Patient use of a self‐monitoring app during eating disorder treatment: Naturalistic longitudinal cohort study

Abstract

Objective To explore patients’ use of the self‐monitoring app Recovery Record during 26 weeks of naturalistic eating disorder treatment. Methods Selected patient characteristics at baseline were explored as predictors of app use using linear regression. Patients were grouped according to diagnosis (anorexia versus bulimia), and mixed‐effects analyses were used to explore differences in app use between diagnoses across four time periods (weeks 1–4; weeks 5–8; weeks 9–12; weeks 13–26). Results Eighty‐four patients were included of which 41 had anorexia and 43 had bulimia. The total number of logs varied greatly (mean (SD): 592 (628.50)), and patient app activity almost ceased at week 13. Increasing age and no previous eating disorder treatment predicted increased app activity (p = .007; p = .039, respectively). Patients with anorexia logged over four times more often than patients with bulimia in the last time period (median (CI): 4.27 (1.28;14.31); p = .018). Time predicted declining app use (all p ≤ .007). Conclusion Future research on long‐term app engagement should investigate associations between patients’ app use and changes in their eating disorder symptom severity over time.

Characterising use of recovery record among a large, transdiagnostic sample of adults with eating disorders across higher levels of care

“…Comparing our study to past work, in one prior study of individuals receiving outpatient treatment for 26 weeks, participants completed ~600 logs (~3 logs/day), with significant drop-off following the first four weeks of treatment (Lindgreen et al, 2021). While this number is higher than that observed in our sample (~1.5 meal logs/ day), it may be the case that this is accounted for by a focus on outpatient, weekly care in the former investigation; within our study, participants were engaged in care that included supervision of meals, perhaps affecting patient perception of the need for meal logs.…”

“…We operationalised RR use in three ways consistent with past research (Lindgreen et al., 2021): (a) number of meal logs completed in treatment; (b) percentage of possible meals logged by multiplying the length of stay by 6, given that most enroled patients were assigned to a meal plan comprising 3 meals and 3 snacks per day (i.e., 6 possible meal logs); (c) last day of treatment that an RR meal log was completed, operationalised as days following admission date. We conceptualised more frequent meal logs, higher percentage of possible meal logs, and greater number of days until final log as indications of greater app engagement.…”

“…Only one study has explored variables that relate to RR use in treatment. Lindgreen et al (2021) found that RR use among 84 outpatients with anorexia nervosa (AN) and BN peaked in the beginning of treatment and decreased over 26 weeks. Further, older patients and those with greater cognitive restraint engaged more heavily with RR.…”

Optimizing digital health technologies to improve therapeutic skill use and acquisition alongside enhanced cognitive‐behavior therapy for binge‐spectrum eating disorders: Protocol for a randomized controlled trial

“…Despite the promise of mHealth tools for facilitating skill use and therefore improving treatment response to CBT‐E, use of these tools can be burdensome and often declines over time (Shaw et al, 2016). Specifically, a study examining compliance with Recovery Record during naturalistic treatment among individuals with EDs found that logging in the app decreased from an average of almost 46 logs per week during the first 4 weeks to fewer than 6 logs per week during weeks 13–26 (Lindgreen et al, 2021). However, the use of JITAIs alongside may be associated with more sustained engagement in mHealth tools.…”

“…Specifically, a study examining compliance with Recovery Record during naturalistic treatment among individuals with EDs found that logging in the app decreased from an average of almost 46 logs per week during the first 4 weeks to fewer than 6 logs per week during weeks 13-26 (Lindgreen et al, 2021). However, the use of JITAIs alongside may be associated with more sustained engagement in mHealth tools.…”