The Effect of SMS Reminders on Adherence in a Self-Guided Internet-Delivered Intervention for Adults With ADHD

Abstract

BackgroundSelf-guided Internet-delivered interventions may serve as an accessible and flexible non-pharmacological treatment supplement for adults with ADHD. However, these interventions are challenged by low adherence.ObjectiveTo examine whether weekly SMS reminders improve adherence to a self-guided Internet-delivered intervention for adults with ADHD.MethodThe study used a multiple randomized trial design where the participants who had not completed their weekly module within 2 days were randomized to either receive or not receive an SMS reminder. The primary outcome was adherence, defined as module completion, logins, time spent on intervention, and self-reported practice of coping strategies.ResultsA total of 109 adults with a self-reported ADHD diagnosis were included in the study. The results showed that SMS reminders were associated with an increased likelihood of login within 48 h during the second module of the intervention, but not for the remaining modules. Moreover, receiving an SMS reminder was associated spending more time on the modules and faster login time in module three and five, specifically. However, the overall results did not show an effect of SMS reminders on module completion, number of logins or practice of coping strategies.ConclusionThe results showed that SMS reminders do not improve number of logins, module completion rates or practice of coping strategies, but they may lead to faster login time and more time spent on the modules. To utilize the potential of self-guided Internet-delivered intervention in making non-pharmacological accessible for adults with ADHD, new methods to facilitate meaningful engagement should be developed and tested.Trial RegistrationClinicalTrials.gov NCT04511169.

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…Nordby et al [34] is unique in that it does not involve the measurement of engagement as usage of a mobile application or wearable sensor technology. In this study, researchers measured engagement to a web-based intervention delivered via SMS.…”

“…Engagement as practicethat is, performing a behavior/activity taught, prompted, and/or promoted by the interventionwas measured in six out of the 20 studies (30%) to measure engagement [25,[32][33][34][35][36]. All six studies measured this category of engagement via self-reports: Latham [25] evaluated a sleep intervention designed to improve the regularity of wake times in college students via prompts.…”

“…Nahum-Shani et al [33] proposed to study how prompts to engage in self-regulatory strategies increased engagement in self-regulatory activitiesresearchers planned to operationalize engagement as self-reported engagement in self-regulatory activities during the hour after receiving a prompt. The Nordby et al [34] study introduced above also included a measure of engagement as the self-reported frequency of practicing the coping strategies taught in the web-based intervention. Yang et al [36] measured engagement as the percentage of prompted strategies self-reported as completed in their evaluation of a JITAI for smoking cessation.…”

“…Of the 20 included studies that measured engagement, six studies (30%) investigated the determinants of participant engagement (Table 3). Four of the six studies were designed to evaluate strategies to improve engagement; all four of these studies investigated the influence of notification-related variables on participant engagement as variables of interest [17,[32][33][34]. For example, Bidargaddi et al [32] investigated the causal effect of sending (versus not sending) a contextually tailored push notification on participant engagement (measured as responsiveness).…”

“…In studies that did assess the determinants of engagement, notification-related causal effects were most common. This is likely attributable to the fact that most of the said studies were designed to evaluate strategies to improve engagement [17,[32][33][34]. Even fewer studies (three out of the six studies) assessed the moderators of engagement.…”