Attrition Revisited: Adherence and Retention in a Web-Based Alcohol Trial

Murray, Elizabeth; White, Ian R.; Varagunam, Mira; Godfrey, Christine; Khadjesari, Zarnie; McCambridge, Jim

doi:10.2196/jmir.2336

Cited by 117 publications

(113 citation statements)

References 43 publications

(47 reference statements)

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“…A review of studies showed that theoretical foundation of the intervention, perceived personal relevance to the user, perceived effectiveness, persuasive technologies, credibility and social networking also influence engagement with online interventions. 252 Self-regulatory strategies, such as inviting users to commit to revisiting the intervention (if required), by indicating a time when the user might like to revisit, can be used to enhance exposure. 253 As described in Chapter 3, design features of interventions can also influence engagement.…”

Section: Fidelity Of Digital Interventionsmentioning

confidence: 99%

“…88 Eysenbach has hypothesised that dropout from a trial usually follows the pattern of non-usage of an intervention, 254 although this was not substantiated in a trial of a website for alcohol harm reduction, in which greater adherence to the intervention was not necessarily associated with greater retention, especially in the intervention arm, and factors associated with intervention usage and retention in the trial were not similar. 252 There is a need to conduct further research to better understand factors influencing retention in trials of digital interventions and engagement with digital interventions. Various strategies can be used to enhance retention in trials of digital interventions, as follows.…”

Section: Retention In Randomised Controlled Trials Of Digital Intervementioning

confidence: 99%

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Sexual health promotion for young people delivered via digital media: a scoping review

et al. 2015

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BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.

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Section: Fidelity Of Digital Interventionsmentioning

confidence: 99%

Section: Retention In Randomised Controlled Trials Of Digital Intervementioning

confidence: 99%

Sexual health promotion for young people delivered via digital media: a scoping review

et al. 2015

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“…Non-usage attrition was assessed in relation to use of more than one intervention component (i.e. use of the PA monitoring system and the website) and this improves upon previous studies which typically assess non-usage attrition in relation to website use only [71,[82][83][84][85][86].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

Murray¹,

French²,

Patterson³

et al. 2018

Preprint

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Loyalty (PAL) scheme. AbstractBackground: Investigating participant engagement and levels of non-usage attrition can help researchers identify which are the likely 'active ingredients' operating in eHealth interventions. Research on engagement can identify which intervention components predict health outcomes. Research on non-usage attrition is important to make recommendations for retaining participants in future studies. Objective:To investigate engagement and non-usage attrition in the Physical Activity Loyalty (PAL) scheme, a six month complex physical activity (PA) intervention implemented in workplaces in Northern Ireland (NI). The intervention included financial incentives with reward redemption, and self-regulation techniques. Specific objectives included: (1) To determine whether engagement in specific intervention components predicted PA at six months; (2) To determine whether engagement in specific intervention components predicted mediators targeted by the intervention at six months; (3) To investigate rates, and predictors, of non-usage attrition for participants recording daily activity via the PAL scheme PA monitoring system and logging onto the PAL scheme website. Methods:PA was assessed at baseline and six months using pedometers (Yamax Digiwalker CW-701, Japan).Markers of engagement and website use, PA monitoring system use and reward redemption were collected throughout the scheme. Random-effects generalised least squares (GLS) regressions determined whether engagement with specific intervention components predicted six month PA and mediator variables (mediators).Cox proportional hazards regressions were used to investigate predictors of non-usage attrition (i.e. days until first two week lapse). Results:A multivariable GLS regression model showed frequency of hits on the monitoring and feedback One example of an internet-delivered intervention was the Physical Activity Loyalty (PAL) scheme, implemented in workplaces in Northern Ireland (NI). The PAL scheme was a complex PA intervention which offered financial incentives and other behaviour change techniques (BCTs) delivered via the study website to increase workplace PA (recorded by outdoor sensors located within 2 km of the workplace). Paradoxically, results showed there was a small but significant decline in pedometer steps/day at six months relative to baseline, for the intervention group compared to controls, which dissipated at 12 months [4]. Mediation and moderation analyses showed that decreases in PA were partially mitigated by positive indirect effects through the constructs of integrated regulation, intrinsic motivation and habit measured at six months whilst the negative intervention effect was moderated by participants' perceptions of availability of PA opportunities in the workplace environment [5]. The current report aims to further investigate mechanisms of behaviour change for participants in the PAL scheme by examining usage rates for specific intervention components, predictors of usage rates, and whether usage was related ...

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“…Intervention studies show substantial variability in attrition rates, depending on treatment orientation and clinical severity [43,44]. Generally, drop-out rates are high in populations with alcohol and substance use disorders -ranging from 21-80% [43].…”

Section: Limitations and Mitigation Planmentioning

confidence: 99%

Efficacy of an Online Self-Help Treatment for Comorbid Alcohol Misuse and Emotional Problems in Young Adults: Protocol for a Randomized Controlled Trial (Preprint)

Frohlich¹,

Rapinda²,

Schaub³

et al. 2018

Preprint

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Background: Alcohol misuse and emotional problems (i.e., depression and anxiety) are highly comorbid among Canadian young adults. However, there is a lack of integrated, accessible, and evidence-based treatment options for these young adults. Objective:The main goal of this study is to develop and test the efficacy of an integrated, online self-help program designed to target both alcohol misuse and emotional problems. Methods:A two-arm randomized controlled trial (RCT) design will be used to compare the efficacy of the online integrated treatment to a psychoeducational control group. A target sample of 214 participants will be recruited and randomly assigned to either condition. The integrated treatment will last 8-weeks and participants will work through 12 modules. Modules will incorporate content based on principles of Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI). Participants in the control group will receive links to psychoeducational resources and will have access to the full treatment after follow-up. The primary outcome will be the number of Canadian standard drinks consumed in the week leading up the assessment. Secondary outcomes of interest include symptoms of depression, anxiety, alcohol-related problems, quality of life, and use of other drugs. Assessments will be completed at three time points: at baseline, at the end of treatment (i.e., 8-weeks), and at follow-up (i.e., 24-weeks). Upon completion, data will be analyzed using Generalized Linear Mixed Models (GLMM).Results: Data collection will begin in June 2018 and will continue until January 2020. Final study results will be submitted for publication by July 2020. Conclusions:Currently, there are no integrated treatments designed to target alcohol misuse and the range of emotional problems experienced in young adults. This research stands to provide an effective, accessible (i.e., online), and feasible option to treat the many struggling young adults in this country.Trial Registration: Clinicaltrials.gov ID -NCT03406039

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Attrition Revisited: Adherence and Retention in a Web-Based Alcohol Trial

Cited by 117 publications

References 43 publications

Sexual health promotion for young people delivered via digital media: a scoping review

Sexual health promotion for young people delivered via digital media: a scoping review

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

Efficacy of an Online Self-Help Treatment for Comorbid Alcohol Misuse and Emotional Problems in Young Adults: Protocol for a Randomized Controlled Trial (Preprint)

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