Insufficient physical activity, an unhealthy diet and obesity are among the leading causes of death and disability in Australia and represent a considerable burden to the nation.1 Accordingly, in February 2009, the New South Wales (NSW) Government launched the ‘Get Healthy Information and Coaching Service’ to help adults reduce these health risks.2,3 The innovative service provides free brief telephone calls, print information and resources to all callers, and for the interested, expert individualised telephone coaching consisting of up to 10 calls for up to 6 months. Systematic reviews of randomised trials support the efficacy of extended telephone support in achieving health behaviour change.4 As such, broad community use of such services has the potential to make important contributions to improving public health.
Promotional strategies for preventive health services in the community such as television or radio advertisements, or mailed pamphlets, increase awareness of available services but require adults to initiate contact with the service. An alternate and potentially more effective strategy in encouraging service use is to telephone participants in an unsolicited manner and offer service support. For example, to increase utilisation of smoking cessation Quitlines, the researchers demonstrated that an unsolicited proactive telephone recruitment approach encouraged 52% of randomly selected smokers in the community to use the service,5 a far higher market penetration than the <5% of smokers in the Australian community who do so of their own volition.6 The recruitment approach was considered acceptable by smokers in the community (93%),7 and compared favourably in terms of increasing use of the service compared with media strategies.5
To examine the acceptability of a proactive recruitment strategy as a means to increase the utilisation of the NSW Get Healthy Service we conducted a brief cross-sectional telephone survey earlier this year. Items were included in a larger telephone survey regarding the health risks of 620 randomly selected NSW residents. Of these participants, 139 who were insufficiently active (<150 minutes of physical activity/week); or were consuming too few fruits or vegetables (<2 serves of fruit or <5 serves of vegetables/day); or were overweight or obese (Body Mass Index >25) were randomly selected to complete a short series of items. The mean age of this sample was 54 years, 63% were female, 38% had a tertiary educational qualification and 9% spoke a language other than English at home.
Eighty-six per cent of respondents believed it was appropriate for health services to proactively telephone them and offer support to help them lose weight, and improve their diet or physical activity levels. Thirty-two per cent reported they would utilise such a telephone support service if it was offered to them. When informed of the Get Healthy Information and Coaching Service, and specifically asked if they would like their details forwarded to the service to receive telephone support, 23% agreed.
Such findings, coupled with those previously reported for promoting the use of Quitlines,5,7,8 demonstrate the potential acceptability of proactive telephone recruitment to a telephone service promoting healthy eating, physical activity and achieving or maintaining a healthy weight. Vocal opposition from the small proportion of the community that perceive unsolicited telephone contact to be inappropriate, however, may represent an impediment to proactive telephone-recruitment initiatives. Pre-notification of households via mail prior to telephone contact may reduce such risk, and could enhance rates of referral to preventive health services such as Get Healthy.9 Further, the perceived appropriateness of proactive telephone-based recruitment approaches may be improved if contact is made on behalf of relevant institutions, such as health insurance organisations, where members may expect that such organisations would contact them to offer services to promote their health.
Nonetheless, the findings provide a basis for further experimental investigation of the potential for proactive telephone-based strategies to increase service use relative to other recruitment approaches, and to assess the extent to which recruitment strategy may influence program attrition and effectiveness.