JMIR Publications

ABSTRACT

Background:

Online interventions are effective for a number of psychological problems. However, recruitment, adherence, and missing data are challenges when evaluating these interventions.

Objective:

The aim of this study is to describe the usage patterns during the commencement phase, possible retention patterns, and response to prompts and reminders among participants in two randomized controlled trials (RCTs) evaluating online interventions.

Methods:

Data on usage patterns logged in two RCTs aiming to reduce symptoms of anxiety and depression among adults recently diagnosed with cancer (AdultCan), and patients with a recent myocardial infarction (Heart) respectively, were analyzed. The online intervention in AdultCan consisted of unguided self-help and psychoeducation and the online intervention in Heart consisted of therapist-supported cognitive behavior therapy. 2360 participants’ usage patterns at first login including baseline data collection (commencement) and two follow-up data collections (follow ups) were analyzed to describe commencement activities, retention (continuation of data provision), and responses to prompts and reminders.

Results:

At commencement, 71% and 87% of consenting participants in AdultCan and Heart respectively, logged in and completed baseline data collection within one week from receiving a welcome e-mail including instructions and login credentials. The median duration of the first login, from first to last click, was 44 and 38 minutes in AdultCan and Heart respectively. Slightly more than 50% of the participants’ first logins were done on a weekday during standard office hours. More than 80% of the participants in both trials explored the intervention within two weeks after being randomized to the treatment group at a median duration time of 7 and 47 minutes in AdultCan and Heart respectively. There was a significant association between intervention exploration time during the first two weeks and retention in Heart but not in AdultCan. However, the control group was most likely to retain and provide complete follow-up data. Across the three time points of data collection explored in this study, the proportion of participants responding to all questionnaires within one week from the prompt, without a reminder varied between 36 and 66%. After two reminders, up to 97% of the participants responded.

Conclusions:

Most participants in both RCTs, completed the baseline questionnaires within one week from receiving a welcome e-mail. Around half of the participants answered questions in the baseline data collection outside office hours suggesting that the time flexibility inherent in online interventions is contributing to commencement and use. Even though the control group was better at providing complete follow-up data in the Heart-study, this may not be explained by online exhaustion in the treatment group as active participants provided more complete data than passive participants. About half of the participants completed the questionnaires without a reminder, but thereafter two reminders contributed to both baseline and follow-up retention supporting the effectiveness of reminders.