Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation

Abstract

Background Anorexia Nervosa (AN) is a key target for E-Health programs considering the many barriers hindering patients’ access to care and the disorder’s severity. Although these programs have become more common and effective, they often have low adherence, especially among youth. This can hinder their implementation and effectiveness in real-world settings. User experience partly overlaps with the acceptability field and may provide insight into factors affecting adherence and adoption of E-Health programs. This study aimed to explore early acceptability and user experience of a companion app prototype for adolescents with AN using user-centered design methods. Methods We developed a prototype containing self-help material and emotions and behaviors evaluation and management features. Then we conducted a mixed evaluation combining semi structured focus group interviews and questionnaires in a clinician group and an AN patient group. We analyzed data using thematic analysis and descriptive statistics. Results The app’s overall appeal was adequate. The user experience questionnaire revealed the weakest dimensions, including novelty, dependability, and efficiency versus stimulation (i.e., ability to induce motivation to use the product) and perspicuity (i.e., easy to understand, to get familiar with). The qualitative data analysis revealed three central axes: acceptability, features, and use. We identified acceptability barriers and facilitators such as the importance of design and customization, especially for adolescents. Psychoeducation was a major feature for participants, as patients highlighted the difficulties they encountered when seeking disorders-related information. Conclusions This study shows the importance of including users in the different stages of an e-health intervention development, in order to identify their needs, general use and compliance patterns, to improve adherence and adoption of the program and its effectiveness.

The use of technology in the treatment of youth with eating disorders: A scoping review

“…Four studies explored participant perspectives on the use of four different smartphone applications, Recovery Record [ 46 , 50 ], TCApp [ 48 ], and a recently developed unnamed app [ 51 ]. Two studies describing the development of new smartphone applications for EDs were also identified (no data was collected) [ 40 , 72 ].…”

“…Finally, one study examined user experience of a new smartphone app for adolescents with AN [ 51 ]. The app has an unguided self-help program based on psychoeducation, CBT, and motivational interviewing.…”

“…Qualitative data showed that the app was viewed positively by both patients and clinicians, although concerns were raised surrounding novelty, dependability, and efficiency. Overall, the psychoeducation portion was deemed important by both patients and clinicians [ 51 ].…”

“…Clinicians and patients agree that mobile apps are useful in early stages of the disease [ 51 ] and features such as psychoeducation and self-monitoring can be relevant at these points. The ease with which they can be implemented [ 80 ] also means that there is high potential to providing these interventions early in the course of treatment.…”

“…Qualitative data themes: 1) new discoveries 2) lost in translation 3) best of bad situation Lindgreen et al [ 50 ] Qualitative study N = 41 Mean age = 24.0 (age range = 15–41 years, SD 5.9) Sex: 3 male, 38 female Diagnoses = anorexia nervosa and bulimia, as diagnosed by clinicians at the specialized ED treatment facility Recruited = from a specialized ED treatment facility Denmark NR Treatment as usual (for AN: family-based treatment or weekly group/individual sessions; for BN: 10 weekly manualized group sessions followed by an additional group or individual treatment) augmented using Recovery Record (RR) self-monitoring app for eating disorders Hybrid: in-person sessions augmented by guided self-monitoring smartphone app use Therapists provided guidance on app usage during in-person therapy sessions User experience with Recovery Record app Patient experience with the app 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 Naccache et al [ 51 ] Qualitative study N = 8 Mean age = 15.5 (age range = 12–18, SD 1.07), Sex = all females Diagnosis = AN, according to DSM-5 criteria All enrolled in treatment at Toulouse Teaching Hospital France NR Unguided self-help program app: based on psychoeducation, CBT, and motivational interview strategies. Additional emotional management feature and gamification elements Online: testing only user experience of the smartphone app No additional support in relation to the app UEQ and semi-structured interviews Patient experience of the app was demonstrated with key themes, including finding coping strategies, information, motivational content helpful.…”