JMIR Publications

ABSTRACT

Background:

Early assessment and treatment of eating disorder patients is important for patient outcome. However up to a third of people referred for treatment do not access services and 16.4% do not attend their first scheduled assessment appointment. MotivATE is a fully automated novel web-based program intended to increase motivation to change eating disorder behaviours, designed for delivery at the point of invitation to an eating disorder service, with the aim of increasing service attendance.

Objective:

This paper assesses the impact of MotivATE on attendance at assessment when compared with treatment as usual.

Methods:

A zelen randomised control design was used. All individuals referred to a specialist eating disorder service, Kimmeridge House, Dorset, UK, over the course of a year (24/10/17 - 23/10/18), were randomised to treatment as usual (TAU) or treatment as usual plus an additional letter offering access to MotivATE. Attendance at the initial scheduled assessment appointment was assessed. Logistic regression analysis assessed the impact of MotivATE on attendance at assessment. Additional analyses based on levels of engagement with MotivATE were also undertaken.

Results:

A total of 313 participants took part (156 randomised to TAU, 157 randomised to receive the additional offer to access MotivATE). Intention-to-treat analysis between conditions showed no impact of MotivATE on attendance at assessment (OR = 1.35, 95% CI = 0.69-2.66, p = 0.38). Examination of the usage data indicated that only 53 of 157 participants (33%) in the MotivATE condition registered with the web-based intervention. An analysis comparing those that registered with the intervention with those that did not found greater attendance at assessment in those that had registered (OR = 9.46, 95% CI = 1.22-73.38, p = .03).

Conclusions:

Our primary analyses suggest no impact of MotivATE on attendance at the first scheduled assessment appointment, but secondary analyses revealed limited engagement with the program, and improved attendance in those who did engage. It is unclear, however, if engagement with the program increased motivation and so attendance, or if more motivated individuals were more likely to access the intervention. Further research is required to facilitate engagement with web-based interventions, and to understand the full value of MotivATE for users. Clinical Trial: ClinicalTrails.gov. Trial number: NCT02777944 (19/05/2016)