and suggestions for intervention improvement. Message framing on step feedback, call completion incentives and incremental goal setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, the flexibility to call in or receive a call, the ability to make-up missed calls, the narration, and the physical activity tips.

Conclusions:

The usability testing and the feedback received from the rural county coordinators and research staff helped inform a final round of refinements to the interactive voice response system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. Clinical Trial: ClinicalTrials.gov NCT03903874