Web-based education support for people with health problems is now widespread, but there is comparatively little research that explores the reasons why people do not complete online courses once they are enrolled.
This paper presents data from a randomised controlled trial based in Australia, where 370 participants were randomly allocated to:
- An online bipolar education programme consisting of 8 modules
- The same online bipolar education programme with email support from informed supporters
- A control intervention (basic online information about bipolar disorder)
The main predictors of attrition (drop-out from the study) were:
- Male gender
- Young age
- Method of recruitment (one recruitment site had more recently diagnosed participants than the others and this site saw more drop-outs)
Patient reported reasons for non-adherence included:
- Being in an acute phase of illness (depression or mania)
- Not wanting to think about their illness
- Feeling that the online programme was too simplistic
- Feeling well
- Time pressures and competing demands
The discussion section of the study includes some interesting observations:
- Patients who are supported by an expert patient “informed supported” are significantly more likely to adhere to the program compared with those who worked through the intervention modules and workbooks alone
- The overall attrition rate of 26.5% is slightly lower than the average from other similar studies (31%) but considerably lower than the 47% drop-out rate found in studies of face-to-face psychotherapy programmes
- The finding that young age and male gender predicted non-adherence supports that of previous e-mental health findings but is in contrast to research involving face-to-face treatments, which have reported that such demographic variables do not predict patient adherence across health conditions
- No association was found between education level and attrition, although other studies of face-to-face therapies have shown that clients who were from minority ethnic backgrounds, lower income groups, or were less educated were more likely to terminate therapy prematurely
The research team concludes:
The dropout rate was equivalent to other Internet interventions and to face-to-face therapy. Findings from our qualitative study provide participant-reported reasons for discontinuing the online intervention, which, in conjunction with the quantitative investigations about predictors, add to understanding about Internet interventions. However, further research is needed to determine whether there are systematic differences between those who complete and those who do not complete eHealth interventions. Ultimately, this may lead to the identification of population subgroups that most benefit from eHealth interventions and to informing the development of strategies to improve adherence.
Nicholas J, Proudfoot J, Parker G, Gillis I, Burckhardt R, Manicavasagar V, Smith M. The ins and outs of an online bipolar education program: a study of program attrition. J Med Internet Res. 2010 Dec 19;12(5):e57.