Postel Marloes G, de Haan Hein A, ter Huurne Elke D, van der Palen Job, Becker Eni S, de Jong Cor A J
Tactus Addiction Treatment, Enschede, Netherlands.
J Med Internet Res. 2011 Dec 27;13(4):e117. doi: 10.2196/jmir.1811.
Web-based interventions for problem drinking are effective but characterized by high rates of attrition. There is a need to better understand attrition rates in order to improve the completion rates and the success of Web-based treatment programs.
The objectives of our study were to (1) examine attrition prevalence and pretreatment predictors of attrition in a sample of open-access users of a Web-based program for problem drinkers, and (2) to further explore attrition data from our randomized controlled trial (RCT) of the Web-based program.
Attrition data from two groups of Dutch-speaking problem drinkers were collected: (1) open-access participants enrolled in the program in 2009 (n = 885), and (2) RCT participants (n = 156). Participants were classified as noncompleters if they did not complete all 12 treatment sessions (9 assignments and 3 assessments). In both samples we assessed prevalence of attrition and pretreatment predictors of treatment completion. Logistic regression analysis was used to explore predictors of treatment completion. In the RCT sample, we additionally measured reasons for noncompletion and participants' suggestions to enhance treatment adherence. The qualitative data were analyzed using thematic analysis.
The open-access and RCT group differed significantly in the percentage of treatment completers (273/780, 35.0% vs 65/144, 45%, χ(2) (1) = 5.4, P = .02). Logistic regression analysis revealed a significant contribution of treatment readiness, gender, education level, age, baseline alcohol consumption, and readiness to change to predict treatment completion. The key reasons for noncompletion were personal reasons, dissatisfaction with the intervention, and satisfaction with their own improvement. The main suggestions for boosting strategies involved email notification and more flexibility in the intervention.
The challenge of Web-based alcohol treatment programs no longer seems to be their effectiveness but keeping participants involved until the end of the treatment program. Further research should investigate whether the suggested strategies to improve adherence decrease attrition rates in Web-based interventions. If we can succeed in improving attrition rates, the success of Web-based alcohol interventions will also improve and, as a consequence, their public health impact will increase.
International Standard Randomized Controlled Trial Number (ISRCTN): 39104853; http://www.controlled-trials.com/ISRCTN39104853 (Archived by WebCite at http://www.webcitation.org/63IKDul1T).
基于网络的问题饮酒干预措施是有效的，但存在高流失率的特点。有必要更好地了解流失率，以提高基于网络的治疗项目的完成率和成功率。
我们研究的目的是：（1）在一个针对问题饮酒者的基于网络项目的开放获取用户样本中，检查流失率和流失的治疗前预测因素；（2）进一步探索我们基于网络项目的随机对照试验（RCT）中的流失数据。
收集了两组说荷兰语的问题饮酒者的流失数据：（1）2009年参加该项目的开放获取参与者（n = 885）；（2）RCT参与者（n = 156）。如果参与者没有完成全部12个治疗疗程（9次作业和3次评估），则被归类为未完成者。在两个样本中，我们评估了流失率和治疗完成的治疗前预测因素。使用逻辑回归分析来探索治疗完成的预测因素。在RCT样本中，我们还测量了未完成的原因以及参与者对提高治疗依从性的建议。使用主题分析对定性数据进行分析。
开放获取组和RCT组在治疗完成者的百分比上有显著差异（273/780，35.0%对65/144，45%，χ(2)(1)=5.4，P = .02）。逻辑回归分析显示，治疗准备度、性别、教育水平、年龄、基线酒精消费量和改变意愿对预测治疗完成有显著贡献。未完成的主要原因是个人原因、对干预不满意以及对自身改善的满意度。提高策略的主要建议包括电子邮件通知和干预措施更具灵活性。
基于网络的酒精治疗项目的挑战似乎不再是其有效性，而是让参与者坚持到治疗项目结束。进一步的研究应该调查所建议的提高依从性的策略是否能降低基于网络干预中的流失率。如果我们能够成功提高流失率，基于网络的酒精干预的成功率也将提高，其对公共卫生的影响也将随之增加。
国际标准随机对照试验编号（ISRCTN）：39104853；http://www.controlled-trials.com/ISRCTN39104853（由WebCite存档于http://www.webcitation.org/63IKDul1T）。
