A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study

Martina Nitsch, Christina N Dimopoulos, Edith Flaschberger, Kristina Saffran, Jenna F Kruger, Lindsay Garlock, Denise E Wilfley, Craig B Taylor, Megan Jones, Martina Nitsch, Christina N Dimopoulos, Edith Flaschberger, Kristina Saffran, Jenna F Kruger, Lindsay Garlock, Denise E Wilfley, Craig B Taylor, Megan Jones

Abstract

Background: Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement.

Objective: The aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program-a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement.

Methods: We conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires.

Results: Participants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users' symptoms, the program's features and effectiveness, trust, anonymity, and affordability were relevant to engagement.

Conclusions: This study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of "real-world" adoption.

Keywords: adherence; digital health intervention; dropout; eating disorder; engagement; mobile application; online program; self-help; usability study.

Conflict of interest statement

Conflicts of Interest: MJ and LG are employed at Lantern, which is a for-profit digital health company. However, they did not have any contact with participants, data, and were not involved in analysis and thus could not in any way bias results.

Figures

Figure 1
Figure 1
Mobile app of the Student Bodies–Eating Disorders program.
Figure 2
Figure 2
Integrated messaging function of the Student Bodies–Eating Disorders program.

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