Qualitative Feasibility and Usability Study of an Ecological Momentary Assessment (EMA) Smartphone Application in Binge Eating Disorder Treatment.

OBJECTIVE

Cognitive behaviour therapy (CBT) for binge eating disorder (BED) is fairly effective, yet relapse remains problematic. Treatment outcomes may be improved if patients gain more insight into symptom patterns. In this qualitative study embedded in BED treatment, we evaluated user experiences with an Ecological Momentary Assessment (EMA) smartphone application to self-monitor affect and binge eating episodes in daily life.

METHODS

Participants were 20 adults who received group-CBT for BED at a mental health institute in the Netherlands. Via an EMA smartphone app, the participants filled out 5 micro-questionnaires daily for 6 weeks. An overview of mood fluctuations and binge eating episodes was graphically displayed in the app and discussed with the therapist. Semi-structured interviews were conducted with 16 participants and 5 practitioners to evaluate feasibility and usefulness.

RESULTS

Qualitative analyses of the interviews showed that the app was perceived as user-friendly, yet invasive due to many registrations. This was reflected in low response rates (mean: 31.1%), with only 9 participants reaching a response rate above 30% (>65 of 210 EMA micro-questionnaires completed). Some participants thought the daily registrations were insightful, but some also perceived the registrations as confronting and shameful, suggesting potential iatrogenic effects.

CONCLUSIONS

This study offers a real-world example of using EMA in treatment and provides meaningful insights for developers of behaviour change-focused EMA tools. The experiences of the participants and practitioners were mixed, yet several indicated improved reflection and awareness of (fluctuations in) emotions. Given the cautiously positive feedback from several participants and therapists, we recommend a carefully designed evaluation, including a shorter assessment period, a control group and an assessment of emotional awareness.