Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 19, 2020
Open Peer Review Period: Jun 19, 2020 - Jul 15, 2020
Date Accepted: Dec 21, 2020
(closed for review but you can still tweet)
Factors associating with dropout of participants in an app-based child injury prevention study: A secondary-data analysis of a cluster randomized controlled trial
ABSTRACT
Background:
Mobile health interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mobile health interventions.
Objective:
We explored factors associated with attrition of study participants in a mobile health randomized clinical trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China.
Methods:
The cluster RCT compared two versions of an app intervention for caregivers of 3-6 year old children (Bao Hu San). One version provided parenting education on unintentional child injury prevention and the other on child nutrition. The trial included 2920 study participants in Changsha, China and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, plus between attrition and intervention engagement, were tested and quantified separately for the injury and nutrition education groups using adjusted odds ratio (aOR) based on generalized linear mixed models.
Results:
In total, 2920 caregivers from 20 eligible preschools participated, 1510 in the injury education group and 1410 in the nutrition education group. The six-month attrition rate differed significantly between the two groups (p<0.001), 28.9% (437/1510) in the injury education group and 35.7% (503/1410) in the nutrition education group. For the injury education group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR=2.69, 95% CI 1.19-6.09). For the nutrition education group, significant predictors of attrition risks were lower monthly login frequency (aOR=1.48, 95% CI 1.00-2.18); learning fewer knowledge segments (aOR=1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR=2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition.
Conclusions:
Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Clinical Trial: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84)
Citation
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Copyright
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