Recruitment, adherence and attrition challenges in internet-based indicated prevention programs for eating disorders: lessons learned from a randomised controlled trial of ProYouth OZ

Kathina Ali; Daniel B Fassnacht; Louise M Farrer; Elizabeth Rieger; Markus Moessner; Stephanie Bauer; Kathleen M Griffiths

doi:10.1186/s40337-021-00520-7

Recruitment, adherence and attrition challenges in internet-based indicated prevention programs for eating disorders: lessons learned from a randomised controlled trial of ProYouth OZ

J Eat Disord. 2022 Jan 4;10(1):1. doi: 10.1186/s40337-021-00520-7.

Authors

Kathina Ali^{1

2

3

4}, Daniel B Fassnacht^{5

6

7}, Louise M Farrer⁸, Elizabeth Rieger⁵, Markus Moessner⁹, Stephanie Bauer⁹, Kathleen M Griffiths⁵

Affiliations

¹ Research School of Psychology, The Australian National University, Canberra, Australia. kathina.ali@flinders.edu.au.
² Centre for Mental Health Research, The Australian National University, Canberra, Australia. kathina.ali@flinders.edu.au.
³ College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia. kathina.ali@flinders.edu.au.
⁴ Órama Institute for Mental Health and Wellbeing, Adelaide, Australia. kathina.ali@flinders.edu.au.
⁵ Research School of Psychology, The Australian National University, Canberra, Australia.
⁶ College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
⁷ Órama Institute for Mental Health and Wellbeing, Adelaide, Australia.
⁸ Centre for Mental Health Research, The Australian National University, Canberra, Australia.
⁹ Centre for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.

Abstract

Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders, but the adjunctive benefit of synchronous peer support has yet to be investigated. In the current study, a randomised controlled trial was conducted to evaluate the effectiveness of an indicated Internet-based prevention program (ProYouth OZ) with and without peer-to-peer support in reducing disordered eating behaviours and attitudes.

Method: Fifty young adults (18-25 years) with eating disorder symptoms were randomised to one of three study conditions: (1) ProYouth OZ (without peer-to-peer support), (2) ProYouth OZ Peers (with peer-to-peer support), and (3) a waitlist control group. Outcomes were assessed at three different time points. Eating disorder symptoms (primary outcome) were measured with the Eating Disorder Examination Questionnaire.

Results: Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms. Fifteen participants (30%) completed the post-intervention survey. Of the two intervention groups, 20.6% failed to access any component of the program. Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2-5 sessions, and 11.8% attended all six sessions. Due to limited outcome data, it was not possible to statistically examine between-group differences in outcomes. Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ.

Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community. The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs. offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology but may not be ready or able to seek professional face-to-face treatment.

Trial registration: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527.

Keywords: Barriers; Body image; Digital health; Eating disorder literacy; Help-seeking; Mental health; Online intervention; Peer support; Stigma.

Plain language summary

Internet-based prevention programs for eating disorders are effective, but a variety of challenges have been found when offering them in real-world settings. The current study aimed to test ProYouth OZ, an Internet-based eating disorder prevention program consisting of multiple components including peer support. In total, 50 young adults (18–25 years) with eating disorder symptoms were allocated to one of three versions of the program. In total, 21% did not access the program. From 17 participants in the peer support group, 60% attended at least one chat session and 12% attended all six sessions. Given that only fifteen participants (30%) completed the questionnaire after the intervention, it is not possible to draw reliable conclusions about the effectiveness of the program. Findings demonstrate the difficulty of recruiting emerging adults, engaging them with the program and collecting data after participation. The majority of interested participants experienced an eating disorder, suggesting they may be searching for help online. Future studies should investigate the use of peer support, identify strategies for reaching eligible participants and develop approaches to increase engagement. Finally, it is important to develop innovative programs that provide self-help strategies and facilitate help-seeking for those who are experiencing an eating disorder.