Recruitment to online therapies for depression: pilot cluster randomized controlled trial.
Recruitment to online therapies for depression: pilot cluster randomized controlled trial.
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DOI：
10.2196/jmir.2367
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发表时间：
2013-03-05
影响因子：
7.4
通讯作者：
Williams CJ
中科院分区：
文献类型：
--
作者：
Jones RB;Goldsmith L;Hewson P;Williams CJ
提高对在线认知行为疗法（CBT）的认识可以使许多抑郁症患者受益，但我们不知道购买在线广告与从相关本地网站放置免费链接相比如何增加吸收。进行一项群集随机对照试验（RCT），比较购买Google AdWords与放置免费网站链接，以提高对抑郁症在线CBT资源的认识，以便更好地了解研究设计问题。我们比较了两个在线干预与没有干预的对照。试验RCT有4个分支，每个分支有4个英国邮政编码区：（A）地理定位的AdWords，（B）通过联系网站所有者并请求添加链接在当地网站上投放广告，（C）两种干预措施，（D）控制。参与者被引导到我们的研究项目网站链接到两个免费的在线CBT资源网站（Moodgym和Living Life To The Full（LLTTF））和其他两个抑郁症支持网站。我们使用来自（1）AdWords的数据，（2）Google Analytics用于我们的项目网站和LLTTF，以及（3）研究项目网站。我们比较了两个结果：（1）抑郁症患者访问研究项目网站，然后选择链接到两个CBT网站之一，以及（2）在LLTTF注册的人数。我们记录了成本，并探讨了干预和评估方法，提出一般性建议，以告知研究人员在未来的研究中使用类似的方法。尝试放置本地网站链接似乎比AdWords的成本效益低得多，尽管可能证明对服务提供有用，但在当前研究设计的背景下不值得追求。我们的AdWords干预在为项目网站招募人员方面是有效的，但我们的定位“泄露”，并不像声称的那样具有地理特异性。通过为参与者提供其他目的地选择，在线CBT的影响也被稀释了。难以衡量对使用LLTTF的影响，因为使用LLTTF的总人数不到所有用户的5%，而且不可能实现网站之间的记录链接。混淆活动可能导致对照组的注册数量有所增加。从业人员应考虑在线广告以增加在线治疗的使用，但需要检查其附加价值。使用定位广告的集群RCT是可行的，并且该研究设计提供了成本效益的最佳证据。虽然我们的英国试点研究仅限于抑郁症的在线CBT，但具有类似设计的集群RCT适用于其他在线治疗和国家，我们的建议可能适用。它们包括处理可能的污染的方法（缓冲区和AdWords技术），混淆因素（大量集群），广告剂量（与用户总数成比例），记录链接（在目标网站内登陆）和研究长度（4-6个月）。clinicaltrials.gov（注册号NCT 01469689）; http://clinicaltrials.gov/ct2/show/NCT01469689（由WebCite存档，网址为http：//www.webcitation.org/6EtTthDOp）
Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting “leaked” and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp)
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