Standardized reporting of patient adherence and engagement among digital health interventions for depression offers more effective comparisons between digital health tools and populations.
Reporting of patient adherence and engagement to digital health interventions would be more effective using a standardized method, a study finds.
Standardizing reporting methods would allow for more accurate comparisons between different digital health interventions, as well as across various populations.
“As the number of such studies continues to increase, it is important for clinical trials of digital interventions to align with a common set of core adherence and engagement metrics,” wrote the researchers of the study. “This alignment will encourage the consistent reporting of user engagement to make comparisons of digital interventions across studies more meaningful.”
The full systematic literature review study is published in JMIR Publications.
In the study, the researchers aimed to understand how patient adherence and engagement was reported in clinical trials, what levels were reported, and whether higher adherence and engagement was associated with increased efficiency.
The study included patients ages 18 years and older with depression or major depressive disorder and included clinical studies, feasibility studies, and pilot digital interventions for treating depression.
A database search was conducted for articles published between January 1, 2000 to April 15, 2022, in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Embase, and the Cochrane Library.
The database search resulted in 1181 records and an additional 590 records that were manually searched. A total of 756 studies were screened, in which 94 studies met the inclusion criteria.
The researchers extracted data from all eligible studies, including:
These studies included results from 20,111 participants in studies using 47 different web-based interventions, 15 mobile app interventions, 5 app-based interventions, and 1 CD-ROM.
Adherence to these interventions were commonly measured as the percentage of participants who completed all available modules. Although less than half (44.2%) of participants completed all the modules, the average dose received was 60.7% of all available modules.
Despite some differences in measurements of engagement, it was most commonly measured as the number of modules completed, with a mean of 6.4 (range, 1.0-19.7) modules. The mean amount of time participants engaged with interventions was 3.9 hours.
Additionally, 76% of studies that were web-based and 89% of studies that were app-based had substantially greater improvement in at least 1 outcome in the intervention group compared with the control group. Furthermore, of the 14 studies that measured the relationship between efficacy and engagement, 64% found that increased engagement with digital interventions significantly improved patient outcomes.
The researchers acknowledged some limitations to the study. The main limitation was publication bias, in which studies with statistically significant results and larger effect sizes are more likely to be published than a study with negative results or a smaller effect size. Other limitations include the potential for bias for studies of higher adherence and engagement levels, and the possible overestimation of the effects of engagement with digital interventions.
Despite these limitations, the researchers believe the study highlights the importance of standardized methods of reporting patient adherence and engagement to improve efficacy with digital interventions.
“For the research field, improvements could be made by using consistent metrics to report adherence (eg, dose received) and engagement (eg, hours spent using the intervention), through regular inclusion of control groups and patients of diverse backgrounds in studies, by always reporting race and ethnicity data in publications, by investigating the interplay of socioeconomic factors and the efficacy of digital interventions, and by measuring the dose-response relationship to make data-informed decisions about dose recommendations,” wrote the researchers.
Reference
Forbes A, Keleher MR, Venditto M, DiBiasi F. Assessing patient adherence to and engagement with digital interventions for depression in clinical trials: Systematic literature review. J Med Internet Res. 2023;25:e43727. doi:10.2196/43727
Public Hospitals More Likely to Extend Unprofitable Services After 340B Participation, Study Finds
May 10th 2024Public hospitals were significantly more likely to sustain access to unprofitable services following 340B Drug Pricing Program participation, while nonprofit hospitals were mostly unaffected, according to a recent study.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Research Shows Prior Authorization Denials Delay Critical Immunology Care
May 10th 2024Results featured at the Academy of Managed Care Pharmacy 2024 annual meeting revealed a pattern of prior authorization rejections that could delay necessary therapeutic treatments for various patient groups.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Patients With Advanced, Recurrent Melanoma May Experience Lasting AEs From ICM Therapy
May 9th 2024A cross-sectional, mixed-methods study found that adverse effects (AEs) can occur even after 1 year of treatment with immune checkpoint modulator (ICM) therapy in patients with melanoma.
Read More