@Article{info:doi/10.2196/13609,
author="Mohr, David C
and Schueller, Stephen M
and Tomasino, Kathryn Noth
and Kaiser, Susan M
and Alam, Nameyeh
and Karr, Chris
and Vergara, Jessica L
and Gray, Elizabeth L
and Kwasny, Mary J
and Lattie, Emily G",
title="Comparison of the Effects of Coaching and Receipt of App Recommendations on Depression, Anxiety, and Engagement in the IntelliCare Platform: Factorial Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="Aug",
day="28",
volume="21",
number="8",
pages="e13609",
keywords="depression; anxiety; mHealth; clinical trial",
abstract="Background: IntelliCare is a modular platform that includes 12 simple apps targeting specific psychological strategies for common mental health problems. Objective: This study aimed to examine the effect of 2 methods of maintaining engagement with the IntelliCare platform, coaching, and receipt of weekly recommendations to try different apps on depression, anxiety, and app use. Methods: A total of 301 participants with depression or anxiety were randomized to 1 of 4 treatments lasting 8 weeks and were followed for 6 months posttreatment. The trial used a 2X2 factorial design (coached vs self-guided treatment and weekly app recommendations vs no recommendations) to compare engagement metrics. Results: The median time to last use of any app during treatment was 56 days (interquartile range 54-57), with 253 participants (84.0{\%}, 253/301) continuing to use the apps over a median of 92 days posttreatment. Receipt of weekly recommendations resulted in a significantly higher number of app use sessions during treatment (overall median=216; P=.04) but only marginal effects for time to last use (P=.06) and number of app downloads (P=.08). Coaching resulted in significantly more app downloads (P<.001), but there were no significant effects for time to last download or number of app sessions (P=.36) or time to last download (P=.08). Participants showed significant reductions in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) across all treatment arms (P s<.001). Coached treatment led to larger GAD-7 reductions than those observed for self-guided treatment (P=.03), but the effects for the PHQ-9 did not reach significance (P=.06). Significant interaction was observed between receiving recommendations and time for the PHQ-9 (P=.04), but there were no significant effects for GAD-7 (P=.58). Conclusions: IntelliCare produced strong engagement with apps across all treatment arms. Coaching was associated with stronger anxiety outcomes, and receipt of recommendations enhanced depression outcomes. Trial Registration: ClinicalTrials.gov NCT02801877; https://clinicaltrials.gov/ct2/show/NCT02801877 ",
issn="1438-8871",
doi="10.2196/13609",
url="http://www.jmir.org/2019/8/e13609/",
url="https://doi.org/10.2196/13609",
url="http://www.ncbi.nlm.nih.gov/pubmed/31464192"
}