Abstract
BackgroundAdherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model.MethodsA total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment.ResultsParticipant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group.ConclusionsThis study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.Trial registrationclinicaltrials.gov NCT02895308. Retrospectively registered 30 August 2016.
Highlights
Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate
The results suggests that while most participants show high levels of adherence to an assignment in a face-to-face intervention, it is primarily people who report high levels of intrinsic and/or identified motivation that will adhere to the assignment in an online intervention
In line with previous studies, adherence to assignments was associated with intrinsic motivation and intervention credibility, especially in the online condition
Summary
Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. The aims of this study were, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model. Adherence to assignments is often only moderate, and patients report obstacles such as time restraints and competing priorities [3] It is, important to investigate factors, such as motivation, that are associated with adherence to prescribed assignments in more detail [4]. Kazantzis and colleagues have identified that patients that feel engaged in the treatment and receive positive feedback are more adherent to homework They have further provided a therapist checklist and an instrument to measure patients’ experience of assignments, the Homework Rating Scale II (HRS II) [12]. There is still a need to better understand the processes behind homework adherence in order to improve clinical outcomes [13]
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