Adherence in Internet Interventions for Anxiety and Depression: Systematic Review

Centre for Mental Health Research, Australian National University, Canberra ACT 0200, Australia.
Journal of Medical Internet Research (Impact Factor: 3.43). 02/2009; 11(2):e13. DOI: 10.2196/jmir.1194
Source: PubMed


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.

43 Reads
  • Source
    • "Internet interventions are increasingly used to improve health behaviors to manage chronic illness, but their efficacy is limited by patient adherence to the program. Many participants never complete a healthbehavior focused Internet intervention, limiting the potential impact (Blankers et al., 2009; Christensen et al., 2009,2009; Ritterband et al., 2008). Characteristics of Internet interventions that seem to foster more program adherence include highly relevant content, tailored interactivity, and personalization of feedback and user assignments (Ritterband et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: While Internet interventions can improve health behaviors, their impact is limited by program adherence. Supporting program adherence through telephone counseling may be useful, but there have been few direct tests of the impact of support. We describe a Telephone Motivational Interviewing (MI) intervention targeting adherence to an Internet intervention for drivers with Type 1 Diabetes,, and compare completion of intervention benchmarks by those randomized to plus MI vs. only. The goal of the pre-intervention MI session was to increase the participant’s motivation to complete the Internet intervention and all its assignments, while the goal of the post-treatment MI session was to plan for maintaining changes made during the intervention. Sessions were semi-structured and partially scripted to maximize consistency. MI Fidelity was coded using a standard coding system, the MITI. We examined the effects of MI support vs. no support on number of days from enrollment to program benchmarks. Results show that MI sessions were provided with good fidelity. Users who received MI support completed some program benchmarks such as Core 4 (t176 df = -2.25; p < .03) and 11 of 12 monthly driving diaries significantly sooner, but support did not significantly affect time to intervention completion (t177 df = -1.69; p < .10) or rates of completion. These data suggest that there is little benefit to therapist guidance for Internet interventions including automated email prompts and other automated minimal supports, but that a booster MI session may enhance collection of follow-up data.
    Full-text · Article · Feb 2015 · Internet Interventions
  • Source
    • "Understanding how, why and for whom interventions affect symptom change is critical for maximising the clinical potency and cost effectiveness of online public health interventions for common mental disorders. Furthermore, rates of adherence with these interventions, which are characteristically low [7], may be improved by incorporating program content and functions that increase therapeutic efficiency by targeting intervening processes directly [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Online psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown. In the present study, we examined whether mental health self-efficacy (MHSE), a construct derived from Bandura¿s Social Learning Theory (SLT), influenced symptom and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress.MethodsSTUDY I: Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and construct validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES).
    Full-text · Article · Sep 2014 · BMC Psychiatry
  • Source
    • "Prior work has shown that patients will not engage with technology that is challenging to use or perceived as irrelevant to their needs (Chiu & Eysenbach, 2010; Lenert et al., 2003). This has resulted in limited engagement and completion of other technology-based strategies for care delivery such as the Internet delivered interventions (Christensen, Griffiths, & Farrer, 2009; Donkin et al., 2011; Price, Gros, McCauley, Gros, & Ruggiero, 2012). Research has found that some of the main usability hurdles for mobile devices include small screens that display a limited amount of information at a time, touch activation screens that are error prone and small keyboards that result in slow text entry and typographical errors (Gong & Tarasewich, 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The increased popularity and functionality of mobile devices has a number of implications for the delivery of mental health services. Effective use of mobile applications has the potential to (a) increase access to evidence-based care; (b) better inform consumers of care and more actively engage them in treatment; (c) increase the use of evidence-based practices; and (d) enhance care after formal treatment has concluded. The current paper presents an overview of the many potential uses of mobile applications as a means to facilitate ongoing care at various stages of treatment. Examples of current mobile applications in behavioural treatment and research are described, and the implications of such uses are discussed. Finally, we provide recommendations for methods to include mobile applications into current treatment and outline future directions for evaluation. Copyright © 2013 John Wiley & Sons, Ltd. Mobile devices are becoming increasingly common among the adult population and have tremendous potential to advance clinical care. Mobile applications have the potential to enhance clinical care at stages of treatment-from engaging patients in clinical care to facilitating adherence to practices and in maintaining treatment gains. Research is needed to validate the efficacy and effectiveness of mobile applications in clinical practice. Research on such devices must incorporate assessments of usability and adherence in addition to their incremental benefit to treatment.
    Full-text · Article · Sep 2014 · Clinical Psychology & Psychotherapy
Show more