The Internet Intervention Patient Adherence Scale for Guided Internet-Delivered Behavioral Interventions: Development and Psychometric Evaluation

Abstract

Background Patient adherence is defined as the extent to which a patient complies with medical or health advice. At present, there is a lack of reliable and valid measures specifically designed to measure adherence to internet-delivered behavioral interventions. Objective The objective of this study was to develop and psychometrically evaluate a novel measure of adherence to guided internet-delivered behavioral interventions. Methods In collaboration with experienced clinicians and researchers in the field, a 5-item, clinician-rated internet intervention Patient Adherence Scale (iiPAS) was developed. The initial scale was tested in a sample of children and adolescents (N=50) participating in internet-delivered cognitive behavioral therapy (ICBT) studies. A revised version of the iiPAS was then administered to a larger sample of children and adolescents (N=148) with various behavioral problems participating in ICBT trials. The scale was evaluated according to a classical test theory framework. Results The iiPAS demonstrated excellent internal consistency. Factor analyses revealed one underlying factor, explaining about 80% of the variance, suggesting that the scale captures a homogeneous adherence construct. The iiPAS was strongly associated with objective measures of patient activity in ICBT (number of logins, number of written characters, and completed modules). Furthermore, mid- and posttreatment ratings of the iiPAS were significantly correlated with treatment outcomes. By contrast, objective measures of patient activity in the Web-based platform did not correlate with treatment outcomes. Conclusions The iiPAS could be a useful tool to measure adherence in a broad range of internet-delivered behavioral interventions.

Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial

“…Other secondary clinician-rated outcomes include general functioning measured with the Children’s Global Assessment Scale (CGAS) [ 40 , 41 ], and participant adherence to the internet-delivered interventions measured with the Internet Intervention Patient Adherence Scale (iiPAS) [ 42 ].…”

Adaptation of an Evidence-Based Online Depression Prevention Intervention for College Students: Intervention Development and Pilot Study Results

“…While it has been suggested that increased engagement in online interventions may predict better outcomes in the prevention and treatment of depression (Christensen et al 2002;Christensen et al 2006;Van Voorhees et al 2011), the relationship between use and outcome may not be linear (Donkin et al 2013). Moreover, it is possible that our current measures of adherence (e.g., modules completed, time logged in) may not be reliable if, for example, some intervention users practice applying the concepts they have learned while not logged into the program (Lenhard et al 2019). At this point, there is no evidence to suggest that there is a threshold effect for the use of this or related interventions; in fact, participants in this and similar technology-based depression prevention programs exhibited preventive benefits using only a few modules (Gladstone et al 2018;Ip et al 2016).…”

Feasibility of internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder in youth with autism spectrum disorder: A clinical benchmark study

“…The clinician-rated Internet Intervention Patient Adherence Scale (iiPAS) was used in the ICBT group as a brief clinician-rated measure of adherence to internet-delivered interventions. The iiPAS has demonstrated robust psychometric properties and associations with objective measures of ICBT patient adherence ( Lenhard et al, 2019 ). The Obsessional Compulsive Inventory – Child version (OCI-CV) is a self-rated measure of OCD symptom severity.…”