Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions

By David C. Mohr, Pim Cuijpers, K. Lehman. Journal of Medical Internet Research, 2011

1,068 citations recorded by the source corpus.

The effectiveness of and adherence to eHealth interventions is enhanced by human support. However, human support has largely not been manualized and has usually not been guided by clear models. The objective of this paper is to develop a clear theoretical model, based on relevant empirical literature, that can guide research into human support components of eHealth interventions. A review of the literature revealed little relevant information from clinical sciences. Applicable literature was drawn primarily from organizational psychology, motivation theory, and computer-mediated communication (CMC) research. We have developed a model, referred to as “Supportive Accountability.” We argue that human support increases adherence through accountability to a coach who is seen as trustworthy, benevolent, and having expertise. Accountability should involve clear, process-oriented expectations that the patient is involved in determining. Reciprocity in the relationship, through which the patient derives clear benefits, should be explicit. The effect of accountability may be moderated by patient motivation. The more intrinsically motivated patients are, the less support they likely require. The process of support is also mediated by the communications medium (eg, telephone, instant messaging, email). Different communications media each have their own potential benefits and disadvantages. We discuss the specific components of accountability, motivation, and CMC medium in detail. The proposed model is a first step toward understanding how human support enhances adherence to eHealth interventions. Each component of the proposed model is a testable hypothesis. As we develop viable human support models, these should be manualized to facilitate dissemination.

Subfields: Applied Psychology, Health, Sociology and Political Science

View Paper: https://www.semanticscholar.org/paper/3e9c5f482542c1d2f5c587f8c30d691eab374f37

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Citations in the corpus

Behavioral Intervention Technologies: Evidence review and recommendations for future research (2010, neutral): “interactions that align with principals of supportive accountability [4].”
Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review (2021, background): “Although human support enhances engagement more than automated means such as email reminders [250], several studies included in our review found that such automated reminders not only facilitated engagement but were also experienced positively by users.”
Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support (2017, background): “, “implicit or explicit expectation that an individual may be called upon to justify his/her actions or inactions” [53]) is”
Integrating Human Support Into Behavioral Intervention Technologies: The Efficiency Model of Support (2017, background): “Some principles are likely to remain; for example, the relationship between patient and supporter remains a key consideration (Mohr et al., 2011), and studies showed that therapeutic alliance formed during supported Internet treatments is predictive of outcomes (e.g., Nordgren, Carlbring, Linna, &…”
The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis (2017, positive): “Providing support to clients in terms of weekly feedback may enhance adherence to the intervention and thus improve treatment efficacy [62].”
Embodied Conversational Agents in Clinical Psychology: A Scoping Review (2017, positive): “To revert to delivering support in Internet interventions, we know that not all people require the same amount of support, considering, for example, that people with low intrinsic motivation benefit more from human support than those who are already motivated or prefer to work on their own [5].”
Harnessing Context Sensing to Develop a Mobile Intervention for Depression (2011, methodology): “A manualized telephone coaching protocol [23] was used to enhance adherence via principles of supportive accountability [24].”
Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions. (2016, background): “The “supportive accountability” conveyed by having a benevolent but expert human coach maintain surveillance of the participant’s interactions is usually valuable to maintain motivation and adherence to intervention requirements.(64) Human facilitation by peer counselors may help as well, creating a”
Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. (2014, neutral): “human supported systems, type of human moderation (Mohr et al., 2011), level of intrinsic motivation, insight, cognitive deficits).”