We measured Spanish-speaking patients' engagement in Interactive Voice Response (IVR) calls using data from self-management support studies in Honduras, Mexico and the US. A total of 268 patients with diabetes or hypertension participated in 6-12 weeks of weekly IVR follow-up. Participants had an average of 6.1 years of education, and 73% of them were women. After 2443 person-weeks of follow-up, patients had completed 1494 IVR assessments. The call completion rates were higher in the US (75%) than in Honduras (59%) or Mexico (61%; P < 0.001). Patients participating with an informal caregiver were more likely to complete calls (adjusted odds ratio 1.5; P = 0.03) while patients reporting fair or poor health at enrolment were less likely (adjusted odds ratio 0.59; P = 0.02). Satisfaction rates were high, with 98% of patients reporting that the system was easy to use, and 86% reporting that the calls helped them a great deal in managing their health problems. IVR self-management support is feasible among Spanish-speaking patients with chronic disease, including those living in less-developed countries. Involving informal caregivers may increase patient engagement.