Differential attrition in health behaviour change trials: A systematic review and meta-analysis |
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| Authors: | Rik Crutzen Wolfgang Viechtbauer Mark Spigt Daniel Kotz |
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| Institution: | 1. CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlandsrik.crutzen@maastrichtuniversity.nl;3. MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands;4. CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands;5. Department of General Practice, Tromso University, Tromso, Norway;6. Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK |
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| Abstract: | Objective: Attrition is a common problem in health behaviour change (HBC) trials. When the degree of attrition differs between treatment conditions, then this is called differential attrition and is regarded as a major threat to internal validity. The primary research question of this study was: how often and to what degree does differential attrition occur in HBC trials?Design: A systematic review and meta-analysis of a random selection of HBC trials (k = 60). We meta-analysed the relative attrition rates using a random-effects model and examined the relationship between the relative attrition rates and the potential moderators: the amount of human contact in delivery and the intensity of the intervention/control condition, the type of control condition, and the follow-up intensity and duration.Main outcome measures: Relative attrition rates.Results: The average attrition rate was 18% (SD = .15; M = .15) in the intervention and 17% (SD = .13; M = .13) in the control conditions. The estimated average relative attrition rate was 1.10 (95% CI: 1.01–1.20, p = .02), suggesting an overall higher attrition rate of 10% in the intervention conditions. This relative attrition rate was not related to any of the potential moderators.Conclusion: There is indication of a slightly higher amount of attrition on average in the intervention conditions of HBC trials. |
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| Keywords: | differential attrition bias RCT health behaviour change internal validity |
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