Developing an interactive voice response system for behavioral change communication in ethiopia

Addis Ababa University School of Information Science and School of Public Health Developing an Interactive Voice Response System for behavioral change communication in Ethiopia By Abenezer Tsegaye June, 2017 Advisors Dr Dereje Teferi Dr Eshetu Girma A Thesis Submitted to the School of Graduate Studies of Addis Ababa University in Partial Fulfillment of the Requirements for the Degree of Master of Science in Health Informatics i Affiliation: Addis Ababa University School of Information Science and School of Public Health Programme: M.Sc in Health Informatics Project Title: Developing an Interactive Voice Response System for behavioral change communication in Ethiopia Student: Abenezer Tsegaye Date: June, 2017 Approval Dr Dereje Teferi Name _ Date Signature Dr Eshetu Girma Name _ Date Signature Name _ Date Signature Name _ Date Signature ii DEDICATION This thesis is dedicated to my mother Samrawit Tesfaye iii ACKNOWLEDGEMENT First of all, I would like to thank Almighty God for giving me the patience, wisdom, knowledge and strength I needed to complete this study and for always guiding me in every phase of my life I would like to express my gratitude and heartfelt thanks to my advisors Dr Eshetu Girma and Dr Dereje Teferi for their guidance and kindness throughout this thesis Last but not least, my special thanks go to my beloved family and friends who supported and encouraged me throughout my study iv List of Contents ACRONYMS x Executive Summary xi CHAPTER ONE: INTRODUCTION 12 1.1 Background 12 1.2 Statement of the Problem 14 1.3 Objectives of the Project 16 1.3.1 General Objectives 16 1.3.2 Specific Objectives 16 1.4 Scope and limitation of the System 17 1.5 Significance of the System 17 1.6 Organization of the Project 18 CHAPTER TWO: LITERATURE REVIEW AND RELATED WORK 19 2.1 Overview 19 2.2 Health Education, Health Promotion and Behavioral Change Communications 20 2.4 Behavioral Change Communication and Information Communication Methods 22 2.5 Talk-lines with respect to Ethiopia 23 2.6 Interactive Voice Response (IVR) Systems 24 2.7 Related Works 26 2.8 Conceptual Framework 28 CHAPTER THREE: METHODOLOGY 29 3.1 Study Period and Area 29 3.2 Study Design 29 3.3 Source and Sample Population 29 3.4 Sample Size 30 3.5 Data Collection Instruments 30 3.6 System Development 31 3.7 System Evaluation 31 3.8 Tools and Techniques 32 3.9 Operational Definitions 34 3.10 Ethical Consideration 34 v 3.11 Result Dissemination 35 CHAPTER FOUR: SYSTEM ANALYSIS 36 4.1 Overview 36 4.2 The Existing System 37 4.2.1 Gaps in the existing system 38 4.3 The Proposed System 40 4.4 Functional Requirements 41 4.5 Non-functional Requirements 42 4.5.1 User friendliness 42 4.5.2 Accessibility 42 4.5.3 Portability 42 4.5.4 Security 42 4.5.5 Reliability 43 4.5.6 Performance and Speed 43 4.5.7 Customer satisfaction 43 4.6 System Models 43 4.6.1 Use Case Diagram 44 4.6.2 Actor Definitions 45 4.6.3 Use Case Descriptions 46 4.6.4 Class Diagram 56 4.6.5 Activity Diagrams 57 4.6.6 Sequence Diagrams 59 CHAPTER FIVE: SYSTEM DESIGN 63 5.1 Design Goals 63 5.1.1 Performance 63 5.1.2 Dependability 63 5.1.3 Cost 64 5.1.4 Maintainability 64 5.1.5 Usability 64 5.2 Tradeoffs 65 5.3 System Architecture 66 5.4 Sub-System Decomposition 67 vi 5.5 Interface and IVR Menu 67 5.5.1 Interface 67 5.5.2 IVR Menu 69 5.6 Hardware/Software Mapping 70 CHAPTER SIX: IMPLEMENTATION AND EVALUATION OF THE SYSTEM 71 6.1 Implementation of the system 71 6.1.1 System Development Tools 71 6.1.2 Prototype 73 6.2 System Evaluation 77 6.2.1 Overview 77 6.2.2 Usability Testing Methodology 78 6.2.3 Usability Test Participants 78 6.2.4 Usability Test Training 78 6.2.5 Usability Test Procedure 78 6.2.6 Usability Test Roles 79 6.2.7 Usability Test Goals 79 6.2.8 Usability Test Tasks 80 6.2.9 Test Results and Conclusion 81 CHAPTER SEVEN: CONCLUSION AND FUTURE WORKS 84 7.1 Conclusion 84 7.2 Future Works 85 REFERENCES 86 ANNEX 89 Annex A: Requirement collection Discussion guide 89 Annex B: Requirement collection Discussion guide 2, for health professionals 90 Annex C: Usability Test Questionnaire 91 Annex D: Informed Consent 92 Annex E: English IVR Menu 93 Annex F: Declaration 99 vii List of Figures Figure 1: Mobile cellular subscribers in Ethiopia both rural and urban, Source Trading Economics (2014) 20 Figure 2: Conceptual framework of the BCC-IVR 28 Figure 3: Use Case Diagram for the BCC-IVR system 45 Figure 4: Class Diagram for the BCC-IVR system 57 Figure 5: Activity Diagram for Listening BCC message 58 Figure 6: Activity Diagram for View Call Records 59 Figure 7: Sequence Diagram for Listen to BCC Message 60 Figure 8: Sequence Diagram for Start Server 61 Figure 9: Sequence Diagram for View Call Records 62 Figure 10: System Architecture 66 Figure 11: Subsystem Decomposition 67 Figure 12: Standard Touch-Tone Dial (Key pad) 68 Figure 13: Voice Menu Tree of the BCC-IVR system 69 Figure 14: Hardware/Software Mapping 70 Figure 15: BCC-IVR administration page 74 Figure 16: Zoiper Soft Phone 75 Figure 17: Asterisk Server 76 Figure 18: Audacity, audio recording and editing software 76 Figure 19: Asterisk Server, Call in progress 77 Figure 20: Usability test results, source evaluation survey of the BCC-IVR system 2017 82 viii List of Tables Table 1: Summary of Techniques and Tools used in the project 33 Table 2: Summary of participants’ in the requirement analysis 37 Table 4: Description for Call-in 46 Table 5: Description for Insert Input 47 Table 6: Description for Select Language 48 Table 7: Description for Record Voice Input 49 Table 8: Description for Terminate call 50 Table 9: Description for Login 51 Table 10: Description for Listen to BCC message 52 Table 11: Description for Hold call 53 Table 12: Description for View CDR 54 Table 13: Description for Start server 55 Table 14: Description for Stop Server 56 Table 15: Usability test participants 78 Table 16: Usability test task 80 Table 17: Usability test interview results, source evaluation survey of the BCC-IVR system 2017 82 ix ACRONYMS BCC-IVR Behavioral Change Communication Interactive Voice Response DTMF Dual Tone Multi-Frequency ETC Ethiopia Telecommunication Corporation FMOH Federal Ministry of Health HEP Health Extension Program IBCTs Interactive Behavioral Change Technologies IVR Interactive Voice response MDB Major Disease Burden MHB Major Health Burden PMTCT Preventing Mother to Child Transmission PSTN Public Switched Telephone Network SMS Short Messaging Service TB Tuberculosis UHF Ultra High Frequency UML Unified Modeling Language VHF Very High Frequency VOIP Voice over IP WHO World Health Organization x telephony is also used in the implementation At last, the BCC-IVR interacts with the user on the channel based on predefined IVR process tree on BCC-IVR application Evaluation of the BCC-IVR is conducted by involving people who are speakers of English or the local language Amharic In conclusion, universal access is the important while providing information People should be able to choose the access method that suits them Literate people might still be more comfortable with written information, in booklets or on a web page where they can print the information they are interested in, but the need for voice information is still there, mainly for illiterate and visually impaired people IVR systems are the future of health promotion in Ethiopia! 7.2 Future Works In order to increase the speech naturalness of IVR system for the Amharic language using high quality speech synthesis systems is recommended, since using recorded audio has an overhead of playing high compression audio files for several of callers simultaneously Any further hotline implementation of the BCC-IVR should unquestionably consider including the “0 option” of speaking to a human attendant To make the system more complete increasing the amount topics is necessary, but some concerns arise with the quick fix Because, as important it is to increase the amount of information provided by the system, it is more important to maintain the easy navigation within it One possibility is to have separate phone numbers for different diseases categories to keep the average time of the phone calls to IVR menu as short as possible with simple and navigable menu tree For future researchers In the case of IVR systems, confidentiality is protected by unique personal identification numbers and passwords and callers interacting with IVR systems provide information that is used to tailor current and future interactions This type of interaction may be most beneficial in treating chronic diseases and frequently occurring behaviors that intrude on daily life, such as smoking, drinking, sexual behaviors, obsessive-compulsive behaviors, depression etc 85 REFERENCES Central Statistics Agency, Population and housing census estimation for 2015, Ethiopia 2007 UNESCO institute for Statistics, Ethiopia: Adult literacy rate 1994-2015, Montreal, Canada, May 2013 Central Statistics Agency, Demographic and health survey, Ethiopia, 2011 FMOH, Road map for accelerating the reduction of maternal and newborn morbidity & mortality, 2012-2015, Addis Ababa Ethiopia, 2012 FMOH, National Health Promotion and Community Strategy, Ethiopia, 2016-2020 American Public Health Association, Primary Care: Is there enough time for prevention? Kimberly S.H Yarnall, Kathryn I.Pollak, Katrina M Krause and J.Lloyd Michener, April 2003 FMOH, Health Sector Transformation Plan, Ethiopia, 2008 E.F.Y Ethiopian News Agency, International Tele Union, Regional workshop on ICT indicators and measurements for Africa, October 2015 Ross Corkrey, Lynne Parkinson and Lucy Bates, Pressing the key pad: Trial of a novel approach to health promotion advice, April 2005 10 WHO, Country cooperation strategic agenda, 2012-2015 11 FMOH, National Reproductive Health Strategy, Ethiopia, 2006-2015 12 Family Health International, Assessment of youth reproductive health programs in Ethiopia, Addis Ababa, 2004 13 WHO, Africa Health Observatory, www.who.afro.int/profiles_information/index.php/Ethiopia/AnalyticalAummary/HIV/AI DS, accessed in May 2017 14 FMOH, National Nutrition Program June 2013- June 2015 and WHO, Country Health Statistics, 2004 15 FMOH, First Aid Extension Package, Addis Ababa Ethiopia, September 2003 16 WHO, www.who.int/hac/donorinfo/callformobilisation/eth/en/, accessed in May 2017 17 WHO, Global health observatory report and Resource mobilization for Health Action in crisis, April 2014 86 18 Health Promotion International, The WHO Health promotion glossary, Oxford University Press, 1998 19 www.who.int./topics/health-promotion/en/, accessed in June 2017 20 United Nation Population Funds, Communication/Behavior change tools, January 2002 21 Government Social Research (GSR), Darnton, An overview of Behavioral Change Models and their uses, 2008 22 www.measureevaluation.org/Behavior Change Communication, accessed in June 2017 23 USAID, Health Extension Program: An Innovative Solution to Public Health Challenges of Ethiopia A Case Study, 2015 24 FMOH, www.moh.gov.et/Disease-PreventionandControl, accessed in May 2017 25 FMOH, National Health promotion and Communication Strategy, 2016 26 Chaudhry B, Wang J, Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care, May 2006 27 mHealth in Ethiopia: Strategies for a New Framework Vital Wave Consulting, Bill & Melinda Gates Foundation, 2011 28 Cognizant 20-20 insights, The future of contact centers, may 2014 29 Russell Bryant, Leif Madsen, and Jim Van Meggelen, Asterisk, The Definitive Guide fourth edition, O’Reilly Media, 2013 30 Mark Spencer, Mack Alison, and Christopher Rhodes, Asterisk Handbook, Version 2, March 2003 31 Jonny Martin, The basics of Asterisk IVR systems, November 2009 32 www.etharc.org/oromia/spotlight/wegenprofileweb.pdf, accessed in May 2017 33 www.adiszena.com/ethiopia-massive-sucess-for-agricultual-hot-line, accessed in May 2017 34 Public pilot study report, Interactive Voice Response System to Deliver Refresher Training, Senegal, March 2015 35 James Martin Information Engineering Book I: Introduction Englewood Cliffs, NJ: Prentice Hall, 1989 36 www.usability.org/usabilitytestingmethods, accessed in May 2017 37 Ulrich & Eppinger, Product design and Development Irwin, McGraw-Hill, 2000 38 FMOH, Health Promotion and Communication SWOT Analysis, 2016 87 39 WHO, Ottawa Charter 1986, Health promotion Glossary, 1998 40 Doug Rosenberg and Matt Stephens, Use Case Driven Object Modeling with UML, 2007 41 Grady Booch, Jim Rumbaugh, and Ivar Jacobson, UML User Guide, Addison-Wesley, 1999 42 Martin Fowler, UML distilled, Third version, Melrose, Massachusetts, June 2003 88 ANNEX Annex A: Requirement collection Discussion guide 1 Demographic data (Optional) Name Age _ Educational background _ Where you work? Sex M F Do you have any remarks on how information can positively impact the following areas? 4.1 Healthy behavior adoption 4.2 Risky behavior avoidance Do you have any comments on how to present brief behavioral health intervening advices on the following areas? 5.1 Sanitation & Nutrition 5.2 First Aid 5.3 Periodical and Cancer screening 5.4 Reproductive Care 89 Annex B: Requirement collection Discussion guide 2, for health professionals Do you own a phone? Yes _ No (If yes skip question number 2) Do you have access to a phone? Yes No Demographic data Name _ Age Sex M F Educational background _ Where you get health information from especially preventive advices? (Multiple selection is possible) _ Health institutions _ Broadcasts (TV, Radio) _ Hotlines Please provide details on the following areas 5.1 Preventive sexual and reproductive care 5.2 Sanitation and environmental hygiene dos and don’ts 5.3 Nutritional facts Do the sources satisfy your health information need? _ Yes _ No Are you willing use your phone as alternate health information for minimum or no charge? Yes No If no, please disclose why? 90 Annex C: Usability Test Questionnaire On the scale from one to five shown below, indicate if you agree or disagree with the nineteen statements on this page Participant’s Name _ Age Sex _ Literacy/Education level _ I General Instruction Please rate each item according to the scale below: = Strongly Disagree = Disagree = Neutral = Agree = Strongly Agree Scale Questions The IVR system easy to use It was confusing to choose between menu options The operator’s voice used was clear The operator spoke too slow or too quick …… 5 I understood how to use the system The behavioral change messages of the system were useful .1 I could recover easily when I made mistakes while using The menu directed me to the questions I wanted answered I wouldn’t use the system to get health information I desire .1 10 I could remember the list of options provided to choose from Discussion questions What was the biggest challenge you faced when using the IVR system? What did you like most about the IVR system? Do you have any other comment/s about the IVR system? 91 Annex D: Informed Consent All information about you is protected by law and your identity, contact information, or any information about you will not be given to any outside parties By answering the interview questions, you will be helping the development of Behavioral Change Communication Interactive Voice Response system prototype, which aims to deliver preventive advices to Ethiopian residents in a local language Participant’s name (optional) I know the discussion will take less than an hour I decided to participate in this project, and know I will be asked to complete a survey The participation was completely voluntary I knew I may skip any question I not want to answer and I will not be affected in any way if I chose not to participate Conducted Date Time _ Participant’s signature _ 92 Annex E: English IVR Menu The wav files are recorded BCC messages and the rest is IVR menu! Welcome to ICARE hot line! Your call is important to us, please choose a language Press one for English or Press two for Amharic Press three for Introduction to the BCC.IVR system Please choose a topic Press one for First Aid Press two for Reproductive Care Press three for Nutrition Press four for Sanitation Press five for Screening and treatment Press if you want to listen again press if you want to go back to the previous menu 1.1 Please choose Emergency Type Press one for Allergies Press two for Bleeding Press three for Burns Press four for Heart attack Press five for Diabetic emergency Press six for Unconsciousness Press if you want to listen again Press if you want to go back to the previous menu 1.1.1 What you want to know about allergic reactions? Press one for “What should I if someone is having an allergic reaction?” Press two for “What is anaphylactic shock?” Press three for “What sort of food items can cause an allergic reaction” Press four for “Can I give them an auto-injection or Epi-pen?” Press if you want to listen again press if you want to go back to the previous menu 1.1.1.1 What should I if someone is having an allergic reaction? Msg1111E.wav 1.1.1.2 What is anaphylactic shock? Msg1112E.wav 1.1.1.3 What sort of food items can cause an allergic reaction? Msg1113E.wav 1.1.1.4 Can I give them an auto-injection/Epi-pen? Msg1114E.wav 1.1.2 Please choose your question Press one for “What should I if someone is bleeding?” Press two for “What can I use put pressure on a bleeding wound?” Press three for “What should I if someone has a head injury?” Press four for “Should I worry about infection or catching something from their blood?” Press five for “Should I wash the wound?” Press six for “What should I if there is an embedded object in the wound?” Press if you want to listen again and press if you want to go back to the previous menu 1.1.2.1 What should I if someone is bleeding? Msg1121E.wav 1.1.2.2 What can I use put pressure on a bleeding wound? Msg1122E.wav 93 1.1.2.3 What should I if someone has a head injury? Msg1123E.wav 1.1.2.4 Should I worry about infection or catching something from their blood? Msg1124E.wav 1.1.2.5 Should I wash the wound? Msg1125E.wav 1.1.2.6 What should I if there is an embedded object in the wound? Msg1126E.wav 1.1.3 Please choose one question Press one for “How should I treat burn victims?” Press two for “Should I put butter or cream on a burn?” Press three for “How I know when to go to hospital?” Press four for “If clothes are stuck to the burn, should I try to remove them?” Press five for “Should I use ice to cool the burn? Press if you want to listen again and press if you want to go back to the previous menu 1.1.3.1 How should I help burn victims? Msg1131E.wav 1.1.3.2 Should I put butter or cream on a burn? Msg1132E.wav 1.1.3.3 How I know when to go to hospital? Msg1133E.wav 1.1.3.4 If clothes are stuck to the burn, should I try to remove them? Msg1134E.wav 1.1.3.5 Should I use ice to cool the burn? Msg1135E.wav 1.1.4 Please choose one question Press one for “What should I to help someone suffering from a heart attack?” Press two for “How can I tell if someone is having a heart attack?” Press three for “Can I give them aspirin?” Press four for “What is the difference between heart attack and cardiac arrest?” Press five for “What is angina?” Press if you want to listen again and press if you want to go back to the previous menu 1.1.4.1 What should I to help someone suffering from a heart attack? Msg1141E.wav 1.1.4.2 How can I tell if someone is having a heart attack? Msg1142E.wav 1.1.4.3 Can I give them aspirin? Msg1143E.wav 1.1.4.4 What is the difference between heart attack and cardiac arrest? Msg1144E.wav 1.1.4.5 What is angina? Msg1145E.wav 1.1.5 Please choose one question Press one for “What are the symptoms of a diabetic emergency?” Press two for “What is diabetes and how will I know if it is a long term condition?” press three for “Press four for “How should I know when to call an ambulance?” Press five for “What should I if someone is having a diabetic emergency?” Press if you want to listen again and press if you want to go back to the previous menu 94 1.1.5.1 What are the symptoms of a diabetic emergency? Msg1151E.wav 1.1.5.2 What is diabetes and how will I know if it is a long term condition? Msg1152E.wav 1.1.5.3 What happens in diabetic emergency? Msg1153E.wav 1.1.5.4 How should I know when to call an ambulance? Msg1154E.wav 1.1.5.5 What should I if someone is having a diabetic emergency? Msg1155E.wav 1.1.6 Please choose one question Press one for “How I look and feel for breaths?” Press two for “How should I help if someone is unconscious and breathing?” Press three for “How should I help someone who is unconscious and not breathing?” Press if you want to listen again and press if you want to go back to the previous menu 1.1.6.1 How I look and feel for breaths? Msg1161E.wav 1.1.6.2 Please choose one question Press one for “What is a recovery position?” Press two for “How I help a baby who is unconscious and breathing?” Press three for “What should I if someone is falling faint?” Press four for “How I help an adult who is unconscious and breathing?” Press if you want to listen again and press if you want to go back to the previous menu 1.1.6.2.1 What is a recovery position? Msg11621E.wav 1.1.6.2.2 How I help a baby who is unconscious and breathing? Msg11622E.wav 1.1.6.2.3 What should I if someone is falling faint? Msg11623E.wav 1.1.6.2.4 How I help an adult who is unconscious and breathing? Msg11624E.wav 1.1.6.3 Please choose one question Press one for “Do I chest compressions differently on a child or a baby?” Press two for “Will I break their ribs?” Press three for “How I mouth to mouth?” Press four for “What is a defibrillator and can I use it?” Press five for “What should I to help someone who had been in a drowning accident?” Press if you want to listen again and press if you want to go back to the previous menu 1.1.6.3.1 Do I chest compressions differently on a child or a baby? Msg11631E.wav 1.1.6.3.2 Will I break their ribs? Msg11632E.wav 1.1.6.3.3 How I mouth to mouth? Msg11633E.wav 1.1.6.3.4 What is a defibrillator and can I use it? Msg11634E.wav 95 1.1.6.3.5 What should I to help someone who had been in a drowning accident? Msg11635E.wav 1.2 Please choose one topic Press one for “Sexually Transmitted Infections” Press two for “Male Family Planning options” Press three for “Female Family Planning options” Press four for “HIV/AIDS” Press five for “Womens' Perinatal Care” Press if you want to listen again and press if you want to go back to the previous menu 1.2.1 Sexually Transmitted Infections Msg121E.wav 1.2.2 Male Family Planning Msg122E.wav 1.2.3 Female Family Planning Msg123E.wav 1.2.4 HIV/AIDS Msg124E.wav 1.2.5 Please choose one question Press one for “Preconception counseling and interventions” Press two for “Prenatal Care” Press three for “Postpartum testing and counseling” Press if you want to listen again and press if you want to go back to the previous menu 1.2.5.1 Preconception counseling and interventions Msg1241E.wav 1.2.5.2 Please choose one question Press one for “First Prenatal Visit” Press two for “Each Subsequent Prenatal Visit” Press three for “Testing recommended for all pregnant women” Press four for “Education and counseling” Press five for “Treatment and Immunization” Press if you want to listen again and press if you want to go back to the previous menu 1.2.5.2.1 First Prenatal Visit Msg12421E.wav 1.2.5.2.2 Each Subsequent Prenatal Visit Msg12422E.wav 1.2.5.2.3 Testing recommended for all pregnant women Msg12423E.wav 1.2.5.2.4 Education and counseling Msg12424E.wav 1.2.5.2.5 Treatment and Immunization Msg12425E.wav 1.2.5.3 Postpartum testing and counseling Msg1253E.wav 1.3 Please choose which one group Press one for “Pregnant or Lactating” Press two for “Child under five” Press three for “HIV positive” Press four if you don't belong to none of the categories Press five for “What is malnutrition?” Press if you want to listen again and press if you want to go back to the previous menu 96 1.3.1 Please choose food category Press one for “Micro-nutrients” Press two for “Protein” Press if you want to listen again and press if you want to go back to the previous menu 1.3.1.1 Micro-nutrients Msg1311E.wav 1.3.1.2 Protein Msg1312E.wav 1.4 Please choose sanitation and hygiene category Press one for “Clean Water” Press two for “Food hygiene” Press three for “Toilet hygiene” Press four for “Clean Hands” Press five for “What is personal hygiene?” Press six for “What is environmental hygiene?” Press if you want to listen again and press if you want to go back to the previous menu 1.4.1 Water Msg141E.wav 1.4.2 Food Msg142E.wav 1.4.3 Toilet Msg143E.wav 1.4.4 Hand Msg144E.wav 1.4.5 Personal Msg145E.wav 1.4.6 Environmental Msg146E.wav 1.5 Please choose one question Press one for “General Screening and Treatment” Press two for “Cancer Screening and Counseling” Press if you want to listen again and press if you want to go back to the previous menu 1.5.1 Please choose age group Press one for “Infant” Press two for “Early childhood” Press three for “Middle childhood” Press four for “Adolescent” Press five for “Adult” Press if you want to listen again and press if you want to go back to the previous menu 1.5.1.1 Please choose one topic Press one for “Immunization” Press two for “Periodical Doctor Visits and tests” Press three for “Drugs” Press if you want to listen again and press if you want to go back to the previous menu 1.5.1.1.1 Immunization Msg15111E.wav 1.5.1.1.2 Periodical Doctor Visits and Tests Msg15112E.wav 1.5.1.1.3 Drugs Msg15113E.wav 97 1.5.2 Please choose one topic Press one for “Colorectal Cancer Screening” Press two for “Prostate Cancer Screening male only” Press three for “Breast cancer screening female” Press four for “Cervical Cancer Screening female only” Press if you want to listen again and press if you want to go back to the previous menu 1.5.2.1 Colorectal Cancer Screening Msg1521E.wav 1.5.2.2 Prostate Cancer Screening male only Msg1522E.wav 1.5.2.3 Breast cancer screening female only Msg1523E.wav 1.5.3.4 Cervical Cancer Screening female only Msg1524E.wav 98 Annex F: Declaration I, the undersigned, declare that this research project is my original work and has not been presented for degree in any other university, and that all sources of materials used for the project have been acknowledged Declared by: Name: Abenezer Tsegaye Signature: _ Date: _ Approved by: Name: Dr Dereje Teferi Signature: _ Date: _ Name: Dr Eshetu Girma Signature: _ Date: _ Place and time of submission: Addis Ababa University, June 2017 99 ... of Information Science and School of Public Health Programme: M.Sc in Health Informatics Project Title: Developing an Interactive Voice Response System for behavioral change communication in Ethiopia. .. The main objective of the project is developing and testing an Interactive Behavioral Change Communication Voice Response system in English and Amharic to ease access to health information in the... Designing easily navigable and Interactive Voice Response Menu tree 16  Implementing and Evaluating the Behavioral Change Communication Interactive Voice Response System prototype 1.4 Scope and