Intervention Adherence And Cognitive Processing In Adolescents: A Secondary Analysis Of A School-Based Randomized Controlled Trial

Abstract

Background: Participant adherence is an important component of intervention implementation and may influence the extent of exposure to behavioural programmes. While randomized controlled trials commonly evaluate intervention efficacy, secondary analyses examining the relationship between adherence and outcomes provide valuable evidence regarding intervention dose and participant engagement.   Objective: To examine whether adherence to a structured mind–body intervention was associated with changes in intuitive and rational cognitive processing among adolescents participating in a school-based randomized controlled trial.   Methods: This secondary analysis included participants allocated to the intervention arm of a randomized controlled trial conducted among adolescents aged 10–15 years. Attendance records were maintained throughout the intervention period. Based on overall attendance, participants were classified into a high-adherence group (≥90% attendance; n = 26) and a low-adherence group (<90% attendance; n = 12). Change scores were calculated by subtracting baseline scores from post-intervention scores. Between-group comparisons were performed using the Mann–Whitney U test.   Results: Attendance ranged from 73% to 99% of scheduled sessions. Twenty-six participants (68.4%) demonstrated high adherence, while twelve (31.6%) had attendance below 90%. Participants with high adherence showed significantly greater improvements in intuitive processing than those with lower adherence (U = 96.50, p = 0.028). Similarly, rational processing improved significantly more among participants with high adherence (U = 102.00, p = 0.041).   Conclusion: Greater adherence to the intervention was associated with superior cognitive outcomes. These findings suggest that greater intervention exposure and consistent participation may be associated with greater improvements in cognitive processing among adolescents and highlight the importance of strategies that promote consistent engagement in school-based interventions.