Culturally-Adapted, Telephone-Based System to Promote Physical Activity
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Boston Medical Center
Boston
Hypertension
Urban safety net provider
African Americans |
PROJECT
Patients received weekly telephone calls from an automated health monitoring and counseling system.
An automated, interactive behaviorchange program is delivered to patients by telephone, which individually tailors health messages based on a range of individual and cultural variables, functioning as an at-home monitor, educator and conduit of messaging designed to reinforce or change health-related behaviors. Patients receive one call per week for 12 weeks that lasts about 10 minutes. Patients are asked about their levels of physical activity. Based on their responses, the system provides feedback, assistance in developing goals for healthy behaviors, and a physical activity ‘prescription’ for the upcoming week. The system also explores the benefits of and possible barriers to regular physical activity. The telephone system delivers messages that are specifically tailored to the patient’s cultural background and most closely aligned with the patient’s own personal values.
RATIONALE
Moderate physical activity can play an important role in reducing blood pressure. Even though the health benefits of regular physical activity have been well-established, many Americans do not engage in leisure-time physical activities. Interactive, computer-based telephone systems can help encourage healthy behaviors: they are flexible, easy to use, and have a relatively low cost to implement. These telephone systems can be accessed by patients at any time, and from any location. An automated telephone system may be particularly helpful for patients who experience obstacles to participating in face-to-face behavior-change programs. The culturally adapted intervention being investigated by this study has the potential to be even more helpful: ‘culture neutral’ interventions intended
for a general audience often have
poorer outcomes than those that are
specifically adapted to the cultural
background of patients.
EVALUATION PLAN
Funded by Finding Answers in 2009.
Two complementary, but distinct, studies are part of this project. The first is assessing the effectiveness of the telephone-based intervention using a randomized control trial design. The study is recruiting African American patients with hypertension and low levels of physical activity and is randomizing them to either the control or intervention group. Researchers are conducting a three-month follow-up assessment examining whether the use of the culturally adapted telephone-linked care system has an effect on physical activity and blood pressure, relative to the control group.
The second study is assessing the feasibility of the intervention in normal practice, outside of the research setting. This study is examining actual referral and usage patterns. Patient and physician experiences using this system are being assessed to inform future efforts. The study is analyzing direct costs of implementing the telecommunications system along with patients’ out-of-pocket expenses and the opportunity costs of time spent on the phone.
Principal Investigators:
- Julien J. Dedier, MD, MPH (Assistant Professor of Medicine, Boston Medical Center)
- Robert H. Friedman, MD (Chief of the Medical Information Systems Unit, Boston Medical Center)
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