Dr. Santosh Krishna and Dr. Gianluca Deleo:

Diabetes Education by Phone to Hispanic Populations using an Automated Call Center

Saint Louis University




Diabetes is a chronic disease that causes a great deal of morbidity and mortality and poor quality of life for millions of people. It also costs billions of dollars in treatment and other related expenses. Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. In 2002, on average, Hispanic/Latino Americans were 1.5 times more likely to have diabetes than non-Hispanic whites of similar age. (CDC, 2004) Maintaining good glycemic control is the key to preventing complications but requires education on how to control and manage it. Since current available resources are limited to providing such an education during physician visits only, system barriers such as language and access to care present significant problems for the Hispanic and Latinos in Missouri to receive such education. A computer and telephone-based automated system has been developed to deliver educational messages by phone to diabetics at regular intervals and at the time of their choice. The following paragraphs provide a description of the diabetes education call center.


We have developed an automated call center that is capable of providing people with diabetes educational messages in Spanish to a phone number provided by the patient at patients’ preferred time of the day (see Figure 1). This system is an interactive system that allows a person to navigate through, select relevant information and respond to questions using a telephone. Twenty-four messages can be delivered in a sequential order or alternatively, patients can call the system twenty-four hours a day and follow the diabetes educational sections based on their interest and need. System also permits patients to forward the educational messages to their friends and family members in HTML format.


Educational messages are organized into four main topics, diabetes and prevention, glucose level, diet and activity and management and coping. Each main topic is broken down into their relative subtopics. (See Figure 3). Educational messages allow patients to learn more and get their progressive knowledge assessed by random questions on these topics. Each educational message takes approximately four minutes to be heard. A question is asked halfway during the educational messages to keep the patient’s attention in the message.

At the end of each message patients are asked to provide feedback about the general quality of the messages heard. All educational messages in English were recorded and certified by a certified diabetes educator. The messages in Spanish were translated and recorded by Spanish speaking person.


Each patient will receive a laminated pocketsize card with the call center phone number, their personal identification number and the list of topics. In the center of the card is the message to remind patients to call their doctor in case of health emergency (see Figure 2). Every time a patient logs into the computer telephony based call center the same opening general information message is delivered prior to playing any other educational messages. The educational material has been structured so that in addition to being delivered by telephone, it can also be offered via text and audio on the Web as well.


The automated call center is completely secure. Security and privacy policies are addressed in the system by using user identification number and password authentication, firewall policies and by providing varying levels of access to users. For example, patients are allowed to have access to the educational messages from anywhere but the administrative access is available to authorized personnel only through user and password authentication. The system uses local risk management and intrusion detection alerts through the firewall software to support deterrence. In order to monitor the authorized and unauthorized access and to determine the duration and frequency of the calls and to keep track of the messages patients listened to, system stores user actions and the time of login and logout.



Contact Information:


Santosh Krishna, PhD, EdS

Gianluca Deleo, PhD,

School of Public Health,

St Louis University,

St Louis, MO.     


3545 Lafayette Avenue

School of Public Health

Saint Louis University

St. Louis, MO 63104.


Telephone: (314) 977-8280 (Office) (573) 268-2673 (Mobile)

krishnas@slu.edu or (for attachments) santoshkri2003@yahoo.com