Dissemination of an Internet-Based Program for the Prevention and Early Intervention in Eating Disorders.

Objective: Research on the dissemination of e-mental health interventions is in an early stage, so that little is known about the reach, costs, participant characteristics, and patterns of program utilization associated with different recruitment strategies and access paths. This study investigated differences between user groups informed about an Internet-based program for the prevention and early intervention in eating disorders via different recruitment channels. Method: Participant characteristics and user behavior of 3548 participants in the Internet-based program ProYouth were analyzed. Participants were informed about ProYouth via different channels (e. g., print materials, high school, Internet). Results: Results indicate significant relationships between access paths and both user characteristics and program utilization. Participants who were informed about ProYouth at their high schools were more likely to be male, younger, and at lower risk of developing eating disorders. In contrast, other recruitment channels (e. g., Internet, print materials) resulted in participants with significantly higher risk and symptom levels who used the program more frequently and with higher intensity. Conclusion: Efforts aimed at the dissemination of Internet-based interventions should consider the effects that different recruitment channels and access paths may have on sample composition and utilization of the intervention.

Efficacy and cost-effectiveness of Internet-based selective eating disorder prevention: study protocol for a randomized controlled trial within the ProHEAD Consortium.

BACKGROUND: The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth. METHODS: The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and - as part of ProHEAD - at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed. DISCUSSION: This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00014679 . Registered on 25 April 2018.

Associations between eating disorder related symptoms and participants' utilization of an individualized Internet-based prevention and early intervention program.

OBJECTIVE: Flexible, individualized interventions allow participants to adjust the intensity of support to their current needs. Between-persons, participants with greater needs can receive more intense support, within-persons, participants can adjust utilization to their current level of symptoms. The purpose of the present study was to analyze associations between ED-related symptoms and utilization of the individualized program ProYouth both between- and within-persons, aiming to investigate whether participants adapt utilization intensity to their current needs. METHOD: Generalized estimated equations (GEEs) were used to analyze log data on program utilization (monthly page visits, monthly use of chats and forum) assessed via server logs and self-reported data on ED-related symptoms from N = 394 ProYouth participants who provided longitudinal data for at least two months. RESULTS: Between-persons, page visits per month were significantly associated with compensatory behavior, body dissatisfaction, and binge eating. Monthly use of the more intense modules with personal support chat and forum was associated with the frequency of compensatory behavior. Within-persons, unbalanced nutrition and dieting showed the strongest associations with monthly page visits. Monthly use of chats and forum was significantly associated with compensatory behavior and unbalanced nutrition and dieting. DISCUSSION: Results indicate that program utilization is associated with ED-related symptoms between- as well as within-persons. The individualized, flexible approach of ProYouth thus seems to be a promising way for Internet-based provision of combined prevention and early intervention programs addressing ED.

Can an internet-based program for the prevention and early intervention in eating disorders facilitate access to conventional professional healthcare?

BACKGROUND: The majorities of individual suffering from eating disorders do not seek or receive adequate professional treatment. Internet-based approaches promise to facilitate access to conventional healthcare by providing an easy-access, low-threshold contact. AIM: The current study investigated whether an Internet-based program for the prevention and early intervention for eating disorders (ProYouth) may contribute to the actual and intended uptake of professional care. Characteristics of individuals who seek help are explored as well as barriers to help-seeking. METHOD: The sample included 453 ProYouth participants who were surveyed three months after registration. Actual help-seeking behavior, intended help-seeking, potential help-seeking, and barriers to help-seeking were assessed. RESULTS: Within three months of participation, 43 individuals (9.5%) took up treatment, 32 (7.8%) intended to start treatment, and 163 (43.1%) of the remaining reported that they would seek professional help in case of need (potential help-seeking). Approximately 50% of (potential) help-seekers stated that participation in ProYouth has changed their attitude towards help-seeking. Mental health literacy and shame/stigma were the most frequently mentioned barriers. CONCLUSIONS: This is the first study indicating that an online program for prevention and early intervention may serve as facilitator in accessing conventional healthcare.

Reducing eating disorder symptoms and risk factors using the internet: A meta-analytic review.

OBJECTIVE: The purpose of this meta-analytic review was, first, to evaluate the efficacy of Internet-based programs in decreasing eating disorder (ED) symptoms, and, second, to identify moderator variables these effects. METHOD: Twenty studies were identified and between-group effect sizes were calculated for ED symptoms and risk factors. RESULTS: Compared with control conditions, Internet-based programs successfully decreased body dissatisfaction (d = 0.28, 95% CI [0.15-0.41], p < .001), internalization of the thin ideal (d = 0.36, 95% CI [0.07-0.65], p < .05), shape and weight concern (d = 0.42, 95% CI [0.13-0.71], p < .05), dietary restriction (d = 0.36, 95% CI [0.23-0.49], p < .001), drive for thinness (d = 0.47, 95% CI [0.33-0.60], p < .001), bulimic symptoms (d = 0.31, 95% CI [0.20-0.41], p < .001), purging frequency (d = 0.30, 95% CI [0.02-0.57], p < .05), and negative affect (d = 0.32, 95% CI [0.12-0.52], p < .001). Moderator analyses revealed no impact of data analytic strategy on intervention effects. Similarly, participant risk status was not a moderator for most outcomes. DISCUSSION: Internet-based programs are successful in decreasing ED symptoms and risk factors with small to moderate between-group effect sizes.

Effectiveness and Cost-effectiveness of School-based Dissemination Strategies of an Internet-based Program for the Prevention and Early Intervention in Eating Disorders: A Randomized Trial.

Only little is known about costs and effects (i.e., success) of dissemination strategies, although cost-effective dissemination strategies are crucial for the transfer of interventions into routine care. This study investigates the effects and cost-effectiveness of five school-based dissemination strategies for an Internet-based intervention for the prevention and early intervention of eating disorders. Three-hundred ninety-five schools were randomly assigned to one of five dissemination strategies. Strategies varied with respect to intensity from only sending advertisement materials and asking the school to distribute them among students to organizing presentations and workshops at schools. Effects were defined as the number of page visits, the number of screenings conducted, and the number of registrations to the Internet-based intervention. More expensive strategies proved to be more cost-effective. Cost per page visit ranged from 2.83€ (introductory presentation plus workshop) to 20.37€ (dissemination by student representatives/peers). Costs per screening ranged from 3.30€ (introductory presentation plus workshop) to 75.66€ (dissemination by student representatives/peers), and costs per registration ranged from 6.86€ (introductory presentation plus workshop) to 431.10€ (advertisement materials only). Dissemination of an Internet-based intervention for prevention and early intervention is challenging and expensive. More intense, expensive strategies with personal contact proved to be more cost-effective. The combination of an introductory presentation on eating disorders and a workshop in the high school was most effective and had the best cost-effectiveness ratio. The sole distribution of advertisement materials attracted hardly any participants to the Internet-based program.

Cost-effectiveness of an internet-based aftercare intervention after inpatient treatment in a psychosomatic hospital.

OBJECTIVE: The implementation of new interventions into routine care requires the demonstration of both their effectiveness and cost-effectiveness. METHOD: We explored the cost-effectiveness of an Internet-based aftercare program in addition to treatment as usual (CHAT) which was compared to treatment as usual (TAU) following inpatient treatment. Incremental cost-effectiveness ratios were calculated based on cost of the intervention, cost of outpatient treatment, and remission rates within 1 year after discharge from hospital. RESULTS: Assuming a willingness-to-pay of an additional 14.87 € per treatment for every additional percent of remission, CHAT was cost-effective against TAU at a 95% level of certainty. Cost per remission equaled 2664.84 € in TAU and 1752.75 € in CHAT (34.2% savings). CONCLUSIONS: This is the first evidence that Internet-based aftercare may enhance long-term treatment outcome in a cost-effective way.

[Implementation and dissemination of an internet-based program for prevention and early intervention in eating disorders]. / Implementierung und Dissemination eines internetbasierten Programms zur Prävention und frühen Intervention bei Essstörungen.

OBJECTIVE: The study reports on the implementation and dissemination of an internet-based program for prevention and early intervention in eating disorders (ProYouth). METHODS: The program consists of several modules that can be flexibly combined by users depending on their individual needs for support. The uptake and utilization of the online intervention, user characteristics, as well as the estimated amount of required resources to maintain the program are analyzed. RESULTS: Within 16 months, 1211 individuals registered for participation in the program. Active utilization of the different modules varies highly between participants and is related to their degree of impairment. User satisfaction is high. With the current sample, managing the platform requires approximately 11.5 hours of staff time per week. In a sample of 1000 participants, fixed costs (e. g. server and software maintenance) and cost for provision of online support amount to approx. 15 Euro per participant per year. CONCLUSIONS: ProYouth allows for the provision of individualized support based on participants' needs. Maintenance of the program is efficient since modules are partly automated. More research on the implementation and dissemination of internet-based interventions is needed to facilitate transfer into routine care.