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Recruitment, Adherence And Attrition Challenges In Internet-Based Prevention Programs For Eating Disorders: The Example of A Randomised Controlled Trial of ProYouth OZ


 Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders. Peer-to-peer support has also been identified as a potentially useful component of these programs, but the adjunctive benefit of synchronous peer support has yet to be investigated. ProYouth OZ is an Internet-based prevention program for eating disorders consisting of psychoeducation, a supportive monitoring and feedback system, and synchronous peer support. The current study aimed to undertake an indicated prevention randomised controlled trial to evaluate the effectiveness of ProYouth OZ with and without peer-to-peer support in reducing disordered eating behaviours and attitudes relative to a waitlist control group.Method: In total, 50 young adults (18 to 25 years) with eating disorder symptoms were randomised to one of the three study conditions: (1) ProYouth OZ with peer-to-peer support, (2) ProYouth OZ without peer-to-peer support, and (3) a waitlist control group. Primary and secondary outcomes were assessed at three different time points.Results: Fifteen (30%) of the 50 randomised participants completed the post-intervention assessment. Due to limited outcome data, it was not possible to statistically examine between-group differences on the primary and secondary outcomes from pre- to post-intervention. However, trends in the available data suggested that peer support may be promising and warrants further investigation.Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community, including the difficulty in recruiting emerging adults, maintaining program adherence and reducing attrition. Although not eligible for the current trial, the study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on the topic of synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology and choose to access help online but may not be ready or able to seek professional face-to-face treatment.Trial registration: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527