Adherence to a web-based pre-treatment for phobias in outpatient clinics

Robin N Kok; Aartjan T F Beekman; Pim Cuijpers; Annemieke van Straten

doi:10.1016/j.invent.2017.05.004

Adherence to a web-based pre-treatment for phobias in outpatient clinics

Internet Interv. 2017 Jun 1:9:38-45. doi: 10.1016/j.invent.2017.05.004. eCollection 2017 Sep.

Authors

Robin N Kok^{1

2

3}, Aartjan T F Beekman⁴, Pim Cuijpers¹, Annemieke van Straten¹

Affiliations

¹ Department of Clinical, Developmental and Neuropsychology, EMGO Institute for Health and Care Research, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, The Netherlands.
² Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
³ Centre for Innovative Medical Technology, Department of Clinical Innovation, Odense University Hospital, Odense, Denmark.
⁴ Department of Psychiatry, EMGO institute for Health and Care Research, VU University Medical Centre, GGZ InGeest, Amsterdam, The Netherlands.

Abstract

Background: Non-adherence in Internet interventions is a persistent and multifaceted issue and potentially limits the applicability and effectiveness of these interventions. Factors that influence non-adherence are poorly understood, especially in outpatient samples with more complex symptoms.

Objective: The current study is a secondary analysis of data from a randomised controlled trial that examined the cost-effectiveness of offering an Internet-based exposure treatment to phobic outpatients on a wait-list to receive face-to-face psychotherapy.

Methods: We collected baseline demographic and clinical information, and adherence data of the Internet-based intervention and conducted regression analyses to predict non-adherence to the intervention.

Results: The adherence to the intervention was low, with only 13.3% of 105 patients completing all five lessons of the intervention. The median number of exercises completed (out of a possible 8) was 3. In a multi-predictor model, a higher baseline score of anxiety (OR = 0.94, 95% CI 0.90-0.99) was a risk factor for low adherence. Higher age (OR = 1.05, 95% CI 1.00-1.09) was a protective factor against non-adherence. Participants who adhered to the intervention were more likely to complete post-test assessments, further biasing results. However, overall participant attrition was high. The results are based on a small subset of participants and should be interpreted with caution.

Conclusions: Poor baseline clinical status and age are factors to consider when deciding whether to offer an Internet-based intervention to outpatients. Low adherence among those patients might be related to intrinsic motivation and might even be lower in outpatient settings where participants expect to receive face-to-face treatment. It might be worthwhile to develop a concise instrument to assess intrinsic motivation and treatment expectations for using Internet-based interventions, and for the therapist to review the range of possible (Internet-based) intervention options to suit personal preferences and expectations.

Trial registration: Netherlands Trial Register, NTR2233.

Keywords: Adherence; Dropout; Internet Intervention; Non-adherence; Predictors.