Attrition in an online loneliness intervention for adults aged 50 years and older: Survival analysis

Tamara Bouwman*, Theo Van Tilburg, Marja Aartsen

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review


Background: Online interventions can be as effective as in-person interventions. However, attrition in online intervention is high and potentially biases the results. More importantly, high attrition rates might reduce the effectiveness of online interventions. Therefore, it is important to discover the extent to which factors affect adherence to online interventions. The setting for this study is the online Friendship Enrichment Program, a loneliness intervention for adults aged 50 years and older. Objective: This study examined the contribution of severity of loneliness, coping preference, activating content, and engagement in attrition within an online intervention. Methods: Data were collected from 352 participants in an online loneliness intervention for Dutch people aged 50 years and older. Attrition was defined as not completing all 10 intervention lessons. The number of completed lessons was assessed through the management system of the intervention. We tested 4 hypotheses on attrition by applying survival analysis (Cox regression). Results: Of the 352 participants who subscribed to the intervention, 46 never started the introduction. The remaining 306 participants were divided into 2 categories: 73 participants who did not start the lessons of the intervention and 233 who started the lessons of the intervention. Results of the survival analysis (n=233) showed that active coping preference (hazard ratio [HR]=0.73), activating content (HR=0.71), and 2 indicators of engagement (HR=0.94 and HR=0.79) lowered attrition. Severity of loneliness was not related to attrition. Conclusions: To reduce attrition, developers of online (loneliness) interventions may focus on stimulating active behavior within the intervention.

Original languageEnglish
Article numbere13638
Number of pages10
JournalJMIR Aging
Issue number2
Publication statusPublished - 24 Jul 2019


  • Attrition
  • Coping
  • Engagement
  • Loneliness
  • Older adults
  • Online intervention


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