Using an automated telephone system to promote the patient's central role in diabetes self-management

A number of computerized automated programs for preventing and managing chronic diseases are now available. Some have even been transferred from their country of origin to other countries. In 2004, we performed a usability assessment of a Telephone Linked Care (TLC) system designed by Boston University Medical Center to promote physical activity which was transferred to Australia. The results highlighted the need to consider language, health system and other socio-environmental factors when “translating” such programs. In 2005, we adapted a more complex TLC program (TLC-Diabetes) aimed at providing self-management support for people with Type 2 diabetes in Australia. In doing so, we considered how the program might impact patients’ self-care skills and behaviors. TLC-Diabetes targets key diabetes self-care behaviors. Self-management is enhanced by emphasizing the central role of the patients in their care and by ensuring the system supports informed personal decision-making. Goals are set collaboratively between physicians and patients at the outset. Patients are encouraged to prioritize the sequencing of behaviors targeted in the weekly conversations with the system over 6 months. These conversations include monitoring and feedback against goals, and strategies for overcoming barriers to behaviors. TLC-Diabetes is currently being studied to assess its usability with a small group of individuals with Type 2 diabetes. The findings from this study will be used in a controlled evaluation comparing the Australian version of TLC-Diabetes against usual care