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Background In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective This study fills this research gap by applying a web-app aiming at improving pregnant women’s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker–Lewis index=0.971; root mean square error of approximation=0.055). Conclusions Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735
Background In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective This study fills this research gap by applying a web-app aiming at improving pregnant women’s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker–Lewis index=0.971; root mean square error of approximation=0.055). Conclusions Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735
BACKGROUND Regarding their use in treating mental disorders, research into apps has increased rapidly in recent years with positive effects being demonstrated. However, increasing nonparticipation in research studies and high dropout rates in research on mental health apps compromise interpretability and generalizability of results. Analyzing nonparticipation and dropout helps understanding the underlying reasons to improve recruitment methods, study design, and app features in future studies. OBJECTIVE This study aimed to investigate reasons of adults with psychiatric disorders not to participate in or drop out of a study examining an app and to determine potential differences between dropouts and completers. METHODS Data were collected as part of a prospective longitudinal observational study examining an app among adult patients in a psychiatric outpatient department in Germany. Descriptive statistics on reasons for nonparticipation using an anonymous questionnaire and for dropout based on semistructured telephone interviews were performed. Potential differences between dropouts and completers in sociodemographic, clinical, app-related, and daily mood data were analyzed. RESULTS Of all 88 persons who were approached for potential study participation, 57 (65%) participated in the study examining an app, while 31 (35%) declined a study participation. Of these 31 nonparticipants, 29 (94%) indicated specific reasons for their nonparticipation. On average, 1.72 (SD 1.03) reasons for nonparticipation were given per person, with no motivation for regular app use (7/29, 24%), no interest in using an app for the presented content (6/29, 21%), and no time for app use (6/29, 21%) or app installation (5/29, 17%) being the most common. Of all 57 study participants, 40 (70%) were defined as completers and 17 (30%) as dropouts. On average, 2.82 (SD 1.29) reasons for dropout were given per person among all dropouts, with too severe health complaints (6/17, 35%), not individually suitable contents (5/17, 29%), and lack of incentives to use the app (5/17, 29%) being the most frequent. The analysis of group differences between dropouts and completers did not identify statistically significant differences for any of the sociodemographic, clinical, and app-related variables (all P>.05). However, dropouts reported their mood significantly less often than completers during the first five (U=48.0; P<.001; r=0.61) and the first seven (U=25.5; P<.001; r=0.67) days of the intervention period. CONCLUSIONS This study provides a better understanding of reasons of adults with psychiatric disorders not to participate in or drop out of a study examining an app. Personal motivation, app-related aspects, no interest in app–based offers, and personal health complaints were identified as common reasons, and suggestions for improvement in future studies were developed. Further, significantly fewer reports of daily mood were observed among dropouts within the first days of the intervention period, which could be helpful in future studies to detect potential dropouts early. CLINICALTRIAL German Clinical Trials Register DRKS00027536; https://drks.de/search/de/trial/DRKS00027536
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