An intervention may potentially be incredibly beneficial and innovative, but it does little good if individuals do not adhere to the intervention protocol. The same is true for any behavioral intervention that involves technology: If a participant does not actually use the BIT, there will likely be no noticeable change in the outcome of interest. Murray (2012, p. e3) states, “Adherence to any specified intervention may be related to characteristics of the intervention, characteristics of the user, or characteristics of the condition addressed by the intervention.” Predictors of adherence, as identified by Kelders, Kok, Ossebaard, and Van Gemert-Pijnen (2012) in systematic review of Internet-based health interventions, included: being involved in a randomized controlled trial intervention as opposed to an observational study; increased interaction with a counselor; intended use of BITs; increased updates (in the form of new information uploaded for participants or new “lessons” becoming available) in intervention content; and increased use of dialogue support (e.g., a BIT forwarding a message to a participant after successfully completing an intervention task). Adherence can be increased through a variety of mechanisms that depend heavily on the characteristics of the BIT, intervention, and study population—examples include rewards and incentives for participants for successfully adhering to the protocol (Thompson et al., 2008) or instituting periodic prompts to remind participants to use the BIT or increased interactivity (Fry & Neff, 2009).

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