Telephone-linked care for physical activity: a qualitative evaluation of the use patterns of an information technology program for patients

Automated health behavior interventions that involve discretionary use by patients or consumers over extended periods of time are becoming more common and it is generally assumed that adherence to the recommended schedule is related to the impact of the system on users. Yet reasons for use or non-use of such systems have not been carefully explored. An understanding of factors that influence people to use, not use, or underutilize these automated behavioral change and self-care management systems can help in designing systems that are more effective and acceptable to users. Using qualitative research methods, this study explored the experiences of 45 users of a multiple-contact health promotion application with the goal of understanding the major factors that affect patterns of use (frequency of and duration of contact). The in-depth exploration of users' perceptions and views made possible by the qualitative research methods revealed a number of important themes. Reported reasons for underutilization or non-use were found to be both user-related and system-related. User-related reasons encompassed personal and individual events that prevented or impeded system utilization. System-related reasons included those that related to the medium itself as well as the content of the application. The qualitative methods employed in this study created a forum through which users' feedback could be fully explored and then synthesized to assist in the improvement of this and other automated health behavior interventions.