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

Background Integrating therapist-led sessions and Cognitive Behavioural Therapy (CBT) materials within one online platform may be effective for people with depression. A trial evaluating this mode of delivering CBT is being conducted. To maximize future trial recruitment and understand patients’ views of health interventions, it is important to explore reasons for declining to participate.

Aim To explore patients’ reasons for declining to participate in a trial of integrated online CBT for depression.

Design & setting A mixed methods study collecting data from patients via questionnaires and telephone interviews at the three UK trial sites.

Method Individuals completed a short questionnaire about their reasons for not taking part in the trial. Telephone interviews further explored these reasons with a sub-group. Quantitative data were summarized using descriptive statistics. Qualitative interviews were analysed thematically.

Results Of 1799 patients who responded to an invitation to participate in the trial, 40.3% declined contact. The most common reasons were not wanting: to take part in research (n=387); therapy provided online (n=284); to receive CBT (n=262). Qualitative interviews with 15 ‘decliners’ highlighted that decisions related to perceptions of eligibility, previous experiences of CBT and uncertainty about receiving CBT online. Personal circumstances, depressive symptoms or other mental health issues were also barriers to participation.

Conclusion Reasons given by primary care patients for not taking part in a trial of integrated online CBT suggest that, at the point of recruitment, it is important to discuss the patient’s perceptions of their eligibility and whether they would accept the intervention being evaluated.