JMIR Publications

ABSTRACT

Background:

Psychosocial self-guided online programs are effective for depression and anxiety. However, community uptake of these programs is poor. Recent approaches to increasing engagement (defined as both uptake and adherence) in online programs include brief engagement-facilitation interventions (EFI). However, these programs require evaluation to assess their efficacy.

Objective:

The study aims were to 1) examine the effectiveness of a brief online EFI presented prior to an online cognitive behavioral therapy (iCBT) self-help program (myCompass 2) in improving engagement (uptake and adherence) to that program, and 2) assess if greater engagement was associated with improved efficacy (greater reduction in depression/anxiety symptoms) relative to control.

Methods:

A three-arm randomized controlled trial ([N=849] recruited via social media) assessed the independent efficacy of the EFI and myCompass 2. The myCompass 2 program was delivered with (1) or without (2) the EFI; both conditions were compared with an attention control condition (3).

Results:

Uptake was high in all groups; 82.8% of participants clicked through to the intervention following the pre-test survey. However, the difference in uptake between the EFI + myCompass 2 condition (83.6%) and the myCompass 2 alone condition (77.9%) was not significant, χ2(1, N=565)=29.2, P=.09. There was also no significant difference in the proportion of participants who started any number of modules (1-14 modules) vs those who started none, between the EFI + myCompass 2 (37.9%) and the myCompass 2 alone (37.2%) conditions, χ2(1, N=565)=0.03, P=.87. Finally, there was no significant difference between the EFI + myCompass 2 and the myCompass 2 alone conditions in the number of modules started (U=39366.50, z=-.32, P=.75) or completed (U=39494.0, z=-.29, P=.77). The mycompass 2 program was also not found to be efficacious over time for symptoms of depression, F(4, 349.97)=1.16, P=.33, or anxiety, F(4, 445.99)=0.12, P=.98). However, planned contrasts suggested myCompass 2 may have been effective for those with elevated GAD symptoms (F=3.50, P=.01).

Conclusions:

This brief online EFI did not increase uptake or adherence to an existing online program for depression and anxiety. Individual motivation to initiate and complete online self-guided interventions is complex and remains a significant challenge for self-guided interventions. Clinical Trial: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001565235