Adherence in internet interventions for anxiety and depression.

Centre for Mental Health Research, Australian National University, Canberra ACT 0200, Australia.
Journal of Medical Internet Research (Impact Factor: 3.77). 02/2009; 11(2):e13. DOI: 10.2196/jmir.1194
Source: PubMed

ABSTRACT Open access websites which deliver cognitive and behavioral interventions for anxiety and depression are characterised by poor adherence. We need to understand more about adherence in order to maximize the impact of Internet-based interventions on the disease burden associated with common mental disorders.
The aims of this paper are to review briefly the adherence literature with respect to Internet interventions and to investigate the rates of dropout and compliance in randomized controlled trials of anxiety and depression Web studies.
A systematic review of randomized controlled trials using Internet interventions for anxiety and depression was conducted, and data was collected on dropout and adherence, predictors of adherence, and reasons for dropout.
Relative to reported rates of dropout from open access sites, the present study found that the rates of attrition in randomized controlled trials were lower, ranging from approximately 1 - 50%. Predictors of adherence included disease severity, treatment length, and chronicity. Very few studies formally examined reasons for dropout, and most studies failed to use appropriate statistical techniques to analyze missing data.
Dropout rates from randomized controlled trials of Web interventions are low relative to dropout from open access websites. The development of theoretical models of adherence is as important in the area of Internet intervention research as it is in the behavioral health literature. Disease-based factors in anxiety and depression need further investigation.

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    Iranian journal of public health 01/2014; · 0.24 Impact Factor
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    ABSTRACT: Web-based preventive interventions have shown to be effective for the prevention of depression, but high rates of non-use and drop-out, less than optimal implementation in the care organization and low acceptance rates cause interventions to be less effective in practice than in theory and research. The lack of a holistic overview where the human and technological context is given a prominent place, seems to be one of the main reasons for this less than optimal effectiveness. This study employs methods based on the holistic approach of the CeHRes roadmap to create a viable web-based intervention and to investigate the suitability of the chosen methods and the pitfalls that can be encountered. The study shows that it is possible to create a viable web-based intervention by including different stakeholders (users, designers, programmers, researchers) in different phases of the development process. The employed methods are suitable and yield complementary results, but made our approach more user and expert driven than fully stakeholder driven. Furthermore, our project team was organized with the researcher as the central hub. Although this worked well most of the time, we propose a more ideal organizational structure in which a formal project leader, who can be a researcher, has a mandate to make decisions and resources to be involved in all steps of the process.
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    ABSTRACT: Background There are first indications that an Internet-based cognitive therapy (CT) combined with monitoring by text messages (Mobile CT), and minimal therapist support (e-mail and telephone), is an effective approach of prevention of relapse in depression. However, examining the acceptability and adherence to Mobile CT is necessary to understand and increase the efficiency and effectiveness of this approach. Method In this study we used a subset of a randomized controlled trial on the effectiveness of Mobile CT. A total of 129 remitted patients with at least two previous episodes of depression were available for analyses. All available information on demographic characteristics, the number of finished modules, therapist support uptake (telephone and e-mail), and acceptability perceived by the participants was gathered from automatically derived log data, therapists and participants. Results Of all 129 participants, 109 (84.5%) participants finished at least one of all eight modules of Mobile CT. Adherence, i.e. the proportion who completed the final module out of those who entered the first module, was 58.7% (64/109). None of the demographic variables studied were related to higher adherence. The total therapist support time per participant that finished at least one module of Mobile CT was 21 min (SD = 17.5). Overall participants rated Mobile CT as an acceptable treatment in terms of difficulty, time spent per module and usefulness. However, one therapist mentioned that some participants experienced difficulties with using multiple CT based challenging techniques. Conclusion Overall uptake of the intervention and adherence was high with a low time investment of therapists. This might be partially explained by the fact that the intervention was offered with therapist support by telephone (blended) reducing non-adherence and that this high-risk group for depressive relapse started the intervention during remission. Nevertheless, our results indicate Mobile CT as an acceptable and feasible approach to both participants and therapists.
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