Telehealth: TOTALLY AUTOMATED TELEHEALTH SYSTEMS
TO DELIVER HEALTH BEHAVIOR CHANGE INTERVENTIONS
by: Robert Friedman, M.D. December, 1999
Telehealth systems have only recently been utilized to deliver health
behavior change interventions. TLC (Telephone-Linked Computer) system
is an interactive, totally automated, computer-controlled telephone conversation
system which can be utilized as a stand alone intervention or as a supplement
to the care provided by a clinician. TLC speaks to patients in their homes
over the telephone using computer-controlled speech generation. Conversations
usually last between 2-15 minutes. Patients communicate with TLC using
the touch-tone keypad of their telephones or by speaking into the phone.
TLC asks questions and provides education and behavioral reinforcement
to change or sustain targeted health-related behaviors. Selected information
obtained from patients during TLC conversations can be sent to the users
or to their caregivers. TLC applications for health behavior change include
those used to improve medication adherence, modify dietary behavior, promote
weight loss and regular physical activity, assist in the cessation of
cigarette smoking and increase mammography screening.
Structure of a TLC Conversation is as follows:
- Salutation
- Password (PIN) verification
- Conversation clinical core
- Closing
A typical TLC health behavior application contains three elements in
its clinical core:
-
Assessment of Behavior
- Assessment of behavioral performance
- Assessment of the underlying behavioral factors
- Assessment of goal attainment
-
Behavior Intervention
- Education
- Providing information
- Counseling
- Empathy
- Motivation
- Practical advice
-
Behavior Goal Setting
- Shared decision-making between user and system
Randomized clinical trials have demonstrated that TLC can be an effective
behavior modification tool with statistically and clinically significant
effects demonstrated in improving medication adherence among patients
with a chronic health condition (hypertension), in increasing physical
activity levels among sedentary elders and changing dietary behavior (reducing
fat intake) in patients with hypercholesterolemia. TLC is inexpensive
($1:00-$2:00 per call) and easily accessible and convenient. It is capable
of widespread dissemination and it can be tailored to patients' specific
demographic, language and behavioral characteristics.
Dr. Friedman
Chief Medical Information Systems Unit
Boston Medical Center
Associate Professor of Medicine and Public Health
Boston University School of Medicine
rfriedma@bu.edu
720 Harrison Avenue, Suite 1102
Boston, MA 02118
(617) 638-7580
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