Abstract
BackgroundOnly one in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Early intervention has been associated with better prognosis, with those seeking specialised intervention in the early stages of their illness more than twice as likely to achieve remission. Current screening measures typically require expert administration and are rarely validated across a spectrum of DSM-5 eating disorder presentations or for online use. In light of COVID-19 and increasing reliance on telehealth technologies in the intervention and delivery of mental health services, online assessments suitable for self-referral are likely to be the first step to seeking care. InsideOut Institute has developed a 6-item online screening tool for the purposes of identifying eating disorder risk and symptomatology, aimed specifically at increasing help-seeking behaviour in subsyndromal and early presentations.MethodsThis study investigates the reliability and validity of the InsideOut Institute Screener (IOI-S), using a cross-sectional survey research design. Participants aged 14 and over will complete an extensive baseline survey battery for evaluation. 50% of participants will be randomly selected for one follow-up re-test of the IOI-S only, 2 weeks post initial testing. The IOI-S will be analysed for statistical reliability on two parameters: internal consistency and test re-test reliability, and for statistical validity on four parameters: concurrent validity, sensitivity and specificity, convergent and discriminant validity.DiscussionThe rapid and ongoing shift to digital intervention has highlighted gaps and opportunities in our pathways to care. Adequate screening for eating disorders is a major gap. This study aims to validate an online screening tool for use in telehealth early intervention, designed for users seeking information for a suspected eating disorder. The screener meets those at risk ‘where they are’ (i.e. online) and may improve timely referrals to relevant services. This is of particular salience as face-to-face healthcare and traditional frontline interventions are disrupted, and we are challenged to re-design our practices to deliver diagnostic and treatment services in highly adaptive digital contexts.
Highlights
One in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course
The internet is changing the way we seek and deliver healthcare, and current circumstances brought on by the COVID-19 global pandemic have intensified the need for validated online interventions and services, where appropriate intervention at first point of contact is shown to be of fundamental gain to outcome
The primary outcome of this study is to establish if the Inside Out Institute Screener is a statistically reliable, valid and accurate online measure of eating disorder risk and symptomatology in those aged 14 and over so that it can be reliably used by those seeking information for a suspected eating disorder
Summary
One in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Eating disorder stereotypes exacerbate ambivalence towards treatment seeking [13] and contribute to the ego-syntonic nature of the illness, where people can be stuck between the precontemplation (denial) and contemplation (awareness with resistance) stages as described by Prochaska’s transtheoretical model of change [14]. This ambivalence may be compounded by cultural normalisation of dietary and exercise excess, contributing to confusion around experiences of pathology and distress [15]
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