BackgroundThe Recovery Record smartphone app is a self-monitoring tool for individuals recovering from an eating disorder. Unlike traditional pen-and-paper meal diaries, which are often used in eating disorder treatment, the app holds novel features, such as meal reminders, affirmations, and patient-clinician in-app linkage, the latter allowing for clinicians to continuously monitor patients' app data.ObjectiveTo explore patients' experiences with using Recovery Record as part of outpatient eating disorder treatment.MethodsA total of 41 patients from a Danish eating disorder treatment facility were included in the study. All 41 patients participated in participant observations of individual or group treatment sessions, and 26 were interviewed about their experiences with using the app in treatment. The data material was generated and analyzed concurrently, applying the inductive methodology of Interpretive Description.ResultsThe patients' experiences with Recovery Record depended on its app features, the impact of these features on patients, and their specific app usage. This patient-app interaction affected and was affected by changeable contexts making patients' experiences dynamic. The patient-app interaction affected patients' placement of specific Recovery Record app features along a continuum from supportive to obstructive of individual everyday life activities including the eating disorder treatment. As an example, some patients found it supportive being notified by their clinician when their logs had been monitored as it gave them a sense of relatedness. Contrarily, other patients felt under surveillance, which was obstructive, as it made them feel uneasy or even dismissing the app.ConclusionsSome patients experienced the app and its features as mostly supportive of their everyday life and the eating disorder treatment, while others experienced it primarily as obstructive. When applying apps in eating disorder treatment, we therefore recommend that patients and clinicians collaborate to determine how the app in question best fits the capacities, preferences, and treatment needs of the individual patient. Thus, we encourage patients and clinicians to discuss how specific features of the applied app affect the individual patient to increase the use of supportive features, while limiting the use of obstructive ones.

Objective The Diagnostic and Statistical Manual of Mental Disorders 5 suggests the 5th age‐adjusted body mass index (BMI) percentile as the numeric cut‐off for anorexia nervosa (AN) in children and adolescents. We aimed to investigate the degree to which the 5th age‐adjusted percentile as the numeric cut‐off for AN in youths reflects the clinical population of patients accepted for treatment. Method From a specialized eating disorder clinic, 305 patients with AN below 18 years of age were grouped according to age‐adjusted BMI percentiles [below the 5th (low), above the 10th (high), and between the 5th and the 10th (medium)]. The distribution of eating disorder diagnoses and severity measured by the Eating Disorder Examination was compared. Results Full‐syndrome anorexia nervosa (F.50.0) was found in 182 (59.5%) patients and atypical anorexia nervosa (F.50.1) in 123 patients (40.5%). The number of patients in the low, medium, and high BMI percentile groups was 189 (62.0%), 34 (11.1%), and 82 (26.9%), respectively. Patients in the low BMI group differed from patients in the medium BMI group by a lower frequency of vomiting. The high BMI group presented with more weight and shape concern than the lower BMI group. Age was not a confounder of these associations. Discussion We question the applicability of the 5th BMI percentile as a substantiated cut‐off for the weight criterion in anorexia nervosa in youths and argue that the cut‐off should not be ascribed great clinical importance as this may hinder early detection of illness and initiation of treatment.

Recovery Record induced new and affected pre-existing treatment and work conditions for clinicians. Clinicians were preoccupied with challenges associated with the app, for example, an added work load and potential harm to the patient-clinician collaboration. Thus, prior to adopting the app, we encourage clinicians and managements to discuss the objectives, advantages and disadvantages of adopting the app, and outline specific guidelines for patient and clinician app usage.

Living with type 2 diabetes (T2D) is demanding and requires lifelong self-management to prevent diabetes complications and enhance quality of life (Young-Hyman et al., 2016). Diabetes self-management education (DSME) is an essential component of care to support people with type 2 diabetes (PWT2D) in implementing self-management in their daily lives outside clinical settings (American Diabetes Association, 2020;Fan & Sidani, 2009). A global study among healthcare professionals (HCPs), PWT2D and their family members found that healthcare systems are poorly equipped to effectively support PWT2D (Holt et al., 2013). Although DSME was considered important, access was limited and typically not well-organized due to a lack of resources for providing psychological support (Holt et al., 2013).

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