Motivators and Motivations to Persist With Online Psychological Interventions: A Qualitative Study of Treatment Completers

Abstract

BackgroundMany users of Internet interventions do not persist with the full treatment program. As persistence may influence outcomes of such interventions, being able to maximize persistence is vital. However, while studies have begun to explore the predictors of dropout in Internet interventions, few have explored reasons why users persist with the programs, which may not just be the converse of the reasons for dropout.ObjectiveTo answer the question of what influences persistence with online interventions.MethodsWe interviewed participants in the Cardiovascular Risk E-couch Depression Outcome (CREDO), a trial evaluating the efficacy of an eHealth intervention (e-couch) in treating depressive symptoms in those with comorbid depression and cardiovascular risk factors. Interviews were semistructured in nature and were analyzed using a grounded theory approach. Interview numbers were curtailed (n = 12) after theoretical saturation.ResultsAll participants reported substantial barriers to completing the program including time constraints, competing priorities, anxiety about spending time on the computer, and perception of limited worth of the intervention. Participants who persisted with the trial reported intrinsic motivations such as personal values about task completion and sense of control, and recognized external motivators that aided the development of habits and identified personal benefits attributable to the program.ConclusionsOnline interventions may benefit from content that enhances the intrinsic motivations such as a having sense of control and being able to identify with the program, and by increasing the relative value of the program in order to enhance persistence. Persistence within a trial setting appears modifiable through explicit messages regarding supporting others. In terms of motivators, the use of a hook to engage participants who are starting the intervention due to curiosity and the use of reminder systems to prompt participants may also improve persistence. The worth of such additions should be evaluated using adherence and outcomes metrics.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077; http://www.anzctr.org.au/ACTRN12610000085077.aspx (Archived by WebCite at http://www.webcitation.org/68MtyPO3w)

Women's experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural Activation for Postnatal Depression

“…Women expressed a desire for information on parenting in the context of PND, managing the transition to motherhood, content on communication and eliciting support, managing maternal sleep in the postnatal period, and anxiety, particularly social anxiety as it impacted on women's ability to integrate with other new mothers. Treatments that include a wide variety of treatment examples, modular and/or adaptive content can help ensure that individuals can personalize materials (Donkin and Glozier, 2012). This will help ensure that women are able to immediately access treatment relevant content.…”

Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study

“…A pilot study (Watts et al, 2013) comparing a depression program via mobile phone to a program via computer showed that slightly more participants using the computer (64% versus 54%) endorsed the program stating that they were 'very satisfied', with the remaining participants endorsing 'somewhat satisfied'. Donkin and Glozier (2012) focused on adherence and motivation in their study on internet-based treatment for depression in persons with risk of cardiovascular disease and found that content which enhances motivation such as having a sense of control and being able to identify with the program could be useful as well as increasing the relative value of the treatment program in order to enhance persistence. A meta-synthesis of qualitative studies revealed a number of themes, including the nature of personal experience in depression; help-seeking in primary care; control and helplessness in engagement with treatment; stigma associated with treatment; and patients' understandings of self-help interventions (Khan et al, 2007).…”

Investigating the Direct Impact of a Gamified Versus Nongamified Well-Being Intervention: An Exploratory Experiment (Preprint)

“…The meaningful experience is closely related to the concept of engagement which is seen as an important predictor of both adherence to online interventions and the effectiveness of these interventions [12,14,42]. This study is a first step in uncovering how gamification, and design in general, may enhance motivation in the context of psychological online interventions and offers a starting point for creating engaging interventions.…”

“…More recently, it has been posited that just adherence (i.e. using the intervention as intended by the developers) may nog be enough for an intervention to be effective, but that it is also necessary for participants to feel involved with an intervention, or to be able to identify with the intervention [12,13]. Together, these factors may be called engagement, i.e.…”