Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 3, 2022
Date Accepted: Nov 28, 2022
Dropout rate in digital health interventions for the prevention of skin cancer: A Systematic Review, Meta-analysis and Meta-regression
ABSTRACT
Background:
Digital strategies are innovative approaches to the prevention of skin cancer, but the attrition of this kind of interventions needs to be analyzed.
Objective:
To assess the dropouts of the studies focused on digital strategies for the prevention of skin cancer.
Methods:
To conduct this systematic review with meta-analysis and meta-regression, we followed the PRISMA statements. Search terms for skin cancer, digital strategies and prevention were combined in PubMed, Scopus, Web of Science, CINAHL, and Cochrane Library from inception until July 2022. Randomized clinical trials that reported dropouts of participants and used digital strategies compared to other interventions to prevent skin cancer in healthy or free participants from disease were included. Two independent reviewers extracted data for analysis. The Revised Cochrane Collaboration Bias tool was employed. We calculated the pooled dropout rate of participants through a proportion meta-analysis and examined whether the dropout event was more or less frequent with an odds ratio (OR) meta-analysis. Data were pooled using random-effects model. A univariate meta-regression based on mixed-methods effects model assessed possible moderators of dropouts. Participants’ dropout rates as pooled proportions were calculated for all, digital and comparators groups. OR > 1 indicated higher dropouts for digital-based interventions. Meta-regressions were performed for age, sex, length of intervention, and sample size.
Results:
17 studies were included. The overall pooled dropout rate was 9·5% (95% CI, 5·0%–17·5%). Digital strategies reached an 11·6% (95% CI, 6·8%–19·0%) loss and comparators a 10·0% (95% CI, 5·5%–17·7%) in subgroup proportion meta-analysis. A trend of higher dropout rates for digital strategies was observed in the overall (OR 1·16, 95% CI, 0·98–1·36) and subgroup OR meta-analysis, but no significant differences were reached between the groups. None covariates moderated the effect size in the univariate meta-regression.
Conclusions:
The overall pooled dropout rate should be considered in the sample size calculation in future studies. Digital strategies did not show differences for the appearance of dropouts compared to other prevention interventions. Standardization is needed to report the number and reasons for dropouts. Clinical Trial: CRD42022329669
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