Tailoring advice and optimizing response: a case study of a telephone-based support for patients with type 2 diabetes

Health care increasingly incorporates telephone counselling, but the dynamics of interactions supporting its delivery are not well understood. This paper explores how advice was packaged and received by participants with type 2 diabetes within the context of a Pro-Active Call-Centre Treatment Support (PACCTS) system delivered to provide diabetes self-care training over the telephone.

The data relate to nine participants who formed part of the qualitative evaluation within the intervention arm of a randomized controlled trial (n = 591) of PACCTS. One consultation call between the tele-carer and the participant was tape recorded towards the end of the 3-year study and each participant was interviewed by telephone within 24 hours of the consultation. The nine calls and interviews were transcribed and analysed using the constant comparative method.

The type of advice the participants received was packaged in six forms: advice as explanation, general information-giving, generic advice, advice in the form of practitioner self-disclosure, personalized advice and responsive advice. Variation was evident in terms of the nature of advice provided, level of generality, form and context.

As the participants had to make multiple behavioural changes over time, advice needed to be delivered, reiterated and reinforced to achieve understanding and uptake. The more specific and personalized the information and advice, the more likely it was for the participant to give a positive and engaged response. Seizing every opportunity to deliver good quality personalized and/or responsive advice is essential in order to facilitate effective behavioural change.