(PS14-24) Understanding Patients’ Preferences for a Digital Intervention to Prevent Post-treatment Deterioration for Bulimia-spectrum Eating Disorders: A User-centered Design Approach

Abstract Text: Deterioration rates after enhanced cognitive-behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high. One reason for high rates of deterioration post-treatment is that patients commonly report difficulty with self-accountability, which often leads to a reduction in the use of key therapeutic skills that were effective during treatment. Digital interventions could be an ideal option to enhance accountability and improve skill use after treatment ends, but have yet to be investigated for BN-EDs.  The current study used a user-centered design approach to qualitatively explore patients’ interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Twelve participants who previously received CBT-E for BN-EDs 2-3 years ago and experienced at least a modest level of treatment responses completed a qualitative interview. During the interview, participants were asked whether they would be interested in using an app designed to prevent deterioration after treatment ended, and what features they wanted to have in the app and why. Then, participants were presented with features commonly used in digital interventions for EDs (e.g., self-monitoring, goal setting) and were asked to provide feedback. All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. They believed it could provide continued support and accountability for skill use (n = 12) and help them monitor progress and learn from patterns (n = 11). Five key features emerged based on the thematic analysis of participants’ responses. Two of the key features, goal-setting and self-monitoring, were proposed to participants during the interview. Eleven participants thought the proposed feature of setting a goal related to skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals on how to deal with specific triggers because they would know what skills to use in high-risk situations (e.g., work stress). Ten participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels and help them learn from patterns. Participants also reported wanting to track mood (n = 6) and food intake (n = 5) besides the proposed tracking feature. Participants also endorsed three other key features besides the proposed ones. Ten participants reported wanting knowledge-based content in the app, including instructions on skill practice (n = 6), general mental health strategies outside of EDs (n = 4), guided mindfulness exercises (n = 3), and nutrition recommendations (n = 3). Eight participants reported a desire for the app to send targeted interventions via push notification, including reminders of skill use (n = 7) and inspirational quotes for encouragement (n = 3). Finally, eight participants reported wanting a human connection in the app, 6 wishing to interact with other users to support and learn from each other, and 4 wanting to connect with professionals as needed. Insights from participants highlighted the perceived importance of continued support to build self-accountability in digital interventions to promote sustained skill use and prevent deterioration.