Vendlinski Siena S, Laboe Agatha A, Crest Peyton, McGinnis Claire G, Steinhoff Molly F, Wilfley Denise E, Taylor C Barr, Fitzsimmons-Craft Ellen E, Accurso Erin C
Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
BMC Public Health. 2025 Apr 7;25(1):1296. doi: 10.1186/s12889-025-22494-w.
Publicly-insured and uninsured individuals-many of whom are marginalized because of race/ethnicity, ability status, and/or other social identities-experience barriers to accessing evidence-based interventions (EBIs) for eating disorders (EDs). Additionally, EBIs have not been developed with or for diverse populations, exacerbating poor treatment uptake. Mobile technology is well-positioned to bridge this gap and increase access to low-cost, culturally-sensitive EBIs.
This study leverages a user-centered design approach to adapt an existing coached cognitive-behavioral therapy-based digital program and evaluate its usability in a sample of 11 participants with (sub)clinical binge type EDs who are publicly-insured (n = 10) or uninsured (n = 1). Participants were primarily non-Latinx White women (n = 8). Two semi-structured interviews occurred with participants: one to assess treatment needs and the other to obtain program-specific feedback. Interviews were coded using inductive thematic analysis.
Interview 1 feedback converged on three themes: Recovery Journey, Treatment Experiences, and Engagement with and Expectations for Online Programs. Participants endorsed facing barriers to healthcare, such as poor insurance coverage and a lack of trained providers, and interest in a coach to increase treatment accountability. Interview 2 feedback converged on three themes: Content Development, Participant Experiences with Mental Health, and Real-World Use. Participants liked the content but emphasized the need to improve diverse representation (e.g., gender, body size).
Overall, user feedback is critical to informing adaptations to the original EBI so that the intervention can be appropriately tailored to the needs of this underserved population, which ultimately has high potential to address critical barriers to ED treatment.
This study was reviewed and approved by the Institutional Review Board (IRB) at the University California, San Francisco (IRB #22-35936) and the IRB at Washington University in St. Louis (IRB ID 202304167).
参加公共保险和未参保的个体——其中许多人因种族/族裔、能力状况和/或其他社会身份而被边缘化——在获取饮食失调（ED）的循证干预措施（EBI）方面面临障碍。此外，EBI并非针对不同人群开发，也没有与不同人群共同开发，这加剧了治疗接受率低下的问题。移动技术有能力填补这一差距，并增加获得低成本、具有文化敏感性的EBI的机会。
本研究采用以用户为中心的设计方法，改编现有的基于指导认知行为疗法的数字项目，并在11名患有（亚）临床暴饮暴食型ED的参与者样本中评估其可用性，这些参与者参加了公共保险（n = 10）或未参保（n = 1）。参与者主要是非拉丁裔白人女性（n = 8）。对参与者进行了两次半结构化访谈：一次评估治疗需求，另一次获取针对项目的反馈。访谈采用归纳主题分析法进行编码。
访谈1的反馈集中在三个主题上：康复历程、治疗体验以及对在线项目的参与度和期望。参与者认可面临医疗保健方面的障碍，如保险覆盖不足和缺乏训练有素的医疗服务提供者，以及对有教练以提高治疗责任性的兴趣。访谈2的反馈集中在三个主题上：内容开发、参与者的心理健康体验以及实际应用。参与者喜欢这些内容，但强调需要改善多样化的代表性（如性别、体型）。
总体而言，用户反馈对于为改编原始EBI提供信息至关重要，以便该干预措施能够根据这一服务不足人群的需求进行适当调整，这最终极有可能解决ED治疗的关键障碍。
本研究经加利福尼亚大学旧金山分校机构审查委员会（IRB #22 - 35936）和圣路易斯华盛顿大学IRB（IRB ID 202304167）审查并批准。
