title: Design and evaluation of a peer network to support adherence to a web-based intervention for adolescents.
abstract: BACKGROUND
  Depression during adolescence is common but can be prevented. Behavioral intervention technologies (BITs) designed to prevent depression in adolescence, especially standalone web-based interventions, have shown mixed outcomes, likely due to poor intervention adherence. BIT research involving adults has shown that the presence of coaches or peers promotes intervention use. Developmentally, adolescence is a time when peer-based social relationships take precedence. This study examines whether peer-networked support may promote adherence to BITs in this age group.
  
  
  OBJECTIVE
  Adopting the framework of the Supportive Accountability model, which defines the types of human support and interactions required to maintain engagement and persistence with BITs, this paper presents a feasibility study of a peer-networked online intervention for depression prevention among adolescents. We described the development of the peer network, the evaluation of participant use of the peer networking features, and qualitative user feedback to inform continued BIT development.
  
  
  METHODS
  Two groups of adolescents (N = 13) participated in 10-week programs of the peer networked based online intervention. Adolescents had access to didactic lessons, CBT based mood management tools, and peer networking features. The peer networking features are integrated into the site by making use expectations explicit, allow network members to monitor the activities of others, and to supportively hold each other accountable for meeting use expectations. The study collected qualitative feedback from participants as well as usage of site features and tools.
  
  
  RESULTS
  Participants logged in an average of 12.8 sessions over an average of 10.4 unique days during the 10-week program. On average, 66% of all use sessions occurred within the first 3 weeks of use. The number of "exchange comments", that is, comments posted that were part of an exchange between two or more participants, was significantly positively correlated with mean time spent on site (r= 0.62,p= 0.032), use of the Activity Tracker (r= 0.70,p= 0.012) and Didactic Lesson (r= 0.73,p= 0.007). Qualitative interviews revealed that adolescents generally liked and were motivated by the peer networking features during the first weeks of the intervention when general site use by group members was high. However, the decrease of site use by group members during the subsequent weeks negatively affected participants' desire to log on or engage with group members.
  
  
  CONCLUSIONS
  This pilot study highlights the potential that a BIT designed to harness the connection among a peer network, thereby promoting supportive accountability, may improve adolescent adherence to BITs for depression prevention.
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Ho
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA.
authors.forename: Marya E
authors.initials: ME
authors.lastname: Corden
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Caccamo
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA.
authors.forename: Kathryn Noth
authors.initials: KN
authors.lastname: Tomasino
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, 1061 W. Taylor St., Chicago, IL 60612, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Duffecy
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Begale
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
keywords: Adherence; Adolescents; Depression; Peer network; Prevention; Usability