The peril of self-reported adherence in digital interventions: A brief example

• Published in: Internet interventions : the application of information technology in mental and behavioural health 2019-12, Vol.18, p.100267-100267, Article 100267
• Main Authors: Flett, Jayde A.M., Fletcher, Benjamin D., Riordan, Benjamin C., Patterson, Tess, Hayne, Harlene, Conner, Tamlin S.
• Format: Article
• Language: English
• Subjects: Adherence; Applications; Digital interventions; Mobile phones
• ISSN: 2214-7829; 2214-7829
• DOI: 10.1016/j.invent.2019.100267

Adherence is an important predictor of intervention outcomes, but not all measures of adherence are created equally. Here, we analyzed whether there was a discrepancy between self-report adherence and objective adherence in a digital mindfulness meditation randomised, controlled trial. A sample of 174 young adult undergraduate university students trialled either an app-based or email-based mindfulness meditation program (or an app-based attention control). Participants' adherence (number of sessions completed) and mental health was self-reported. Objective adherence data were provided by the owners of the digital mindfulness programs. We found evidence of inflated self-reported adherence to the app-based intervention and argue that the inflation was not explained by social desirability biases because participants were aware we would have access to object data and no remuneration was tied to adherence. We also comment on the different conclusions we would have drawn about the effectiveness of the digital interventions on mental health, had we used the self-reported adherence data rather than the objective adherence data. We use this example to suggest that it may be perilous to rely on self-reported measures of adherence when assessing the effectiveness of digital interventions. •Self-reported adherence is not an accurate representation of objective digital intervention adherence.•App-based intervention use, but not email-based intervention use, was associated with self-reported adherence over-reporting.•Self-reported adherence using experience sampling methods was not more accurate than retrospective self-reported adherence.