Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 20, 2020
Date Accepted: May 24, 2021
Do facilitator contact, discussion boards, or virtual badges increase adherence to an online self-guided positive psychological intervention for depression?: A randomized controlled trial
ABSTRACT
Background:
Adherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another.
Objective:
The objective of our study was to test whether three enhancements –facilitator contact (FC), an online discussion board (ODB), and virtual badges (VB) – alone, or in combination, improved adherence to a self-guided online intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects of each enhancement on adherence.
Methods:
Participants were recruited through online sources and, after completing at least 4 of 7 daily emotion reports, were sequentially assigned to one of 9 conditions: the intervention alone, the intervention plus one, two, or all three enhancements, or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotion and that were delivered over 5 weeks in a self-guided online format. We operationalized adherence as the number of skills (of 8) accessed.
Results:
A total of 602 participants were enrolled. Participants accessed, on average, 5.61 of 8 skills. The total number of enhancements participants received (0 to 3) did not predict the number of skills accessed. Participants who were assigned to the VB + FC condition accessed significantly more skills compared to the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements together (VB + FC, VB + FC + ODB) accessed a greater number of skills relative to participants who received either VB or FC without the other. Moderation analyses revealed that receipt of VB (vs. no VB) predicted higher adherence among participants with moderately severe depression at baseline.
Conclusions:
Results suggested that the VB plus FC combination significantly increased the number of skills accessed in a self-guided online intervention for elevated depression. We conclude with suggestions for refinements to these enhancements that may further improve adherence. Clinical Trial: NCT02861755
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