Abstract
Background Non-adherence in Internet interventions is a persistent and multifaceted issue and potentially limits the applicability and effectiveness of these interventions. Factors that influence non-adherence are poorly understood, especially in outpatient samples with more complex symptoms. Objective The current study is a secondary analysis of data from a randomised controlled trial that examined the cost-effectiveness of offering an Internet-based exposure treatment to phobic outpatients on a wait-list to receive face-to-face psychotherapy. Methods We collected baseline demographic and clinical information, and adherence data of the Internet-based intervention and conducted regression analyses to predict non-adherence to the intervention. Results The adherence to the intervention was low, with only 13.3% of 105 patients completing all five lessons of the intervention. The median number of exercises completed (out of a possible 8) was 3. In a multi-predictor model, a higher baseline score of anxiety (OR = 0.94, 95% CI 0.90–0.99) was a risk factor for low adherence. Higher age (OR = 1.05, 95% CI 1.00–1.09) was a protective factor against non-adherence. Participants who adhered to the intervention were more likely to complete post-test assessments, further biasing results. However, overall participant attrition was high. The results are based on a small subset of participants and should be interpreted with caution. Conclusions Poor baseline clinical status and age are factors to consider when deciding whether to offer an Internet-based intervention to outpatients. Low adherence among those patients might be related to intrinsic motivation and might even be lower in outpatient settings where participants expect to receive face-to-face treatment. It might be worthwhile to develop a concise instrument to assess intrinsic motivation and treatment expectations for using Internet-based interventions, and for the therapist to review the range of possible (Internet-based) intervention options to suit personal preferences and expectations. Trial registration Netherlands Trial Register, NTR2233.
Original language | English |
---|---|
Pages (from-to) | 38-45 |
Number of pages | 8 |
Journal | Internet Interventions |
Volume | 9 |
Issue number | September |
DOIs | |
Publication status | Published - 2017 |
Funding
We would like to thank ms. Julia van Oenen for data collection and adherence calculations, and all patients and outpatient staff involved. Furthermore, we would like to thank Marleen Bakker and Kim Setkowski for data collection and Koen Nijenhuis for statistical input. This study was funded by ZonMw (project number 80-82310-97-10015). The funding body had no influence in the design, execution, analysis, or interpretation of the results of this study.
Keywords
- Adherence
- Dropout
- Internet Intervention
- Non-adherence
- Predictors