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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:

A typical TLC health behavior application contains three elements in its clinical core:

Assessment of Behavior

Behavior Intervention

Behavior Goal Setting

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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