Understanding Behavioral Influences on Eating Disorders and App Engagement to Inform Eating Disorder App Development:...

Area of Science:

• Psychology
• Digital Health
• Behavioral Science

Background:

• Eating disorders (EDs) are severe mental health conditions with limited treatment access.
• Digital interventions offer potential but often lack systematic behavior change frameworks and lived experience input.
• This gap hinders effective targeting of mechanisms underlying ED behaviors.

Purpose of the Study:

• To identify priority behavioral change targets for ED apps.
• To capture lived experience perspectives on factors maintaining disordered eating and driving app engagement.
• To map determinants using the COM-B and TDF frameworks to guide app development.

Main Methods:

• Conducted 6 focus groups with 18 adults with lived experience of EDs in the UK.
• Explored psychological, social, and environmental determinants of disordered eating and app engagement.
• Utilized a hybrid thematic analysis applying the COM-B model and TDF, mapping themes to behavior change techniques.

Main Results:

• Identified needs across 5/6 COM-B and 13/14 TDF domains for changing ED behaviors and app engagement.
• Highlighted the importance of less-targeted domains like identity and belief in capabilities.
• Emphasized that implementation, not just content, affects effectiveness; sex and culture moderate needs, necessitating personalization.

Conclusions:

• This study is the first to apply COM-B and TDF to ED behaviors and app engagement, revealing overlooked mechanisms and design pitfalls.
• Provides a blueprint for developing safer, personalized, and behaviorally effective ED apps.
• Stresses the need for ongoing collaboration with diverse lived experience to advance digital ED interventions.