JMIR Publications

ABSTRACT

Background:

University students are an at-risk group for the development of eating disorders (EDs), yet many college campuses lack sufficient resources to provide ED specialty care. Students report unique reasons for not seeking ED treatment, including desire to solve the problem on their own (e.g., seeking help from friends, self-medicating, or waiting to see if their problems improve), inability to afford treatment, lack of time to participate in treatment, fear of seeing their primary care physician, and lack of recognition of their issues as an ED. Mobile health (mHealth) apps may be a cost-effective helpful adjunctive tool to overcome personal and systemic barriers and encourage help seeking.

Objective:

The current paper describes the development, usability, and acceptability of the Building Healthy Eating and Self-Esteem Together for University Students (BEST-U) mHealth smartphone application that is designed to fill critical gaps in access to ED treatment on college campuses.

Methods:

We used a four-phase iterative development process that focused on user-centered design. The four-phases included: 1) needs assessment, on the basis of literature reviews; 2) prototype development and initial evaluation in a pilot trial; 3) redesign; and 4) further pilot testing to assess usability and acceptability of the final version of the mHealth app. Acceptability and user satisfaction were assessed using an ad hoc survey that ranged from 1 (strongly disagree) to 7 (strongly agree).

Results:

Our needs assessment identified a lack of accessible and affordable treatments for university students. To help meet this need, the BEST-U prototype was an 11-week program that provided interactive, weekly “modules'' that focused on second and third-wave cognitive-behavioral skills. Modules focused on topics such as psychoeducation, reducing thought distortions and body checking, improving body image, interpersonal effectiveness, and behavior chain analysis. Content included interactive quizzes, short answer questions, and daily and weekly logs and surveys completed in the app. BEST-U was paired with brief 25-30 minute weekly telehealth “coaching” sessions provided by a licensed provider or supervised trainee. Pilot testing revealed minor issues with one module of the app content, which some participants viewed as having low relevance to their experience, and therapist concerns with the organization of the app content. These issues were addressed through removal, addition, and reorganization of BEST-U modules with the help of therapists-in-training across two workshops. The revised version of BEST-U had a grand mean acceptability rating of 5.73 out of 7. Participants completed 90.13% of the BEST-U modules, which indicated high compliance.

Conclusions:

BEST-U is an acceptable and user-friendly new mHealth app to help therapists deliver brief, evidence-based cognitive-behavioral intervention. Due to its acceptability and user-friendly nature, BEST-U had high user compliance, and holds promise for future implementation and dissemination in university mental-health settings.