ANALYZING ACCEPTANCE AND ADHERENCE FACTORS IN A DIGITAL INTERVENTION FOR WOMEN WITH GYNECOLOGICAL CONDITIONS AND SEXUAL DYSFUNCTIONS: A MIXED-METHODS STUDY

This study investigates the feasibility of a digital intervention for adults with endometriosis and sexual distress, focusing on acceptance and adherence compared to treatment as usual (TAU). Sexual distress impacts approximately 68% of women with endometriosis and access to health care providers is scarce. Scalable digital health interventions have the potential to improve health care but adherence remains challenging. This study aims to identify factors that may enhance retention in future interventions.

We employ a randomized controlled, mixed-methods design with 60 participants, diagnosed or suspected of endometriosis and significant sexual distress (Female Sexual Distress Scale (FSDS) score > 18), allocated to digital intervention or TAU control group. The intervention spans eight modules over 8 to 12 weeks. In the intervention group, acceptance is evaluated through quantitative measures – including the Visual Analog Scale (VAS), Client Satisfaction Questionnaire (CSQ-8), Client Satisfaction with Internet Interventions Questionnaire (CSWIQ-8), and German mHealth App Usability Questionnaire (G-MAUQ) – as well as focus group discussions with participants who complete the intervention. Adherence is assessed via dropout rates, weekly engagement, and completion metrics, with dropout defined as four consecutive weeks of inactivity. Participants who discontinue are invited for free list interviews to explore their reasons for withdrawal.

Data collection is ongoing with 35 participants enrolled (age 20-58 years, mean FSDS-DAO score 35.5). Dropouts from the intervention group are invited for free list interviews to identify contributing factors, prevention strategies, and areas for improvement. Once initial participants complete the intervention, focus groups will further assess acceptance and satisfaction. Qualitative data will be analyzed using inductive thematic analysis. Quantitatively, acceptance (VAS, CSQ-8, CSWIQ-8, G-MAUQ) and adherence metrics (dropout rates, engagement, completion) are assessed, with group comparisons using two-sided t-tests and continuous outcomes analyzed using ANCOVA on an intention-to-treat basis.

This study addresses key acceptance and adherence factors in digital health interventions for managing endometriosis-related sexual distress, offering insights for user-centered design in sustainable digital health solutions. Findings will guide the development of more engaging, accessible interventions. Upon demonstrating feasibility, the next phase will involve a clinical efficacy trial.

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