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Cited by 46Digital Mental Health InterventionsCancer survivorship and careTelemedicine and Telehealth Implementation

Uptake and adherence to an online intervention for cancer-related distress: older age is not a barrier to adherence but may be a barrier to uptake

Beatty, Lisa, Kemp, Emma, Binnion, Claire, Turner, Jane, Milne, Donna, Butow, Phyllis, Lambert, Sylvie, Yates, Patsy +2 more·2017·Supportive Care in Cancer
DOI 10.1007/s00520-017-3591-1
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Abstract

Purpose While online interventions are increasingly explored as an alternative to therapist-based interventions for cancer-related distress, limitations to efficacy potentially include low uptake and adherence. Few predictors of uptake or adherence to online interventions have been consistently identified, particularly in individuals with cancer. This study examined rates and predictors of uptake and adherence to Finding My Way, a RCT of an online intervention versus an information-only online control for cancer-related distress.Methods Participants were adults with cancer treated with curative intent. Adherence was assessed by login frequency, duration and activity level; analyses examined demographic, medical and psychological predictors of uptake and adherence.Results The study enrolled 191 adults (aged 26-94 years) undergoing active treatment for cancer of any type. Uptake was highest for females and for individuals with ovarian (80%) and breast cancer (49.8%), and lowest for those with melanoma (26.5%). Adherence was predicted by older age and control-group allocation. Baseline distress levels did not predict adherence. High adherers to the full intervention had better emotion regulation and quality of life than low adherers.Conclusions Uptake of online intervention varies according to age, gender and cancer type. While uptake was higher amongst younger individuals, once enrolled, older individuals were more likely to adhere to online interventions for cancer-related distress.

AI snapshot

Written from the paper’s full text.

TL;DR

In a secondary analysis of the Finding My Way RCT, 41.3% of 462 eligible cancer survivors enrolled, with uptake higher among younger, female, ovarian/breast cancer patients and lower among melanoma patients. Once enrolled, older age predicted higher adherence across multiple website-use measures, while baseline distress did not predict adherence.

Key findings

  • Uptake was 191/462 (41.3%); 177 (38.3%) explicitly declined. Decliners were significantly older than participants (M = 56.32, SD = 12.53 vs M = 53.86, SD = 10.30; p = .028, d = 0.21). Uptake was highest for ovarian (80%) and breast cancer (49.8%) and lowest for melanoma (26.5%); females were more likely to participate than males (p = .008).
  • Adherence: 117 (61.3%) were high adherers (4–6 modules) and 74 (38.7%) low adherers (≤3 modules); 78 (40%) completed all 6 modules and 20 (10.5%) completed none. Control participants completed more modules than intervention participants (52.6% vs 28.7% completed the full program; t(189) = −3.84, p < .001, d = 0.56).
  • Older age was the most consistent predictor of adherence across measures, including number of logins (β = .245, p < .01), total time logged in (β = .252, p < .01), and pages viewed (β = .229, p < .01); control-group allocation predicted number of modules completed (β = −.275, p < .01). Baseline distress did not predict adherence.
  • Within the intervention group, high adherers had better emotional functioning (p = .032, d = 0.45), better cognitive functioning (p = .046, d = 0.41), and less total difficulty in emotion regulation (p = .007, d = .57) than low adherers.

Methods

  • Secondary analysis of a randomised clinical trial comparing the 6-module/6-week CBT-based online intervention Finding My Way versus a web-based attention-control in adults with cancer treated with curative intent at seven Australian sites, recruited 30 September 2013 to 16 November 2015.
  • Uptake was measured as fully enrolled participants as a proportion of approached eligible individuals. Adherence was measured by frequency (days accessed, logins), duration (total time logged in), and activity (modules completed, pages viewed); high adherence was defined as completion of 4–6 modules (≥66% therapeutic dose).
  • Analyses used χ² tests and t-tests for participant-versus-decliner differences, simultaneous multiple regression for adherence predictors, and exploratory χ²/t-tests comparing low versus high adherers within control and intervention groups.

Limitations

  • Stated in the paper: underrepresentation of males limits generalisability to males and minimises the ability to assess gender differences in predictors of adherence; exploratory low/high adherer analyses were not adjusted for multiple comparisons.
  • Evident from the text: the sample was predominantly female (84%), Australian (92%), partnered (77%), tertiary educated (71%), urban (69%), employed (63%), and breast cancer (63.4%), limiting generalisability to broader cancer populations.
  • Evident from the text: adherence was derived from website-use indicators within a trial context, and the control condition had minimal demands and higher module completion, which may affect interpretation of adherence predictors.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00520-017-3591-1

Cites

46 of 46 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 47 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Results

    Uptake of the online intervention was highest for females.

    “Uptake was highest for females and for individuals with ovarian (80%) and breast cancer (49.8%), and lowest for those with melanoma (26.5%).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Results

    High adherers to the full intervention had better quality of life than low adherers.

    “High adherers to the full intervention had better emotion regulation and quality of life than low adherers.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Adherence

    High adherers had greater total number of logins (M=10.41, SD=4.70) than low adherers (M=3.81, SD=2.27), t(189)=-14.01, p<.001, d=2.14.

    “greater total number of logins (M = 10.41, SD = 4.70) than low adherers (M = 3.81, SD = 2.27), t (189) = -14.01, p < .001 d = 2.14”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Adherence

    High adherers on module completion had greater number of days logged in (M=8.18, SD=3.02) than low adherers (M=3.20, SD=1.87), t(189)=-14.38, p<.001, d=2.16.

    “they demonstrated greater number of days logged in (M = 8. 18, SD = 3.02) than low adherers (M = 3.20, SD = 1.87), t (189) = -14.38, p < .001, d = 2.16”
    Quote in the paperNot a substantial claim
  • Findingown data
    § [Insert Table 2 about here]

    Only age made a significant unique contribution to total number of pages viewed (R2=.094, F(4,186)=4.838, p<.01).

    “total number of pages viewed ( R 2 = .094, F (4, 186) = 4.838, p = <.01)”
    Quote in the paperSubstantial claim
  • May combine two claims. 39
  • Classified as probably not a substantial claim. 34
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data
    § Results

    The study enrolled 191 adult survivors of multiple cancers, aged 26-94 years.

    “The study enrolled 191 adult (aged 26 - 94 years) survivors of multiple cancers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    Adherence in the current study was not predicted by baseline distress, nor were the other psychological variables under investigation (coping, information seeking preferences).

    “adherence in the current study was not predicted by baseline distress, nor were the other psychological variables under investigation (coping, information seeking preferences).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Adherence

    117 (61.3%) individuals were categorised as high adherers (4+ modules), 74 (38.7%) as low adherers (3 or less).

    “117 (61.3%) individuals were categorised as 'high adherers' (accessed a therapeutic dose of 4 or more modules), whereas 74 (38.7%) were 'low adherers' (accessed 3 modules or less)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Adherence

    Intervention participants completed significantly less modules overall than control participants, t(189)=-3.84, p<.001, d=0.56; higher proportion of control participants completed the full program (52.6%) compared to intervention participants (28.7%).

    “intervention participants completed significantly less modules overall than control participants, t (189) = -3.84, p < .001, d = 0.56, with a higher proportion of control participants completing the full program (52.6%) compared to intervention participants (28.7%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    Prediction of adherence by control group membership was significant only for the 'number of modules completed' and not for total number of logins, number of pages viewed, number of days logged in or time logged in.

    “Prediction of adherence by control group membership was significant only for the 'number of modules completed' and not for total number of logins, number of pages viewed, number of days logged in or time logged in.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Findingown data
    § Exploratory analyses of group differences in baseline characteristics between low and high adherers in control and intervention groups.

    In the experimental group only, high adherers had better emotional functioning, t(92)=-2.183, p=.032, d=0.45, and better cognitive functioning, t(92)=-2.020, p=.046, d=0.41, than low adherers.

    “high adherers having better emotional functioning t (92) = -2.183, p = .032, d = 0.45, and cognitive functioning, t (92) = -2.020, p = .046, d = 0.41, than low adherers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Adherence

    Intervention and control participants did not significantly differ on number of days logged in, total number of logins, total time logged in, and total number of pages viewed.

    “intervention and control participants did not significantly differ on other measures of adherence, namely number of days logged in, total number of logins, total time logged in and total number of pages viewed”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Participant and decliner differences

    Decliners were mostly female (73.6%) and had a mean age of 56.32 years (SD=12.53, N=229).

    “Those who declined were also mostly female (73.6%,); mean age was 56.32 years (SD = 12.53, N = 229).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Adherence

    Usage ranged from completion of the full 6-module program (n=78; 40%) to no modules (n=20; 10.5%).

    “usage ranging from completion of the full 6-module program (n=78; 40%) to no modules (n=20; 10.5%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § [Insert Table 2 about here]

    In step 2, none of the variables including the interaction effect made a significant unique contribution; including the interaction did not explain any further variance (R2=.097, F(3,187)=6.71, p<.01).

    “in step 2 none of the variables including the interaction effect made a significant unique contribution; including the interaction in the model did not explain any further variance R 2 = .097, F (3, 187) = 6.71, p = <.01”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Participant and decliner differences

    Participants were mostly female (84%).

    “were female (84%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § [Insert Table 2 about here]

    For number of modules completed, group membership and age both made a significant unique contribution; overall model explained 9.7% of variance (R2=.097, F(2,188)=10.12, p<.01).

    “Group membership and age both made a significant unique contribution to module completion and the overall statistical regression model explained a small but significant 9.7% of variance ( R 2 = .097, F (2, 188) = 10.12, p = <.01)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Reasons for declining participation

    Reasons for declining participation among 177 decliners: 37 (20.9%) coping well, 30 (17.0%) not interested, 29 (16.4%) not enough time, 22 (12.4%) not comfortable using internet, 17 (9.6%) not a priority, 6 (3.4%) too unwell, 10 (5.7%) other; 26 (14.7%) returned opt-out slip with no reason.

    “Of the 177 individuals who explicitly declined to participate, 37 individuals (20.9%) declined due to coping well enough on their own, 30 (17.0%) were 'not interested' in the program, 29 (16.4%) felt they did not have enough time, 22 (12.4%) were not comfortable using the internet, 17 (9.6%) felt that program participation was not a priority, 6 (3.4%) felt too unwell to participate, and 10 (5.7%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    After controlling for group-allocation, older age was the most consistent predictor of adherence, with higher adherence predicted by age across all measures.

    “After controlling for group-allocation, this study found older age to be the most consistent predictor of adherence, with higher adherence predicted by age across all measures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Uptake

    13 (2.8%) initially consented but did not complete baseline questionnaires/enrolment.

    “13 (2.8%) initially consented but did not go on to complete baseline questionnaires/enrolment despite follow-up”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Exploratory analyses of group differences in baseline characteristics between low and high adherers in control and intervention groups.

    In the experimental group only, high adherers had lower total health service use, t(92)=2.33, p=.022, d=0.48, and accessed lower number of health professionals other than doctors, t(92)=2.33, p=.022, d=0.48, than low adherers.

    “In the experimental group only, low and high adherers differed significantly in health service use , with high adherers having lower total health service use, t (92) = 2.33, p = .022, d = 0.48, and accessing lower number of health professionals other than doctors, t (92) = 2.33, p = .022, d = 0.48, than low adherers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    Within the intervention group only, high adherers had less difficulty regulating emotions, and better emotional and cognitive functioning.

    “there were differences within the intervention group only, namely high adherers had less difficulty regulating emotions, and better emotional and cognitive functioning.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Participant and decliner differences

    Differences in uptake existed between cancer types, χ2(7,n=448)=19.25, p=.007, phi=.207; individuals with ovarian and breast cancer were more likely to participate compared to individuals with bowel cancer or melanoma.

    “Differences also existed between cancer types, χ 2 (7, n = 448) = 19.25, p = .007, phi = .207; individuals with ovarian and breast cancer were more likely to participate compared to individuals with bowel cancer or melanoma.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    60% of participants completed a therapeutic dose of four or more modules and 40% completed all 6 modules.

    “Overall adherence to FMW was acceptable, with 60% completing a therapeutic dose of four or more modules and 40% completing all 6 modules.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Participant and decliner differences

    Within cancer types, individuals diagnosed with breast cancer were more likely, and those with melanoma less likely, to participate; rates of uptake did not differ significantly within any other cancer type.

    “Within cancer types, individuals diagnosed with breast cancer were more likely, and those with melanoma less likely, to participate; rates of uptake did not differ significantly within any other cancer type.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Findingown data
    § Exploratory analyses of group differences in baseline characteristics between low and high adherers in control and intervention groups.

    In the experimental group only, high adherers had less difficulty regulating emotions than low adherers, including less difficulty with emotion awareness, t(92)=2.239, p=.028, d=.46, strategies, t(92)=2.507, p=.014, d=.51, and emotion clarity, t(92)=3.559, p=.001, d=.74, and less total difficulties in emotion regulation, t(92)=2.768, p=.007, d=.57.

    “high adherers had less difficulty regulating emotions than low adherers, including less difficulty with emotion awareness, t (92) = 2.239, p = .028, d = .46), strategies, t (92) = 2.507, p = .014, d = .51), and emotion clarity, t (92) = 3.559, p = .001, d = .74), and less total difficulties in emotion regulation, t (92) = 2.768, p = .007, d = .57).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Participant and decliner differences

    Mean age of participants was 53.86 years (SD=10.30).

    “mean age was 53.86 years (SD = 10.30)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Exploratory analyses of group differences in baseline characteristics between low and high adherers in control and intervention groups.

    For the control group only, higher adherence was associated with living in a regional or rural, rather than urban, area, χ2(1,n=97)=9.62, p=.002, phi=-.315.

    “For the control group only, higher adherence was associated with living in a regional or rural, rather than urban, area, χ 2 (1, n = 97) = 9.62, p = .002, phi = -.315.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    The difference between women and men was found only in uptake, and not adherence; no differences were found in the extent to which women and men engaged with the program once enrolled.

    “the difference between women and men was found only in uptake, and not adherence; that is, no differences were found in the extent to which women and men actually engaged with the program once enrolled.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Adherence

    After controlling for group allocation, number of modules completed was significantly positively correlated with number of days logged in (r=.765, p<.001), total number of logins (r=.771, p<.001), total time logged in (r=.803775, p<.001), and total pages viewed (r=.877, p<.001).

    “the number of modules completed was significantly positively correlated with the number of days logged in ( r = .765, p < .001), total number of logins (r = .771, p < .001), total time logged in ( r = .803775, p < .001), and total pages viewed ( r = .877, p < .001)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Uptake of the online intervention was highest for individuals with ovarian cancer (80%) and breast cancer (49.8%).

    “Uptake was highest for females and for individuals with ovarian (80%) and breast cancer (49.8%), and lowest for those with melanoma (26.5%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given
    § Discussion

    Survivors with poorer emotional functioning have more limited adherence to the online intervention.

    “younger survivors and those with poorer emotion regulation, emotional functioning, or cognitive functioning may need additional or alternative support to access psychological intervention given their more limited adherence to the online intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given
    § Implications for Cancer Survivors

    Mixed findings were obtained for the potential relationships between intervention adherence and age, baseline symptom severity and control group allocation.

    “Mixed findings were obtained for the potential relationships between intervention adherence and age, baseline symptom severity and control group allocation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Implications for Cancer Survivors

    Non-completion in research studies of online interventions typically ranges from 30-60%.

    “non-completion in research studies of online interventions typically ranges from 30-60% [20, 21] and is as low as 1% [21] and 0.5% [22] for interventions offered in open access format.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] Ghaderi A (2006) Attrition and outcome in self-help treatment for bulimia nervosa and binge eating disorder: a constructive replication. Eat Behav 7(4):300–308 source

      Not checked in the free run.

    • cites [21] Beatty, L., & Binnion, Claire 2016, A systematic review of predictors of, and reasons for, adherence to online psychological interventions. International Journal of Behavioral Medicine source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Implications for Cancer Survivors

    Differing recruitment strategies may explain varying levels of uptake of computerised cognitive behavioural therapy.

    “A systematic review on barriers to uptake of computerised cognitive behavioural therapy found a median uptake of 38% (range 4-84%) and suggested differing recruitment strategies may explain varying levels of uptake [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Christensen H, Griffiths K, Farrer L (2009) Adherence in internet interventions for anxiety and depression: systematic review. Journal of Medical Internet Research 11(2):e13 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Implications for Cancer Survivors

    Low adherence can moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits.

    “Low adherence has clear implications for research and clinical practice, as it can: (i) skew interpretations of efficacy if not clearly measured and reported, and (ii) moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits [20, 23-26].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [20] Ghaderi A (2006) Attrition and outcome in self-help treatment for bulimia nervosa and binge eating disorder: a constructive replication. Eat Behav 7(4):300–308 source

      Not checked in the free run.

    • cites [23] Kanera IM et al (2016) Use and appreciation of a tailored self-management ehealth intervention for early cancer survivors: process evaluation of a randomized controlled trial. Journal of Medical Internet Research 18(8):e229 source

      Not checked in the free run.

    • cites [24] Wade TD, Nehmy T, Koczwara B (2005) Predicting worries about health after breast cancer surgery. Psycho-Oncology 14(6):503–509 source

      Not checked in the free run.

    • cites [25] Berrigan D et al (2003) Patterns of health behavior in U.S. adults. Prev Med 36(5):615–623 source

      Not checked in the free run.

    • cites [26] Donkin L et al (2011) A systematic review of the impact of adherence on the effectiveness of e-therapies. Journal of Medical Internet Research 13(3):e52 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Implications for Cancer Survivors

    A systematic review of barriers to uptake of computerised cognitive behavioural therapy found a median uptake of 38% (range 4-84%).

    “A systematic review on barriers to uptake of computerised cognitive behavioural therapy found a median uptake of 38% (range 4-84%) and suggested differing recruitment strategies may explain varying levels of uptake [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Christensen H, Griffiths K, Farrer L (2009) Adherence in internet interventions for anxiety and depression: systematic review. Journal of Medical Internet Research 11(2):e13 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation
    § Implications for Cancer Survivors

    Online self-guided interventions have demonstrated efficacy across a range of psychological health conditions, including distress arising from physical health conditions such as cancer.

    “Compared to educational (information only) programs which are considered therapeutically inactive, online self-guided interventions have a demonstrated efficacy across a range of psychological health conditions [16, 17], including distress arising from physical health conditions such as cancer [16-18].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Christensen H et al (2004) A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website. Journal of Medical Internet Research 6(4):e46 source

      Not checked in the free run.

    • cites [17] Farvolden P et al (2005) Usage and longitudinal effectiveness of a Web-based self-help cognitive behavioral therapy program for panic disorder. Journal of Medical Internet Research 7(1):e7 source

      Not checked in the free run.

    • cites [18] Christensen H et al (2006) Free range users and one hit wonders: community users of an Internet-based cognitive behaviour therapy program. Aust N Z J Psychiatry 40:59–62 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Implications for Cancer Survivors

    Provision of module referrals, higher perceived personal relevance and not having a partner was associated with higher adherence to an online intervention for early cancer survivors.

    “while another found that provision of module referrals, higher perceived personal relevance and not having a partner was associated with higher adherence to an online intervention for early cancer survivors [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Beatty L, Lambert S (2013) A systematic review of internet-based self-help therapeutic interventions to improve distress and disease-control among adults with chronic health conditions. Clin Psychol Rev 33:609–622 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Implications for Cancer Survivors

    User perceptions of usefulness, user-friendliness, and overall satisfaction predicted higher adherence to an online intervention for breast cancer survivors.

    “one recent exception found no significant effect of age or baseline distress on adherence, but found user perceptions of usefulness, user-friendliness, and overall satisfaction predicted higher adherence to an online intervention for breast cancer survivors [28]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Proudfoot NJ et al (2010) The ins and outs of an online bipolar education program: a study of program attrition. Journal of Medical Internet Research 12(5):e57 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data
    § Discussion

    Higher adherence in the control condition appears likely to be due to minimal demands on participants in the control condition, given that it was not associated with the other adherence measures, and indicates that the control condition was appropriately pitched.

    “higher adherence in the control condition appears likely to be due to minimal demands on participants in the control condition, given that it was not associated with the other adherence measures, and indicates that the control condition was appropriately pitched.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Discussion

    A key limitation was underrepresentation of males, which may limit generalisability of results to males and minimising the ability to assess gender differences in predictors of adherence.

    “A key limitation of this study was underrepresentation of males, which may limit generalisability of results to males, as well as minimising the ability to assess gender differences in predictors of adherence.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Methods

    The study was a randomised clinical trial.

    “The study was a randomised clinical trial examining a CBT-based online psychological intervention Finding My Way (FMW) versus attention-control”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Discussion

    This adherence compares favourably with other online psychological interventions for cancer survivors, for example, one trial found 'continuous' usage to be 44.3%, with all weeks of the intervention logged in to by less than 10% of participants.

    “compares favourably with other online psychological interventions for cancer survivors, for example, one trial found 'continuous' usage to be 44.3%, with all weeks of the intervention logged in to by less than 10% of participants [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Proudfoot NJ et al (2010) The ins and outs of an online bipolar education program: a study of program attrition. Journal of Medical Internet Research 12(5):e57 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data
    § Discussion

    Uptake of the online intervention varies according to age, gender and cancer type, with older age associated with lower uptake but higher adherence.

    “shows that uptake of the online intervention varies according to age, gender and cancer type with older age being associated with lower uptake but higher adherence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion

    Uptake was higher among females, and among individuals diagnosed with ovarian or breast cancer, and lower among individuals diagnosed with melanoma or bowel cancer, with participants being slightly younger than those who declined.

    “Uptake was higher among females, and among individuals diagnosed with ovarian or breast cancer, which also corresponds with female gender, and lower among individuals diagnosed with melanoma or bowel cancer, with participants being slightly younger than those who declined.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Journal of Cancer Survivorship

    Uptake of online intervention varies according to age, gender and cancer type.

    “Uptake of online intervention varies according to age, gender and cancer type.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationown data
    § Discussion

    Higher uptake in those diagnosed with ovarian and breast cancer suggests either that the intervention had more relevance/appeal to ovarian and breast cancer patients, or that these individuals had higher motivation to participate for other reasons.

    “Higher uptake in those diagnosed with ovarian and breast cancer suggests either that the intervention had more relevance/appeal to ovarian and breast cancer patients, or that these individuals had higher motivation to participate for other reasons.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion

    Psychological predictors are of some importance in predicting adherence, but only in the context of a full intervention as opposed to a minimal-demand control.

    “This suggests psychological predictors are of some importance in predicting adherence, but only in the context of a full intervention as opposed to a minimal-demand control.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion

    As decliners were significantly older than participants, age may be a barrier to uptake of online interventions and preselect for the older participant who consider themselves adequately proficient with web use.

    “as decliners were significantly older than participants, age may be a barrier to uptake of online interventions and preselect for the older participant who consider themselves adequately proficient with web use.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given
    § Purpose

    Limitations to the efficacy of online interventions potentially include low uptake and adherence.

    “While online interventions are increasingly explored as an alternative to therapist-based interventions for cancer-related distress, limitations to efficacy potentially include low uptake and adherence.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § Discussion

    A key strength was the use of a web-based attention-control, rather than waitlist-control, as recommended by previous research.

    “Another key strength was the use of a web-based attention-control, rather than waitlist-control, as recommended by previous research [27]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Batterham PJ et al (2008) Predictors of adherence among community users of a cognitive behavior therapy website. Patient Preference and Adherence 2:97–105

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    Even distressed individuals can use and potentially benefit from online interventions.

    “even distressed individuals and older individuals, who may be assumed to have less internet proficiency, can use and potentially benefit from online interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given
    § Discussion

    This study explored a more comprehensive range of psychological predictors than previous research.

    “and explored a more comprehensive range of psychological predictors than previous research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Women are more likely to engage in health-related behaviours than men.

    “women are more likely to engage in health-related behaviours than men [41]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Lovibond SH, Lovibond PH (1995) Manual for the Depression Anxiety Stress Scales (DASS). University of New South Wales, Sydney

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Discussion

    A key strength was the use of multiple adherence measures as recommended by previous research.

    “a key strength of this study was the use of multiple adherence measures as recommended by previous research [27]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Batterham PJ et al (2008) Predictors of adherence among community users of a cognitive behavior therapy website. Patient Preference and Adherence 2:97–105

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    Even older individuals can use and potentially benefit from online interventions.

    “even distressed individuals and older individuals, who may be assumed to have less internet proficiency, can use and potentially benefit from online interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning
    § Discussion

    This study supports and expands on the literature on predictors of uptake and adherence to online interventions.

    “this study both supports and expands on the literature on predictors of uptake and adherence to online interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Control group membership has been reported as a predictor of adherence of online interventions.

    “Control group membership has been reported as a predictor of adherence of online interventions [24]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Wade TD, Nehmy T, Koczwara B (2005) Predicting worries about health after breast cancer surgery. Psycho-Oncology 14(6):503–509 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Compliance with Ethical Standards

    Informed consent was obtained from all individual participants.

    “Informed consent was obtained from all individual participants in the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Emotion regulation has been indicated as a maintenance factor in psychological disorder.

    “as a maintenance factor in psychological disorder [47]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    One determinant of higher health service use is poor adjustment to illness.

    “one determinant of higher health service use is poor adjustment to illness [48]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Discussion

    Due to the exploratory nature of analysis of group differences between low and high adherers, significance levels were not adjusted for multiple comparisons.

    “due to the exploratory nature of analysis of group differences between low and high adherers in intervention and control groups, significance levels were not adjusted for multiple comparisons.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Discussion

    Adherence and age may fall on a normal-distribution curve, with an optimum mid-age range for adherence.

    “adherence and age may fall on a normal-distribution curve, such that there is an optimum 'mid-age' range for adherence, as across studies middle-aged participants were found to have higher adherence than either younger or older adults [27]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Batterham PJ et al (2008) Predictors of adherence among community users of a cognitive behavior therapy website. Patient Preference and Adherence 2:97–105

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Emotion regulation has been indicated as a moderator of anxiety and depressive symptoms.

    “emotion regulation has been indicated as a moderator of anxiety and depressive symptoms [46]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Gratz K, Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and inital validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26(1):41–54 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Online intervention has the potential to improve quality of life.

    “with the potential to improve quality of life [1]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Zabora J et al (2001) The prevalence of psychological distress by cancer site. Psycho-Oncology 10:19–28 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Younger cancer patients experience higher levels of distress than older cancer patients.

    “younger cancer patients experience higher levels of distress than older cancer patients [44]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Compliance with Ethical Standards

    All procedures were conducted in accordance with ethical standards.

    “All procedures in studies involving human participants were conducted in accordance with the ethical standards of the Southern Adelaide Clinical Human Research Ethics Committee, the Royal Brisbane and Women's Hospital Human Research Ethics Committee, and the ACT Health Human Research Ethics Committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given
    § Discussion

    This study adopted a multiple adherence measure approach, providing a detailed view of predictors of adherence.

    “This study adopted a multiple adherence measure approach, thus providing a detailed view of predictors of adherence”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    More recent reviews have found mixed evidence on control group membership as a predictor of adherence.

    “although more recent reviews have found mixed evidence [27]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Batterham PJ et al (2008) Predictors of adherence among community users of a cognitive behavior therapy website. Patient Preference and Adherence 2:97–105

      Not checked in the free run.

65 of 65

  • The paper relies on this without support.

    Few predictors of uptake or adherence to online interventions have been consistently identified, particularly in cancer survivors, and research on uptake and adherence to online psychological interventions is sparse.

    “Few predictors of uptake or adherence to online interventions have been consistently identified, particularly in cancer survivors.”
    “research on uptake (typically defined as the number of consenting participants, as a proportion of approached eligible individuals; e.g. [2, 19]) and adherence (the amount of an intervention an individual engages with or completes [20]) to online psychological interventions is sparse.”

  • The paper relies on this without support.

    Few studies have reported rates or predictors of adherence to online interventions among cancer populations specifically.

    “Further, few studies have reported rates or predictors of adherence to online interventions among cancer populations specifically”

  • The paper relies on this without support.

    Few studies to date have comprehensively summarised the characteristics/profile of users and non-users of web-based psychological interventions, both in terms of initial uptake and subsequent adherence, and very few have examined these characteristics specifically for cancer survivors.

    “In sum, few studies to date have comprehensively summarised the characteristics / profile of users and non-users of web-based psychological interventions, both in terms of initial uptake of the program, and subsequent adherence, and very few have examined these characteristics specifically for cancer survivors.”

  • The paper relies on this without support.

    There are currently knowledge gaps with regard to rates and predictors of uptake to online interventions, particularly those aimed at cancer distress; the relationship between adherence and predictors previously identified as having mixed findings (e.g. age); and rates and predictors of adherence to online interventions aimed specifically at the cancer population.

    “There are therefore currently knowledge gaps with regard to (i) rates and predictors of uptake to online interventions, particularly those aimed at cancer distress, (ii) the relationship between adherence to online interventions and those predictors previously identified as having mixed findings (e.g. age) and (iii) rates and predictors of adherence to online interventions aimed specifically at”

  • The paper relies on this without support.

    Cognitive dysfunction is a commonly reported distressing and intrusive side-effect of cancer-treatment.

    “Given that cognitive dysfunction is a commonly reported distressing and intrusive side-effect of cancer-treatment”

  • The paper relies on this without support.

    There is a dearth of research exploring health service use and adherence.

    “While there is a dearth of research exploring health service use and adherence”

  • The paper relies on this without support.

    Online intervention offers an important alternative means to address cancer-distress beginning in the early stages of the survivorship trajectory.

    “online intervention offers an important alternative means to address cancer-distress beginning in the early stages of the survivorship trajectory”

  • The paper relies on this without support.

    As the number of cancer survivors increases, the need for efficacious web-based resources that meet their needs will become increasingly required.

    “As the number of cancer survivors increases, the need for efficacious web-based resources that meet their needs will become increasingly required.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A total of 6 studies found that higher engagement was seen with adults aged ≥30 years.

    “A total of 6 studies found that higher engagement was seen with adults aged ≥30 years [54,57,64,65,69-71].”

    From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [65]

    The Discussion reports that older participants engaged more with the online intervention than younger participants, including completing more modules and viewing more pages. It does not establish a ≥30-year cutoff. This paper is one of the cited studies, so it need not itself substantiate the citing sentence’s count of six studies. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • A similar study showed younger age may be associated with greater uptake of a CBT program for people with cancer.

    “A similar study (Beatty et al., 2017) examining a CBT program for people with cancer showed that younger age may also be associated with greater uptake.”

    From Predictors of acceptability and engagement in a self-guided online program for depression and anxiety (2021) · cites this paper as Beatty et al., 2017

  • Beatty et al considered a user to be highly adherent when a therapeutic dose of 66% of the intervention was received, and this threshold was obtained from previous studies.

    “Beatty et al considered a user to be highly adherent when a therapeutic dose of 66% of the intervention was received [76]. This threshold for a therapeutic dose was obtained from previous studies.”

    From Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence (2017) · cites this paper as [76]

  • The intended use or therapeutic dose can be justified using existing guidelines for healthy living and medication use or using previous research regarding other technologies.

    “the intended use or the “therapeutic dose” can be justified just as well using existing guidelines for healthy living and medication use [74,77] or using previous research regarding other technologies [75,76].”

    From Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence (2017) · cites this paper as [76]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(418) = 2.21reported p = .028 · recomputed p = .028

    “t (418) = 2.21, p = .028”

  • Consistentt(189) = -3.84reported p < .001 · recomputed p < .001

    “t (189) = -3.84, p < .001”

  • Consistentt(189) = -14.38reported p < .001 · recomputed p < .001

    “t (189) = -14.38, p < .001”

  • Consistentt(189) = -14.01reported p < .001 · recomputed p < .001

    “t (189) = -14.01, p < .001”

  • Consistentt(189) = 14.95reported p < .001 · recomputed p < .001

    “t (189) = 14.95, p < .001”

  • Consistentt(189) = -16.71reported p < .001 · recomputed p < .001

    “t (189) = -16.71, p < .001”

  • Consistentt(92) = 2.33reported p = .022 · recomputed p = .022

    “t (92) = 2.33, p = .022”

  • Consistentt(92) = -2.183reported p = .032 · recomputed p = .032

    “t (92) = -2.183, p = .032”

  • Consistentt(92) = -2.02reported p = .046 · recomputed p = .046

    “t (92) = -2.020, p = .046”

  • Consistentt(92) = 2.239reported p = .028 · recomputed p = .028

    “t (92) = 2.239, p = .028”

  • Consistentt(92) = 2.507reported p = .014 · recomputed p = .014

    “t (92) = 2.507, p = .014”

  • Consistentt(92) = 3.559reported p = .001 · recomputed p < .001

    “t (92) = 3.559, p = .001”

  • Consistentt(92) = 2.768reported p = .007 · recomputed p = .007

    “t (92) = 2.768, p = .007”

13 of 13

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Login averages imply different overall totals

    Major

    The control and intervention averages imply about 1,253 total logins across 191 participants, whereas the high- and low-adherer averages imply about 1,500. Both breakdowns cover the same participants, so the reported averages cannot all be correct.

  • Page-view averages imply different overall totals

    Major

    The control and intervention averages imply about 20,496 total page views, whereas the high- and low-adherer averages imply about 29,064. These are two breakdowns of the same 191 participants.

  • Decliner female percentage differs between text and table

    Minor

    The results text reports 73.6% of decliners as female, while Table 1 reports 73.1%. The difference is larger than rounding to one decimal place.

  • Time-logged-in model reports one rather than three predictors

    Minor

    The reported F statistic has numerator degrees of freedom of 1, but Table 3 lists three predictors for the total-time-logged-in model: age, employment and difficulties in emotion regulation.

  • Partnered percentage uses the wrong denominator

    Minor

    The intervention low-adherer group has 48 people; 38 partnered people are 79.17% of that group, not 95.00%.

    Reported 95 · recomputed 79.166667

  • Social-support means exceed the stated score range

    Minor

    The measure is described as having scores from 0 to 76, but Table 4 reports group means of 83.19, 79.72 and 80.53. A mean cannot exceed the maximum possible individual score.

6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Cancer Australia and Cancer Council Australia (2010) Review of national cancer control activity in Australia. Cancer Australia, Canberra
  2. National Institute for Health and Care Excellence (2009) Depression in adults with a chronic physical health problem: recognition and management. National Institute for Health Care and Excellence, Manchester, UK
  3. Lovibond SH, Lovibond PH (1995) Manual for the Depression Anxiety Stress Scales (DASS). University of New South Wales, Sydney

Cited by

Sorted by citations

Related

Authors
Beatty, L., Kemp, E., Binnion, C., Turner, J., Milne, D., Butow, P., Lambert, S., Yates, P., Yip, D., & Koczwara, B.
Affiliations
  • Flinders University (AU)
  • The University of Queensland (AU)
  • Peter MacCallum Cancer Centre (AU)
  • The University of Sydney (AU)
  • McGill University (CA)
  • Queensland University of Technology (AU)
  • Australian National University (AU)
Corresponding author
Kemp, Emma
ORCID
Venue
Supportive Care in Cancer
Publisher
Springer Science and Business Media LLC
Published
2017-02-02
Volume
25
Issue
6
Pages
1905-1914
ISSN
  • 0941-4355 (ISSN-L)
  • 1433-7339
DOI
10.1007/s00520-017-3591-1
OpenAlex
W2586003953
Semantic Scholar
993758c3e5812ac1d09af5231adb39b49c40a0ef
Cited by
46
References
44
Citations by year
2026: 4 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 8 · 2020: 7 · 2019: 1 · 2018: 4 · 2017: 2
FWCI
4.39
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (unspecified)
Locations
  • Supportive Care in Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • Flinders Academic Commons (Flinders University) (acceptedVersion)
  • ANU Open Research (Australian National University) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion)
Funders
National Health and Medical Research Council (1042942)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
online intervention, cancer-related distress, intervention uptake, intervention adherence, old age, predictors of adherence, emotion regulation, quality of life, cancer types, gender differences, melanoma, breast cancer, ovarian cancer
MeSH terms
Aging, Female, Humans, Male, Middle Aged, Neoplasms, Quality of Life, Cognitive Behavioral Therapy, Telemedicine, Internet

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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