Abstract
BackgroundMobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies.ObjectiveWe explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China.MethodsThe cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models.ResultsIn total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9% (437/1510) in the intervention group and 35.7% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition.ConclusionsEngagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition.Trial RegistrationChinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376International Registered Report Identifier (IRRID)RR2-10.1186/s12889-018-5790-1
Highlights
Owing to recognized advantages such as cost-effective dissemination, real-time data collection and feedback, reduced burden, flexible customization, self-monitoring capacity, and visually attractive multimedia presentation [1,2,3], mobile health technology has become increasingly popular in health intervention research and practice over the past decade
Engagement in the app intervention was associated with participant attrition
The intervention group received all content that the control group received, but the participants were exposed to additional similar essays, games, comics, and videos twice a week, and engaged in a second set of thematic discussions once a month to learn about parenting skills related to unintentional child injury prevention
Summary
Owing to recognized advantages such as cost-effective dissemination, real-time data collection and feedback, reduced burden, flexible customization, self-monitoring capacity, and visually attractive multimedia presentation [1,2,3], mobile health (mHealth) technology has become increasingly popular in health intervention research and practice over the past decade. A wide range of mHealth interventions have been developed to prevent diseases and injuries, increase the compliance to recommended health interventions, and offer remote access to health services [4,5,6,7,8,9,10]. Despite these advantages, mHealth interventions suffer from the challenge of high dropout attrition rates compared to studies adopting traditional interventions. High attrition rates threaten evaluation and implementation of mHealth intervention studies
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