title: A randomized controlled trial evaluating a manualized TeleCoaching protocol for improving adherence to a web-based intervention for the treatment of depression.
abstract: BACKGROUND
  Web-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes.
  
  
  METHODS
  101 patients with MDD, recruited from primary care, were randomized to 12 weeks moodManager+TeleCoach, 12 weeks of self-directed moodManager, or 6 weeks of a waitlist control (WLC). Depressive symptom severity was measured using the PHQ-9.
  
  
  RESULTS
  TeleCoach+moodManager, compared to self-directed moodManager, resulted in significantly greater numbers of login days (p = 0.01), greater time until last use (p = 0.007), greater use of lessons (p = 0.03), greater variety of interactive tools used (p = 0.02), but total instances of tool use did not reach statistical significance. (p = 0.07). TeleCoach+moodManager produced significantly lower PHQ-9 scores relative to WLC at week 6 (p = 0.04), but there were no other significant differences in PHQ-9 scores at weeks 6 or 12 (ps>0.20) across treatment arms. Baseline PHQ-9 scores were no significantly related to adherence to moodManager.
  
  
  CONCLUSIONS
  TeleCoach produced significantly greater adherence to moodManager, relative to self-directed moodManager. TeleCoached moodManager produced greater reductions in depressive symptoms relative to WLC, however, there were no statistically significant differences relative to self-directed moodManager. While greater use was associated with better outcomes, most users in both TeleCoach and self-directed moodManager had dropped out of treatment by week 12. Even with telephone coaching, adherence to web-based interventions for depression remains a challenge. Methods of improving coaching models are discussed.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00719979.
authors.affiliation: Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.forename: Jenna
authors.initials: J
authors.lastname: Duffecy
authors.forename: Joyce
authors.initials: J
authors.lastname: Ho
authors.forename: Mary
authors.initials: M
authors.lastname: Kwasny
authors.forename: Xuan
authors.initials: X
authors.lastname: Cai
authors.forename: Michelle Nicole
authors.initials: MN
authors.lastname: Burns
authors.forename: Mark
authors.initials: M
authors.lastname: Begale
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019212:Multimedia; D010349:Patient Compliance; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome