Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 23, 2024
Date Accepted: Jul 26, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Participant Attrition in Digital Dietary Interventions: Systematic Review and Meta-synthesis on Reasons and Solutions
ABSTRACT
Background:
Digital technology provides a promising avenue for dietary interventions, crucial in enhancing health outcomes and diminishing economic burdens. Nevertheless, high attrition rates in digital dietary interventions challenge their effectiveness.
Objective:
This study aims to conduct a meta-analysis of attrition rates in digital dietary interventions, systematically review the reasons for participant attrition, and identify potential solutions.
Methods:
We systematically searched PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus with Full Text, and Academic Search Complete using terms related to attrition in digital dietary interventions, focusing on studies published from 2013 to 2024. A random effects model was employed for the meta-analysis to determine attrition rates, complemented by a qualitative synthesis of included studies to explore reasons for attrition and suggest potential solutions.
Results:
From 442 screened publications, 21 met the criteria for the final systematic review. Meta-analyses for control and intervention groups in randomized controlled trials, as well as for observational studies, indicated average attrition rates of 35% (95% CI 20–52), 38% (95% CI 19–59), and 40% (95% CI 21–62), respectively. Thematic synthesis, grounded in behavior theories, identified 14 interconnected themes related to driving forces and supporting resources. These themes led to the development of the force-resource model, highlighting the essential balance between these elements. Imbalance between these systems can cause participant attrition, significantly affecting the generalizability of intervention strategies in digital dietary interventions. Effective strategies should address specific causes of attrition and also include comprehensive approaches that tackle multiple aspects, such as enhancing social support, personalizing strategies, and applying dynamic intervention methods.
Conclusions:
High attrition rates are a significant challenge in digital dietary interventions. The force-resource model offers a novel framework for understanding attrition through the lens of behavior theories, and it is expected to guide design of future interventions aimed at mitigating this problem. Clinical Trial: PROSPERO CRD42024512902; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024512902
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