Reasons for Nonparticipation and Dropout in a Longitudinal Study of an App–Based Support Service Among Adult Patients in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Cross-Sectional Study (Preprint)

Abstract

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.

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.

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.

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.

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.

German Clinical Trials Register DRKS00027536; https://drks.de/search/de/trial/DRKS00027536