Risk appraisal spurs behavior change
Risk appraisal spurs behavior change
Computerized system provides chances for change
A telephone health risk appraisal at Cleveland State University was designed to provide quick feedback to participants to spur behavior change. The computerized system instantly evaluates the callers’ response and offers advice for making changes that will improve his or her health.
"Many health risk appraisals successfully change knowledge, but the key is to change behavior. To do that you have to take advantage of a short window of opportunity," says program developer Farrokh Alemi, PhD, associate professor of health administration at the university. People usually are ready to take action immediately after hearing what their risks are, he explains.
If a caller is at high risk for health problems related to cigarette smoking, the caller will be told the dangers and asked if he or she would like to enroll in a smoking cessation class.
The telephone assessment targets seven health risks that are verifiable and modifiable. These risks, which were selected by a scientific panel, include: smoking, physical inactivity, high cholesterol, high blood pressure, overweight, motor vehicle accidents, and alcohol use. For example, to prevent injuries in automobile accidents, people can modify their behavior by wearing seatbelts, and the change can be verified by observation.
Program designed to give advice
The program is designed to give advice on behavior change.
"We don’t shirk the responsibility by telling the caller to talk to his or her physician. We give them real advice on what they should do," says Alemi.
Therefore, high-risk groups such as pregnant women, people with acute or chronic illnesses or a handicap, and those over 65 or under 18 are told not to participate in the assessment. The advice to exercise three times a week for physically inactive individuals might not be appropriate for those callers, explains Alemi.
Recommendations for healthy individuals are drawn from published literature to protect the institution from liability. "We have very little liability because the advice is from published literature and is what is recommended for our target audience," says Alemi.
If people have two or three health risks upon completion of the assessment, the telephone assessment system will help them set priorities if they want to. To do so, it identifies the area for biggest risk reduction. Reduction and risk depends on the caller’s age. If a person is young, the computer program will tell him or her to focus on driving safety rather than high cholesterol because accidents pose a greater health risk.
Touch-tone phone part of program
The computerized health risk assessment was initiated at Cleveland State University in 1991 to be used by employees and their families. Its purpose was to create a healthier workforce to reduce the use of health care benefits and eventually lower health insurance premiums.
People access the program with a touch-tone phone by dialing a special number and entering a password. The computer program asks a series of questions and tells the caller which keys to press to answer. It then instantly analyzes the answers, provides an assessment of health risk, and offers advice on changing bad habits and maintaining good ones. The university sells the system for $2,000.
Start off slowly
Alemi recommends that health care facilities introduce the system to potential users a few at a time so as not to overload telephone lines. Send postcards to 1,000 households, wait a week or two, send about 1,000 more, and continue until your service area is covered, he advises. Managed care organizations could use their membership list, or often marketing departments at hospitals have a list of people who live in the hospital’s service area, he says.
"When we set the system up, hospitals weren’t concerned with community outreach, but now they have a lot more community orientation. The computerized telephone system is a good way for having an entire city go through health risk appraisal," says Alemi.
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