Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: A systematic review and meta‐analysis

Abstract

Objective Despite the existence of reviews which document the effectiveness of online therapies, there is little consensus regarding the exact components of online treatment delivery that are most effective in maintaining user engagement and reducing eating disorder (ED) symptomology. The current review and meta‐analysis aimed to determine which components of web‐based, ED self‐help interventions are associated with lower attrition and improved therapeutic outcome. Method A systematic search of electronic databases (PsycINFO, Medline, Web of Science, Scopus) was conducted for published studies of web‐based interventions for EDs and a meta‐analysis of the final included studies was performed. Each intervention was coded across four dimensions, including the multimedia channels employed (e.g., text, audio, videos), degree of user interactivity (e.g., online self‐monitoring, skills exercises), level of automated feedback (e.g., reminders, personalized feedback), and technological device through which the program was accessed (e.g., smartphone, computer). Results A final 23 papers were included. The results of meta‐regressions indicated that higher scores on the multimedia subscale were associated with greater ED symptom improvement in treatment groups. Conversely, a higher degree of feedback in the treatment group was associated with a group difference in ED psychopathology favoring the control group. Other intervention components were not associated with treatment outcome or dropout. Discussion The results are discussed in relation to limitations of the scale used to quantify digital intervention features, as well as the limited diversity and technological sophistication of available ED digital interventions. Such findings indicate the importance of understanding the digital components, which differentiate online therapeutic programs.

COVID‐19 and implications for eating disorders

“…It allows for families to get support and reduces the stigma they may feel. Online‐ and e‐health measures for ED patients have been developed and tested for over 20 years worldwide and are available for implementation, but more research is necessary (Anastasiadou et al, ; Anderson et al, 2017; Barakat et al, ; Vollert et al, 2019; Zerwas et al, 2017). However, some aspects of the assessment can be challenging to monitor without face‐to‐face contact or some form of surrogate measure (Keshen et al, 2020; McLean et al, 2019), especially in more extreme cases (e.g., severely underweight, non‐suicidal self‐injury, self‐destructive patients).…”

Access to evidence‐based care for eating disorders during the COVID‐19 crisis

“…Featured here is a systematic review and meta‐analysis by Barakat and colleagues, entitled “Evaluating the role of digital intervention design in treatment outcomes and adherence to etherapy programs for eating disorders” (Barakat et al, 2019). Focusing specifically on interventions designed for self‐help (unguided or guided) and on studies where the entire treatment was delivered via a digital platform, the authors posed the question of which features of digital interventions would be shown to be associated with outcome of and adherence to treatment.…”

Review of Randomized Controlled Trials Using e-Health Interventions for Patients With Eating Disorders

“…The primary objective of the present paper was to identify, summarize, synthesize, and critically evaluate current evidence regarding effectiveness and user experience/acceptability of ehealth interventions in the ED field. To do so, only studies in cohorts diagnosed with an ED and only randomized controlled studies were considered in this work -in contrast to previous reviews that had no restrictions in study design of included studies and also included non-clinical cohorts (34,36).…”