Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study

Abstract

Background Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general.

Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach

“…In the previous project led by the first author for the provision of cancer information 40 , similar findings in terms of challenges faced by patients, requirements and recommendations for the system, and generally positive reception after implementation were reported. The cancer awareness system mainly used the IVR feature with pre-recorded information, with the option to speak to a live agent added as an emergency due to COVID-19 outbreak.…”

Leveraging interactive voice response technology to mitigate COVID-19 risk in refugee settlements in Uganda: Lessons learned implementing “Dial-COVID” a toll-free mobile phone symptom surveillance and information dissemination tool

“…IVR has previously been used in remote and humanitarian contexts including in Afghanistan, the Democratic Republic of the Congo (DRC), Ghana, Haiti, Niger, and Somalia to collect and disseminate information on a host of topics including food insecurity, cash transfers, aid presence, health behavior, and violence prevention [22][23][24][25][26][27][28][29]. It is a flexible system that lends itself to a range of different content and has effectively been used in low-and middle-income countries for both information collection and dissemination during the COVID-19 pandemic [30][31][32][33][34]. IVR can be used as a standalone tool, or can be combined with other tools/methods to augment data collection and dissemination as was done by the International Organization for Migration (IOM) in Cox's Bazaar, Bangladesh, where participants were screened using an IVR survey to identify those eligible to receive a call back with a specific needs assessment survey [23, 24,35].…”

Cancer as a death sentence: developing an initial program theory for an IVR intervention

“…After coding, OI and JKK revised the codebook based on emergent codes and discussed axial codes and themes occurring in the data. A detailed overview of this codebook is presented in our previous publication on the implementation of the IVR system ( Kabukye et al , 2021 ). In this manuscript we report on the development of CMOs and ultimately the initial program theory.…”