Patients' reasons for declining a primary care trial online therapy: a mixed-methods study

Area of Science:

• Mental Health Research
• Digital Therapeutics
• Clinical Trial Recruitment

Background:

• Online platforms integrating therapist support and Cognitive Behavioural Therapy (CBT) offer a potential avenue for depression treatment.
• A clinical trial is evaluating this integrated online CBT delivery model.
• Understanding reasons for declining participation is crucial for optimizing recruitment in such trials.

Purpose of the Study:

• To investigate primary care patients' motivations for refusing to join a trial for integrated online CBT for depression.

Main Methods:

• A mixed-methods approach was employed across three UK trial sites.
• Data collection involved questionnaires for all decliners and in-depth telephone interviews with a subset.
• Quantitative data were analyzed using descriptive statistics, and qualitative data underwent thematic analysis.

Main Results:

• 40.3% of 1799 potential participants declined further contact.
• Primary reasons included reluctance towards research participation (n=387), online therapy (n=284), and CBT itself (n=262).
• Interviews revealed concerns about eligibility, prior CBT experiences, and uncertainty regarding online delivery, alongside personal circumstances and symptom severity.

Conclusions:

• Patient reluctance to join online CBT trials stems from perceptions of eligibility, prior experiences, and acceptance of the intervention.
• Addressing patient concerns about research, online delivery, and therapy type at recruitment is vital.
• This insight aids in improving recruitment strategies for digital mental health interventions.