Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches

BACKGROUND

App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials.

OBJECTIVE

To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding.

METHODS

In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified.

RESULTS

Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery.

CONCLUSIONS

Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.

Does masculinity moderate the relationship of height with height dissatisfaction? Findings from an Internet forum for short statured men

Research suggests that height is fundamental to Western conceptualisations of masculinity. However, researchers are yet to examine whether individual differences in conformity to Western masculine norms can help to explain why men experience height dissatisfaction. Thus, we investigated conformity to Western masculine norms as a moderator of the relationship between men's height and height dissatisfaction. Men experiencing height dissatisfaction (N = 249) were recruited from an Internet forum that functions as a discussion space for short-statured individuals. Results indicated that shorter men and more masculine men reported greater height dissatisfaction. As hypothesised, we observed a significant interaction between height and masculinity, such that the strength of the relationship of short stature with height dissatisfaction was stronger for more masculine men. Crucially, results from a Johnson-Neyman analysis indicated that it was only for men extremely low in their endorsement of masculine norms (i.e., the 2^nd percentile or lower) that the relationship of height with height dissatisfaction was nonsignificant, suggesting that, in the near-absence of masculine norm conformity, height no longer contributes to male body dissatisfaction. Whilst acknowledging that our findings require further exploration, we propose that conformity to masculine norms may be an influential factor in males' experience of height dissatisfaction.

Experiences of weightism among sexual minority men: Relationships with Body Mass Index, body dissatisfaction, and psychological quality of life

RATIONALE

Experiences of weightism are associated with reduced psychological quality of life among heterosexual men and women. However, despite noted vulnerability to body image pressures, weightism has not been quantitatively examined among sexual minority men. We tested two hypotheses: first, that Body Mass Index (BMI) and weightism would evidence a curvilinear relationship, such that underweight and overweight men would report experiencing more weightism than men in the "normal" weight range; and second, that a negative association between BMI and quality of life would be explained by experiences of weightism and body dissatisfaction.

METHOD

Sexual minority men living in Australia and New Zealand (N = 2733) completed an online survey and provided data on their height, weight, experiences of weightism, body dissatisfaction, and psychological quality of life.

RESULTS

Participants' BMIs ranged from 14.15 to 68.12 with 3.0% classified as underweight, 50.5% as "normal" weight, 28.0% as overweight, and 17.4% as obese. Weightism was experienced by 38.9% of participants. As predicted, weightism evidenced a curvilinear relationship with BMI, such that underweight and overweight participants reported experiencing more weightism relative to "normal" weight participants. Yet, this curvilinear relationship evidenced a dominant linear component: Overall, weightism markedly increased as BMI increased, and obese participants reported experiencing the most weightism. In addition, we found evidence supporting our hypothesis that men with higher BMIs would report experiencing more weightism and higher body dissatisfaction, and through these variables, reduced quality of life. Adjusted for body dissatisfaction and weightism, the formerly negative association of BMI with psychological quality of life became (weakly) positive.

CONCLUSIONS

Weightism is a salient phenomenon experienced by sexual minority men in smaller and larger bodies with potential direct and indirect adverse effects on psychological quality of life. Whilst BMI and weightism evidenced a curvilinear relationship, the burden of weightism is disproportionately borne by sexual minority men with higher BMIs.

Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review

We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations.