Adherence analyses
REGRESSION, SECONDARY, TRANSFORMATION
Overall adherence will be measured by class attendance across the two groups. For all other analyses we will focus on adherence within the structured group, in this case the primary adherence metric will focus on a total adherence metric (e.g., EMMA usage), but secondary analyses will investigate adherence metrics representing the different intervention components as measured in EMMA (e.g., use of the calendar, weekly healthy lifestyle behaviors). We will utilize the adherence metrics collected during the two weeks prior to the post-intervention assessment as a measure of adherence during the intervention, and we will also assess adherence changes over time through the 6- and 12-month post-intervention assessments. For adherence during the intervention, linear regression will be used with the adherence metric as the outcome and participant characteristics or tool use as independent variables. Transformations or non-linear models will be used if suggested by model diagnostics. Repeated measures, random effects models will be used to assess change over time in adherence and whether certain participant characteristics, or tool use at each assessment, are associated with change in adherence. Finally, repeated measures, random effects models will be used to assess the association between adherence and change in Aim 1 primary and secondary outcomes. If we find that adherence changes over time, change in adherence will be considered as a time-varying independent variable in the models to see how it influences trial outcomes at later assessments.For the qualitative data analysis, participants’ responses to the open-ended interview questions will be coded and analyzed by a team of trained reviewers. Common patterns related to adherence will be identified and resulting themes will be derived iteratively; the frequency of each theme will be tabulated. These analyses will complement quantitative analyses and provide further insight on the relationship between adherence and the primary and secondary outcome measures, components of the intervention important for treatment effectiveness, and reasons for poor uptake.