Data_Sheet_1_The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence.docx

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02336841.借助在线技术提升民众福祉正日益成为全球优先议题。本研究依托二手数据开展二次分析，聚焦神经性厌食症（anorexia nervosa）患者所接受的在线指导式自助干预（online guided self-help intervention）的脱落率问题。具体而言，本研究考察了治疗结束节点（即6周评估阶段）的脱落率、干预依从性标准（需完成6次在线指导课程中的至少4次），以及完成干预者与脱落者之间的群体差异。研究采用结构方程模型（structural equation modeling），将改变动机及相关患者特征变量作为脱落风险的预测因子进行分析。本试验的干预组共纳入99名随机分配的患者，最终获取82名个体的有效观测数据，其中67名完成了6周评估且完成了至少4次在线指导课程。基线阶段，完成者与脱落者之间未发现显著差异。在参与治疗首周结束时，未完成6周评估或未达干预依从要求的脱落者，对其与提供在线指导的导师的合作体验满意度显著更低。更强的自我改变能力信心与更高的控制型动机（即因外界压力而产生改变意愿），可显著预测更低的6周评估脱落率。与治疗中心治疗师的更强治疗联结、更低的心理痛苦水平，与更高的自主型动机（即自我导向的改变动机）、改变的重要性感知及改变能力呈正相关。研究数据表明，针对神经性厌食症患者的新型在线指导式自助干预具备临床可行性。参与者对项目的早期满意度与改变的外部压力，对脱落风险具有保护作用。 临床试验注册：www.ClinicalTrials.gov，编号NCT02336841。