Adherence in Internet Interventions for Anxiety and Depression: Systematic Review

By Helen Christensen, K. Griffiths, L. Farrer. Journal of Medical Internet Research, 2009

1,173 citations recorded by the source corpus.

Background Open access websites which deliver cognitive and behavioral interventions for anxiety and depression are characterised by poor adherence. We need to understand more about adherence in order to maximize the impact of Internet-based interventions on the disease burden associated with common mental disorders. Objective The aims of this paper are to review briefly the adherence literature with respect to Internet interventions and to investigate the rates of dropout and compliance in randomized controlled trials of anxiety and depression Web studies. Methods A systematic review of randomized controlled trials using Internet interventions for anxiety and depression was conducted, and data was collected on dropout and adherence, predictors of adherence, and reasons for dropout. Results Relative to reported rates of dropout from open access sites, the present study found that the rates of attrition in randomized controlled trials were lower, ranging from approximately 1 - 50%. Predictors of adherence included disease severity, treatment length, and chronicity. Very few studies formally examined reasons for dropout, and most studies failed to use appropriate statistical techniques to analyze missing data. Conclusions Dropout rates from randomized controlled trials of Web interventions are low relative to dropout from open access websites. The development of theoretical models of adherence is as important in the area of Internet intervention research as it is in the behavioral health literature. Disease-based factors in anxiety and depression need further investigation.

Subfields: Applied Psychology, General Health Professions, Sociology and Political Science

View Paper: https://www.semanticscholar.org/paper/06e53719b6f3018bd0bebdde8fb30cac676ec3de

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Citations in the corpus

Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. (2016, background): “Given the dose–response relationship that has been found for the use of online interventions (Christensen et al., 2009; Donkin et al., 2011;Wangberg et al., 2008), adherence seems an important factor to take into account when considering the effectiveness of online MBIs.”
Advantages and limitations of Internet‐based interventions for common mental disorders (2014, background): “Third, there are clear indications that support increases adherence and prevents dropout, an important issue given that at least some unguided interventions have suffered from unacceptably high dropout rates (33).”
Positive psychology interventions: a meta-analysis of randomized controlled studies (2013, positive): “Adherence tends to be quite low in self-help interventions [90,91] and therefore, enhancing adherence could be a major factor in improving effectiveness.”
Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review (2013, background): “In a similar way to guided Internet interventions [28], guided apps might derive larger effect sizes and adherence rates than stand-alone self-help apps, but more research is necessary to elucidate this.”
The impact of guidance on Internet-based mental health interventions — A systematic review (2014, background): “Guidance is, however, not the only adherence facilitating measure (Christensen et al., 2009; Donkin et al., 2011; Andersson et al., 2009; Brouwer et al., 2009; Baumeister et al., 2014, online first) and a comparison across trials might overlook other important differences between the…”
Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis (2019, background): “These findings reflect the lower ranges of real-world retention rates reported in developer-led studies [17-20,22].”
A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods (2017, positive): “The most central one, according to current literature, is its low adherence (Christensen et al., 2009; Schueller, 2010).”
Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis (2016, background): “Furthermore, challenge [61, 100, 141], aesthetics and design [120, 139, 142, 143] and credibility features [68, 73], referring to features that inculcate a feeling of trust, familiarity [97, 139, 144], and the provision of guidance or tutorials [68, 106, 145] have been hypothesised to positively inf”
Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions (2012, background): “Adherence, or non-usage attrition, refers to the extent to which individuals experience the content of an intervention [13, 15].”
A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies (2011, positive): “This lack of human centeredness explains the incidence of usability problems [7-9], or high attrition rates [10-18].”
A Behavior Change Model for Internet Interventions (2009, background): “As with any health intervention, better understanding adherence can help maximize the impact of treatment, in this case Internet-delivered treatment [42].”
A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011, positive): “Recent studies have begun to address this through the exploration of the relationship between program exposure and outcomes [27-30].”
Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions (2011, background): “A growing body of data from RCTs shows that adherence to eHealth interventions varies widely [3].”
Harnessing Context Sensing to Develop a Mobile Intervention for Depression (2011, background): “Internet interventions have been touted as an antidote to access barriers, but they appear to produce more modest outcomes [9], in part also due to high attrition [10].”
Behavioral Intervention Technologies: Evidence review and recommendations for future research (2010, positive): “Adherence to Web-based interventions has been widely acknowledged to be a problem [25,28] and should constitute a standard outcomemeasure and a focus of new research.”
Effectiveness of telemedicine: A systematic review of reviews (2010, background): “[85] Anxiety and depression Not mentioned Open access websites which deliver cognitive and behavioural interventions Behavioural outcomes Twenty-three studies included.”