JMIR Publications

ABSTRACT

Background:

The low level of adherence in self-guided Internet-based interventions for depression suggests that in many existing programs, the motivational fit between the program and the user is insufficient (e.g., the user seeks for autonomy, but the program provides directive guidance). Personalized, motive-oriented self-help interventions could enable participants who interact with a program and its contents to have more engaging and less aversive experiences and thus increase adherence.

Objective:

In an experimental study with a non-clinical analog sample, we aimed to test the hypotheses that a better motivational person-program fit is linked with higher anticipated adherence, working alliance and satisfaction with the program.

Methods:

This was examined regarding the two opposing motives 'being autonomous' and 'need for support'. The hypotheses were tested by specifically varying the motivational person-program fit in a non-clinical sample (N=55), where participants were asked to work on and subsequently evaluate a limited set of individual pages of a self-help program for depression. Sections of the self-help program have been redesigned to either emphasize the autonomy motive (AutCond) or the need for support motive (SuppCond). For the quasi-experimental variation of the motivational person characteristics, two extreme groups (n=27, n=28) were formed by screening (using the Questionnaire for the Analysis of Motivation Schemas) corresponding the two motives. Both extreme groups went (in randomized order) through two excerpts of the program: one that matched their motive (fit) and one that was contrary to it (no fit). Immediately after each excerpt, anticipated adherence, working alliance and treatment satisfaction were assessed.

Results:

Regarding the motive ‘need for support’, a satisfaction or violation of this motive had an impact on (optimal) anticipated adherence as well as working alliance and satisfaction with the intervention – a congruent person-program fit resulted in significantly higher anticipated adherence (t(27)=3.00, P=.006), working alliance (t(27)=3.20, P=.003) and satisfaction (t(27)=2.86, P=.008) compared to a non-congruent fit. This could however not be found for the motive ‘being autonomous’. Several correlations were found that support our hypothesis (e.g., for the congruent person-program fit AutCond/AutGrp, support satisfaction negatively correlated with optimal anticipated adherence).

Conclusions:

This first experimental study gives reason to assume that motive orientation may have a positive influence on adherence, working alliance, and satisfaction in Internet-based interventions for depression and other mental disorders. Future studies should conduct randomized controlled trials with clinical samples and assessing clinical outcomes.