Attrition and adherence in the online treatment of chronic insomnia

Behav Sleep Med. 2010;8(3):141-50. doi: 10.1080/15402002.2010.487457.


This study examined the ability of the Theory of Planned Behavior (TPB; Ajzen, 1985) and the Transtheoretical Model of Behavior Change (TTM; Prochaska & DiClemente, 1983) to explain adherence and attrition in an online treatment program for chronic insomnia. Responses to questionnaire measures of the TPB and TTM were used to predict adherence and dropout over the subsequent 5 weeks of treatment. Results showed that there was a 17% dropout rate and that perceived behavioral control, social support, and intention to complete the program were significantly associated with adherence to sleep hygiene homework. Attrition was predicted only by symptom severity and psychiatric comorbidity. Implications are that these models should be considered to maximize adherence.

MeSH terms

  • Adult
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Mental Disorders / complications
  • Mental Disorders / psychology
  • Patient Compliance / psychology*
  • Patient Dropouts / psychology*
  • Patient Dropouts / statistics & numerical data
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / complications
  • Sleep Initiation and Maintenance Disorders / psychology*
  • Sleep Initiation and Maintenance Disorders / therapy
  • Therapy, Computer-Assisted / methods
  • Therapy, Computer-Assisted / statistics & numerical data*