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      Predictors of Participant Retention in a Guided Online Self-Help Program for University Students: Prospective Cohort Study

      research-article
      , BSc (Hons) 1 , , , PhD 2 , , OC, PhD, FRSC 3 , 4
      (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      JMIR Publications Inc.
      self-help, online treatment, Web-based, retention, dropouts, theory of planned behavior

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          Abstract

          Background

          Attrition is a persistent issue in online self-help programs, but limited research is available on reasons for attrition or successful methods for improving participant retention. One potential approach to understanding attrition and retention in such programs is to examine person-related variables (eg, beliefs and attitudes) that influence behavior. Theoretical models, such as the Theory of Planned Behavior, that describe conditions influencing human behavior may provide a useful framework for predicting participant retention in online-based program.

          Objective

          We examined predictors of participant retention in a guided online anxiety, depression, and stress self-help program for university students using the theory of planned behavior. We also explored whether age, symptom severity, and type of coaching (ie, email vs phone) affected participant retention.

          Methods

          65 university students with mild to moderate depression, anxiety, and stress were enrolled in this prospective cohort study. Participants completed a questionnaire based on the theory of planned behavior prior to commencing the online-based program and the Depression Anxiety and Stress Scale (DASS) during the assessment module of the program. Participant retention was operationalized as the number of program modules completed.

          Results

          Perceived control over completing the online program significantly predicted intention to complete the program ( F 3,62=6.7; P=.001; adjusted R 2=.2; standardized beta=.436, P=.001). Age (standardized beta=.319, P=.03) and perceived behavioral control (standardized beta=.295, P=.05) predicted the number of program modules completed ( F 3,61=3.20, P=.03, adjusted R 2 =.11). Initial level of distress (ie, symptom severity) did not predict participant retention ( P=.55). Participants who chose phone-based coaching completed more program modules than participants who chose email-based coaching (Mann-Whitney’s U=137; P=.004).

          Conclusions

          Participants’ age, level of perceived behavioral control, and choice of interaction (ie, phone-based or email-based coaching) were found to influence retention in this online-based program.

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          Most cited references27

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          Self-Efficacy: An Essential Motive to Learn.

          During the past two decades, self-efficacy has emerged as a highly effective predictor of students' motivation and learning. As a performance-based measure of perceived capability, self-efficacy differs conceptually and psychometrically from related motivational constructs, such as outcome expectations, self-concept, or locus of control. Researchers have succeeded in verifying its discriminant validity as well as convergent validity in predicting common motivational outcomes, such as students' activity choices, effort, persistence, and emotional reactions. Self-efficacy beliefs have been found to be sensitive to subtle changes in students' performance context, to interact with self-regulated learning processes, and to mediate students' academic achievement. Copyright 2000 Academic Press.
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            Dropout from Internet-based treatment for psychological disorders.

            The purpose of this review was to present an in-depth analysis of literature identifying the extent of dropout from Internet-based treatment programmes for psychological disorders, and literature exploring the variables associated with dropout from such programmes. A comprehensive literature search was conducted on PSYCHINFO and PUBMED with the keywords: dropouts, drop out, dropout, dropping out, attrition, premature termination, termination, non-compliance, treatment, intervention, and program, each in combination with the key words Internet and web. A total of 19 studies published between 1990 and April 2009 and focusing on dropout from Internet-based treatment programmes involving minimal therapist contact were identified and included in the review. Dropout ranged from 2 to 83% and a weighted average of 31% of the participants dropped out of treatment. A range of variables have been examined for their association with dropout from Internet-based treatment programmes for psychological disorders. Despite the numerous variables explored, evidence on any specific variables that may make an individual more likely to drop out of Internet-based treatment is currently limited. This review highlights the need for more rigorous and theoretically guided research exploring the variables associated with dropping out of Internet-based treatment for psychological disorders.
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              The role of motivation in promoting and sustaining self-regulated learning

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                May 2013
                22 May 2013
                : 15
                : 5
                : e96
                Affiliations
                [1] 1Department of Psychology and Neuroscience Dalhousie University Halifax, NSCanada
                [2] 2Dalhousie Counselling Centre Dalhousie University Halifax, NSCanada
                [3] 3Department of Psychology and Neuroscience, Psychiatry, & Pediatrics Dalhousie University Halifax, NSCanada
                [4] 4IWK Health Centre Halifax, NSCanada
                Author notes
                Corresponding Author: Magdalena Wojtowicz m.wojtowicz@ 123456dal.ca
                Article
                v15i5e96
                10.2196/jmir.2323
                3668607
                23697614
                15e1b13f-a358-4a5b-ad15-590f69127d03
                ©Magdalena Wojtowicz, Victor Day, Patrick J McGrath. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.05.2013.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 24 August 2012
                : 08 February 2013
                : 04 March 2013
                : 26 March 2013
                Categories
                Original Paper

                Medicine
                self-help,online treatment,web-based,retention,dropouts,theory of planned behavior
                Medicine
                self-help, online treatment, web-based, retention, dropouts, theory of planned behavior

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