Background: Psychosocial, self-guided, internet-based programs are effective in treating depression and anxiety. However, the community uptake of these programs is poor. Recent approaches to increasing engagement (defined as both uptake and adherence) in internet-based programs include brief engagement facilitation interventions (EFIs). However, these programs require evaluation to assess their efficacy. Objective: The aims of this hybrid implementation effectiveness trial are to examine the effects of a brief internet-based EFI presented before an internet-based cognitive behavioral therapy self-help program (myCompass 2) in improving engagement (uptake and adherence) with that program (primary aim), assess the relative efficacy of the myCompass 2 program, and determine whether greater engagement was associated with improved efficacy (greater reduction in depression or anxiety symptoms) relative to the control (secondary aim). Methods: A 3-arm randomized controlled trial (N=849; recruited via social media) assessed the independent efficacy of the EFI and myCompass 2. The myCompass 2 program was delivered with or without the EFI; both conditions were compared with an attention control condition. The EFI comprised brief (5 minutes), tailored audio-visual content on a series of click-through linear webpages. Results: Uptake was high in all groups; 82.8% (703/849) of participants clicked through the intervention following the pretest survey. However, the difference in uptake between the EFI + myCompass 2 condition (234/280, 83.6%) and the myCompass 2 alone condition (222/285, 77.9%) was not significant (n=565; χ21=29.2; P=.09). In addition, there was no significant difference in the proportion of participants who started any number of modules (1-14 modules) versus those who started none between the EFI + myCompass 2 (214/565, 37.9%) and the myCompass 2 alone (210/565, 37.2%) conditions (n=565; χ21P=.87). Finally, there was no significant difference between the EFI + myCompass 2 and the myCompass 2 alone conditions in the number of modules started (U=39366.50; z=−0.32; P=.75) or completed (U=39494.0; z=−0.29; P=.77). The myCompass 2 program was not found to be efficacious over time for symptoms of depression (F4,349.97=1.16; P=.33) or anxiety (F4,445.99=0.12; P=.98). However, planned contrasts suggested that myCompass 2 may have been effective for participants with elevated generalized anxiety disorder symptoms (F4,332.80=3.50; P=.01). Conclusions: This brief internet-based EFI did not increase the uptake of or adherence to an existing internet-based program for depression and anxiety. Individuals’ motivation to initiate and complete internet-based self-guided interventions is complex and remains a significant challenge for self-guided interventions. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12618001565235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839

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中文翻译：

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提高抑郁症和焦虑症基于互联网的计划的接受度和依从性的简短干预措施（增强社会心理干预的参与度）：随机对照试验

背景：社会心理、自我指导、基于互联网的项目可有效治疗抑郁和焦虑。然而，社区对这些计划的接受度很差。最近在基于互联网的计划中增加参与度（定义为吸收和坚持）的方法包括简短的参与促进干预 (EFI)。但是，这些计划需要评估以评估其功效。目标：这项混合实施有效性试验的目的是检查在基于互联网的认知行为治疗自助计划 (myCompass 2) 之前提交的基于互联网的简短 EFI 对提高该计划的参与度（吸收和依从性）的影响（主要目标），评估 myCompass 2 程序的相对功效，并确定与对照组（次要目标）相比，更大程度的参与是否与提高疗效（抑郁或焦虑症状的减轻程度更大）相关。方法：一项 3 臂随机对照试验（N=849；通过社交媒体招募）评估了 EFI 和 myCompass 2 的独立功效。myCompass 2 程序在有或没有 EFI 的情况下交付；两种条件都与注意力控制条件进行了比较。EFI 包括一系列可点击的线性网页上的简短（5 分钟）、量身定制的视听内容。结果：所有组的吸收率都很高；82.8% (703/849) 的参与者在前测调查后点击了干预。但是，EFI + myCompass 2 条件 (234/280, 83.6%) 和单独使用 myCompass 2 条件 (222/285, 77. 9%）不显着（n=565；χ21=29.2；P=.09）。此外，在 EFI + myCompass 2 (214/565, 37.9%) 和单独的 myCompass 2 之间，开始任何数量模块（1-14 个模块）的参与者与未开始的参与者比例没有显着差异（ 210/565, 37.2%）条件（n=565；χ21P=.87）。最后，EFI + myCompass 2 和单独使用 myCompass 2 的条件在模块数量开始（U=39366.50；z=-0.32；P=.75）或完成（U=39494.0；z=-）方面没有显着差异0.29；P=.77）。没有发现 myCompass 2 程序随着时间的推移对抑郁症 (F4,349.97=1.16; P=.33) 或焦虑症 (F4,445.99=0.12; P=.98) 的症状有效。然而，计划的对比表明 myCompass 2 可能对广泛性焦虑症症状升高的参与者有效 (F4,332.1)。80=3.50；P=.01）。结论：这个基于互联网的简短 EFI 没有增加对现有的基于互联网的抑郁和焦虑计划的采用或坚持。个人发起和完成基于互联网的自我指导干预的动机是复杂的，并且仍然是自我指导干预的重大挑战。临床试验：澳大利亚新西兰临床试验注册处 ACTRN12618001565235；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839 澳大利亚新西兰临床试验注册中心 ACTRN12618001565235；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839 澳大利亚新西兰临床试验注册中心 ACTRN12618001565235；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839

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