JMIR Publications

ABSTRACT

Background:

Dropout from internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare limits the intervention’s impact and generalizability of findings. Accordingly, baseline-differences may be putting patients at risk for dropping out, making the comparison between online with face-to-face (F2F) and care as usual (CAU) necessary to examine.

Objective:

Thus, the study investigated adherence to online, F2F, and CAU interventions, study dropout among these groups, and the subjective evaluation of therapeutic relationship. Socio-demographic, social-cognitive, and health-related variables were considered.

Methods:

In a randomized controlled trial, N=6,023 patients were recruited and n=300 completed the baseline measures (T1); n=144 completed T2 (Retention 44-52%) and n=95 completed T3 (Retention 23-36%). If patients had F2F-therapy available they were randomly assigned to online aftercare (n=79), or F2F (n=88). Study participants without F2F-therapy were randomly assigned to online aftercare (n=70), or CAU (n=63). Socio-demographic variables (age, gender, marital status, educational level, etc.), social-cognitive determinants (eg, self-efficacy, social support) and health-related variables (depressiveness etc.) and expectation in patients assigned to online or F2F were measured at T1.

Results:

There were no significant differences between the groups with regard to dropout rates over time (χ2=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F condition with 3-6% and the CAU condition with 14-32% (P≤.01). Within study arms gender differences were significant only in the CAU group at T2, with women being more likely to dropout (84% vs. 59% remaining in the study). At T3, age (dropouts were 8 years older) and marital status (80% of those who remained in the study were married whereas only 35% of the dropouts were married) were not significant in the online or F2F group (P>.06). Patients in the online therapy were significantly more satisfied with their treatment than patients in the F2F group (P=.022; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02-.03). Combining all study arms, patients who reported lower depressiveness scores at T1 (OR=0.55-.56) were more likely to be retained, and patients who had higher self-efficacy (OR=0.52-0.57) were more likely to drop out. Additionally, at T3 the lower social support patients reported was related to a higher likelihood of remaining in the study (OR=0.68-0.79). Positive expectation was significantly related to questionnaire completion at T2 and T3 after controlling to other variables (OR=1.59-1.64, P=.02-.05).

Conclusions:

While online interventions have many advantages to F2F variants such as saving time and effort to commute to the therapy, they also creating difficulties for therapists and hindering their ability to adequately react to patients’ challenges. Accordingly, patient characteristics which might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Clinical Trial: Trial Registration: The trial was planned to be registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) and the study protocol was published at https://www.researchgate.net/project/webbased-psychosomatic-aftercare/update/6087bb4deb77a3000177517f