A Randomized Controlled Trial Evaluating a Manualized TeleCoaching Protocol for Improving Adherence to a Web-Based Intervention for the Treatment of Depression
A Randomized Controlled Trial Evaluating a Manualized TeleCoaching Protocol for Improving Adherence to a Web-Based Intervention for the Treatment of Depression
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DOI：
10.1371/journal.pone.0070086
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发表时间：
2013-08-21
期刊：
影响因子：
3.7
通讯作者：
Begale, Mark
中科院分区：
文献类型：
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作者：
Mohr, David C.;Duffecy, Jenna;Begale, Mark
背景资料：相对于独立的基于网络的干预措施，在辅导支持下的基于网络的抑郁症干预措施通常会产生更大的效果。这可能是由于教练对坚持的影响。我们评估了手动电话辅导干预（TeleCoach）的有效性，旨在提高坚持以网络为基础的干预（moodManager），以及坚持和抑郁症状outcomes.Methods之间的关系：101例抑郁症患者，从初级保健招募，被随机分配到12周的moodManager+TeleCoach，12周的自我导向moodManager，或6周的候补控制（WLC）。采用PHQ-9量表测量抑郁症状的严重程度。与自我指导的moodManager相比，TeleCoach+moodManager的登录天数显著增加（p = 0.01），距末次使用的时间更长（p = 0.007），更多地利用经验教训（p = 0.03），使用的互动工具种类更多（p = 0.02），但工具使用的总实例未达到统计学显著性。（p = 0.07）。在第6周，TeleCoach+moodManager产生的PHQ-9评分显著低于WLC（p = 0.04），但在第6周或第12周，各治疗组的PHQ-9评分无其他显著差异（p>0.20）。基线PHQ-9分数没有显着相关的坚持moodManager.Conclusions：TeleCoach产生显着更大的坚持moodManager，相对于自我导向moodManager。与WLC相比，TeleCoached moodManager对抑郁症状的减少更大，但是，与自我导向moodManager相比，没有统计学显著差异。虽然更多的使用与更好的结果相关，但TeleCoach和自我导向moodManager的大多数用户在第12周时退出了治疗。即使有电话辅导，坚持基于网络的抑郁症干预仍然是一个挑战。讨论了改进教练模式的方法。
Background: Web-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes.Methods: 101 patients with MDD, recruited from primary care, were randomized to 12 weeks moodManager+TeleCoach, 12 weeks of self-directed moodManager, or 6 weeks of a waitlist control (WLC). Depressive symptom severity was measured using the PHQ-9.Results: TeleCoach+moodManager, compared to self-directed moodManager, resulted in significantly greater numbers of login days (p = 0.01), greater time until last use (p = 0.007), greater use of lessons (p = 0.03), greater variety of interactive tools used (p = 0.02), but total instances of tool use did not reach statistical significance. (p = 0.07). TeleCoach+moodManager produced significantly lower PHQ-9 scores relative to WLC at week 6 (p = 0.04), but there were no other significant differences in PHQ-9 scores at weeks 6 or 12 (ps>0.20) across treatment arms. Baseline PHQ-9 scores were no significantly related to adherence to moodManager.Conclusions: TeleCoach produced significantly greater adherence to moodManager, relative to self-directed moodManager. TeleCoached moodManager produced greater reductions in depressive symptoms relative to WLC, however, there were no statistically significant differences relative to self-directed moodManager. While greater use was associated with better outcomes, most users in both TeleCoach and self-directed moodManager had dropped out of treatment by week 12. Even with telephone coaching, adherence to web-based interventions for depression remains a challenge. Methods of improving coaching models are discussed.