Background: Low health literacy is a significant problem affecting our country.  While the associations between low health literacy and poorer health outcomes have been well documented (Berkman et al., 2011), the literature lacks evidence of effective strategies to address health literacy in the context of health behaviors such as diet and physical activity (PA). Likewise, few interventions have reported on how health literacy status influences performance and engagement in the intervention. Two potential intervention strategies include the teach back method or teach to goal approach and interactive voice response (IVR) technology. These strategies hold promise as a means of improving health literacy and reaching vulnerable, low health literate populations, but these strategies have not been widely explored in the literature (Paasche-Orlow et al., 2005; Baker et al., 2011; Schillinger et al., 2009; Bennett et al., 2012; Piette et al., 1999). Primary Aims: This research was embedded in a larger trial, Talking Health, which is a 6-month, 2 group randomized controlled trial to determine the effects of a health behavior intervention on reducing sugar-sweetened beverage (SSB) consumption in Southwest Virginians. The primary aims of this study were to examine the associations between health literacy status and 1) number of rounds of teach back needed to reinforce key concepts, 2) proportion of correct answers on the first round of teach back, 3) level of intervention engagement (i.e., completion rates for teach back call, IVR calls, and small group classes), and 4) perceptions of the intervention components. Methods: The data reported represent the first 3 cohorts of the Talking Health trial including participants in Lee, Giles, and Pulaski Counties. Eligibility requirements included being 18 years or older, English speaking, consuming at least 200 calories per day from SSB, able to participate in moderate intensity PA, and having reliable access to a telephone. Data were collected at baseline and at the 6-month follow-up assessment. Health literacy was assessed using the validated Newest Vital Sign. Participants were randomized to a behavioral intervention aimed at decreasing SSB consumption (SipSmartER) or to a matched-contact control group targeting PA (Move More). Both groups participated in 3 small group education sessions, received a live teach back call, and 11 supportive IVR calls. Participants completed a summative evaluation at the 6-month follow-up, which captured their perceptions of the intervention components. ANOVAs were used to measure differences in outcomes by health literacy status, randomized condition, and interactions. Results: Of the 125 enrolled participants, 92.0% were Caucasian, 76.8% were female, 29.6% had d high school education, 64.0% had <$25,000 annual household income, and 32.8% had low health literacy skills. Eighty-five participants (68.0%) completed the teach back call. The overall model when looking at the degree to which health literacy status and randomized condition predicted the number of rounds of teach back needed to reinforce key concepts was significant (F= 8.323, p < 0.001). Out of 3 possible teach back attempts, participants in the low health literacy category required a significantly higher number of teach back attempts as compared to those with high health literacy (F= 16.769, p <0.001), and participants randomized to Move More required a significantly higher number of teach back attempts compared to SipSmartER participants (F=7.296, p= 0.008). Similarly, the overall model when looking at the degree to which health literacy status and randomized condition predicted the proportion correct on the first round of teach back was significant (F= 9.836, p<0.001), such that those with higher health literacy status  (F= 19.176, p< 0.001) and those randomized to SipSmartER condition answered a significantly higher proportion of questions correct (F= 9.783, p= 0.002). Intervention engagement including completion of the small group education sessions, the live teach back call, and the IVR calls did not vary significantly across randomized condition or literacy levels. Low health literate participants had a significantly higher overall perceived satisfaction with the IVR, as compared to high health literate participants (F= 5.849, p= 0.020). However, perceptions of other intervention components (e.g., small group sessions, teach back call, personal action plans, drink diaries/exercise logs,) were similar among participants with low and high health literacy status and across randomized conditions.   Conclusion: These data confirm the importance for multiple teach back opportunities and additional exposure to health information to ensure participant comprehension of key intervention content"in particular for those with lower health literacy. This research also supports that IVR is an effective approach to reaching vulnerable, low health literate populations. Future research should investigate the efficacy and cost-effectiveness of utilizing teach back methods delivered using automated technologies. Future research also is needed to determine how teach back performance are related to other study factors such as retention, engagement, and health outcomes. / Master of Science

Many researchers and speech user interface practitioners assert that interactive voice response (IVR) menus must be relatively short due to constraints of the human memory system. These individuals commonly cite Miller's (1956) paper to support their claims. The current paper argues that these authors commonly misuse the information provided in Miller's paper and that hypotheses drawn from modern theories of working memory (e.g., Baddeley and Hitch, 1974) would lead to the opposite conclusion – that reducing menu length by creating a greater number of menus and a deeper structure will actually be more demanding on users' working memories and will lead to poorer performance and poorer user satisfaction. The primary purpose of this series of experiments was to gain a greater understanding of the role of working memory in speech-enabled IVR use. The experiments also sought to determine whether theories of visual search and signal detection theory (SDT) could be used to predict auditory search behavior. Results of this experiment indicate that creating a deeper structure with shorter menus is detrimental to performance and satisfaction and more demanding of working memory resource. Further the experiment provides support for arguments developed from Macgregor, Lee, and Lam's dual criterion decision model and is a first step toward applying SDT to the IVR domain.

No description available.

Currently, there is a lack of usable, remote, and accessible voting technologies that must be addressed. An interactive voice response (IVR) system is one potential solution to this problem, due to its capability of remote use and its audio interface, which is very beneficial for those who are visually impaired. An IVR voting system developed by Holmes and Kortum (2011) was fitted with a synthetic voice and an audio speed adjustment feature for increased accessibility and usability, especially for blind voters (Piner, 2011). This system was tested on the three ISO 9241-11 usability metrics (ISO 9241-11, 1998), efficiency (time to complete a ballot), effectiveness (accuracy), and satisfaction (subjective usability) and compared with the usability of other voting methods in an attempt to determine its viability as a voting method. The usage of the accessibility feature was also examined. Results showed that the IVR voting system is comparable with other voting methods in terms of usability. Results also showed a noticeable portion of non-visually impaired participants utilized the accessibility feature.

The main goal of this project was to enhance the use and usability of Interactive Voice Response Systems (IVR) for older people. The objective of study one was to examine older people’s perceptions of the technology and identify the most common difficulties experienced by older people when interactive with IVR using focus groups. Twenty-six people aged 65 and older took part in the study. Data were analyzed using frequency and chi square analyses. The results revealed negative attitudes towards the technology. Long menus, frustration about not being able to reach an operator and absence of shortcuts were some of the most common difficulties reported by participants. Study two examined the cognitive factors predicting successful IVR interaction in four commercially available IVR systems in a sample of 185 older adults. Linear regressions were performed on the data. Results indicated that working memory and auditory memory were the best predictors of successful IVR interaction. Using the same sample of participants as study two, study three examined older adults’ attitudes towards the four IVR systems in relation to their success in interacting with the technology. The study also evaluated the impact of gender on success and attitudes towards IVR. There was a significant positive correlation between success with IVR and favorable attitudes towards the technology. No gender differences emerged in both performance on IVR tasks and attitudes towards the technology. Study four evaluated the feasibility of using a voice-activated IVR to administer and score three short neuropsychological tests using a sub sample of the original sample of 185 older adults involved in study two and three. One hundred and fifty eight participants took part in the study. Results showed high correlations between the IVR and clinician scoring of the three tests. Nevertheless, a number of discrepancies and technical issues were discovered.

The main goal of this project was to enhance the use and usability of Interactive Voice Response Systems (IVR) for older people. The objective of study one was to examine older people’s perceptions of the technology and identify the most common difficulties experienced by older people when interactive with IVR using focus groups. Twenty-six people aged 65 and older took part in the study. Data were analyzed using frequency and chi square analyses. The results revealed negative attitudes towards the technology. Long menus, frustration about not being able to reach an operator and absence of shortcuts were some of the most common difficulties reported by participants. Study two examined the cognitive factors predicting successful IVR interaction in four commercially available IVR systems in a sample of 185 older adults. Linear regressions were performed on the data. Results indicated that working memory and auditory memory were the best predictors of successful IVR interaction. Using the same sample of participants as study two, study three examined older adults’ attitudes towards the four IVR systems in relation to their success in interacting with the technology. The study also evaluated the impact of gender on success and attitudes towards IVR. There was a significant positive correlation between success with IVR and favorable attitudes towards the technology. No gender differences emerged in both performance on IVR tasks and attitudes towards the technology. Study four evaluated the feasibility of using a voice-activated IVR to administer and score three short neuropsychological tests using a sub sample of the original sample of 185 older adults involved in study two and three. One hundred and fifty eight participants took part in the study. Results showed high correlations between the IVR and clinician scoring of the three tests. Nevertheless, a number of discrepancies and technical issues were discovered.

Since the early 2000s, Interactive Voice Response (IVR) has become a widely popular method of conducting public opinion surveys in the United States. IVR surveys use an automated computer voice to ask survey questions and elicit responses in place of a live interviewer. Previous studies have shown that IVR polls conducted immediately before elections are generally accurate, but have raised questions as to their validity in other contexts. This study examines whether IVR polls generate measurably different levels of candidate support when compared to live interviewer polls, as a result of non-response bias owing to lower response rates in IVR surveys. It did so by comparing polling in 2010 U.S. gubernatorial and U.S. Senate elections that was conducted using both live interviewers and IVR. The findings suggest that in general elections, IVR polls find fewer undecided voters compared to surveys conducted using live interviewers. In primary elections, IVR polls can show larger support than live interview polls for a more ideologically extreme candidate who has high levels of support among more opinionated and engaged voters. Implications are that journalists and other consumers of polling data should take into account whether a poll was conducted using IVR or live interviewers when interpreting results. IVR polls may tend to over-sample more engaged and opinionated voters, often resulting in smaller percentages of undecided respondents, and higher levels of support for specific candidates in certain contexts. / Master of Arts

The research described in this thesis reviewed previous uses of Interactive Voice Response (IVR), developed appropriate software, and employed IVR to obtain self-report of sensitive issues in surveys and conduct brief public health interventions. Chapter 1 introduces IVR and describes a systematic critical review of the use of IVR. IVR is a telephone interviewing technique where the human speaker is replaced by a high quality recorded interactive script to which the respondent provides answers by pressing the keys of a touch-telephone (touchphone). IVR has numerous advantages, including: economy, autonomy, confidentiality, access to certain population groups, improved data quality, standardised interviewing, multi-lingual interfaces, and detailed longitudinal assessments. Despite this, there have been few survey applications of IVR compared to alternative methods such as Computer-Assisted Telephone Interview (CATI). There has not been any evaluation of the use of IVR for asking sensitive questions in surveys or as a tool for health promotion at the community level. A literature review, described in Chapter 2, was conducted to identify other methods of asking sensitive questions. The literature review identified 19 different methods. Those methods that were most successful were those that provided the greatest degree of anonymity to the respondent. It was suggested that IVR may be a suitable method for community surveys. As described in Chapter 3, a custom software called Generalized Electronic Interviewing System (GEIS) was developed. This provided both CATI and IVR interviewing modes. As described in Chapter 4, it was found that the response rate obtained using IVR was unacceptably low, and an alternative interviewing method, the Hybrid method was developed. In the Hybrid method the interview was initiated by the interviewer but completed using IVR with GEIS. As described in Chapter 5, the IVR, CATI and Hybrid methods were used to investigate self-reported rates of alcohol and drug consumption within a telephone household survey of 2880 households. The self-report rates were compared to the National Drug Strategy Household Survey (NDSHS). Response rates did not differ significantly between the CATI and Hybrid methods, however the response rate for IVR was significantly less than the other methods. The Hybrid and IVR methods obtained significantly higher self-report consumption rates for alcohol and marijuana, and significantly higher hazardous drinking scores using Alcohol Use Disorders Identification Test (AUDIT). In Chapter 6 a pilot of an IVR cervical screening brief advice interface is described. A total of 5000 households were contacted by the IVR system. The system randomly selected an eligible woman aged 18-69 per household and determined her cervical screening status. A total of 661 women listened to the IVR message. The IVR call was shown to be acceptable and inexpensive compared to a mail pamphlet intervention. In Chapter 7 a randomized controlled trial of an IVR cervical screening brief advice involving 17,008 households is described. Cervical screening rate data were obtained from the Health Insurance Commission (HIC) for a period spanning six months before and following the intervention. The cervical screening rate was increased in the intervention postcodes by 0.43% compared to the control postcodes, and the increase was greater for older women at 1.34%. This was a desirable outcome since this group is considered to be an at-risk group. The overall conclusion was that IVR technology could be feasibly used to contact women to deliver brief interventions aimed at increasing cervical screening rates, but the cost per screen was likely to be high. It is suggested that an IVR system could be linked to cervical screening registers to more directly and economically contact women, and provide an efficacious complementary approach to the existing letter reminder system. / PhD Doctorate

Families migrate to improve their outcomes, however the process is very disruptive. My research asks and answers the question can scaffolding communication through technology mitigate the disruption caused to families by migration, and if so, how? In my work I have explored two forms of disruptive family migration—parental migration (where parents and children live in separate countries) and refugee resettlement (resulting from forced migration). In both forms, families are embedded in support networks of individuals they rely on to minimize vulnerabilities faced post-migration and to rebuild a stable family structure. My empirical results revealed barriers (distance, language, literacy and so forth) that render the communication between families and their support network less than effective. Through participatory approaches, I then design and evaluate separately, two systems to mitigate the barriers and improve communication in the various support networks. The end contributions of my work include: i) contributing a nascent agenda on migration for Human-Computer Interaction (HCI) and related fields through providing an increased understanding of the challenges that limit the livelihoods of migration-separated and refugee families; ii) demonstrating two communication scaffolding systems for transient use by migrants to mitigate communication barriers--- time and distance on one hand (to support transnational home-school communication) and language and literacy on the other (through mediated human-in-the-loop voice translations for everyday interactions with refugees); iii) putting forth a reflection on methods to guide others seeking to work with similar groups and establishing the notion of designing for transient use in the development of systems to scaffold communication.

Föreliggande arbete utgör en delstudie i projektet Automatiserad telefonuppföljning inom Kriminalvården. Projektets övergripande syfte var att undersöka tillämpbarheten av Interactive Voice Response (IVR) som en modern metod för utvärdering, övervakning och påverkan av intagna som blivit villkorligt frigivna från ett fängelsestraff. IVR är en metodik baserat på automatiserade telefonintervjuer som bl. a innebär att en dator har programmerats för att ringa upp, ställa frågor, registrera svar och ge feedback till klienterna. I tidigare publikation från projektet undersöktes med hjälp av automatiserade telefonuppföljningar (IVR) hur stress och mående samt användande av alkohol och droger utvecklas under de trettio första dagarna efter avslutad anstaltsvistelse (Andersson et al, 2011). Syftet med det här arbetet var att undersöka om det fanns skillnader i psykiskt mående, alkohol- och drogvanor samt personlighet mellan intagna som medverkade vid åtminstone en telefonuppföljning efter den villkorliga frigivningen respektive intagna som inte medverkade vid någon telefonuppföljning efter den villkorliga frigivningen. Ytterligare ett syfte med arbetet var att beskriva den totala undersökningsgruppen i projektet med avseende på psykiskt mående, alkohol- och drogvanor samt personlighet. Den enda signifikanta skillnaden mellan deltagarna och icke-deltagarna i telefonuppföljningarna återfanns för personlighetsdraget skuld. Individer som genomförde åtminstone en telefonuppföljning var något mer benägna att känna skuld- och skamkänslor än de som inte deltog vid någon telefonuppföljning efter den villkorliga frigivningen. Den beskrivande analysen av den totala undersökningsgruppen i projektet fann att klienterna utgjorde en problembelastad grupp intagna med avseende på psykiskt mående, alkohol-och drogmissbruk och personlighet; en hög andel av klienterna hade en möjlig missbruksdiagnos och depressions och/eller ångestrelaterade symptom samt skattade höga värden på personlighetsdragen socialisation, impulsivitet och monotoniundvikande. / This study is a part of the research project Automated Phone Follow-Up inCorrectional Services. The overall aim of the research project was to investigate if Interactive Voice Response can be used as tool to investigate, monitor and influence levels of stress, depression, anxiety, and use as well as urge of alcohol and drugs among paroled offenders. IVR is a technology based on automated phone interviews, which means that a computer has been programed to call up, ask questions, record answers and provide a feedback to the paroled offenders. Previous publication from the research project explored if it is possible to use automated phone interviews (IVR) to follow-up the development of stress, psychological mood, and use of alcohol and drugs in paroled offenders during the first 30 days following probation (Andersson et al, 2011). The main aim of this study was to investigate if there were any differences in psychological mood, substance use and personality between paroled offenders that participated in at least one automated phone follow-up and paroled offenders that did not participate in any automated phone follow-up. Another aim of this study was to describe the psychological mood, substance use and personality in the total sample group of paroled offenders. The only significant difference between participants and non-participants in the phone follow-up´s was found for the personality trait guilt. The paroled offenders that participated in the phone follow-up scored significant higher on guilt, a scale measuring feelings of guilt and shame after wrongdoing, cheating, of having bad thoughts. The results of the descriptive analysis showed high levels of substance misuse, depression and anxiety symptoms in the total sample group of paroled offenders. The paroled offenders also scored high on personality scales socialization, impulsivity and monotony avoidance compared to healthy subjects.