Adherence Reporting in Randomized Controlled Trials Examining Manualized Multisession Online Interventions: Systematic Review of Practices and Proposal for Reporting Standards
Open accessAbstract
Background: Adherence reflects the extent to which individuals experience or engage with the content of online interventions and poses a major challenge. Neglecting to examine and report adherence and its relation to outcomes can compromise the interpretation of research findings. Objective: The aim of this systematic review is to analyze how adherence is accounted for in publications and to propose standards for measuring and reporting adherence to online interventions. Methods: We performed a systematic review of randomized controlled trials on online interventions for the prevention and treatment of common mental disorders (depression, anxiety disorders, substance related disorders, and eating disorders) published between January 2006 and May 2018 and indexed in Medline and Web of Science. We included primary publications on manualized online treatments (more than 1 session and successive access to content) and examined how adherence was reported in these publications. Results: We identified 216 publications that met our inclusion criteria. Adherence was addressed in 85% of full-text manuscripts, but only in 31% of abstracts. A median of three usage metrics were reported; the most frequently reported usage metric (61%) was intervention completion. Manuscripts published in specialized electronic health journals more frequently included information on the relation of adherence and outcomes. Conclusions: We found substantial variety in the reporting of adherence and the usage metrics used to operationalize adherence. This limits the comparability of results and impedes the integration of findings from different studies. Based on our findings, we propose reporting standards for future publications on online interventions.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
Comparison with other online programs based in other orientations is somewhat difficult due to high heterogeneity regarding how adherence, attrition, and engagement are reported in research on online interventions.
“Given the high heterogeneity regarding how adherence, attrition, and engagement are reported in research on online interventions, comparison with other online programs based in other orientations is somewhat difficult (Beintner et al., 2019).”
From A systematic review and meta-analysis of self-guided online acceptance and commitment therapy as a transdiagnostic self-help intervention (2023) · cites this paper as Beintner et al., 2019
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
No citation lists for this paper
No citation lists for this paper yet — checked again daily.
References 33 · Cited by 89
Research works printed but not linked: 12
- [1]Carlbring P Andersson G Cuijpers P Riper H Hedman-Lagerlöf E Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis Cogn Behav Ther 2018 1 47 1 1 18 10.1080/16506073.2017.1401115 29215315 29215315 · DOI · Paper page
- [11]Eysenbach G The law of attrition J Med Internet Res 2005 7 1 e11 10.2196/jmir.7.1.e11 15829473 15829473 PMC1550631 · DOI · Paper page
- [14]Donkin L Christensen H Naismith SL Neal B Hickie IB Glozier N A systematic review of the impact of adherence on the effectiveness of e-therapies J Med Internet Res 2011 13 3 e52 10.2196/jmir.1772 21821503 21821503 PMC3222162 · DOI · Paper page
- [16]Eysenbach G CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions J Med Internet Res 2011 12 31 13 4 e126 10.2196/jmir.1923 22209829 22209829 PMC3278112 · DOI · Paper page
- [18]Moher D Hopewell S Schulz KF Montori V Gøtzsche PC Devereaux PJ Elbourne D Egger M Altman DG CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials BMJ 2010 3 340 c869 20332511 20332511 PMC2844943
- [19]Little RJ D'Agostino R Cohen ML Dickersin K Emerson SS Farrar JT Frangakis C Hogan JW Molenberghs G Murphy SA Neaton JD Rotnitzky A Scharfstein D Shih WJ Siegel JP Stern H The prevention and treatment of missing data in clinical trials N Engl J Med 2012 10 4 367 14 1355 60 10.1056/NEJMsr1203730 23034025 23034025 PMC3771340 · DOI · Paper page
- [20]Aronson Jeffrey K Compliance, concordance, adherence Br J Clin Pharmacol 2007 4 63 4 383 4 10.1111/j.1365-2125.2007.02893.x 10.1111/j.1365-2125.2007.02893.x 17378797 17378797 PMC2203247 · DOI
- [23]Andersson E Hedman E Wadström O Boberg J Andersson E Axelsson E Bjureberg J Hursti T Ljótsson B Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial Behav Ther 2017 5 48 3 391 402 10.1016/j.beth.2016.07.003 28390501 28390501 · DOI · Paper page
- [28]Schulz A Stolz T Vincent A Krieger T Andersson G Berger T A sorrow shared is a sorrow halved? A three-arm randomized controlled trial comparing internet-based clinician-guided individual versus group treatment for social anxiety disorder Behav Res Ther 2016 9 84 14 26 10.1016/j.brat.2016.07.001 27423374 27423374 · DOI
- [31]Nyström MBT Stenling A Sjöström E Neely G Lindner P Hassmén P Andersson G Martell C Carlbring P Behavioral activation versus physical activity via the internet: A randomized controlled trial J Affect Disord 2017 12 215 85 93 10.1016/j.jad.2017.03.018 28319696 28319696 · DOI
- [33]Calear AL Batterham PJ Poyser CT Mackinnon AJ Griffiths KM Christensen H Cluster randomised controlled trial of the e-couch Anxiety and Worry program in schools J Affect Disord 2016 5 15 196 210 7 10.1016/j.jad.2016.02.049 26926660 26926660 · DOI
- [34]Beintner I Jacobi C Taylor CB Participant adherence to the Internet-based prevention program StudentBodies for eating disorders — A review Internet Interventions 2014 3 1 1 26 32 10.1016/j.invent.2014.03.001 · DOI
- Authors
- Beintner, I., Vollert, B., Zarski, A.-C., Bolinski, F., Musiat, P., Görlich, D., Ebert, D. D., & Jacobi, C.
- Affiliations
- Technische Universität Dresden (DE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Vrije Universiteit Amsterdam (NL)
- King's College London (GB)
- University of Münster (DE)
- Corresponding author
- Beintner, Ina
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2019-08-15
- Volume
- 21
- Issue
- 8
- Pages
- e14181
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC6713038
- OpenAlex
- W2968951394
- Cited by
- 89
- References
- 33
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 20 · 2023: 18 · 2022: 11 · 2021: 13 · 2020: 5 · 2019: 2
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- Research Portal (King's College London) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- adherence, online intervention, reporting guidelines, usage metrics, intervention completion, common mental disorders, depression, anxiety disorders, substance use disorders, eating disorders, randomized controlled trials
- MeSH terms
- Mental Disorders, Humans, Research Design, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Telemedicine, Guideline Adherence, 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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
