Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Informatics and Media, Uppsala University, Visby, Sweden.
J Med Internet Res. 2021 Mar 12;23(3):e24590. doi: 10.2196/24590.
Web-based interventions are effective for several psychological problems. However, recruitment, adherence, and missing data are challenges when evaluating these interventions.
This study aimed to describe the use patterns during the commencement phase, possible retention patterns (continuation of data provision), and responses to prompts and reminders among participants in 2 randomized controlled trials (RCTs) evaluating web-based interventions.
Data on use patterns logged in 2 RCTs aiming to reduce symptoms of anxiety and depression among adult patients recently diagnosed with cancer (AdultCan RCT) and patients with a recent myocardial infarction (Heart RCT) were analyzed. The web-based intervention in the AdultCan trial consisted of unguided self-help and psychoeducation and that in the Heart trial consisted of therapist-supported cognitive behavioral therapy. In total, 2360 participants' use patterns at first log-in, including data collection at baseline (ie, commencement) and at 2 follow-ups, were analyzed. Both the intervention and comparison groups were analyzed.
At commencement, 70.85% (909/1283) and 86.82% (935/1077) of the participants in AdultCan and Heart RCTs, respectively, logged in and completed baseline data collection after receiving a welcome email with log-in credentials. The median duration of the first log-in was 44 minutes and 38 minutes in AdultCan and Heart RCTs, respectively. Slightly less than half of the participants' first log-ins were completed outside standard office hours. More than 80% (92/114 and 103/111) of the participants in both trials explored the intervention within 2 weeks of being randomized to the treatment group, with a median duration of 7 minutes and 47 minutes in AdultCan and Heart RCTs, respectively. There was a significant association between intervention exploration time during the first 2 weeks and retention in the Heart trial but not in the AdultCan trial. However, the control group was most likely to retain and provide complete follow-up data. Across the 3 time points of data collection explored in this study, the proportion of participants responding to all questionnaires within 1 week from the prompt, without a reminder, varied between 35.45% (413/1165) and 66.3% (112/169). After 2 reminders, up to 97.6% (165/169) of the participants responded.
Most participants in both RCTs completed the baseline questionnaires within 1 week of receiving the welcome email. Approximately half of them answered questions at baseline data collection outside office hours, suggesting that the time flexibility inherent in web-based interventions contributes to commencement and use. In contrast to what was expected, the intervention groups generally had lower completion rates than the comparison groups. About half of the participants completed the questionnaires without a reminder, but thereafter, reminders contributed to both baseline and follow-up retention, suggesting they were effective. Strategies to increase commencement of and retention in eHealth interventions are important for the future development of effective interventions and relevant research.
基于网络的干预措施对于多种心理问题都具有疗效。然而，在评估这些干预措施时，招募、依从性和缺失数据都是挑战。
本研究旨在描述 2 项随机对照试验（RCT）中参与者在起始阶段的使用模式、可能的保留模式（数据提供的延续），以及对提示和提醒的反应，这些试验旨在评估基于网络的干预措施。
对旨在减少近期被诊断患有癌症的成年患者（AdultCan RCT）和近期心肌梗死患者（Heart RCT）的焦虑和抑郁症状的 2 项 RCT 中记录的使用模式数据进行分析。AdultCan 试验中的基于网络的干预措施包括非指导性自助和心理教育，Heart 试验中的干预措施则包括治疗师支持的认知行为疗法。总共分析了 2360 名参与者在首次登录时的使用模式，包括基线（即起始）和 2 次随访时的数据收集。对干预组和对照组均进行了分析。
在起始阶段，AdultCan 和 Heart RCT 分别有 70.85%（909/1283）和 86.82%（935/1077）的参与者登录并完成了欢迎电子邮件中的登录凭证后收集的基线数据。AdultCan 和 Heart RCT 中参与者首次登录的中位数持续时间分别为 44 分钟和 38 分钟。参与者首次登录的时间有近一半是在标准办公时间之外完成的。在这两项试验中，超过 80%（92/114 和 103/111）的参与者在被随机分配到治疗组后的 2 周内探索了干预措施，AdultCan 和 Heart RCT 中参与者探索干预措施的中位数持续时间分别为 7 分钟和 47 分钟。在 Heart 试验中，干预措施探索时间与保留之间存在显著关联，但在 AdultCan 试验中则没有。然而，控制组最有可能保留并提供完整的随访数据。在本研究中探索的 3 个数据收集时间点中，参与者在收到提示后无需提醒在 1 周内回复所有问卷的比例在 35.45%（413/1165）和 66.3%（112/169）之间变化。经过 2 次提醒后，最多可达 97.6%（165/169）的参与者做出了回复。
在这两项 RCT 中，大多数参与者在收到欢迎电子邮件后的 1 周内完成了基线问卷。他们中有近一半在非办公时间完成了基线数据收集，这表明基于网络的干预措施固有的时间灵活性有助于开始使用。与预期相反，干预组的完成率通常低于对照组。大约一半的参与者在没有提醒的情况下完成了问卷，但此后，提醒有助于基线和随访保留，表明提醒是有效的。增加电子健康干预措施的开始和保留率的策略对于未来开发有效的干预措施和相关研究非常重要。
