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Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic
Jian Wang1,2, Jinli Mahe1,2, Yujia Huo1,2
1The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Journal of Medical Internet Research
|August 27, 2024
Summary
Digital dietary interventions face high participant dropout. A new force-resource model explains attrition as insufficient motivation and resources, guiding future intervention design to improve engagement and health equity.
Area of Science:
- Public Health and Nutrition
- Digital Health Interventions
- Behavioral Science
Background:
- Dietary behaviors significantly impact population health, with unhealthy diets contributing to millions of deaths and substantial disease burden annually.
- Digital dietary interventions offer accessible solutions but suffer from high attrition rates (75%-99%), compromising validity and exacerbating health disparities.
- Understanding and addressing attrition is crucial for the effectiveness of digital health strategies.
Purpose of the Study:
- To systematically review literature on attrition in digital dietary interventions.
- To identify causes of attrition and propose solutions, integrating behavior theory concepts.
- To develop a theoretical framework to guide more effective intervention design and reduce attrition.
Main Methods:
- Systematic review, meta-analysis, and thematic synthesis of studies published between 2013-2023.
- Searched 7 electronic databases, including PubMed, MEDLINE, and Web of Science.
- Followed PRISMA and ENTREQ guidelines; utilized RStudio for meta-analysis and NVivo for synthesis.
Main Results:
- 21 studies out of 442 met inclusion criteria; mean attrition rates ranged from 35% (control) to 40% (observational) with high heterogeneity.
- Thematic synthesis identified 15 themes aligning with behavior theory, leading to the development of the force-resource model.
- The force-resource model explains attrition through the interplay of driving forces (motivation) and supporting resources.
Conclusions:
- High attrition in digital dietary interventions stems from insufficient motivation and/or inadequate resources.
- A balanced approach dynamically integrating motivational components with user resources is critical for intervention success.
- Recommendations include user-friendly design, personalized adaptation, social support, and dynamic follow-up to enhance engagement and digital health equity.
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