Donkin Liesje, Glozier Nick
Brain and Mind Institute, The University of Sydney, Camperdown, Australia.
J Med Internet Res. 2012 Jun 22;14(3):e91. doi: 10.2196/jmir.2100.
Many users of Internet interventions do not persist with the full treatment program. As persistence may influence outcomes of such interventions, being able to maximize persistence is vital. However, while studies have begun to explore the predictors of dropout in Internet interventions, few have explored reasons why users persist with the programs, which may not just be the converse of the reasons for dropout.
To answer the question of what influences persistence with online interventions.
We interviewed participants in the Cardiovascular Risk E-couch Depression Outcome (CREDO), a trial evaluating the efficacy of an eHealth intervention (e-couch) in treating depressive symptoms in those with comorbid depression and cardiovascular risk factors. Interviews were semistructured in nature and were analyzed using a grounded theory approach. Interview numbers were curtailed (n = 12) after theoretical saturation.
All participants reported substantial barriers to completing the program including time constraints, competing priorities, anxiety about spending time on the computer, and perception of limited worth of the intervention. Participants who persisted with the trial reported intrinsic motivations such as personal values about task completion and sense of control, and recognized external motivators that aided the development of habits and identified personal benefits attributable to the program.
Online interventions may benefit from content that enhances the intrinsic motivations such as a having sense of control and being able to identify with the program, and by increasing the relative value of the program in order to enhance persistence. Persistence within a trial setting appears modifiable through explicit messages regarding supporting others. In terms of motivators, the use of a hook to engage participants who are starting the intervention due to curiosity and the use of reminder systems to prompt participants may also improve persistence. The worth of such additions should be evaluated using adherence and outcomes metrics.
Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077; http://www.anzctr.org.au/ACTRN12610000085077.aspx (Archived by WebCite at http://www.webcitation.org/68MtyPO3w).
许多互联网干预措施的使用者不会坚持完成整个治疗方案。由于坚持与否可能会影响此类干预措施的效果，因此能够最大限度地提高坚持率至关重要。然而，虽然已有研究开始探索互联网干预措施中退出的预测因素，但很少有研究探讨使用者坚持参与方案的原因，而这些原因可能并非仅仅是退出原因的反面。
回答是什么影响了对在线干预措施的坚持。
我们对心血管风险电子治疗抑郁症结果（CREDO）试验的参与者进行了访谈，该试验旨在评估一种电子健康干预措施（电子治疗）对患有抑郁症和心血管危险因素的患者治疗抑郁症状的疗效。访谈本质上是半结构化的，并采用扎根理论方法进行分析。在理论饱和后，访谈数量缩减至12例（n = 12）。
所有参与者均报告了完成该方案存在的重大障碍，包括时间限制、相互竞争的优先事项、对在电脑上花费时间的焦虑以及对干预措施价值有限的认知。坚持参与试验的参与者报告了内在动机，如关于任务完成的个人价值观和控制感，以及认识到有助于习惯养成的外部动机，并确定了该方案带来的个人益处。
在线干预措施可能会受益于能够增强内在动机的内容，比如拥有控制感并能够认同该方案，以及通过提高方案的相对价值来增强坚持率。在试验环境中，通过关于支持他人的明确信息，坚持率似乎是可以改变的。就动机而言，使用吸引因好奇心而开始干预的参与者的钩子以及使用提醒系统来促使参与者，也可能会提高坚持率。此类附加措施的价值应使用依从性和结果指标进行评估。
澳大利亚新西兰临床试验注册中心（ANZCTR）：ACTRN12610000085077；http://www.anzctr.org.au/ACTRN12610000085077.aspx（由WebCite存档于http://www.webcitation.org/68MtyPO3w）
