Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions

Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
Journal of Medical Internet Research (Impact Factor: 3.43). 03/2011; 13(1):e30. DOI: 10.2196/jmir.1602
Source: PubMed


The effectiveness of and adherence to eHealth interventions is enhanced by human support. However, human support has largely not been manualized and has usually not been guided by clear models. The objective of this paper is to develop a clear theoretical model, based on relevant empirical literature, that can guide research into human support components of eHealth interventions. A review of the literature revealed little relevant information from clinical sciences. Applicable literature was drawn primarily from organizational psychology, motivation theory, and computer-mediated communication (CMC) research. We have developed a model, referred to as "Supportive Accountability." We argue that human support increases adherence through accountability to a coach who is seen as trustworthy, benevolent, and having expertise. Accountability should involve clear, process-oriented expectations that the patient is involved in determining. Reciprocity in the relationship, through which the patient derives clear benefits, should be explicit. The effect of accountability may be moderated by patient motivation. The more intrinsically motivated patients are, the less support they likely require. The process of support is also mediated by the communications medium (eg, telephone, instant messaging, email). Different communications media each have their own potential benefits and disadvantages. We discuss the specific components of accountability, motivation, and CMC medium in detail. The proposed model is a first step toward understanding how human support enhances adherence to eHealth interventions. Each component of the proposed model is a testable hypothesis. As we develop viable human support models, these should be manualized to facilitate dissemination.

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    • "Clinician support appeared to facilitate high engagement in the treatment process as evidenced by frequent app use and more patient interest in pursuing additional treatment. These findings are consistent with the Supportive Accountability Model that argues that clinician support increases intervention adherence through accountability to a clinician who is seen as trustworthy, helpful, and experienced [24]. CS PTSD Coach may strike a good balance between the convenience and self-autonomy offered by mobile interventions and the support and guidance offered through brief primary-care based treatment. "
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    ABSTRACT: Objective: This study aims to evaluate the feasibility and potential effectiveness of two approaches to using the PTSD Coach mobile application in primary care: Self-Managed PTSD Coach and Clinician-Supported PTSD Coach. This study also aims to gather preliminary data to investigate if clinician support improves the benefits of using PTSD Coach on posttraumatic stress disorder (PTSD) severity and specialty mental healthcare utilization. Method: Twenty primary care veterans with PTSD symptoms were randomized to either Self-Managed PTSD Coach consisting of one 10-min session providing instructions for application use or Clinician-Supported PTSD Coach consisting of four 20-min sessions focused on setting symptom reduction goals and helping veterans fully engage with application content. Results: Research procedures and intervention conditions appear feasible as indicated by high rates of assessment and intervention retention and high clinician fidelity and satisfaction. Both treatments resulted in reductions in PTSD symptoms, with 7 Clinician-Supported PTSD Coach and 3 Self-Managed PTSD Coach participants reporting clinically significant improvements. Clinician-Supported PTSD Coach resulted in more specialty PTSD care use postintervention and possibly greater reductions in PTSD symptoms. Conclusions: Both PTSD Coach interventions are feasible and potentially helpful. The addition of clinician support appears to increase the effectiveness of self-management alone. A larger-scale randomized controlled trial is warranted to confirm these encouraging preliminary findings.
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    • "Some emphasize the content and importance of taking into account the psychological factors that influence health outcomes (Ritterband et al., 2009), while others focus on the factors related directly to the websites, that impact the " user experience " (Crutzen et al., 2009). Researchers have proposed the need to evolve and test intervention versions using randomization designs to optimize performance (Mohr et al., 2011), as well as consider specific implementation factors that are necessary for treatment efficacy (Durlak and Dupre, 2008). "
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    Internet Interventions 07/2015; DOI:10.1016/j.invent.2015.07.004
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    • "MedLink has been designed to address each of the components in Figure 1. Communication with the physician was guided by our Supportive Accountability model [15], which indicates that patients are more likely to engage in behaviors if they know that a provider is receiving information about that behavior, and that they are likely to discuss that information at some point in the future. MedLink design was also informed by Wagner's Chronic Care Model, which has received considerable empirical support [16]. "
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