When 'listeners can't talk' : comparing active listening in opening sequences of telephone and online counselling

While there is growing use of online counselling, little is known about its interactional organisation and how it compares to telephone counselling. This is despite past research suggesting that both counsellors and clients report the impact of the different modalities on the presentation and management of the counselling interaction. This paper compares the interactional affordances of telephone and online web counselling in opening sequences on Kids Help Line, a 24-hour Australian counselling service for children and young people up to the age of 25. We examine two ways that counsellors show active listening through response tokens and formulations. The analysis describes how counsellors’ use of minimal response tokens facilitate the clients’ problem presentation and are used in the management of turn taking and sequence organisation. For example, counsellors use the response token Mm hm to show that they understand that the client’s unit of talk to is not yet complete, and to affirm or invite the client to continue speaking. Formulations in phone and web counselling are another way that counsellors display active listening to re-present stretches of the clients’ preceding talk. In phone and web counselling, however, the respective modalities can complicate matters of turn transition and sequence organisation. By examining actual phone and online counselling sessions, this paper offers empirical demonstrations of the interactional affordances of phone and online counselling, and shows how the institutional practice of active listening is accomplished across different counselling modalities

Unsupervised speaker adaptation for telephone call transcription

The use of the PC and Internet for placing telephone calls will present new opportunities to capture vast amounts of un-transcribed speech for a particular speaker. This paper investigates how to best exploit this data for speaker-dependent speech recognition. Supervised and unsupervised experiments in acoustic model and language model adaptation are presented. Using one hour of automatically transcribed speech per speaker with a word error rate of 36.0%, unsupervised adaptation resulted in an absolute gain of 6.3%, equivalent to 70% of the gain from the supervised case, with additional adaptation data likely to yield further improvements. LM adaptation experiments suggested that although there seems to be a small degree of speaker idiolect, adaptation to the speaker alone, without considering the topic of the conversation, is in itself unlikely to improve transcription accuracy.

Cost-effectiveness of a telephone-delivered intervention for physical activity and diet

Background: Given escalating rates of chronic disease, broad-reach and cost-effective interventions to increase physical activity and improve dietary intake are needed. The cost-effectiveness of a Telephone Counselling intervention to improve physical activity and diet, targeting adults with established chronic diseases in a low socio-economic area of a major Australian city was examined. Methodology/Principal Findings: A cost-effectiveness modelling study using data collected between February 2005 and November 2007 from a cluster-randomised trial that compared Telephone Counselling with a “Usual Care” (brief intervention) alternative. Economic outcomes were assessed using a state-transition Markov model, which predicted the progress of participants through five health states relating to physical activity and dietary improvement, for ten years after recruitment. The costs and health benefits of Telephone Counselling, Usual Care and an existing practice (Real Control) group were compared. Telephone Counselling compared to Usual Care was not cost-effective ($78,489 per quality adjusted life year gained). However, the Usual Care group did not represent existing practice and is not a useful comparator for decision making. Comparing Telephone Counselling outcomes to existing practice (Real Control), the intervention was found to be cost-effective ($29,375 per quality adjusted life year gained). Usual Care (brief intervention) compared to existing practice (Real Control) was also cost-effective ($12,153 per quality adjusted life year gained). Conclusions/Significance: This modelling study shows that a decision to adopt a Telephone Counselling program over existing practice (Real Control) is likely to be cost-effective. Choosing the ‘Usual Care’ brief intervention over existing practice (Real Control) shows a lower cost per quality adjusted life year, but the lack of supporting evidence for efficacy or sustainability is an important consideration for decision makers. The economics of behavioural approaches to improving health must be made explicit if decision makers are to be convinced that allocating resources toward such programs is worthwhile.

Knowledge, attitudes and beliefs towards injury prevention : a population based telephone survey

Public knowledge and beliefs about injury prevention are currently poorly understood. A total of 1030 residents in the State of Queensland, Australia responded to questions about injury prevention in or around the home, on the roads, in or on the water, at work, deliberate injury, and responsibility for preventing deliberate injury allowing comparison with published injury prevalence data. Overall the youngest members of society were identified as being the most vulnerable to deliberate injury with young adults accounting for 59% of responses aligning with published data. However, younger adults failed to indicate an awareness of their own vulnerability to deliberate injury in alcohol environments even though 61% of older respondents were aware of this trend. Older respondents were the least inclined to agree that they could make a difference to their own safety in or around the home but were more inclined to agree that they could make a difference to their own safety at work. The results are discussed with a view to using improved awareness of public beliefs about injury to identify barriers to the uptake of injury prevention strategies (e.g. low perceived injury risk) as well as areas where injury prevention strategies may receive public support.

Telephone reliability of the Frenchay Activity Index and EQ-5D amongst older adults

Background Older adults may find it problematic to attend hospital appointments due to the difficulty associated with travelling to, within and from a hospital facility for the purpose of a face-to-face assessment. This study aims to investigate equivalence between telephone and face-to-face administration for the Frenchay Activities Index (FAI) and the Euroqol-5D (EQ-5D) generic health-related quality of life instrument amongst an older adult population. Methods Patients aged >65 (n = 53) who had been discharged to the community following an acute hospital admission underwent telephone administration of the FAI and EQ-5D instruments seven days prior to attending a hospital outpatient appointment where they completed a face-to-face administration of these instruments. Results Overall, 40 subjects' datasets were complete for both assessments and included in analysis. The FAI items had high levels of agreement between the two modes of administration (item kappa's ranged 0.73 to 1.00) as did the EQ-5D (item kappa's ranged 0.67–0.83). For the FAI, EQ-5D VAS and EQ-5D utility score, intraclass correlation coefficients were 0.94, 0.58 and 0.82 respectively with paired t-tests indicating no significant systematic difference (p = 0.100, p = 0.690 and p = 0.290 respectively). Conclusion Telephone administration of the FAI and EQ-5D instruments provides comparable results to face-to-face administration amongst older adults deemed to have cognitive functioning intact at a basic level, indicating that this is a suitable alternate approach for collection of this information.

Electronic telephone directory listings : preferred sampling frame for a population-based study of childhood cancer in Australia

PURPOSE: We report our telephone-based system for selecting community control series appropriate for a complete Australia-wide series of Ewing's sarcoma cases. METHODS: We used electronic directory random sampling to select age-matched controls. The sampling has all listed telephone numbers on an up-dated CD-Rom. RESULTS: 95% of 2245 telephone numbers selected were successfully contacted. The mean number of attempts needed was 1.94, 58% answering at the first attempt. On average, we needed 4.5 contacts per control selected. Calls were more likely to be successful (reach a respondent) when made in the evening (except Saturdays). The overall response rate among contacted telephone numbers was 92.8%. Participation rates among female and male respondents were practically the same. The exclusion of unlisted numbers (13.5% of connected households) and unconnected households (3.7%) led to potential selection bias. However, restricting the case series to listed cases only, plus having external information on the direction of potential bias allow meaningful interpretation of our data. CONCLUSION: Sampling from an electronic directory is convenient, economical and simple, and gives a very good yield of eligible subjects compared to other methods.

Bottlenecks detection of track allocation schemes at rail stations by Petri nets

Robustness of the track allocation problem is rarely addressed in literatures and the obtained track allocation schemes (TAS) embody some bottlenecks. Therefore, an approach to detect bottlenecks is needed to support local optimization. First a TAS is transformed to an executable model by Petri nets. Then disturbances analysis is performed using the model and the indicators of the total trains' departure delays are collected to detect bottlenecks when each train suffers a disturbance. Finally, the results of the tests based on a rail hub linking six lines and a TAS about thirty minutes show that the minimum buffer time is 21 seconds and there are two bottlenecks where the buffer times are 57 and 44 seconds respectively, and it indicates that the bottlenecks do not certainly locate at the area where there is minimum buffer time. The proposed approach can further support selection of multi schemes and robustness optimization.

Petri net modeling of spatial and temporal constraints in track allocation problem at railway stations

The track allocation problem (TAP) at a multi-track, multi-platform mainline railway station is defined by the station track layout and service timetable, which implies combinations of spatial and temporal conflicts. Feasible solutions are available from either traditional planning or advanced intelligent searching methods and their evaluations with respect to operational requirements are essential for the operators. To facilitate thorough analysis, a timed Coloured Petri Nets (CPN) model is presented here to encapsulate the inter-relationships of the spatial and temporal constraints in the TAP.

Quantitative evaluation of route allocation solutions at large-scale passenger stations

Routing trains within passenger stations in major cities is a common scheduling problem for railway operation. Various studies have been undertaken to derive and formulate solutions to this route allocation problem (RAP) which is particularly evident in mainland China nowadays because of the growing traffic demand and limited station capacity. A reasonable solution must be selected from a set of available RAP solutions attained in the planning stage to facilitate station operation. The selection is however based on the experience of the operators only and objective evaluation of the solutions is rarely addressed. In order to maximise the utilisation of station capacity while maintaining service quality and allowing for service disturbance, quantitative evaluation of RAP solutions is highly desirable. In this study, quantitative evaluation of RAP solutions is proposed and it is enabled by a set of indices covering infrastructure utilisation, buffer times and delay propagation. The proposed evaluation is carried out on a number of RAP solutions at a real-life busy railway station in mainland China and the results highlight the effectiveness of the indices in pinpointing the strengths and weaknesses of the solutions. This study provides the necessary platform to improve the RAP solution in planning and to allow train re-routing upon service disturbances.

Multiple Health Behavior Changes and Co-variation in a Telephone Counseling Trial

Background Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care settings is a public health priority. Purpose Within a 12-month, telephone-delivered diet and physical activity intervention with multiple behavioral outcomes, we examined the extent and co-variation of multiple health behavior change. Methods A cluster-randomized trial with 434 patients with type 2 diabetes or hypertension were recruited from 10 general practices, which were randomized to receive telephone counseling or usual care. Results Those receiving telephone counseling were significantly more likely than those in usual care to make greater reductions in multiple behaviors after adjusting for baseline risk behaviors (OR 2.42; 95%CI 1.43, 4.11). Controlling for baseline risk and group allocation, making changes to either physical activity, fat, vegetable, or fiber intake was associated with making significantly more improvements in other behaviors. Conclusions For patients with chronic conditions, telephone counseling can significantly improve multiple health behaviors, with behavioral changes tending to co-vary.

Which components of heart failure programs are effective? A meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of heart failure management in 9,560 patients (Abridged Cochrane Review)

Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project) : study protocol

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. ---------- Methods/Design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.---------- Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.