The Deep South Interactive Voice Response (IVR) System-Supported Active Lifestyle (DIAL) intervention shows efficacy in Rural Alabama: A Randomized Trial.

Abstract

The current study tested the efficacy of the Deep South Interactive Voice Response (IVR) System-Supported Active Lifestyle (DIAL) intervention. A randomized controlled trial was conducted in 2020-2024. Data were analyzed in 2025-2026. 245 adults were recruited from 6 rural Alabama counties. Participants were randomly assigned to the DIAL intervention or wait-list control arms. Moderate-vigorous physical activity (MVPA) was assessed at baseline and 6 months. The sample was comprised of rural (100%) non-Hispanic Black (97.55%) women (91.02%). DIAL participants reported significantly greater MVPA increases from baseline to 6 months (M =>60 min/week more, based on 7-Day Physical Activity Recalls and Godin Leisure Time Exercise Questionnaires), compared to control participants (p<0.001). The DIAL arm was also significantly more likely to reach national physical activity guidelines at 6 months, compared to the control arm, based on the Godin findings (OR = 5.38, 95% CI= 1.67-17.28, p<0.01), but not the 7 -Day Physical Activity Recall (OR=2.85, 95% CI= 0.94-8.65, p= 0.06) or accelerometer data (OR=2.25, 95% CI= .097-5.20, p=0.06). Accelerometer data showed no significant changes in MVPA over time, yet trends in the data indicated that the percentage meeting national guidelines increased for the DIAL arm and decreased for the control arm. Findings support the efficacy of DIAL among rural adults in the Deep South. IVR-automated phone counseling represents a high-reach, low-cost strategy for addressing physical inactivity and related health disparities in underserved rural communities. This study is registered at www. gov [NCT03903874; 4-4-2019] ETHICAL APPROVAL: University of Alabama at Birmingham Institutional Review Board (IRB-300003238; 4-26-2019).