Dyslipidemia is a major risk factor for coronary heart disease (CHD). In dyslipidemia patients, dietary interventions can have a positive impact on total cholesterol and LDL-cholesterol levels and thus reduce the patients' CHD risk. Although dietary counseling can be effective in changing dietary behavior, it is used variably by physicians and their patients. DietAid (Diet Adherence Intervention for Dyslipidemia) is an automated telephone-based system that functions as a physician or nutritionist-extender. Using the NCEP Step I guidelines as the basis, DietAid monitors dietary behavior of dyslipidemia patients in their homes and provides them with nutritional information and advice and behavioral feedback to affect their dietary behavior. DietAid uses computer-controlled speech to speak. The patients communicate by depressing keys on their touch-tone telephones. Conversations take place 1-2 times a week; either DietAid or the patient can initiate a call. DietAid is based on the Telephone-Linked Communication (TLC) technology previously developed by the investigators and successfully applied to improving medication adherence and physical activity levels in patients. An initial version of DietAid was developed and tested in a randomized controlled pilot study, and was shown to be effective in lowering total cholesterol and possibly LDL-cholesterol in dyslipidemia patients. DietAid users were also very satisfied with the program (mean rating of 8 on a 1 (low) to 10 (high) scale). In this proposed project, the pilot version of DietAid will be refined into a final version and then evaluated with regard to its effect on dietary behavior, nutrient intake and serum lipid levels in a randomized clinical trial of 360 general medical patients with total cholesterol 240-299 mg/dL on entry. Subjects will be randomly assigned to DietAid or a TLC control intervention that provides general health information. The minority participation rate is expected to be 19-22%, and about 60% of the subjects will be female. Each subject will be followed for a six month period with assessments at baseline, 3 months and 6 months. The endpoints will be changes in dietary behavior (level of use of highly atherogenic foods), quantitative nutrient intake (fat and cholesterol), and serum lipid levels. The acceptability of DietAid to patient users will be measured by an attitudinal questionnaire that includes both structured and open-ended questions. DietAid's operating costs and cost effectiveness will be calculated.
