title: Differential attrition in health behaviour change trials: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Attrition is a common problem in health behaviour change (HBC) trials. When the degree of attrition differs between treatment conditions, then this is called differential attrition and is regarded as a major threat to internal validity. The primary research question of this study was: how often and to what degree does differential attrition occur in HBC trials?
  
  
  METHODS
  A systematic review and meta-analysis of a random selection of HBC trials (k = 60). We meta-analysed the relative attrition rates using a random-effects model and examined the relationship between the relative attrition rates and the potential moderators: the amount of human contact in delivery and the intensity of the intervention/control condition, the type of control condition, and the follow-up intensity and duration.
  
  
  METHODS
  Relative attrition rates.
  
  
  RESULTS
  The average attrition rate was 18% (SD = .15; M = .15) in the intervention and 17% (SD = .13; M = .13) in the control conditions. The estimated average relative attrition rate was 1.10 (95% CI: 1.01-1.20, p = .02), suggesting an overall higher attrition rate of 10% in the intervention conditions. This relative attrition rate was not related to any of the potential moderators.
  
  
  CONCLUSIONS
  There is indication of a slightly higher amount of attrition on average in the intervention conditions of HBC trials.
authors.affiliation: a CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.
authors.forename: Rik
authors.initials: R
authors.lastname: Crutzen
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Viechtbauer
authors.forename: Mark
authors.initials: M
authors.lastname: Spigt
authors.forename: Daniel
authors.initials: D
authors.lastname: Kotz
mesh_terms: D015982:Bias; D015438:Health Behavior; D006801:Humans; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*
keywords: RCT; bias; differential attrition; health behaviour change; internal validity