Dorothy Pekmezi, Ph.D.New research from the University of Alabama at Birmingham School of Public Health shows that an automated phone counseling program helped people who are inactive in underserved rural communities exercise more
With results published in the American Journal of Preventive Medicine, researchers tested the Deep South Interactive Voice Response (IVR) System-Supported Active Lifestyle (DIAL) intervention, which combined automated phone calls — daily in months 0-3, twice per week in months 4-6 — and fitness trackers with support from local community health advisors trained by staff from the UAB O’Neal Cancer Center. The study included 245 adults, with most participants being Black women from six rural Alabama Black Belt counties.
All participants ultimately received the DIAL intervention, but they were randomly assigned to begin either immediately or after a six-month waiting period. The DIAL intervention emphasized physical activity tracking, goal setting, self-efficacy, social support, enjoyment and positive outcome expectations. At the six-month assessment, participants who had already received the intervention reported significantly greater increases in physical activity than those still waiting to begin
On average, DIAL participants added about an hour of exercise each week, which researchers say can make a meaningful difference for health over time. Six months into the program, 30 percent to 44 percent of DIAL participants were meeting national guidelines by participating in more than 150 minutes per week of moderate- to vigorous-intensity physical activity, compared with roughly half that proportion among wait-list participants
“Similar improvements in physical activity have been linked to a reduced risk of atrial fibrillation and longer life expectancies, more than two and a half years longer in past studies,” said Dori Pekmezi, Ph.D., senior author on the study and professor in the UAB School of Public Health. “The DIAL program encouraged participants to track their daily physical activity, and many people found this habit helpful. Small changes can lead to substantial improvements in a healthy lifestyle.”
The approach has great potential for reducing rural health disparities
Researchers designed DIAL specifically for populations that experience higher rates of inactivity, obesity, diabetes and other chronic diseases. Pekmezi says programs like this could help close health gaps in underserved communities by making healthy living support easier to access.
“Rural, underserved communities often face many barriers to participation in physical activity and traditional face-to-face physical activity programs, such as a lack of nearby fitness centers,” Pekmezi said. “Automated telephone-based interventions, like DIAL, can help overcome such barriers by providing remote physical activity support — at home, available 24/7 — to those in need without requiring costly gym memberships, clinic visits or literacy.”
People stayed engaged
The intervention relied primarily on automated telephone calls, making it accessible for people with limited internet access or transportation options. The study retained 89 percent of participants through six months, and DIAL participants completed about 86 percent of their required phone calls
Pekmezi says local community health advisors played a key role in helping to recruit and support participants of the study
“Extensive community engagement was critical to the success of this intervention,” Pekmezi said. “The DIAL development process involved nearly 15 years of iterative formative research, including focus groups, usability testing, and pilot studies with rural community members, community health advisors and other stakeholders. Their guidance and partnership were invaluable.”
This work was supported by a grant from the National Institutes of Health (R01CA233550)
