Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Eating Disorder | Research

Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation

Authors: Benjamin Naccache, Laure Mesquida, Jean-Philippe Raynaud, Alexis Revet

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Anorexia Nervosa (AN) is a key target for E-Health programs considering the many barriers hindering patients’ access to care and the disorder’s severity. Although these programs have become more common and effective, they often have low adherence, especially among youth. This can hinder their implementation and effectiveness in real-world settings. User experience partly overlaps with the acceptability field and may provide insight into factors affecting adherence and adoption of E-Health programs. This study aimed to explore early acceptability and user experience of a companion app prototype for adolescents with AN using user-centered design methods.

Methods

We developed a prototype containing self-help material and emotions and behaviors evaluation and management features. Then we conducted a mixed evaluation combining semi structured focus group interviews and questionnaires in a clinician group and an AN patient group. We analyzed data using thematic analysis and descriptive statistics.

Results

The app’s overall appeal was adequate. The user experience questionnaire revealed the weakest dimensions, including novelty, dependability, and efficiency versus stimulation (i.e., ability to induce motivation to use the product) and perspicuity (i.e., easy to understand, to get familiar with). The qualitative data analysis revealed three central axes: acceptability, features, and use. We identified acceptability barriers and facilitators such as the importance of design and customization, especially for adolescents. Psychoeducation was a major feature for participants, as patients highlighted the difficulties they encountered when seeking disorders-related information.

Conclusions

This study shows the importance of including users in the different stages of an e-health intervention development, in order to identify their needs, general use and compliance patterns, to improve adherence and adoption of the program and its effectiveness.

Keshaviah A, Edkins K, Hastings ER, Krishna M, Franko DL, Herzog DB, et al. Re-examining premature mortality in anorexia nervosa: a meta-analysis redux. Compr Psychiatry. 2014;55(8):1773–84. https://doi.org/10.1016/j.comppsych.2014.07.017.CrossRefPubMed

Fichter MM, Quadflieg N. Mortality in eating disorders - results of a large prospective clinical longitudinal study. Int J Eat Disord. 2016;49(4):391–401. https://doi.org/10.1002/eat.22501.CrossRefPubMed

Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry Off J World Psychiatr Assoc WPA. 2014;13(2):153–60. https://doi.org/10.1002/wps.20128.CrossRef

Roux H, Chapelon E, Godart N. Epidemiology of anorexia nervosa: a review. L’Encephale. 2013;39(2):85–93. https://doi.org/10.1016/j.encep.2012.06.001.CrossRefPubMed

Pollack LO, McCune AM, Mandal K, Lundgren JD. Quantitative and qualitative analysis of the quality of life of individuals with eating disorders. Prim Care Companion CNS Disord. 2015;17. https://doi.org/10.4088/PCC.14m01667.

Zipfel S, Löwe B, Reas DL, Deter H-C, Herzog W. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet 2000;355:721–722. https://doi.org/10.1016/S0140-6736(99)05363-5, 9205.

Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry 2015;2:1099–1111. https://doi.org/10.1016/S2215-0366(15)00356-9, 12.

Johns G, Taylor B, John A, Tan J. Current eating disorder healthcare services – the perspectives and experiences of individuals with eating disorders, their families and health professionals: systematic review and thematic synthesis. BJPsych Open. 2019;5(4):e59. https://doi.org/10.1192/bjo.2019.48.CrossRefPubMedPubMedCentral

Kästner D, Weigel A, Buchholz I, Voderholzer U, Löwe B, Gumz A. Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals. J Eat Disord. 2021;9(1):28. https://doi.org/10.1186/s40337-021-00381-0.CrossRefPubMedPubMedCentral

10.

Vuillier L, May L, Greville-Harris M, Surman R, Moseley RL. The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences. J Eat Disord. 2021;9(1):10. https://doi.org/10.1186/s40337-020-00362-9.CrossRefPubMedPubMedCentral

11.

Richardson C, Patton M, Phillips S, Paslakis G. The impact of the COVID-19 pandemic on help-seeking behaviors in individuals suffering from eating disorders and their caregivers. Gen Hosp Psychiatry. 2020;67:136–40. https://doi.org/10.1016/j.genhosppsych.2020.10.006.CrossRefPubMed

12.

Revet A, Hebebrand J, Anagnostopoulos D, Kehoe LA, Gradl-Dietsch G, COVID-19 Child and Adolescent Psychiatry Consortium, et al. Perceived impact of the COVID-19 pandemic on child and adolescent psychiatric services after 1 year (February/March 2021): ESCAP CovCAP survey. Eur Child Adolesc Psychiatry. 2021. https://doi.org/10.1007/s00787-021-01851-1.

13.

Iribarren SJ, Akande TO, Kamp KJ, Barry D, Kader YG, Suelzer E. Effectiveness of Mobile apps to promote health and manage disease: systematic review and Meta-analysis of randomized controlled trials. JMIR MHealth UHealth. 2021;9(1):e21563. https://doi.org/10.2196/21563.CrossRefPubMedPubMedCentral

14.

Loo Gee B, Griffiths KM, Gulliver A. Effectiveness of mobile technologies delivering ecological momentary interventions for stress and anxiety: a systematic review. J Am Med Inform Assoc JAMIA. 2016;23(1):221–9. https://doi.org/10.1093/jamia/ocv043.CrossRefPubMed

15.

Scholten H, Granic I. Use of the principles of design thinking to address limitations of digital mental health interventions for youth: viewpoint. J Med Internet Res. 2019;21(1):e11528. https://doi.org/10.2196/11528.CrossRefPubMedPubMedCentral

16.

Torok M, Han J, Baker S, Werner-Seidler A, Wong I, Larsen M, et al. Suicide prevention using self-guided digital interventions: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health. 2019;2(1):e25–36. https://doi.org/10.1016/S2589-7500(19)30199-2.CrossRefPubMed

17.

Barakat S, Maguire S, Smith KE, Mason TB, Crosby RD, Touyz S. Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2019;52(10):1077–94. https://doi.org/10.1002/eat.23131.CrossRefPubMed

18.

Hötzel K, von Brachel R, Schmidt U, Rieger E, Kosfelder J, Hechler T, et al. An internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial. Psychol Med. 2014;44(9):1947–63. https://doi.org/10.1017/S0033291713002481.CrossRefPubMed

19.

Cardi V, Albano G, Ambwani S, Cao L, Crosby RD, Macdonald P, et al. A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa. Psychol Med. 2019;50(15):1–12. https://doi.org/10.1017/S0033291719002824.CrossRef

20.

Brewin N, Wales J, Cashmore R, Plateau CR, Dean B, Cousins T, et al. Evaluation of a motivation and psycho-educational guided self-help intervention for people with eating disorders (MOPED). Eur Eat Disord Rev J Eat Disord Assoc. 2016;24(3):241–6. https://doi.org/10.1002/erv.2431.CrossRef

21.

Aardoom JJ, Dingemans AE, van Ginkel JR, Spinhoven P, Van Furth EF, Van den Akker-van Marle ME. Cost-utility of an internet-based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial. Int J Eat Disord. 2016;49(12):1068–76. https://doi.org/10.1002/eat.22587.CrossRefPubMed

22.

Aardoom JJ, Dingemans AE, Van Furth EF. E-health interventions for eating disorders: emerging findings, issues, and opportunities. Curr Psychiatry Rep. 2016;18(4):42. https://doi.org/10.1007/s11920-016-0673-6.CrossRefPubMed

23.

Fairburn CG, Rothwell ER. Apps and eating disorders: a systematic clinical appraisal. Int J Eat Disord. 2015;48(7):1038–46. https://doi.org/10.1002/eat.22398.CrossRefPubMedPubMedCentral

24.

Juarascio AS, Manasse SM, Goldstein SP, Forman EM, Butryn ML. Review of smartphone applications for the treatment of eating disorders. Eur Eat Disord Rev. 2015;23(1):1–11. https://doi.org/10.1002/erv.2327.CrossRefPubMed

25.

Ahmadiankalati M, Steins-Loeber S, Paslakis G. Review of randomized controlled trials using e-health interventions for patients with eating disorders. Front Psychiatry. 2020;11. https://doi.org/10.3389/fpsyt.2020.00568.

26.

Fry JP, Neff RA. Periodic prompts and reminders in health promotion and health behavior interventions: systematic review. J Med Internet Res. 2009;11(2):e16. https://doi.org/10.2196/jmir.1138.CrossRefPubMedPubMedCentral

27.

Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. https://doi.org/10.2196/jmir.1376.CrossRefPubMedPubMedCentral

28.

Beatty L, Binnion C. A systematic review of predictors of, and reasons for, adherence to online psychological interventions. Int J Behav Med. 2016;23(6):776–94. https://doi.org/10.1007/s12529-016-9556-9.CrossRefPubMed

29.

Ludden GDS, van Rompay TJL, Kelders SM, van Gemert-Pijnen JEWC. How to increase reach and adherence of web-based interventions: a design research viewpoint. J Med Internet Res. 2015;17(7):e172. https://doi.org/10.2196/jmir.4201.CrossRefPubMedPubMedCentral

30.

Achilles MR, Anderson M, Li SH, Subotic-Kerry M, Parker B, O’Dea B. Adherence to e-mental health among youth: considerations for intervention development and research design. Digit Health. 2020;6:2055207620926064. https://doi.org/10.1177/2055207620926064.CrossRefPubMedPubMedCentral

31.

Schueller SM, Neary M, O’Loughlin K, Adkins EC. Discovery of and interest in health apps among those with mental health needs: survey and focus group study. J Med Internet Res. 2018;20(6):e10141. https://doi.org/10.2196/10141.CrossRefPubMedPubMedCentral

32.

Malik A, Suresh S, Sharma S. Factors influencing consumers’ attitude towards adoption and continuous use of mobile applications: a conceptual model. Procedia Comput Sci. 2017;122:106–13. https://doi.org/10.1016/j.procs.2017.11.348.CrossRef

33.

Kim A, Kim K. User experience and the multi-stage adoption of Mobile apps. J Inf Technol Appl Manag. 2014;21:49–79. https://doi.org/10.21219/jitam.2014.21.2.049.CrossRef

34.

Lallemand C, Gronier G. Méthodes de design UX: 30 méthodes fondamentales pour concevoir des expériences optimales. 2nd ed. Eyrolles; 2018.

35.

Murray E. Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress. Med 20 2012;1:e3. https://doi.org/10.2196/med20.1741.

36.

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.CrossRefPubMedPubMedCentral

37.

Schlegl S, Bürger C, Schmidt L, Herbst N, Voderholzer U. The potential of technology-based psychological interventions for anorexia and bulimia nervosa: a systematic review and recommendations for future research. J Med Internet Res. 2015;17(3):e85. https://doi.org/10.2196/jmir.3554.CrossRefPubMedPubMedCentral

38.

Molina-Recio G, Molina-Luque R, Jiménez-García AM, Ventura-Puertos PE, Hernández-Reyes A, Romero-Saldaña M. Proposal for the user-centered design approach for health apps based on successful experiences: integrative review. JMIR MHealth UHealth. 2020;8(4):e14376. https://doi.org/10.2196/14376.CrossRefPubMedPubMedCentral

39.

Ambwani S, Cardi V, Treasure J. Mobile self-help interventions for anorexia nervosa: conceptual, ethical, and methodological considerations for clinicians and researchers. Prof Psychol Res Pract. 2014;45(5):316–23. https://doi.org/10.1037/a0036203.CrossRef

40.

Yim SH, Schmidt U. Self-help treatment of eating disorders. Psychiatr Clin North Am. 2019;42(2):231–41. https://doi.org/10.1016/j.psc.2019.01.006.CrossRefPubMed

41.

Denison-Day J, Appleton KM, Newell C, Muir S. Improving motivation to change amongst individuals with eating disorders: a systematic review. Int J Eat Disord. 2018;51(9):1033–50. https://doi.org/10.1002/eat.22945.CrossRefPubMed

42.

Haynos AF, Fruzzetti AE. Anorexia nervosa as a disorder of emotion dysregulation: evidence and treatment implications. Clin Psychol Sci Pract. 2011;18(3):183–202. https://doi.org/10.1111/j.1468-2850.2011.01250.x.CrossRef

43.

Lavender JM, Wonderlich SA, Engel SG, Gordon KH, Kaye WH, Mitchell JE. Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: a conceptual review of the empirical literature. Clin Psychol Rev. 2015;40:111–22. https://doi.org/10.1016/j.cpr.2015.05.010.CrossRefPubMedPubMedCentral

44.

Prefit A-B, Cândea DM, Szentagotai-Tătar A. Emotion regulation across eating pathology: a meta-analysis. Appetite. 2019;143:104438. https://doi.org/10.1016/j.appet.2019.104438.CrossRefPubMed

45.

Selby EA, Cornelius T, Fehling KB, Kranzler A, Panza EA, Lavender JM, et al. A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa. Front Psychol. 2015;6:1260. https://doi.org/10.3389/fpsyg.2015.01260.CrossRefPubMedPubMedCentral

46.

Dalle Grave R, Eckhardt S, Calugi S, Le Grange D. A conceptual comparison of family-based treatment and enhanced cognitive behavior therapy in the treatment of adolescents with eating disorders. J Eat Disord. 2019;7(1):42. https://doi.org/10.1186/s40337-019-0275-x.CrossRefPubMedPubMedCentral

47.

Dalle Grave R, El Ghoch M, Sartirana M, Calugi S. Cognitive behavioral therapy for anorexia nervosa: an update. Curr Psychiatry Rep. 2016;18(1):2. https://doi.org/10.1007/s11920-015-0643-4.CrossRefPubMed

48.

Lynch TR, Gray KL, Hempel RJ, Titley M, Chen EY, O’Mahen HA. Radically open-dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry. 2013;13(1):293. https://doi.org/10.1186/1471-244X-13-293.CrossRefPubMedPubMedCentral

49.

Chen EY, Segal K, Weissman J, Zeffiro TA, Gallop R, Linehan MM, et al. Adapting dialectical behavior therapy for outpatient adult anorexia nervosa--a pilot study. Int J Eat Disord. 2015;48(1):123–32. https://doi.org/10.1002/eat.22360.CrossRefPubMed

50.

Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–70. https://doi.org/10.1037//0022-3514.54.6.1063.CrossRefPubMed

51.

Caci H, Baylé J. l’échelle d’affectivité positive et d’affectivité négative. Première traduction en français. Congrès L’Encéphale Paris 2007.

52.

Sardi L, Idri A, Fernández-Alemán JL. A systematic review of gamification in e-health. J Biomed Inform. 2017;71:31–48. https://doi.org/10.1016/j.jbi.2017.05.011.CrossRefPubMed

53.

Cheng VWS, Davenport T, Johnson D, Vella K, Hickie IB. Gamification in apps and Technologies for Improving Mental Health and Well-Being: systematic review. JMIR Ment Health. 2019;6(6):e13717. https://doi.org/10.2196/13717.CrossRefPubMedPubMedCentral

54.

Hamari J, Koivisto J, Sarsa H. Does Gamification Work? – A Literature Review of Empirical Studies on Gamification. 2014 47th Hawaii Int. Conf Syst Sci. 2014:3025–34. https://doi.org/10.1109/HICSS.2014.377.

55.

Fleming TM, de Beurs D, Khazaal Y, Gaggioli A, Riva G, Botella C, et al. Maximizing the impact of e-therapy and serious gaming: time for a paradigm shift. Front Psychiatry. 2016;7. https://doi.org/10.3389/fpsyt.2016.00065.

56.

Laugwitz B, Held T. Schrepp M. Construction and Evaluation of a User Experience Questionnaire vol. 2008;5298:63–76. https://doi.org/10.1007/978-3-540-89350-9_6.CrossRef

57.

Schrepp M, Hinderks A, Thomaschewski J. Construction of a benchmark for the user experience questionnaire (UEQ). Int J Interact Multimed Artif Intell. 2017;4(4):40–4. https://doi.org/10.9781/ijimai.2017.445.CrossRef

58.

Hassenzahl M. The thing and I: understanding the relationship between user and product. Funology Usability Enjoyment. 2005;3:31–42. https://doi.org/10.1007/1-4020-2967-5_4.CrossRef

59.

Thüring M, Mahlke S. Usability, aesthetics and emotions in human–technology interaction. Int J Psychol. 2007;42(4):253–64. https://doi.org/10.1080/00207590701396674.CrossRef

60.

Martin N, Erhel S, Jamet É, Rouxel G. What links between user experience and acceptability? Proc. 27th Conf. Interact. Homme-Mach., Toulouse, France: Association for Computing Machinery; 2015, p. 1–6. https://doi.org/10.1145/2820619.2825015.

61.

Paillé P, Mucchielli A. L’analyse qualitative en sciences humaines et sociales - 4e éd. 4e édition. Armand Colin: Malakoff; 2016. https://doi.org/10.3917/arco.paill.2016.01.CrossRef

62.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care J Int Soc Qual Health Care ISQua. 2008;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042.CrossRef

63.

Lipschitz J, Miller CJ, Hogan TP, Burdick KE, Lippin-Foster R, Simon SR, et al. Adoption of Mobile apps for depression and anxiety: cross-sectional survey study on patient interest and barriers to engagement. JMIR Ment Health. 2019;6(1):e11334. https://doi.org/10.2196/11334.CrossRefPubMedPubMedCentral

64.

Arts H, Lemetyinen H, Edge D. Readability and quality of online eating disorder information-are they sufficient? A systematic review evaluating websites on anorexia nervosa using DISCERN and Flesch readability. Int J Eat Disord. 2020;53(1):128–32. https://doi.org/10.1002/eat.23173.CrossRefPubMed

65.

Huang H-Y, Bashir M. Users’ adoption of mental health apps: examining the impact of information cues. JMIR MHealth UHealth. 2017;5:e6827. https://doi.org/10.2196/mhealth.6827.CrossRef

66.

Schmidt-Kraepelin M, Toussaint PA, Thiebes S, Hamari J, Sunyaev A. Archetypes of gamification: analysis of mHealth apps. JMIR MHealth UHealth. 2020;8(10):e19280. https://doi.org/10.2196/19280.CrossRefPubMedPubMedCentral

67.

Lindgreen P, Clausen L, Lomborg K. Clinicians’ perspective on an app for patient self-monitoring in eating disorder treatment. Int J Eat Disord. 2018;51(4):314–21. https://doi.org/10.1002/eat.22833.CrossRefPubMed

Title: Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation
Authors: Benjamin Naccache
Laure Mesquida
Jean-Philippe Raynaud
Alexis Revet
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Eating Disorder
Anorexia Nervosa
Eating Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03478-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Significance of anger suppression and preoccupied attachment in social anxiety disorder: a cross-sectional study

Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study

Comparison of psychological symptoms between infected and non-infected COVID-19 health care workers

Effects of sources of social support and resilience on the mental health of different age groups during the COVID-19 pandemic

Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study

Mental disorders pattern in staff of a military unit in Iran: the role of metabolic syndrome on latent class membership