A systematic digital approach to implementation and dissemination of eating disorders interventions to large populations identified through online screening: implications for post-traumatic stress

A systematic review of reach, adoption, implementation and maintenance of Internet-based interventions to prevent eating disorders in adults

BACKGROUND

There is a growing body of research and evidence for the efficacy of Internet-based eating disorder (ED) prevention interventions for adults. However, much less is known about the reach, adoption, implementation and maintenance of these interventions. The RE-AIM (reach, efficacy/effectiveness, adoption, implementation, maintenance) model provides a framework to systematically assess this information.

METHODS

A literature search was conducted in PubMed, Web of Science and PsycINFO for articles published between 2000 and 2019. Additionally, reference lists of the studies included and existing reviews published until the end of 2020 were searched. Sixty original articles describing 54 individual studies fulfilled inclusion criteria. Data were extracted for a total of 43 RE-AIM indicators for each study. Fostering and hindering factors for reach, adoption, implementation and maintenance were assessed qualitatively.

RESULTS

Overall reporting rates were best for the RE-AIM dimensions reach (62.6%), implementation (57.0%) and effectiveness (54.2%), while adoption (24.2%) and maintenance (21.5%) had comparatively low overall reporting rates. Reporting on indicators of internal validity, such as sample size, effects or description of interventions was better than indicators relevant for dissemination and implementation in real-world settings, e.g. characteristics of non-participants, characteristics and representativeness of settings, and data to estimate cost.

CONCLUSIONS

Because most Internet-based ED prevention interventions are provided in a research-funded context, little is known about their public health impact. Better reporting of factors determining external validity is needed to inform dissemination and implementation of these interventions.

Results of disseminating an online screen for eating disorders across the U.S.: Reach, respondent characteristics, and unmet treatment need

OBJECTIVE

The treatment gap between those who need and those who receive care for eating disorders is wide. Scaling a validated, online screener that makes individuals aware of the significance of their symptoms/behaviors is a crucial first step for increasing access to care. The objective of the current study was to determine the reach of disseminating an online eating disorder screener in partnership with the National Eating Disorders Association (NEDA), as well to examine the probable eating disorder diagnostic and risk breakdown of adult respondents. We also assessed receipt of any treatment.

METHOD

Participants completed a validated eating disorder screen on the NEDA website over 6 months in 2017.

RESULTS

Of 71,362 respondents, 91.0% were female, 57.7% 18-24 years, 89.6% non-Hispanic, and 84.7% White. Most (86.3%) screened positive for an eating disorder. In addition, 10.2% screened as high risk for the development of an eating disorder, and only 3.4% as not at risk. Of those screening positive for an eating disorder, 85.9% had never received treatment and only 3.0% were currently in treatment.

DISCUSSION

The NEDA online screen may represent an important eating disorder detection tool, as it was completed by >71,000 adult respondents over just 6 months, the majority of whom screened positive for a clinical/subclinical eating disorder. The extremely high percentage of individuals screening positive for an eating disorder who reported not being in treatment suggests a wide treatment gap and the need to offer accessible, affordable, evidence-based intervention options, directly linked with screening.