JMIR Publications

ABSTRACT

Background:

Treatment dropout continues to be reported from iCBT interventions and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a pre-defined number of modules is not always necessary for clinical benefit nor considerate of the needs of each individual patient.

Objective:

The study aimed to carry out a qualitative analysis of patients’ experiences of an iCBT intervention in a routine care setting in order to achieve a deeper insight into the phenomenon of dropout.

Methods:

Fifteen purposively sampled participants (8 female) from a larger parent RCT were interviewed via telephone using a semi-structured interview schedule that was developed from the existing literature and research on dropout in iCBT. Data was analysed using the descriptive-interpretive approach.

Results:

The experience of treatment leading to dropout can be understood in terms of ten domains: Relationship to Technology, Motivation to Start, Background Knowledge and Attitudes towards iCBT, Perceived Change in Motivation, Usage of the Programme, Changes due to the Intervention, Engagement with Content, Experience Interacting with the Supporter, Experience of Online Communication and Termination of the Supported Period.

Conclusions:

Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These two groups of participants have different treatment experiences, revealing potential attributes and non-attributes of dropout. The reported between group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded with less importance those that have become loosely affiliated.