门诊诊所中对恐惧症基于网络的预处理的依从性。
Adherence to a web-based pre-treatment for phobias in outpatient clinics.
作者信息
Kok Robin N, Beekman Aartjan T F, Cuijpers Pim, van Straten Annemieke
机构信息
Department of Clinical, Developmental and Neuropsychology, EMGO Institute for Health and Care Research, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, The Netherlands.
Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
出版信息
Internet Interv. 2017 Jun 1;9:38-45. doi: 10.1016/j.invent.2017.05.004. eCollection 2017 Sep.
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.
背景
网络干预中的不依从是一个长期存在且多方面的问题，可能会限制这些干预措施的适用性和有效性。影响不依从的因素尚不清楚，尤其是在症状较为复杂的门诊样本中。
目的
本研究是对一项随机对照试验数据的二次分析，该试验探讨了为等待接受面对面心理治疗的恐惧症门诊患者提供基于网络的暴露疗法的成本效益。
方法
我们收集了基线人口统计学和临床信息，以及基于网络干预的依从性数据，并进行回归分析以预测对干预的不依从情况。
结果
干预的依从性较低，105名患者中只有13.3%完成了干预的所有五节课。完成练习的中位数（可能的8次练习中）为3次。在多预测因素模型中，焦虑基线评分较高（OR = 0.94，95%CI 0.90 - 0.99）是依从性低的危险因素。年龄较大（OR = 1.05，95%CI 1.00 - 1.09）是防止不依从的保护因素。坚持干预的参与者更有可能完成测试后评估，这进一步使结果产生偏差。然而，总体参与者流失率较高。结果基于一小部分参与者，应谨慎解释。
结论
在决定是否为门诊患者提供基于网络的干预时，基线临床状态不佳和年龄是需要考虑的因素。这些患者的低依从性可能与内在动机有关，在参与者期望接受面对面治疗的门诊环境中甚至可能更低。开发一种简明工具来评估使用基于网络干预的内在动机和治疗期望，以及让治疗师审查一系列可能的（基于网络的）干预选项以符合个人偏好和期望，可能是值得的。
试验注册
荷兰试验注册中心，NTR2233
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