Technological adjuncts to increase adherence to therapy: A review

Abstract

This paper identified and reviewed technological adjuncts to increase client adherence to therapy. Three areas of adherence were identified, namely treatment dropout and non-attendance, engagement during and between therapy sessions, and aftercare. Database searches were conducted in each of these areas to identify relevant studies published between the years of 1990 and 2010. Adjuncts designed to replace or reduce direct therapist contact, change the medium of communication between the client and therapist, or alter the content or style of the therapy were not included in this review. Adjuncts were reviewed in light of theories of adherence, including Self Determination Theory, the Transtheoretical Model, and the Theory of Planned Behaviour. Adjuncts reviewed included appointment reminders, exercises and monitoring delivered by mobile phone, and exercises and data collection delivered by computer. Limitations and directions for future research were addressed and discussed.

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

“…At least one in five adult patients drop out of psychotherapy and this rate can be substantially higher in some settings [11]. Although various patient, therapeutic, and social characteristics have been associated with increased risk of patient non-attendance and dropout, research is in large part still inconclusive and sometimes even conflicting, particularly with regards to patient characteristics [12,4]. For example age has been associated with non-attendance in some studies [e.g., 13] but not others DEVELOPMENT OF THE TAP 5 [e.g., 14], as has gender and level of education among others variables [e.g., 12,14,13,15].…”

“…According to the TPB, psychological treatment participation can be encouraged by exploring patient beliefs about subjective norms, and perceived behavioural control, in addition to improving attitudes towards treatment [4]. However, research into the utility of the TPB in mental health settings has been hampered by the absence of an empirically validated tool that can be used by clinicians to understand patient attendance guided by the TPB.…”

“…Treatment dropout and non-attendance by psychotherapy patients are types of nonadherence, and are a costly problem for both clinicians and patients [3,4]. Consequences of patient dropout and non-attendance include poorer treatment outcomes, increased burden of disease, loss of income for services, inefficient use of staff time, and longer waiting lists [5].…”

8. Making and Keeping the Connection: Improving Consumer Attitudes and Engagement in E-Mental Health Interventions

“…Despite this evidence that e-mental health services can be effective, there has been relatively little examination of how well consumers engage with these services (Hordern, Georgiou, Whetton, & Progmet, 2011). Client engagement forms part of the broader concept of adherence to the therapeutic process (Clough & Casey, 2011). Two key issues in client engagement associated with e-mental health services are the rates of uptake (i.e., clients entering the service) and dropout (i.e., people ceasing the service).…”

Measuring barriers to adherence: validation of the problematic experiences of therapy scale

“…Adherence to treatment is a complex issue that has generated a great deal of attention and has been highlighted as one of the most serious problems facing medical practice [1,2]. The consequences of non-adherence are considerable; it can affect the effectiveness and outcome of treatment, increase the amount of time spent with health care professionals and increase the financial cost of health care [3].…”