Abstract
Purpose of Review
Digital (i.e., online, mobile) interventions have potential to increase access to care for people with eating disorders, but engagement with digital interventions has been challenging. Human-centered design is a methodology that centralizes the design of technologies on the people who will be using them and the settings in which they will be implemented, to yield solutions with high engagement and clinical impact. The paper presents an overview of the human-centered design process, followed by a review of publications that have applied design methods to digital interventions for eating disorders.
Recent Findings
Design research has been conducted via needs assessments, prototyping and usability studies, and during ongoing delivery of digital eating disorder interventions.
Summary
There has been growing research applying design methods to digital interventions for eating disorders. Additional opportunities include designing for implementation, designing for equity, and designing for the optimization of digital interventions over time.
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Data Availability
Data sharing is not applicable to this article as no new data were created or analyzed.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, et al. Social and economic cost of eating disorders in the United States: evidence to inform policy action. Int J Eat Disord. 2021;54(5):851–68. https://doi.org/10.1002/eat.23486.
Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord. 2009;42(2):97–103. https://doi.org/10.1002/eat.20589.
Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE. Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord. 2017;50(3):170–89. https://doi.org/10.1002/eat.22670.
Department of Health and Human Services NIH, National Institute of Mental Health, National Advisory Mental Health Council. Opportunities and Challenges of Developing Information Technologies on Behavioral and Social Science Clinical Research. 2017.
Kass AE, Balantekin KN, Fitzsimmons-Craft EE, Jacobi C, Wilfley DE, Taylor CB. The economic case for digital interventions for eating disorders among United States college students. Int J Eat Disord. 2017;50(3):250–8. https://doi.org/10.1002/eat.22680.
Taylor CB, Graham AK, Flatt RE, Waldherr K, Fitzsimmons-Craft EE. Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. Eur J Public Health. 2020. https://doi.org/10.1093/eurpub/ckz208.
Yardley L, Spring BJ, Riper H, Morrison LG, Crane DH, Curtis K, et al. Understanding and promoting effective engagement with digital behavior change interventions. Am J Prev Med. 2016;51(5):833–42. https://doi.org/10.1016/j.amepre.2016.06.015.
Mohr DC, Weingardt KR, Reddy M, Schueller SM. Three problems with current digital mental health research … and three things we can do about them. Psychiatr Serv. 2017;68(5):427–9. https://doi.org/10.1176/appi.ps.201600541.
Mohr DC, Lyon AR, Lattie EG, Reddy M, Schueller SM. Accelerating digital mental health research from early design and creation to successful implementation and sustainment. J Med Internet Res. 2017;19(5):e153. https://doi.org/10.2196/jmir.7725.
Mohr DC, Riper H, Schueller SM. A solution-focused research approach to achieve an implementable revolution in digital mental health. JAMA Psychiat. 2018;75(2):113–4. https://doi.org/10.1001/jamapsychiatry.2017.3838.
Graham AK, Lattie EG, Mohr DC. Experimental therapeutics for digital mental health. JAMA Psychiat. 2019. https://doi.org/10.1001/jamapsychiatry.2019.2075.
Graham AK, Kwasny MJ, Lattie EG, Greene CJ, Gupta NV, Reddy M, et al. Targeting subjective engagement in experimental therapeutics for digital mental health interventions. Internet Interv. 2021;25:100403. https://doi.org/10.1016/j.invent.2021.100403.
Altman M, Huang TTK, Breland JY. Design thinking in health care. Prev Chronic Dis. 2018;15:E117. https://doi.org/10.5888/pcd15.180128.
Linardon J, Messer M, Rodgers RF, Fuller-Tyszkiewicz M. A systematic scoping review of research on COVID-19 impacts on eating disorders: a critical appraisal of the evidence and recommendations for the field. Int J Eat Disord. 2022;55(1):3–38. https://doi.org/10.1002/eat.23640.
Taylor CB, Fitzsimmons-Craft EE, Graham AK. Digital technology can revolutionize mental health services delivery: the COVID-19 crisis as a catalyst for change. Int J Eat Disord. 2020. https://doi.org/10.1002/eat.23300.
• Graham AK, Wildes JE, Reddy M, Munson SA, Barr Taylor C, Mohr DC. User-centered design for technology-enabled services for eating disorders. Int J Eat Disord. 2019;52(10):1095–107.https://doi.org/10.1002/eat.23130. This review presents a model of the human-centered design process and describes methods and techniques that can be applied at different stages of design.
Martin B, Hanington B. Universal methods of design. Beverly, MA: Rockport Publishers; 2012.
Design Council. The ‘double diamond’ design process model. 2005.
Howard Z. Design thinking for designing and delivering services, Design Thinking Workshop. 2014.
Costa R. The Double Diamond model: what is it and should you use it? Justinmind, 2018.
Choudhary S: Design thinking: divergence and convergence cycles. https://medium.com/@i.shubhangich/design-thinking-divergence-and-convergence-cycles-3ce7a6f27815 (2019). Accessed 21 May, 2020.
Houde S, Hill C. What do prototypes prototype? In: Helander M, Landauer T, Prabhu P, editors. Handbook of human-computer interaction. 2nd ed. Amsterdam: Elsevier Science B. V. 1997.
Linardon J, Messer M, Lee S, Rosato J. Perspectives of e-health interventions for treating and preventing eating disorders: descriptive study of perceived advantages and barriers, help-seeking intentions, and preferred functionality. Eating and weight disorders : EWD. 2021;26(4):1097–109. https://doi.org/10.1007/s40519-020-01005-3.
Yim SH, Spencer L, Gordon G, Allen KL, Musiat P, Schmidt U. Views on online self-help programmes from people with eating disorders and their carers in UK. Eur J Public Health. 2021;31(31 Suppl 1):i88–93. https://doi.org/10.1093/eurpub/ckab046.
Honary M, Bell BT, Clinch S, Wild SE, McNaney R. Understanding the role of healthy eating and fitness mobile apps in the formation of maladaptive eating and exercise behaviors in young people. JMIR Mhealth Uhealth. 2019;7(6):e14239. https://doi.org/10.2196/14239.
Muir S, Newell C, Griffiths J, Walker K, Hooper H, Thomas S, et al. MotivATE: a pretreatment web-based program to improve attendance at UK Outpatient services among adults with eating disorders. JMIR Res Protoc. 2017;6(7):e146. https://doi.org/10.2196/resprot.7440.
Graham AK, Neubert SW, Chang A, Liu J, Fu E, Green EA, et al. Applying user-centered design methods to understand users’ day-to-day experiences can inform a mobile intervention for binge eating and weight management. Front Digit Health. 2021;3:651749. https://doi.org/10.3389/fdgth.2021.651749.
Fu E, Neubert SW, Chang A, Smith JD, Graham AK. Characterizing behavior change techniques used in the self-management of binge eating and weight: applying a user-centered design approach. Eat Behav. 2022;44:101591. https://doi.org/10.1016/j.eatbeh.2021.101591.
Weinheimer EA, Chang A, Neubert SW, Wildes JE, Graham AK. Past, current, and future willingness to engage with treatment targets: applying user-centered design to inform the design of a mobile behavioral intervention. Int J Eat Disord. 2020;53(4):611–7. https://doi.org/10.1002/eat.23252.
• Venkatesh A, Chang A, Green EA, Randall T, Gallagher R, Wildes JE, et al. Perceived facilitators and barriers to engaging with a digital intervention among those with food insecurity, binge eating, and obesity. Nutrients. 2021;13(7). https://doi.org/10.3390/nu13072458. This is the first study to use qualitative approaches to understand the experiences of people with food insecurity, recurrent binge eating, and obesity related to engaging in a digital intervention designed for this population.
• LaMonica HM, Milton A, Braunstein K, Rowe SC, Ottavio A, Jackson T, et al. Technology-enabled solutions for australian mental health services reform: impact evaluation. JMIR Form Res. 2020;4(11):e18759.https://doi.org/10.2196/18759. This paper offers an example of designing for context; the authors present results of an impact evaluation needs assessment with staff at different mental health care services who were preparing to implement a digital platform.
Maramis C, Moulos I, Ioakimidis I, Papapanagiotou V, Langlet B, Lekka I, et al. A smartphone application for semi-controlled collection of objective eating behavior data from multiple subjects. Comput Methods Programs Biomed. 2020;194:105485. https://doi.org/10.1016/j.cmpb.2020.105485.
Juarascio AS, Goldstein SP, Manasse SM, Forman EM, Butryn ML. Perceptions of the feasibility and acceptability of a smartphone application for the treatment of binge eating disorders: qualitative feedback from a user population and clinicians. Int J Med Informatics. 2015;84(10):808–16. https://doi.org/10.1016/j.ijmedinf.2015.06.004.
Juarascio A, Srivastava P, Presseller E, Clark K, Manasse S, Forman E. A Clinician-controlled just-in-time adaptive intervention system (CBT+) designed to promote acquisition and utilization of cognitive behavioral therapy skills in bulimia nervosa: development and preliminary evaluation study. JMIR Form Res. 2021;5(5):e18261. https://doi.org/10.2196/18261.
Manasse SM, Lampe EW, Juarascio AS, Zhu J, Forman EM. Using virtual reality to train inhibitory control and reduce binge eating: a proof-of-concept study. Appetite. 2021;157:104988. https://doi.org/10.1016/j.appet.2020.104988.
Graham AK, Munson SA, Reddy M, Neubert SW, Green EA, Chang A, et al. Integrating user-centered design and behavioral science to design a mobile intervention for obesity and binge eating: mixed methods analysis. JMIR Form Res. 2021;5(5):e23809. https://doi.org/10.2196/23809.
Liu J, Munson SA, Chang A, Voss C, Graham AK. Understanding self-monitoring to inform a mobile intervention for binge eating and weight management: a proof-of-concept randomized trial. Int J Eat Disord. 2022;55(5):642–52. https://doi.org/10.1002/eat.23700.
Beilharz F, Sukunesan S, Rossell SL, Kulkarni J, Sharp G. Development of a positive body image chatbot (KIT) with young people and parents/carers: qualitative focus group study. J Med Internet Res. 2021;23(6):e27807. https://doi.org/10.2196/27807.
Shah J, DePietro B, D’Adamo L, Firebaugh ML, Laing O, Fowler LA, et al. Development and usability testing of a chatbot to promote mental health services use among individuals with eating disorders following screening. Int J Eat Disord. 2022;55(9):1229–44. https://doi.org/10.1002/eat.23798.
•• Tregarthen JP, Lock J, Darcy AM. Development of a smartphone application for eating disorder self-monitoring. Int J Eat Disord. 2015;48(7):972–82.https://doi.org/10.1002/eat.22386. This is one of the first publications describing the application of the design process across several phases of development and deployment of an app for eating disorders.
Kim JP, Sadeh-Sharvit S, Darcy AM, Neri E, Vierhile M, Robinson A, et al. The utility and acceptability of a self-help smartphone application for eating disorder behaviors. J Technol Behav Sci. 2018;3(3):161–4.
Connelly K, Stein KF, Chaudry B, Trabold N. Development of an ecological momentary assessment mobile app for a low-literacy, Mexican American population to collect disordered eating behaviors. JMIR Public Health Surveill. 2016;2(2):e31. https://doi.org/10.2196/publichealth.5511.
LaMonica HM, Iorfino F, Lee GY, Piper S, Occhipinti JA, Davenport TA, et al. Informing the future of integrated digital and clinical mental health care: synthesis of the outcomes from project synergy. JMIR mental health. 2022;9(3):e33060. https://doi.org/10.2196/33060.
Nitsch M, Dimopoulos CN, Flaschberger E, Saffran K, Kruger JF, Garlock L, et al. A guided online and mobile self-help program for individuals with eating disorders: an iterative engagement and usability study. J Med Internet Res. 2016;18(1):e7. https://doi.org/10.2196/jmir.4972.
Nitsch M, Adamcik T, Kuso S, Zeiler M, Waldherr K. Usability and engagement evaluation of an unguided online program for promoting a healthy lifestyle and reducing the risk for eating disorders and obesity in the school setting. Nutrients. 2019;11(4). https://doi.org/10.3390/nu11040713.
• Yim SH, Bailey E, Gordon G, Grant N, Musiat P, Schmidt U. Exploring participants’ experiences of a web-based program for bulimia and binge eating disorder: qualitative study. J Med Internet Res. 2020;22(9):e17880. https://doi.org/10.2196/17880. The authors conducted a qualitative analysis of participants' experiences in a web-based intervention during the course of intervention delivery within a pragmatic randomized trial.
• Chan WW, Fitzsimmons-Craft EE, Smith AC, Firebaugh ML, Fowler LA, DePietro B, et al. The challenges in designing a prevention chatbot for eating disorders: observational study. JMIR Form Res. 2022;6(1):e28003.https://doi.org/10.2196/28003. The authors evaluated a chatbot for eating disorder prevention and presented the results of and lessons learned from iteratively evaluating user feedback and updating the chatbot during intervention delivery.
Psihogios AM, Lane-Fall MB, Graham AK. Adolescents are still waiting on a digital health revolution: accelerating research-to-practice translation through design for implementation. JAMA Pediatr. 2022;176(6):545–6. https://doi.org/10.1001/jamapediatrics.2022.0500.
•• Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. Nature Reviews Psychology. 2022;1(2):87–100.https://doi.org/10.1038/s44159-021-00003-1. This review summarizes the evidence base for various digital mental health interventions and presents recommendations for ensuring equity in access among diverse populations.
Lyles CR, Wachter RM, Sarkar U. Focusing on digital health equity. JAMA. 2021;326(18):1795–6. https://doi.org/10.1001/jama.2021.18459.
Figueroa CA, Luo T, Aguilera A, Lyles CR. The need for feminist intersectionality in digital health. Lancet Digit Health. 2021;3(8):e526–33. https://doi.org/10.1016/s2589-7500(21)00118-7.
Burke NL, Schaefer LM, Hazzard VM, Rodgers RF. Where identities converge: the importance of intersectionality in eating disorders research. Int J Eat Disord. 2020;53(10):1605–9. https://doi.org/10.1002/eat.23371.
Mohr DC, Cheung K, Schueller SM, Hendricks Brown C, Duan N. Continuous evaluation of evolving behavioral intervention technologies. Am J Prev Med. 2013;45(4):517–23. https://doi.org/10.1016/j.amepre.2013.06.006.
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This work was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK116925).
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AKG reports grants from the NIDDK during the conduct of the study, as well as personal fees from Alavida Health and Actualize Therapy and grants from the NIMH outside the submitted work. TAM reports personal fees from Adaptive-Health outside the submitted work. JAK has nothing to disclose.
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Graham, A.K., Kosmas, J.A. & Massion, T.A. Designing Digital Interventions for Eating Disorders. Curr Psychiatry Rep 25, 125–138 (2023). https://doi.org/10.1007/s11920-023-01415-x
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DOI: https://doi.org/10.1007/s11920-023-01415-x