title: Attrition and adherence in a WEB-Based Distress Management Program for Implantable Cardioverter defibrillator Patients (WEBCARE): randomized controlled trial.
abstract: BACKGROUND
  WEB-Based Distress Management Program for Implantable CARdioverter defibrillator Patients (WEBCARE) is a Web-based randomized controlled trial, designed to improve psychological well-being in patients with an implantable cardioverter defibrillator (ICD). As in other Web-based trials, we encountered problems with attrition and adherence.
  
  
  OBJECTIVE
  In the current study, we focus on the patient characteristics, reasons, and motivation of (1) completers, (2) those who quit the intervention, and (3) those who quit the intervention and the study in the treatment arm of WEBCARE.
  
  
  METHODS
  Consecutive first-time ICD patients from six Dutch referral hospitals were approached for participation. After signing consent and filling in baseline measures, patients were randomized to either the WEBCARE group or the Usual Care group.
  
  
  RESULTS
  The treatment arm of WEBCARE contained 146 patients. Of these 146, 34 (23.3%) completed the treatment, 88 (60.3%) dropped out of treatment but completed follow-up, and 24 (16.4%) dropped out of treatment and study. Results show no systematic differences in baseline demographic, clinical, or psychological characteristics between groups. A gradual increase in dropout was observed with 83.5% (122/146) completing the first lesson, while only 23.3% (34/146) eventually completed the whole treatment. Reasons most often given by patients for dropout were technical problems with the computer, time constraints, feeling fine, and not needing additional support.
  
  
  CONCLUSIONS
  Current findings underline the importance of focusing on adherence and dropout, as this remains a significant problem in behavioral Web-based trials. Examining possibilities to address barriers indicated by patients might enhance treatment engagement and improve patient outcomes.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT00895700; http://www.clinicaltrials.gov/ct2/show/NCT00895700 (Archived by WebCite at http://www.webcitation.org/6NCop6Htz).
authors.affiliation: Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.
authors.forename: Mirela
authors.initials: M
authors.lastname: Habibović
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Marco
authors.initials: M
authors.lastname: Alings
authors.forename: Pepijn
authors.initials: P
authors.lastname: van der Voort
authors.forename: Dominic
authors.initials: D
authors.lastname: Theuns
authors.forename: Leon
authors.initials: L
authors.lastname: Bouwels
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Herrman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Valk
authors.forename: Susanne
authors.initials: S
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017147:Defibrillators, Implantable / Q000523:psychology*; D003866:Depressive Disorder; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D010352:Patient Dropouts / Q000523:psychology; D010353:Patient Education as Topic; D010551:Personality; D017216:Telemedicine
keywords: Web-based interventions; adherence; attrition; dropout; implantable cardioverter defibrillator