JMIR Publications

ABSTRACT

Background:

Parents of children treated for cancer are at heightened risk of experiencing symptoms of depression, anxiety, and post-traumatic stress syndrome. Digital interventions, such as internet-based cognitive behavioral therapy (iCBT), offer a flexible and accessible means to support parents. However, engagement with and adherence to digital interventions remains a significant challenge, potentially limiting effectiveness. Understanding factors that influence user engagement and adherence is crucial for enhancing the acceptability, feasibility, and efficacy of these interventions. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy (LICBT) based self-help intervention (EJDeR) for parents of children with cancer, which included two LICBT techniques: behavioral activation and worry management. We subsequently examined acceptability and feasibility in the ENGAGE feasibility trial. EJDeR was found to be acceptable and feasible. However, intervention adherence rates were marginally under progression criteria, suggesting a need for modifications.

Objective:

This study aimed to (1) describe user engagement with the EJDeR intervention, (2) examine whether sociodemographic and baseline clinical characteristics differed between adherers and non-adherers, (3) examine whether user engagement differed between adherers and non-adherers, and (4) examine whether user engagement differed between fathers and mothers.

Methods:

We performed a secondary analysis of data from the ENGAGE feasibility trial, including 71 participants. User engagement data was collected through log-data tracking on the Portal, e.g., communication with e-therapists, homework submissions, log-ins, minutes working with EJDeR, and modules completed. Chi-square tests examined differences between adherers and non-adherers and fathers and mothers concerning categorical data. Independent-sample t-tests examined differences regarding continuous variables (P<.05).

Results:

Module completion rates were higher among those who worked with behavioral activation as their first LICBT module versus worry management. Of those non-adherers who opened the first LICBT module they were allocated, 70% (14/20) opened worry management as their first LICBT module and 30% (6/20) opened behavioral activation. No significant differences in sociodemographic or baseline clinical characteristics were found. The number of minutes working with EJDeR, number of log-ins, number of days using EJDeR, number of written messages sent to e-therapists, number of written messages sent to participants, and total number of homework exercises submitted were significantly higher among adherers than non-adherers. Fathers were more likely to choose video-conferencing during the mid-intervention booster session, while mothers more frequently opened the relapse prevention module.

Conclusions:

Findings suggest straightforward intervention techniques, such as behavioral activation, may be well suited for digital delivery and more complex techniques, such as worry management, may require modifications to improve user engagement. User engagement was measured behaviorally, e.g., via log-data, and future research should measure the emotional and cognitive components of engagement components. Clinical Trial: ISRCTN 57233429