Improving treatment engagement in people with eating disorders: utilising digital approaches.

Abstract

Engaging people with psychological treatment is vital to ensuring effective outcomes. This is particularly relevant to the treatment of eating disorders, as up to 35% of individuals referred to an eating disorder service never access treatment. Internet- based programs have emerged as a novel approach to the treatment of eating disorders, however these too have reported issues with lack of uptake and engagement. The aims of this research were (1) to assess the effectiveness of a novel pre-treatment motivational web based intervention (MotivATE) at improving treatment attendance at an eating disorders service, and (2) to explore the factors that might influence engagement with online support tools. An initial systematic review indicated that brief motivational interventions were acceptable for addressing low motivation to change and engagement issues, with online interventions highlighted as a viable delivery method. However, the results of a zelen randomised trial in a local eating disorder service showed no increase in attendance for those offered access to the MotivATE intervention. Only one third of participants offered access to MotivATE actually registered to use the intervention, suggesting that issues with uptake were potentially a key factor in the lack of demonstrated effectiveness. A concurrent online focus group suggested that whilst people with eating disorders do identify a potential role within treatment for online support such as MotivATE, this is limited by negative attitudes towards these approaches which may contribute to low uptake. However, it was also noted that factors such as exposure to online support and effective design may serve to help mitigate these negative attitudes. This was supported by an online survey in which participants rated a range of designs of the front page of MotivATE for aesthetics and behavioural indicators derived from an adapted technology acceptance model. Multi-level modelling of this data showed that judgements of simplicity and craftsmanship significantly influenced behavioural intentions towards the intervention; a finding that was supported in a final online study that compared levels of use and changes in attitudes pre/post between MotivATE and a version redesigned using the factors highlighted in the previous study. Whilst MotivATE was not shown to be effective at improving treatment attendance in its current state, digital approaches may still represent a viable and potentially effective approach to addressing issues with treatment engagement, particularly early in the treatment pathway. However, in order not to themselves be significantly impacted by low engagement, the way in which these interventions are both designed and presented needs to be carefully considered. This research provides a novel contribution to the literature both through the development and piloting of an intervention to increase treatment engagement in people with eating disorders, as well as furthering our understanding of how users engage with digital interventions, in particular the role of visual aesthetics.