Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 27, 2024
Open Peer Review Period: Mar 26, 2024 - May 21, 2024
Date Accepted: Feb 3, 2026
(closed for review but you can still tweet)
Does format matter? Comparison of adherence to a guided self-management program for mild to moderate depression between a browser-based version and a smartphone app: Log data analysis of a convenience sample
ABSTRACT
Background:
Internet-based cognitive behavioral therapy (ICBT) for the treatment of depression have proven to be an efficient and accessible option. However, ICBTs tend to have low adherence rates with negative impact on effectiveness. One such ICBT program is the browser-based proven-effective iFightDepression tool (iFD tool). An app-based version of iFightDepression (iFD app) was developed to improve usability with a smartphone and thus enable better integration into everyday life. This could have an impact on adherence.
Objective:
The following questions were to be investigated in this study: (1) Does adherence parameter, (a) number of worksheets filled in, b) number of sessions, c) number of workshops completed, significantly differ between users of iFD app and the iFD tool? (2) Exploratory, we investigated whether the symptom reduction (delta PHQ-9) between iFD app and iFD tool differs after 5-9 weeks, controlling for covariates (e.g., age, gender, baseline PHQ-9).
Methods:
Data of 56 participants from the pilot study of the iFD app were analysed who used the iFD app for 8 weeks. T-Tests were conducted to compare the usage parameters of the iFD app with those of the 172 participants in the intervention group of a previous RCT using the browser version for 6 weeks. Exploratively, we compared the symptom reduction between iFD app and iFD tool. A multiple regression model was calculated with PHQ-9 delta as the dependent variable and format, baseline PHQ-9, adherence, current psychotherapy, antidepressants, age, gender as independent variables.
Results:
There was no significant difference between the iFD tool and the iFD app in terms of number of sessions per week (t = 0.920, P = .361, P corrected = .361), number of workshops (t = -1.217, P = .297, P corrected = .361) and number of worksheets per week (t = 0.984, P = .328, P corrected = .361). We found no difference in delta PHQ-9 between the iFD app and the iFD tool and baseline PHQ-9 was the only significant predictor (P < .001, b = -0.53).
Conclusions:
Despite the improved availability in the daily life provided by the app version, there were no significant differences in the usage parameters we analysed and no differences in respect of symptom reduction. The current analyses provides first evidence, that delivery of iCBT content can be equally successful using browser and app based interventions. However, this is a convenience sample and therefore the results must be interpreted with caution. It is also notable that in the study of the iFD tool, guidance was provided by the study assistants in a standardised manner. In the pilot study on the iFD app, the amount of guidance varied strongly, as it was provided by the participants' practitioners. This could also have an influence on adherence.
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