Design and Rationale for the Deep South Interactive Voice Response (IVR) System-Supported Active Lifestyle (DIAL) Study: Proposal for a Randomized Controlled Trial (Preprint)

Academic Article



    Physical inactivity and related cancer incidence and mortality rates are disproportionately high in the U.S. Deep South, a rural, medically underserved region with a large African American population compared to the rest of the nation. Given this region’s lower rates of literacy and Internet access, Interactive Voice Response (IVR)-automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs transportation) but have yet to be extended to rural, underserved populations, such as the Deep South. Thus, extensive formative research was conducted to develop, and beta test the Deep South Interactive Voice Response System Supported Active Lifestyle (DIAL) intervention in preparation for dissemination in rural Alabama counties


    To describe the design and rationale of the ongoing efficacy trial of the DIAL intervention.


    The 2-arm randomized controlled trial will compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The DIAL intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity phone counseling (daily in months 0-3, twice weekly in months 4-6 and weekly in months 7-12) and support from local rural county coordinators with the UAB O’Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate-to-vigorous intensity physical activity (7-Day PAR, accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, recreational amenities, and inform future environment/policy efforts.


    Start up activities (hiring/training staff, purchasing supplies) were completed in 2019. Study recruitment and assessments began in September 2020 and are ongoing.


    IVR-supported phone counseling has great potential for addressing physical activity barriers (e.g., culture, literacy, cost, transportation) and reducing related rural health disparities in this region.


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    Author List

  • Neal NI; Powell MA; Baskin M; Demark-Wahnefried W; Hardy C; Pisu M; Thirumalai M; Townsend S; Neal W; Rogers LQ