User experience and perceived impact of the Eating Disorder Support App: a mixed- methods evaluation

User experience and perceived impact of the Eating Disorder Support App: a mixed- methods evaluation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article User experience and perceived impact of the Eating Disorder Support App: a mixed- methods evaluation Veronika Rysinova, Christine E Ramsey-Wade, Carolyn Trippick, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8900696/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Mobile health (mHealth) interventions offer opportunities to improve access to safe, evidence-informed support for people affected by eating disorders (EDs). However, challenges remain around sustained engagement, inclusivity, and integration with care. The co-produced Eating Disorder Support App, developed by the Eating Disorder Health Integration Team (EDHIT) from Bristol Health Partners, aims to provide trusted, accessible information for individuals with lived experience, supporters, and healthcare professionals. This evaluation evaluated user engagement, acceptability, and the perceived impact of the app on knowledge, confidence and support-seeking, while identifying opportunities for refinement. Methods A mixed-methods evaluation was conducted using an online survey and follow-up semi-structured interviews. Sixteen participants (people with lived experience, supporters, and healthcare professionals) completed a survey assessing app use, usability, satisfaction, and perceived impact; four took part in qualitative interviews exploring experiences in depth. Quantitative data were analysed descriptively, and qualitative data were analysed using thematic analysis. Results Participants reported high satisfaction with the app’s accessibility, clarity, and non-judgemental tone. Four themes were identified: (1) Supporting understanding, confidence and empowerment : participants described improved knowledge, reassurance, and confidence; (2) Navigating and engaging with the app : clear layout, navigation and practical features supported use; (3) Areas for development and concerns : participants noted initial information overwhelm and a desire for greater personalisation and expanded media formats; and (4) Creating an inclusive, sensitive and emotionally safe space : participants valued the warm, sensitive, and inclusive approach, while recommending further representation of neurodiversity. Respondents highlighted the value of the app as a trusted, accessible adjunct to care. Conclusions This evaluation suggests that the Eating Disorder Support App is an acceptable and useful digital resource that complements clinical care and supports self-management. Future evaluations should include larger and more diverse samples, longitudinal follow-up, and assessment of clinical outcomes to strengthen the understanding of impact. Continued co-production and lived-experience involvement are likely to enhance inclusivity, relevance, and sustained engagement in digital ED support tools. Eating disorders mHealth digital intervention mobile application lived experience co-production mixed-methods app evaluation Figures Figure 1 Figure 2 Plain English Summary This study examined how people used and experienced the Eating Disorder Support App, a mobile health tool designed to provide reliable, evidence‑based information and support for individuals with eating disorders, their families, and healthcare professionals. Sixteen participants used the app and shared feedback through an online survey, with four completing follow‑up interviews. The aim of the survey was to understand the user interaction and experience, including what people thought of it, how helpful it felt, and how it could be improved. The interviews gave deeper insights into personal experiences. Findings showed high satisfaction, with users valuing the app’s accessibility, clear layout, trustworthy content, and supportive, non‑judgmental tone. Many reported improved knowledge, alongside increased motivation, confidence, and positive behaviour change. Healthcare professionals highlighted its role as a trusted resource to recommend to patients and families. Overall, 93.8% rated the app’s quality as good or excellent. Participants also identified areas for development, including more diverse resources (e.g. content on neurodiversity), alternative formats such as audio or video, and avoiding overwhelming detail. These findings highlight the importance of involving people with lived experience in designing and developing digital health tools. Doing so ensures apps remain engaging, relevant, and effective. Background Eating disorders (EDs) are severe mental health conditions associated with high mortality, diminished quality of life, and substantial economic burden [ 1 , 2 ]. Lifetime prevalence estimates suggest that up to 18.6% of women and 6.5% of men experience a diagnosable eating disorder [ 3 ], with increasing incidence over the past 18 years and further escalations observed during the COVID-19 pandemic [ 4 ]. International evidence indicates that by early adulthood, between 5.5–17.9% of young women and 0.6–2.4% of young men develop an ED [ 5 ]. Both prodromal and formally diagnosed EDs are linked with elevated medical and psychological comorbidities, significant functional impairment, and one of the highest mortality rates among psychiatric conditions [ 6 , 7 ]. The global cost of the disease burden was estimated at US $ 64.7 billion in 2021 [ 8 ]. A range of evidence-based psychological treatments exist, including enhanced cognitive behavioural therapy (CBT-E) [ 9 ], the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) [ 10 ], focal psychodynamic therapy (FPT) [ 11 ], mentalisation-based treatment [ 12 ], pharmacotherapy [ 13 , 14 ], and family-based treatment for children and adolescents [ 15 ]. Despite this, fewer than a quarter of those with, or at risk of, an eating disorder seek or receive support [ 16 – 18 ]. Common barriers include limited specialist availability, financial constraints, long waiting lists, geographical access challenges, concerns about privacy, fear of change and the stigma associated with help-seeking [ 19 – 21 ]. Digital and mobile-health (mHealth) approaches have emerged as promising strategies to reduce access barriers [ 22 ]. Increased global smartphone use has fuelled a rapid expansion of digital health tools [ 23 , 24 ], which offer opportunities to access psychoeducation, self-help, and treatment resources flexibly, confidentially, and at low cost [ 25 , 26 ]. Evidence supports the acceptability, effectiveness, and cost-effectiveness of mHealth interventions for common mental health conditions [ 17 ], as well as emerging promise for eating disorders [ 27 ]. Web-based self-help appears moderately acceptable and accessible [ 28 ], with some evidence of comparable effectiveness to in-person interventions [ 27 , 29 ]. However, mHealth interventions frequently face challenges related to low uptake, limited engagement, and high attrition [ 30 ]. Recent evidence suggests that 41% of participants in mental-health app trials do not download the prescribed app, and only one-third complete all modules [ 31 ]. For individuals with lived experience of EDs, low engagement may reflect ambivalence towards change [ 20 ] and concerns about privacy or content quality [ 32 ]. High attrition and low sustained engagement therefore remain significant challenges in the digital ED space [ 27 , 33 ] Recognising these limitations and the wide availability of misleading or harmful ED-related information online [ 34 , 35 ], the Eating Disorder Health Integration Team (EDHIT) from Bristol Health Partners developed the Eating Disorder Support App. The app aims to provide reliable, evidence-informed, and easily accessible information and resources for individuals with lived experience, carers, and healthcare professionals. Importantly, the app was co-produced, addressing a key gap in the ED app landscape [ 36 ]. Previous literature has highlighted that many ED apps are not designed collaboratively with end users [ 27 ], do not incorporate lived-experience perspectives, and often fail to follow best-practice standards in user engagement or safety [ 27 , 37 ]. Participatory research and co-design are therefore recognised as essential for developing acceptable, safe, and engaging digital interventions [ 38 , 39 ]. The Eating Disorder Support App was developed through a rigorous co-production process involving people with lived experience, carers, specialist clinicians, mental-health practitioners, researchers, and digital designers. The development followed recognised user-centred design principles [ 40 – 42 ], including iterative prototyping, structured feedback cycles, and repeated user testing, consistent with best practice in co-production and Patient Information Forum TICK guidance. All content was benchmarked against evidence-based clinical guidelines, reviewed for clarity, safety, and inclusivity, and refined through multiple consultation rounds. The app also obtained external quality assurance via PIF TICK, demonstrating adherence to nationally recognised standards for health information production, including user involvement, accessibility, and impact evaluation. As of October 2025, the app has been downloaded more than 23,000 times, indicating substantial public demand for reliable and accessible eating-disorder information. The ED Support App is currently the only eating disorder mobile app recommended by Mind, a national mental health charity in the UK, and it is listed in its ‘Mind app library’ of accredited and trusted mental health apps: https://mind.orchahealth.com/en-GB/featured-apps-eating-disorders . Recent studies have emphasised the importance of clinicians’ perspectives in app adoption: 63% of mental health clinicians discuss apps with patients, yet many remain uncertain about which apps are appropriate, safe, and evidence-based [ 43 ]. Research also highlights users’ desire for accessible, empowering, personalised, and non-judgmental digital ED resources [ 44 – 46 ], while engagement studies highlight early drop-off in use among individuals seeking support for binge eating [ 47 ]. Collectively, these findings highlight the need for ongoing evaluation of real-world mHealth tools developed using best-practice co-production methods. Given the prevalence of unregulated and potentially harmful ED-related content online, the importance of co-production, and the limited evidence on user experiences of ED-specific apps developed to recognised quality standards, systematic evaluation is essential. This study therefore uses a mixed-methods approach to examine user engagement, acceptability, perceived impact, and opportunities for refinement. By integrating insights from people with lived experience, supporters, and healthcare professionals, the evaluation aims to support the ongoing development and optimisation of safe, acceptable, and evidence-informed digital support tools for eating disorders. Methods Study design A mixed-methods evaluation was conducted to explore user experiences and the perceived impact of the Eating Disorder Support App. The study combined an online cross-sectional survey with qualitative semi-structured interviews. This design enabled integration of quantitative indicators of satisfaction and perceived usefulness with in-depth qualitative insights into app experiences [ 39 ]. The evaluation followed a pragmatic, critical-realist approach, recognising both observable outcomes and the contextual meaning-making of participants [ 48 , 49 ]. Setting and intervention The Eating Disorder Support App was co-produced by the Eating Disorder Health Integration Team (EDHIT) and Expert Self Care Ltd., with sustained involvement from people with lived experience, carers, and clinicians. The app provides evidence-informed, information-based support including psychoeducation, signposting to services, recovery and wellbeing content, and resources for families and healthcare professionals. It is not designed to deliver therapy or structured self-help and does not replace clinical care. Content development was informed by established behavioural and social models (Health Belief Model [ 50 ]; Transtheoretical Model/Stages of Change [ 51 ]; Social Cognitive Theory [ 52 ]; Social Ecological Model [ 53 ]) and underwent iterative user testing, stakeholder workshops and clinical review. The app meets national health information quality standards and holds the PIF TICK quality mark. As of October 3036, it has been downloaded over 23,000 times, and is the only eating disorder app recommended by the national British mental health charity Mind. Survey respondents An opportunity sample of 16 survey respondents was recruited. Eligibility criteria were: aged ≥ 18 years; able to understand English; and previous use of, or engagement with, the app. Participants represented three stakeholder groups: (a) individuals with lived experience of an eating disorder or disordered eating; (b) supporters (family, friends, or carers); and (c) healthcare professionals (HCPs). Participants’ ages ranged from < 25 to 55–64 years. The sample included 14 women and one participant who did not disclose gender (one response was missing/withheld). The survey was sent out between January–March 2024 via the EDHIT newsletter, social-media posts (Instagram and X), community partners, and an in-app invitation. To support engagement, respondents could enter a random draw for a £20 Asda voucher. A subset of four volunteers (two with lived experience and two HCPs) subsequently completed qualitative interviews. Measures and materials Survey A bespoke Qualtrics survey was developed to explore participants’ demographic characteristics, stakeholder role, and patterns of app use, including frequency, sections accessed, and duration of engagement. The survey also assessed usability, accessibility, and satisfaction using Likert-scale items, and examined perceived impacts on knowledge, confidence, help-seeking, and wellbeing. In addition, participants were invited to comment on inclusivity, tone, and areas for improvement through open-text responses. Survey development was informed by established mHealth and app-evaluation frameworks, including the System Usability Scale (SUS) [ 54 ], the Mobile Application Rating Scale (MARS) [ 55 ], and the Client Satisfaction Questionnaire-8 (CSQ-8) [ 56 ], which have been applied in previous evaluations of eating-disorder–related digital tools [ 57 – 59 ]. As no single validated instrument specific to ED mHealth addressed the full scope of our evaluation aims, items were adapted to reflect the target population and the informational nature of the app. Item pools and wording were refined in collaboration with Patient and Public Involvement and Engagement (PPIE) advisors and the clinical team to enhance clarity, relevance, and acceptability. The full survey instrument is provided in Additional File 1. Interview schedules Semi-structured interviews explored first impressions, perceived usefulness/impact, tone and inclusivity, accessibility/usability, and enhancement priorities. Questions were co-developed with PPIE contributors and clinicians; who contributed expert input to both the survey questionnaire and interview schedules. Interviews were conducted via Microsoft Teams, audio-recorded with consent, and transcribed verbatim. Quantitative analysis used IBM SPSS Statistics v29. Qualitative data management and coding used NVivo (release 1.5). The full interview schedule is provided in Additional File 1. Procedure Survey adverts directed potential participants to the study information and consent page hosted in Qualtrics. After e-consent, participants completed the 10–15-minute survey. At the end, they could volunteer for an interview by submitting contact details through a separate, unlinked form (maintaining anonymity of survey responses). Interview volunteers were contacted to arrange a Teams appointment; interviews lasted 30–60 minutes. All participants were informed that participation was voluntary, data would be anonymised, and they could withdraw without giving a reason up to the point of data analysis. Ethical considerations This evaluation was conducted under the governance of the Eating Disorder Health Integration Team (EDHIT) within the Bristol, North Somerset and South Gloucestershire region. According to the Health Research Authority (HRA) decision tool, it was classified as a service or product evaluation and therefore did not require formal research ethics committee review. Procedures adhered to the British Psychological Society (BPS) Code of Human Research Ethics (2014) and the Declaration of Helsinki (1964 and subsequent amendments) [ 60 ], and were consistent with Health and Care Professions Council (HCPC) professional standards. Participants received information about the survey purpose, confidentiality, and their right to withdraw, and provided informed electronic consent before participation. Data were stored on secure, encrypted university systems; transcripts were anonymised prior to analysis. Data analysis Quantitative Descriptive statistics (frequencies, percentages, means and standard deviations) were generated for demographic variables, app-use patterns, usability and satisfaction ratings, and perceived impacts. Where useful for interpretation, simple cross-tabulations were conducted to explore variation across stakeholder groups. Extended quantitative results are available in Additional File 1. Qualitative Interview transcripts were analysed using thematic analysis, following the six-phase approach outlined by Braun and Clarke [ 61 , 62 ]. The analytic process involved: (1) familiarisation with the data; (2) systematic coding; (3) initial theme development; (4) review and refinement of candidate themes; (5) naming and defining themes; and (6) producing an analytic narrative accompanied by a thematic map. Coding was led by the first author (VR) who is trained in qualitative and health-psychology methods, with regular peer discussion and supervisory review to support reflexive rigour. An audit trail, memoing and codebook documented analytic decisions throughout. The coding framework, including themes, subthemes, boundaries and verbatim participant extracts, is provided in Additional File 1. Reflexivity and patient and public involvement and engagement The lead author (VR), a trainee health psychologist with experience in digital health and behaviour-change services, engaged in reflexive practice throughout, considering positionality and potential influence on data interpretation. Reflexive activities included journalling and regular supervisory meetings (CR-W, CT). PPIE contributors informed the development of survey and interview materials, advised on language and tone, and provided feedback on preliminary themes, which was incorporated iteratively. Results Characteristics of survey respondents A total of 16 respondents completed the online survey. Of these, seven (43.8%) reported personal experience of an eating disorder, four (25.0%) had experience supporting someone with an eating disorder, and five (31.3%) reported both personal and supportive experience. Participants represented a range of ages (under 25 to 55–64 years), gender identities (93.8% female), and locations across the United Kingdom (UK) (Table 1 ). Ten participants (62.5%) identified as healthcare professionals. Four participants subsequently took part in qualitative interviews: two healthcare professionals (a mental-health nurse specialising in eating disorders and a weight-management practitioner) and two individuals with lived experience (Table 2 ). Table 1 Demographic and relevant sample characteristics of the survey group of those with lived experience and healthcare professionals; n = 16. Demographics Survey sample n = 16 Age Under 25 (%) 2 (12.5) 25–34 (%) 2 (12.5) 35–44 (%) 6 (37.5) 45–54 (%) 4 (25.0) 54–64 (%) 2 (12.5) Gender Female (%) 15 (93.8) Prefer not to say (%) 1 (6.3) Ethnicity White (%) 10 (62.5) White other (%) 6 (37.5) Health professional Yes (%) 10 (62.5) No (%) 6 (37.5) Occupation Location Bath and North East Somerset (BANES) 2 (12.5) Bristol 3 (18.8) South Gloucestershire 2 (12.5) Other 9 (56.3) ED-related experience I have a personal experience with an eating disorder 7 (43.8) I have supported someone with an eating disorder. 4 (25.0) I have both personal and supportive experiences. 5 (31.3) Table 2 Interviewees and relevant description. Interview transcript Description Participant 1 Mental health nurse specialising in EDs Participant 2 Weight management practitioner Participant 3 Person with lived experience Participant 4 Person with lived experience App usage patterns Patterns of app engagement varied across respondents (Table 3 ). Most respondents reported using the app rarely (37.5%) or several times per month (25.0%), while one participant reported daily use (6.3%). Half of the sample (50.0%) had used the app for less than one month, whereas one quarter (25.0%) had used it for more than a year. Participants selected multiple reasons for using the app. The most commonly reported purposes included accessing resources (17.6%), supporting someone with an eating disorder (17.6%), and seeking general information about eating disorders (17.6%). A smaller proportion reported using the app primarily for self-help (14.7%). Other motivations included learning about symptoms, understanding treatment options, and identifying risk factors. Reasons for use were assessed through a multiple-choice format; percentages therefore reflect the proportion of total selections rather than participants. Table 3 App usage profiles of the survey respondents. App usage profile Survey sample n = 16 (%) App usage frequency Daily 1 (6.3) Several times a week 2 (12.5) Once a week 3 (18.8) Several times a month 4 (25.0) Rarely 6 (37.5) App usage length 1 year 4 (25.0) Reasons for using the app To gain knowledge about eating disorders 4 (11.8) To understand symptoms and effects 3 (8.8) To find out more about treatment 3 (8.8) To access resources 6 (17.6) To provide support to an individual with lived experience 6 (17.6) For self-help 5 (14.7) To find out who is at risk of getting an eating disorder 1 (2.9) Other 6 (17.6) Overview of themes and subthemes Four overarching themes were identified through thematic analysis, integrating insights from both survey comments and interview data (Table 4 ; Fig. 1 ). These were: (1) supporting understanding, confidence and empowerment; (2) navigating and engaging with the app; (3) areas for development and concerns; and (4) creating an inclusive, sensitive and emotionally safe space. The themes and subthemes are summarised in Table 4 and discussed in detail in the sections that follow, alongside relevant quantitative survey findings. Some themes spanned multiple conceptual domains, and this is noted where applicable. Figure 1 presents the thematic map illustrating how the themes and subthemes relate to one another. While many experiences were shared across individuals with lived experience and healthcare professionals, some themes were more pronounced within particular stakeholder groups, highlighting both convergence and divergence in perspectives. Table 4 Summary of the themes and subthemes across the data set. Theme Subtheme Definition 1. Supporting understanding, confidence and empowerment 1.1 Easy access, satisfaction and integration with care Respondents experienced the app as easy to access and navigate, felt satisfied with its use, and perceived it as a supportive complement to existing ED care or support pathways. 1.2 Trustworthy information offering something “extra” Perceptions that the app provides reliable, evidence-informed information that adds value beyond routine clinical support, informal advice or typical online sources. 1.3 Increased confidence, mindset shifts and behavioural support Experiences of greater confidence, reassurance, and shifts in thinking or behaviour linked to engaging with the app. 1.4 Feeling supported, validated and empowered Accounts of the app fostering feelings of support, emotional validation and empowerment through its tone, content and availability at times of need. 2. Navigating and engaging with the app 2.1 Clear structure, layout and navigation Views on the organisation, clarity and intuitive navigation of the app, contributing to a smooth user experience. 2.2 Engagement features, delivery style and interactivity Reflections on engaging elements (e.g., design, content features, delivery style) and suggestions for strengthened interactivity or visual appeal. 3. Areas for development and concerns 3.1 Desire for personalisation and broader resource options Suggestions for increased tailoring (e.g., personalised pathways or targeted content) and expansion of the resource base available within the app. 3.2 Managing information load and expectations Concerns about information density or complexity, and reflections on the importance of clearly communicating the app’s purpose and limits to avoid overwhelm. 4. Creating an inclusive, sensitive and emotionally safe space 4.1 Inclusivity and sensitivity to diverse experiences Perceptions of how well the app acknowledges and respects diverse identities, lived experiences and needs. 4.2 Clear, warm and non-judgemental communication Views on the clarity, warmth and non-judgemental tone of the language used, contributing to emotional safety and ease of engagement. Theme 1: Supporting understanding, confidence and empowerment This theme reflects how participants experienced the app as a trustworthy, accessible and supportive resource that complemented existing care, strengthened understanding, increased confidence and reassurance, and helped users feel better equipped to manage challenges or support others. 1.1 Easy access, satisfaction and integration with care This subtheme highlights how accessibility, usability and alignment with clinical care underpin users’ overall satisfaction and confidence in recommending the app. Participants consistently described the app as easy to access, straightforward to use and valuable alongside clinical care. Both individuals with lived experience and healthcare professionals appreciated having reliable, evidence-informed information available immediately: “My clients find it useful… having that information readily available is really important.” (Participant 1) “You can access it whenever you need it.” (Participant 3) Healthcare professionals noted that the app fit well with treatment pathways and acted as consistent support between appointments: “It crosses over nicely with our treatment pathways.” (Participant 1) Survey findings aligned strongly: 93.8% rated the app as good or excellent, 75% said it met their information needs, and 87.5% would recommend it to someone experiencing eating difficulties. Seventy-five percent reported they would use the app again. One participant summarised: “A very innovative idea that could help a lot of people… providing carers or loved ones with information and easy signposting.” (Survey) Table 5 App satisfaction ratings and percentages of the survey participants. App satisfaction Survey sample n = 16 (%) How would you rate the quality of the app? Excellent 8 (50.0) Good 7 (43.8) Fair 1 (6.3) Poor 0 Very poor 0 Did the app offer the type of support/information you were looking for? Not at all 1 (6.3) Not particularly 1 (6.3) I'm not sure 2 (12.5) Yes, generally 7 (43.8) Yes, definitely 5 (31.3) To what extent has the app met your needs? Almost all of my needs have been met 5 (31.3) Most of my needs have been met 3 (18.8) Only a few of my needs have been met 3 (18.8) None of my needs have been met 2 (12.5) If a friend was dealing with eating disorders, would you recommend this app? Not at all 0 Not particularly 1 (6.3) I'm not sure 1 (6.3) Yes, I think so 5 (31.3) Yes, definitely 9 (56.3) If you were to seek help again, would you choose this app? Not at all 0 Not particularly 2 (12.5) I'm not sure 2 (12.5) Yes, I think so 7 (43.8) Yes, definitely 5 (31.3) 1.2 Trustworthy information offering something “extra” This subtheme reflects how the app fulfilled an important informational gap by offering credible, well-organised content, something that users saw as an improvement over general online searches and a meaningful addition to clinical practice. Participants valued having comprehensive, credible information in one place, reducing the need to search online, which they described as overwhelming or unreliable: “The information is factual… they don’t have to go searching for it.” (Participant 1); You don’t have to panic-Google… sometimes you go down a rabbit hole.” (Participant 4) Healthcare professionals viewed the app as a meaningful enhancement to their practice: “A really nice resource… something extra I can advise people to look at.” (Participant 1) The thoroughness of the content also contributed to trust: “It looks very genuine because it’s so comprehensive… effort has been put into this app.” (Participant 3) Survey responses strongly supported these views: 62.5% found the information very or extremely useful, 75% rated it as accurate and reliable, and 93.8% as mostly or highly relevant. Only one participant noted that some content felt less applicable to a longstanding illness. Table 6 Participants’ ratings regarding the information usefulness, accuracy, reliability, relevance, and comprehensiveness. App information Survey sample n = 16 (%) How useful is the information about eating disorders in the app? Not at all useful 0 Slightly useful 0 Moderately useful 5 (31.3) Very useful 4 (25.0) Extremely useful 6 (37.5) How accurate and reliable is the information presented in the app? Very inaccurate/unreliable 1 (6.3) Inaccurate/unreliable 0 I don't know 3 (18.8) Accurate/reliable 6 (37.5) Very accurate/reliable 6 (37.5) How relevant is the information on the app to eating disorders? Not relevant at all 0 Slightly relevant 0 Neutral 1 (6.3) Mostly relevant 5 (31.3) Highly relevant 10 (62.5) How would you rate the comprehensiveness of the provided information? Not comprehensive at all 0 Slightly comprehensive 0 Moderately comprehensive 6 (37.5) Very comprehensive 5 (31.3) Extremely comprehensive 5 (31.3) 1.3 Increased confidence, mindset shifts and behavioural support This subtheme illustrates how the app contributed to increased confidence, positive mindset shifts and supportive behavioural patterns, while also highlighting variation in impact across individuals. Participants described increases in confidence, motivation and emotional security following app use. For some, the app reduced anxiety in social contexts and encouraged re-engagement in activities they previously avoided: “It’s given me motivation… made me more confident to engage in situations I wouldn’t have before.” (Participant 3) The app also prompted reflection on relationships, boundaries and wellbeing: “It made me think about people I no longer engaged with… it forced you to look at maintaining good relationships.” (Participant 3) Self-help materials, journaling tools and emotional-expression resources were described as especially valuable: “Journaling… really helped with the management of it.” (Participant 3) Healthcare professionals also drew on the app to support discussions about thinking styles, realistic goals and symptom recognition: “The information about unhelpful thinking styles… they found that really helpful.” (Participant 1) Survey findings strongly reflected the positive qualitative accounts. Most respondents reported that the app increased their awareness of eating disorders (62.5%), enhanced their knowledge (62.5%), and was likely to increase their motivation to address or overcome disordered eating (81.3%). Many anticipated that the app would encourage help-seeking (87.5%) and contribute to positive behaviour change (68.8%), with only a small minority perceiving little impact (Table 7 ). Table 7 Participants’ ratings regarding the impact of the app on awareness, knowledge, motivation, help-seeking, and behaviour change. App impact Survey sample n = 16 (%) How impactful has the app been in raising your awareness about eating disorders? Very impactful 4 (25.0) Moderately impactful 6 (37.5) Neutral 4 (25.0) Slightly impactful 0 Not at all impactful 2 (12.5) How effective has the app been in increasing your knowledge/understanding of eating disorders? Very effective 4 (25.0) Moderately effective 5 (31.3) Neutral 5 (31.3) Slightly effective 0 Not effective 2 (12.5) How likely do you think the use of this app is to increase intentions/motivation to address/overcome disordered eating habits? Highly likely 3 (18.8) Likely 10 (62.5) Neutral 1 (6.3) Unlikely 2 (12.5) Highly Unlikely 0 How likely do you think the use of this app is to encourage further help seeing for individuals dealing with eating disorders? Highly likely 5 (31.3) Likely 9 (56.3) Neutral 2 (12.5) Unlikely 0 Highly Unlikely 0 How likely do you the use of this app is to contribute to positive behaviour changes in managing and overcoming disordered eating? Highly likely 1 (6.3) Likely 10 (62.5) Neutral 4 (25.0) Unlikely 1 (6.3) Highly Unlikely 0 1.4 Feeling supported, validated and empowered This subtheme shows that the app helped to facilitate feelings of emotional safety and empowerment, acting as a supportive companion for both individuals with lived experience and those who care for them. Participants frequently described the app as offering a sense of ongoing support and emotional safety, particularly when professional care was not immediately accessible. Healthcare professionals valued the app as a safe, reliable tool to signpost clients and maintain continuity: “It’s something I signpost clients to… peace of mind for me as well.” (Participant 2) Individuals with lived experience described the app as a secure, private companion: “You always need that security… having this on your phone is different.” (Participant 3) “There’s a sense of security… it’s not going to disappear.” (Participant 3) Participants also described feeling more validated, less dismissed and more positive: “It made me more positive… you wouldn’t feel dismissed.” (Participant 3) Survey findings reinforced these qualitative insights. Most respondents believed the app made them feel more equipped or knowledgeable about supporting someone with an eating disorder (81.3%), and many felt it helped them deal more effectively with related challenges (43.8%). Importantly, none of the respondents reported that the app made things worse (Table 8 ). Participants also described the app as reassuring: “ It provides me with a sense of security” (Survey) and valued its supportive tone and resources for both themselves and loved ones. Table 8 Participants’ ratings regarding the impact of the app on feeling equipped to support or deal more effectively with related challenges. App support Survey sample n = 16 (%) How likely do you think the use of this app is to contribute to feeling more equipped or knowledgeable about supporting someone with an eating disorder? Highly likely 8 (50.0) Likely 5 (31.3) Neutral 2 (12.5) Unlikely 1 (6.3) Highly Unlikely 0 Has the app helped you to deal more effectively with related challenges? Yes, it helped a great deal 5 (31.3) Yes, it helped somewhat 2 (12.5) No, it really didn’t help 2 (12.5) No, it seemed to make things worse 0 Theme 2: Navigating and engaging with the app This theme captures participants’ experiences of using the app, focusing on the clarity of its layout, ease of navigation and perceptions of engagement. While users generally found the design intuitive and helpful, a minority noted areas for enhancement in visual appeal and interactivity. 2.1 Clear structure, layout and navigation This subtheme shows that participants generally found the app’s layout intuitive, clearly structured and easy to navigate, though a small number highlighted opportunities to improve visual appeal and readability. Participants consistently described the app’s structure and layout as clear, well-organised and easy to navigate. The ability to quickly locate relevant information, particularly during moments of distress, was viewed as highly important: “If you're looking for crisis stuff, you can find that in two buttons… it’s structured really well and easy to read.” (Participant 1) Users appreciated the organisation of sections and subsections, which improved clarity and reduced cognitive load: “It was very well laid out… you were able to click into what you thought you needed.” (Participant 3). Features such as colour-coded highlights, bullet points and recognisable icons supported navigation and readability: “I like that important information is flagged… the colours break up the text.” (Participant 2) “The icons were good—exactly what people would associate with those things.” (Participant 4) Survey findings largely mirrored these accounts (see Table 9 ). Most respondents rated the navigation as mostly or extremely intuitive (87.5%) and found the visual design appealing (62.5%). However, a small number found the layout less intuitive or visually engaging: “It was more like an ebook than an app… not very well spaced out… not visually appealing.” (Survey) Table 9 Participants’ ratings regarding the app’s navigation and visual appeal. App navigation and appeal Survey sample n = 16 (%) How intuitive is the app’s navigation and screen changes? Very confusing 0 Somewhat confusing 1 (6.3) Neutral 1 (6.3) Mostly intuitive 10 (62.5) Extremely intuitive 4 (25.0) How visually appealing do you find the app? Not appealing at all 1 (6.3) Slightly appealing 2 (12.5) Moderately appealing 3 (18.8) Very appealing 5 (31.3) Extremely appealing 5 (31.3) 2.2 Engagement features, delivery style and interactivity This subtheme reflects participants’ experiences of the app’s engagement features, with users valuing the breadth and usefulness of content while identifying a need for more modern interactivity and a more visually engaging interface. Participants valued the app’s breadth of content and the range of features designed to support varying needs. Many emphasised its relevance for younger users and those accustomed to digital formats: “Apps are proving very useful, particularly for our younger clients.” (Participant 1) Several participants appreciated being able to “check in” with the app regularly, noting that its structure supported both brief use and deeper engagement: “There are a lot of sections… I do check in on it, and I know it’s always there.” (Participant 3) The self-help section was consistently described as especially helpful, with content closely aligned with clinical practice: “The self-help stuff is particularly useful… especially Overcoming Binge Eating, which we use in clinic.” (Participant 1) Participants valued the app’s guided ideas for self-care, managing overwhelming thoughts and supporting emotional regulation: “There’s a whole section on what to do if you’re struggling… knowing I can check that is really useful.” (Participant 4) However, some felt that the interface could be updated to enhance engagement: “ The user interface is quite outdated… not very person-friendly.” (Participant 4) Survey data reflected a similar spread of views (see Table 10 ). While many respondents found the app useful for identifying risk factors and signposting clients, others reported limited engagement: “Great for understanding risk and red flags… lots of links for signposting.” (Survey); “Didn’t work to engage me.” (Survey). Ratings of interest varied widely, from not interesting at all (18.8%) to extremely interesting (12.5%), though overall functionality was rated positively, with 81.3% describing it as good or excellent . Table 10 Participants’ ratings regarding the impact of the app engagement, functionality and specific app’s features. App engagement and features Survey sample n = 16 (%) How interesting is the app in capturing and maintaining your interest? Not interesting at all 3 (18.8) Slightly interesting 1 (6.3) Moderately interesting 4 (25.0) Very interesting 6 (37.5) Extremely interesting 2 (12.5) Overall, how would you rate the functionality of the app (i.e., how well it does what is supposed to)? Very poor 0 Poor 1 (6.3) Average 2 (12.5) Good 8 (50.0) Excellent 5 (31.3) Which area(s) of the app do you find most useful? Local page 3 (4.3) About ED 7 (10.0) At risk 5 (7.1) Life 6 (8.6) Self help 12 (17.1) Treatment 6 (8.6) Support 10 (14.3) Calm zone 9 (12.9) Supporting others 8 (11.4) Partners 3 (4.3) Other 1 (1.4) Theme 3: Areas for development and concerns Participants identified opportunities to strengthen the app, particularly through greater personalisation, broader and more diverse resources, and enhanced accessibility features. While the comprehensive content was appreciated, some users described initial information overload, highlighting the need for clear signposting and realistic expectations about the app’s role. 3.1 Desire for personalisation and broader resource options This subtheme reflects participants’ desire for greater personalisation and a wider range of resources within the app, including more diverse formats, tailored content and localised information to meet different needs and recovery contexts. While participants valued the existing resources, many felt that additional tailoring could better support different learning preferences, clinical pathways and cultural contexts. Healthcare professionals noted that although regional information was helpful, expanding national resources would improve relevance across locations: “The wider resources are really useful… but the resources aren’t national yet.” (Participant 1) Users also highlighted the benefit of geographical tailoring, explaining that people often want information specific to their own country or local services: “Even just seeing to people in your own country… what’s available in your country.” (Participant 3) Participants suggested integrating more varied media formats to accommodate different learning styles and enhance engagement. Audio options, videos and podcasts were frequently mentioned as ways to support accessibility: “Videos and podcasts… some people learn better or understand information differently.” (Participant 2) Another consistent suggestion was for more content focused on maintenance of wellbeing rather than crisis alone, acknowledging that eating disorder recovery is often cyclical: “Resources around maintaining your wellness… because with an eating disorder you will relapse and have periods of wellness.” (Participant 4) Survey data reinforced these needs. Respondents requested content on interoception, neurodiversity, ADHD, menopause-related eating changes, and support for those beyond initial assessment stages. They also emphasised a desire for enhanced accessibility, including audio descriptions and customisable colour schemes, as well as more visual elements and built-in reflective activities rather than relying solely on external links: “More images… a space to journal or share thoughts… less wordy.” (Survey) “Provide an audio description… different colour schemes.” (Survey) “More downloadable resources… activities built into the app would be useful.” (Survey) 3.2 Managing information load and expectations This subtheme captures participants’ reflections on the balance between comprehensive information and potential overwhelm, highlighting the importance of managing expectations around the app’s purpose while ensuring clarity and emotional safety for users. Participants described mixed initial reactions to the volume of information within the app. While many eventually appreciated its comprehensiveness, some reported feeling overwhelmed when first opening it. One participant explained: “When I first downloaded the app, I was a little bit overwhelmed… there was so much information. Over time it became a positive because it’s very comprehensive.” (Participant 3) Others noted that the density of content could feel confusing, particularly if someone was unsure what they were looking for or using the app during distress: “It’s a very busy app… I can imagine if you weren’t quite sure what you were accessing, it could be confusing.” (Participant 4) Participants emphasised that the app itself was not harmful, but unrealistic expectations of what it could deliver might lead to disappointment. As one person reflected: “It’s done me no harm… the only harm would be if I thought this app would do everything. If I unrealistically looked at it as the be-all and end-all.” (Participant 3) Survey responses largely echoed these experiences. While one respondent reported feeling overwhelmed by the amount of information, others praised the app’s clarity and balance: “Overwhelmed by information.” (Survey) “Informative without being too overwhelming or wordy.” (Survey) “Good balance between being informative but not overwhelming.” (Survey) Quantitative findings showed that the majority of users (68.8%) were “not concerned at all” about the information provided, suggesting that although a minority initially experienced overload, most felt the app maintained an appropriate level of detail and clarity (see Table 11 ). Table 11 Participants’ ratings regarding concerns about the app. App concerns Survey sample n = 16 (%) Do you have any concerns about the information provided by the app? Highly concerned 0 Concerned 0 Neutral 3 (18.8) Not very concerned 2 (12.5) Not concerned at all 11 (68.8) Theme 4: Creating an inclusive, sensitive and emotionally safe space Respondents viewed the app as inclusive, sensitive and emotionally safe, noting that it addressed diverse identities and experiences often overlooked in eating-disorder resources. The language was consistently described as clear, accessible and non-judgemental, offering reassurance without medical jargon or patronising tones. 4.1 Inclusivity and sensitivity to diverse experiences This subtheme illustrates how the app’s inclusive design and sensitive framing contributed to feelings of recognition, safety and relevance across diverse user groups. They valued that the content acknowledged groups often overlooked in eating-disorder resources, including ethnic minorities, LGBTQ+ individuals, dancers, pregnant people, men and people with disabilities. This breadth was viewed as thoughtful, intentional and reflective of real-world diversity: “There are sections on all the things we might come across… different ethnic minorities, LGBTQI, dancers, men, pregnant people. Although they’re minorities, the information is there, which is very inclusive.” (Participant 1) Participants also felt the app addressed areas commonly omitted in clinical conversations, describing the content as “genuine” and recognising experiences that are “so often left out” (Participant 3). This inclusivity contributed to trust and emotional safety, with some users expressing hope that the app would continue to involve diverse communities in its development and feedback processes: “It covers different cultures… it’d be great if you were getting feedback from those groups. It definitely doesn’t discriminate.” (Participant 4) “It comes from specialists, but also from a community of people with lived experience… people have had a voice.” (Participant 4) Survey findings reinforced these perceptions. Respondents noted the inclusion of neurodiversity, ADHD and interoceptive impairment as important areas of representation, while a small number raised questions about language accessibility, such as availability in additional languages. Overall, 87.5% rated the app as moderately to extremely inclusive and sensitive (Table 12 ). Table 12 Participants’ ratings regarding sensitivity, inclusivity, and diversity. App inclusivity Survey sample n = 16 (%) How sensitive is the information presented to the needs and concerns of individuals with eating disorders? Not sensitive at all 0 Slightly sensitive 0 Moderately sensitive 2 (12.5) Very sensitive 8 (50.0) Extremely sensitive 6 (37.5) To what extent do you feel the app includes a diverse range of perspectives and experiences about eating disorders? Not at all inclusive of diverse perspectives and experiences 0 Slightly inclusive of diverse perspectives and experiences 2 (12.5) Moderately inclusive of diverse perspectives and experiences 6 (37.5) Very inclusive of diverse perspectives and experiences 5 (31.3) Extremely inclusive of diverse perspectives and experiences 3 (18.8) 4.2 Clear, warm and non-judgemental communication This subtheme highlights how the app’s clear, warm and non-judgemental communication style supported emotional safety and accessibility, helping users feel informed without feeling overwhelmed or judged. Participants described the app’s language as clear, accessible and non-judgemental, highlighting it as one of the most supportive aspects of the user experience. Individuals with lived experience valued the absence of medical jargon and the use of straightforward, compassionate language that felt inclusive rather than alienating: “It’s easy to understand… there’s no jargon. It’s not going to alienate people who aren’t familiar with medical terms.” (Participant 3) Many contrasted the app’s tone with some previous experiences of feeling dismissed or blamed in healthcare settings. The app’s factual yet sensitive communication style was described as validating and respectful: “The tone is not judgmental… you don’t feel as if you’re being given out to. It’s very inclusive.” (Participant 3). Respondents appreciated that the tone struck a balance, neither overly clinical nor overly informal, providing information in a way that felt appropriate, steadying and emotionally attuned: “It’s not condescending, it’s not too medical… it tells you exactly what you need to know, and it hits the tone so well.” (Participant 4) Survey responses strongly echoed these impressions. Users described the language as “neutral and informative,” “professional but caring,” and “factual yet comforting.” Others emphasised its accessibility, describing it as “inclusive,” “understandable without being patronising,” and “supportive and non-judgemental.” Most respondents (68.8%) rated the language as very clear and easy to understand , and none described it as unclear or difficult. Table 13 Participants ratings regarding the language used in the app. App language Survey sample n = 16 (%) How would you rate the understandability of the language used in the app? Very clear and easy to understand 11 (68.8) Clear and mostly understandable 4 (25.0) Neither clear nor unclear 1 (6.3) Somewhat unclear and challenging to understand 0 Very unclear and difficult to understand 0 Discussion Summary of findings This evaluation provides insight into how people with lived experience, supporters and healthcare professionals engaged with a co-produced, evidence-informed mHealth app for eating disorders. The people who took part in this evaluation consistently described the app as accessible, trustworthy and easy to navigate, reporting high satisfaction with its clarity, organisation and alignment with existing care pathways. Survey data supported these accounts, with most users rating the app as high quality, relevant and useful. Across groups, respondents reported positive impacts on confidence, understanding and emotional reassurance. Many described the app as a supportive resource between appointments, noting that it fostered feelings of safety, empowerment and validation. The app’s language was widely experienced as clear, warm and non-judgemental, and its inclusive representation of diverse identities and experiences was viewed as a key strength. Respondents also identified opportunities for improvement. These included greater personalisation, expanded content relating to neurodiversity, interoception and menopause, additional multimedia formats (e.g., audio, video), and clearer signposting to help users manage initial information overload. A small number of respondents noted that some content felt less relevant to long-standing illness or later stages of recovery. These findings suggest that a co-produced, quality-assured mHealth tool can offer meaningful support to individuals affected by eating disorders, while highlighting areas for continued refinement to enhance relevance, personalisation and long-term engagement, and the challenges of meeting the needs and preferences of all users. Lived experience input guided the design of the app in an e-book style, with no registration requirements and no gathering of personal information, to keep the app simple and usage confidential; these app features preclude greater personalisation. Since the completion of this evaluation, a link to a tested, video-based mindful eating micro-intervention has been embedded in the app in response to requests for more accessible and various information formats. Comparison with existing literature The evaluation findings align closely with existing literature on digital mental-health and eating-disorder interventions. Respondents’ emphasis on accessibility, clarity and ease of navigation reflects a broader evidence base demonstrating that user-centred, intuitive design is essential for engagement and acceptability in mHealth tools [ 63 – 65 ]. Prior work similarly highlights the importance of simple layouts, clear signposting and minimal cognitive burden, particularly during periods of distress, when sustained engagement is most fragile [ 66 , 67 ]. The strong sense of safety and trustworthiness reported by users directly addresses well-established concerns about the prevalence of misleading, unregulated or harmful ED-related information online [ 35 , 68 ]. This is consistent with reviews demonstrating that many existing ED apps lack clinical oversight, are not co-produced with people with lived experience, and show considerable variability in informational accuracy and quality [ 37 , 59 ]. In contrast, the co-produced and quality-assured model underpinning the present app appears to mitigate these risks and contribute to positive user perceptions of credibility and reliability. Participants’ appreciation of the app’s non-judgemental, warm and inclusive tone aligns with evidence that tone, empathy and stigma-sensitive language are central to building digital therapeutic alliance and supporting engagement in mental-health apps [ 36 , 69 , 70 ]. The value placed on diverse representation, including content relevant to different identities, stages of life and cultural contexts, mirrors calls in ED research for more inclusive, intersectional digital resources that reflect the heterogeneity of people affected by eating disorders [ 71 ]. The finding that users experienced the app as a supportive resource between appointments is consistent with literature highlighting the role of digital tools in bridging gaps caused by limited specialist provision, long waiting lists and geographical barriers to care [ 19 – 21 ]. While clinical outcomes were not evaluated in this study, previous research suggests that digital psychoeducation and self-support tools may promote early help-seeking, improve confidence in symptom management, and enhance treatment engagement [ 72 , 73 ]. Participants’ desire for greater personalisation echoes longstanding evidence that adaptive and tailored digital interventions are more likely to maintain relevance and improve engagement over time [ 74 , 75 ]. Requests for expanded content relating to neurodiversity, interoception and menopause-related changes align with emerging ED literature that highlights the importance of attending to these specific experiences [ 76 – 78 ]. Likewise, preferences for multimedia formats (e.g., audio, video) are consistent with studies showing that multimodal delivery supports different learning preferences and improves accessibility for users with cognitive or attentional challenges [ 79 , 80 ]. Finally, mixed experiences related to information overwhelm parallel findings on cognitive load in digital interventions, where initial overload is common and can be mitigated through clearer orientation, pacing and expectation management [ 81 , 82 ]. This reinforces the need for carefully structured content and personalised pathways, particularly in early stages of engagement. Future evaluations Future studies should examine how engagement, perceived usefulness and behavioural impacts evolve over time, particularly given the natural fluctuations and relapse–recovery cycles that characterise many eating-disorder experiences [ 83 ]. Longitudinal designs would help clarify whether the initial benefits reported here are sustained and how users draw on the app during different phases of their recovery journey. Evaluating clinical outcomes, such as help-seeking, treatment adherence, emotional regulation and symptom trajectories, would further strengthen understanding of the app’s effectiveness and its potential role within treatment pathways. Given the clear preference for personalisation, future work could explore adaptive or modular content, potentially using machine learning or decision-support algorithms to tailor material to individual needs, neurodiverse profiles and stages of recovery. Recruiting more diverse samples is essential to improve cultural relevance and ensure the app meets the needs of populations disproportionately affected by structural barriers to ED care. Research exploring implementation within real-world services, including blended-care and stepped-care models, would also provide insight into feasibility, sustainability and optimal integration with existing clinical systems. Practical implications For clinicians, these findings highlight the value of co-produced digital tools as adjunctive supports within care pathways. The app may help bridge gaps between appointments, enhance health literacy, support difficult conversations, and encourage early help-seeking, particularly among younger users or those hesitant to approach services. Managing expectations and guiding users on how to engage with the app may be important to reduce the risk of information overload and ensure that digital support complements, rather than replaces, evidence-based treatment. For developers, the results point to opportunities to strengthen usability through greater personalisation, a broader range of media formats, enhanced accessibility features and clearer signposting tailored to different stages of recovery. The consistent value that users placed on trustworthy information and inclusive, non-judgemental language reinforces the importance of continued clinical oversight, meaningful co-production, and fidelity to recognised quality standards. At a service and commissioning level, evidence-informed digital tools offer a scalable means to support early identification, provide safer alternatives to harmful online content, and extend continuity of support for individuals and families affected by eating disorders. Integrating such tools within stepped-care and blended-care models may help widen access, particularly in contexts of long waiting times and limited specialist provision. Strengths and limitations A key strength of this study is its mixed-methods design, which enabled triangulation between survey data and in-depth interviews with individuals with lived experience, supporters and healthcare professionals. This integration strengthened the interpretation of findings by allowing convergent and divergent perspectives to be explored. Credibility was further enhanced by the analysis being conducted by a health psychologist who was not involved in the app’s development, reducing the likelihood of developer bias. However, several limitations should be considered. The sample was small and predominantly White British/White Other, which constrains the transferability of findings to more diverse populations. Participation was voluntary, raising the possibility that individuals with more positive experiences or higher engagement were overrepresented. Survey and interview participants may also differ in characteristics from the wider app user base. The cross-sectional design limits insight into how perceptions and engagement might change over time, and no clinical outcomes were measured. These limitations indicate the need for larger, more diverse and longitudinal studies to better understand the app’s effectiveness, acceptability and sustained use across different user groups. Reflexivity The analysis was shaped by the first author’s position as a trainee health psychologist with experience in digital health and behaviour-change interventions. This background informed their interest in user experience, engagement and accessibility, and may have influenced the interpretation of participants’ accounts. To support reflexive awareness, the first author engaged in ongoing reflection through journalling and supervisory discussions, considering how their assumptions, training and professional identity might shape coding decisions and theme development. The analytic process followed the principles of thematic analysis, acknowledging the active, interpretative role of the researcher rather than aiming for neutrality or objectivity. Attention was given to alternative interpretations throughout, and emergent insights were sense-checked in discussion with supervisors to enhance clarity and coherence while retaining the researcher’s interpretative voice. Conclusion This evaluation demonstrates that a co-produced, evidence-informed, nationally recommended and quality-assured mHealth app can offer accessible, trustworthy and emotionally supportive resources for people affected by eating disorders and those who support them. Participants valued the app’s clarity, inclusivity and alignment with clinical guidance, and reported benefits for confidence, understanding and reassurance. Stakeholders can use the app to bridge gaps between appointments, enhance health literacy, support difficult conversations, and encourage early help-seeking with confidence. Areas for further refinement include personalisation, accessibility features and expanded content for diverse experiences. Further work and ongoing co-production will be crucial in ensuring digital tools are safe, equitable and responsive to the needs of individuals at different stages of their eating disorder journey. Abbreviations ADHD Attention-Deficit/Hyperactivity Disorder BMC BioMed Central BPS British Psychological Society CBT-E Enhanced Cognitive Behavioural Therapy CSQ-8 Client Satisfaction Questionnaire-8 ED Eating Disorder EDHIT Eating Disorder Health Integration Team HCP Healthcare Professional HCPC Health and Care Professions Council HRA Health Research Authority JED Journal of Eating Disorders MANTRA Maudsley Model of Anorexia Nervosa Treatment for Adults mHealth Mobile Health MARS Mobile Application Rating Scale NIHR National Institute for Health and Care Research NHS National Health Service PIF Patient Information Forum PPIE Patient and Public Involvement and Engagement RTA Reflexive Thematic Analysis SUS System Usability Scale UWE University of the West of England Declarations Ethics approval and consent to participate This evaluation was conducted under the governance of the Eating Disorder Health Integration Team (EDHIT) of Bristol Health Partners within the Bristol, North Somerset and South Gloucestershire NHS Integrated Care Board. According to the Health Research Authority (HRA) decision tool, it was classified as a product or service evaluation and therefore did not require formal NHS Research Ethics Committee review. All procedures followed the British Psychological Society (BPS) Code of Human Research Ethics (2014) and the Declaration of Helsinki (1964 and subsequent amendments). Survey respondents received information about the study purpose, confidentiality, and their right to withdraw, and provided informed consent electronically prior to participation. Consent for publication Participants gave consent for anonymised quotations to be used in academic and professional dissemination. No identifying details have been included. Competing interests The authors declare that they have no competing interests. Funding This study received no external funding. It was supported in kind by the Eating Disorder Health Integration Team (EDHIT) and completed as part of a doctoral programme of study at the University of the West of England (UWE Bristol). Author Contribution VR conceptualised and designed the study, collected and analysed data, and drafted the manuscript. CR-W supervised the project and contributed to study design, interpretation, and manuscript revision. SN and CT contributed to manuscript review, offering clinical and lived-experience perspectives. All authors read and approved the final manuscript. Acknowledgement The authors gratefully acknowledge the support of Hester Careless and Dr Knut Schroeder, who provided expert input in developing the questionnaire and interview schedules, and Hannah Davies, who provided support with literature searches. We thank all participants for their time and openness in sharing experiences, and the Eating Disorder Health Integration Team (EDHIT) for their collaboration and commitment to improving digital support for individuals affected by eating disorders. Appreciation is also extended to the lived-experience contributors whose insights informed the survey design and interpretation. Data Availability The datasets generated and analysed during this study are not publicly available to preserve anonymity but may be obtained from the corresponding author on reasonable request for verification. References Van Eeden AE, Van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021;34:515–24. https://doi.org/10.1097/YCO.0000000000000739 . Van Hoeken D, Hoek HW. Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. 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World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310:2191. https://doi.org/10.1001/jama.2013.281053 . Braun. & Clarke. Thematic Analysis: A Practical Guide. 2021. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706qp063oa . Farao J, Malila B, Conrad N, Mutsvangwa T, Rangaka MX, Douglas TS. A user-centred design framework for mHealth. PLoS ONE. 2020;15:e0237910. https://doi.org/10.1371/journal.pone.0237910 . Ikwunne T, Hederman L, Wall PJ. Design Processes for User Engagement with Mobile Health: A Systematic Review. IJACSA. 2022;13. https://doi.org/10.14569/IJACSA.2022.0130235 . Bonet-Olivencia S, Carrillo-Leal J, Rao A, Sasangohar F. User-Centered Design of a Diabetes Self-Management Tool for Underserved Populations. J Diabetes Sci Technol. 2024;18:22–9. https://doi.org/10.1177/19322968231212220 . Nitsch M, Dimopoulos CN, Flaschberger E, Saffran K, Kruger JF, Garlock L, et al. A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study. J Med Internet Res. 2016;18:e7. https://doi.org/10.2196/jmir.4972 . Rotondi AJ, Eack SM, Hanusa BH, Spring MB, Haas GL. Critical Design Elements of E-Health Applications for Users With Severe Mental Illness: Singular Focus, Simple Architecture, Prominent Contents, Explicit Navigation, and Inclusive Hyperlinks. Schizophr Bull. 2015;41:440–8. https://doi.org/10.1093/schbul/sbt194 . Lemire M, Pare G, Sicotte C, Harvey C. Determinants of Internet use as a preferred source of information on personal health. Int J Med Informatics. 2008;77:723–34. https://doi.org/10.1016/j.ijmedinf.2008.03.002 . Milton AC, Hambleton A, Dowling M, Roberts AE, Davenport T, Hickie I. Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study. J Med Internet Res. 2021;23:e19532. https://doi.org/10.2196/19532 . Tong F, Lederman R, D’Alfonso S, Berry K, Bucci S. Conceptualizing the digital therapeutic alliance in the context of fully automated mental health apps: A thematic analysis. Clin Psychol Psychoth. 2023;30:998–1012. https://doi.org/10.1002/cpp.2851 . Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020;33:562–7. https://doi.org/10.1097/YCO.0000000000000645 . Juarascio AS, Goldstein SP, Manasse SM, Forman EM, Butryn ML. Perceptions of the feasibility and acceptability of a smartphone application for the treatment of binge eating disorders: Qualitative feedback from a user population and clinicians. Int J Med Informatics. 2015;84:808–16. https://doi.org/10.1016/j.ijmedinf.2015.06.004 . Gentile AD, Kritian YY, Cini E. Clinical effectiveness of computer-based psychoeducational self-help platforms for eating disorders (with or without an associated app): A systematic review. 2024. https://doi.org/10.1101/2024.11.08.24316381 Khwaja M, Pieritz S, Faisal AA, Matic A. Personality and Engagement with Digital Mental Health Interventions. In: Proceedings of the 29th ACM Conference on User Modeling, Adaptation and Personalization. Utrecht Netherlands: ACM; 2021. pp. 235–9. https://doi.org/10.1145/3450613.3456823 Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, et al. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res. 2021;23:e24387. https://doi.org/10.2196/24387 . Sharp G, Fernando AN, Davis SR, Randhawa A. Developing an educational resource for people experiencing eating disorders during the menopause transition: A qualitative co-design study. J Eat Disord. 2024;12:179. https://doi.org/10.1186/s40337-024-01139-0 . Mangweth-Matzek B, Hoek HW, Rupp CI, Kemmler G, Pope HG, Kinzl J. The menopausal transition—A possible window of vulnerability for eating pathology. Intl J Eat Disorders. 2013;46:609–16. https://doi.org/10.1002/eat.22157 . Lewis R, Davies-Kabir M. The Hidden Majority? Exploring the Neurodiversity in CAMHS Eating Disorder Caseloads. BJPsych open. 2025;11:S185–185. https://doi.org/10.1192/bjo.2025.10479 . Chen C-Y. The Influence of Representational Formats and Learner Modality Preferences on Instructional Efficiency Using Interactive Video Tutorials. JET. 2020;7:77. https://doi.org/10.5296/jet.v7i2.17415 . Jebadurai ARVN, Vedamanickam IJ, Kumar AM. PU. Design of Generative Multimodal AI Agents to Enable Persons with Learning Disability. In: International Cconference on Multimodal Interaction. Paris France: ACM; 2023. pp. 259–71. https://doi.org/10.1145/3610661.3617514 Koltay T. The bright side of information: ways of mitigating information overload. JD. 2017;73:767–75. https://doi.org/10.1108/JD-09-2016-0107 . Harilal C, Sokhela C, Van Der Walt M. Optimising Instructional Design Strategies to Mitigate Cognitive Overload. ICER. 2024;1:75–83. https://doi.org/10.34190/icer.1.1.3095 . Heal-Cohen N, Allan SM, Gauvain N, Nabirinde R, Burgess A. Relapse in Eating Disorders: A Systematic Review and Thematic Synthesis of Individuals’ Experiences. Clin Psychol Psychoth. 2025;32:e70101. https://doi.org/10.1002/cpp.70101 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8900696","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":601338293,"identity":"f7be58b6-d63c-478c-8631-21e44191b29d","order_by":0,"name":"Veronika Rysinova","email":"","orcid":"","institution":"University of the West of England","correspondingAuthor":false,"prefix":"","firstName":"Veronika","middleName":"","lastName":"Rysinova","suffix":""},{"id":601338294,"identity":"43a788cc-7e32-40e3-af14-04c6e460ebcf","order_by":1,"name":"Christine E Ramsey-Wade","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABSElEQVRIie2PMUvDQBiGv1Coy0nWk6v4FyqBYGlR/Bcd7yhcl8SlIB1Eb0qWStcUxN/QLl175UAXcQ50Mbh2aB1KxIpeKNTatOIomGe5u5d7eL8PICPjD2IGABIAJ9enRYSpfjaXP+i6gsNEoYmCiivKw3alWF3Gq4rh/aCQ62j4Gh+dmYAOX8J5hQlci8LprWJtyEUTw+MppXBfVIjixp4wn4nrcSYIt0qdvmIdkbd0nZNSMAeld2FdaQriCsUGI2qT3b5yuxJsMLzmJmUYa2UgkXpz5h+6pT4j7zfKHcid2UalykGipAUQJ05eMnEwtokhdAugpCU1GA71YIhjFihkl12vZonCuFFq3dWvdNLA9DG1vhnw3DSuXLK237JGzvx4X+B6L4wvypbp+73J5Ly2rnyRWxyn4ltCtwtLTn7xJyMjI+Of8QlRSnOtEMYvmQAAAABJRU5ErkJggg==","orcid":"","institution":"University of the West of England","correspondingAuthor":true,"prefix":"","firstName":"Christine","middleName":"E","lastName":"Ramsey-Wade","suffix":""},{"id":601338295,"identity":"ae168f35-3f91-42db-b146-f04be4251b04","order_by":2,"name":"Carolyn Trippick","email":"","orcid":"","institution":"Bristol Health Partners","correspondingAuthor":false,"prefix":"","firstName":"Carolyn","middleName":"","lastName":"Trippick","suffix":""},{"id":601338296,"identity":"01de5e7b-632d-4042-9a77-471c0bf632a3","order_by":3,"name":"Sanni Norweg","email":"","orcid":"","institution":"Avon and Wiltshire Mental Health Partnership NHS Trust","correspondingAuthor":false,"prefix":"","firstName":"Sanni","middleName":"","lastName":"Norweg","suffix":""}],"badges":[],"createdAt":"2026-02-17 11:40:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8900696/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8900696/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104181002,"identity":"3c683be8-6762-4774-80c2-d4a87aae04a5","added_by":"auto","created_at":"2026-03-08 17:24:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":406997,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eFigure 1:\u003c/u\u003e The Eating Disorder Support App\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8900696/v1/8ac73fac61569f7fd9008ff0.png"},{"id":104181057,"identity":"364294dd-c796-4768-b7e5-d3195eee0160","added_by":"auto","created_at":"2026-03-08 17:24:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25497,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eFigure 1\u003c/u\u003e: Thematic map of the identified themes and subthemes\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8900696/v1/0ad18b9771fbfe565efa96b7.png"},{"id":104404397,"identity":"47895e06-d793-442d-8480-27ec99e66624","added_by":"auto","created_at":"2026-03-11 12:20:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2522670,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8900696/v1/4de0ce7d-743f-4eee-8c3f-fa2efadbffd1.pdf"},{"id":104181010,"identity":"042d5b9c-006f-4d21-a448-e5e4e89a7e2e","added_by":"auto","created_at":"2026-03-08 17:24:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":255990,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8900696/v1/ef622cbd4bd5321f679607d7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"User experience and perceived impact of the Eating Disorder Support App: a mixed- methods evaluation","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eThis study examined how people used and experienced the Eating Disorder Support App, a mobile health tool designed to provide reliable, evidence‑based information and support for individuals with eating disorders, their families, and healthcare professionals. Sixteen participants used the app and shared feedback through an online survey, with four completing follow‑up interviews. The aim of the survey was to understand the user interaction and experience, including what people thought of it, how helpful it felt, and how it could be improved. The interviews gave deeper insights into personal experiences.\u003c/p\u003e\n\u003cp\u003eFindings showed high satisfaction, with users valuing the app’s accessibility, clear layout, trustworthy content, and supportive, non‑judgmental tone. Many reported improved knowledge, alongside increased motivation, confidence, and positive behaviour change. Healthcare professionals highlighted its role as a trusted resource to recommend to patients and families. Overall, 93.8% rated the app’s quality as good or excellent. Participants also identified areas for development, including more diverse resources (e.g. content on neurodiversity), alternative formats such as audio or video, and avoiding overwhelming detail.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings highlight the importance of involving people with lived experience in designing and developing digital health tools. Doing so ensures apps remain engaging, relevant, and effective.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eEating disorders (EDs) are severe mental health conditions associated with high mortality, diminished quality of life, and substantial economic burden [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Lifetime prevalence estimates suggest that up to 18.6% of women and 6.5% of men experience a diagnosable eating disorder [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], with increasing incidence over the past 18 years and further escalations observed during the COVID-19 pandemic [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. International evidence indicates that by early adulthood, between 5.5\u0026ndash;17.9% of young women and 0.6\u0026ndash;2.4% of young men develop an ED [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Both prodromal and formally diagnosed EDs are linked with elevated medical and psychological comorbidities, significant functional impairment, and one of the highest mortality rates among psychiatric conditions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The global cost of the disease burden was estimated at US \u003cspan\u003e$\u003c/span\u003e64.7\u0026nbsp;billion in 2021 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA range of evidence-based psychological treatments exist, including enhanced cognitive behavioural therapy (CBT-E) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], focal psychodynamic therapy (FPT) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], mentalisation-based treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], pharmacotherapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and family-based treatment for children and adolescents [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Despite this, fewer than a quarter of those with, or at risk of, an eating disorder seek or receive support [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Common barriers include limited specialist availability, financial constraints, long waiting lists, geographical access challenges, concerns about privacy, fear of change and the stigma associated with help-seeking [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDigital and mobile-health (mHealth) approaches have emerged as promising strategies to reduce access barriers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Increased global smartphone use has fuelled a rapid expansion of digital health tools [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which offer opportunities to access psychoeducation, self-help, and treatment resources flexibly, confidentially, and at low cost [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Evidence supports the acceptability, effectiveness, and cost-effectiveness of mHealth interventions for common mental health conditions [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], as well as emerging promise for eating disorders [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Web-based self-help appears moderately acceptable and accessible [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], with some evidence of comparable effectiveness to in-person interventions [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, mHealth interventions frequently face challenges related to low uptake, limited engagement, and high attrition [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Recent evidence suggests that 41% of participants in mental-health app trials do not download the prescribed app, and only one-third complete all modules [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. For individuals with lived experience of EDs, low engagement may reflect ambivalence towards change [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and concerns about privacy or content quality [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. High attrition and low sustained engagement therefore remain significant challenges in the digital ED space [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eRecognising these limitations and the wide availability of misleading or harmful ED-related information online [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], the Eating Disorder Health Integration Team (EDHIT) from Bristol Health Partners developed the Eating Disorder Support App. The app aims to provide reliable, evidence-informed, and easily accessible information and resources for individuals with lived experience, carers, and healthcare professionals. Importantly, the app was co-produced, addressing a key gap in the ED app landscape [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Previous literature has highlighted that many ED apps are not designed collaboratively with end users [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], do not incorporate lived-experience perspectives, and often fail to follow best-practice standards in user engagement or safety [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Participatory research and co-design are therefore recognised as essential for developing acceptable, safe, and engaging digital interventions [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Eating Disorder Support App was developed through a rigorous co-production process involving people with lived experience, carers, specialist clinicians, mental-health practitioners, researchers, and digital designers. The development followed recognised user-centred design principles [\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], including iterative prototyping, structured feedback cycles, and repeated user testing, consistent with best practice in co-production and Patient Information Forum TICK guidance. All content was benchmarked against evidence-based clinical guidelines, reviewed for clarity, safety, and inclusivity, and refined through multiple consultation rounds. The app also obtained external quality assurance via PIF TICK, demonstrating adherence to nationally recognised standards for health information production, including user involvement, accessibility, and impact evaluation. As of October 2025, the app has been downloaded more than 23,000 times, indicating substantial public demand for reliable and accessible eating-disorder information. The ED Support App is currently the only eating disorder mobile app recommended by Mind, a national mental health charity in the UK, and it is listed in its \u0026lsquo;Mind app library\u0026rsquo; of accredited and trusted mental health apps: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://mind.orchahealth.com/en-GB/featured-apps-eating-disorders\u003c/span\u003e\u003cspan address=\"https://mind.orchahealth.com/en-GB/featured-apps-eating-disorders\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e .\u003c/p\u003e \u003cp\u003eRecent studies have emphasised the importance of clinicians\u0026rsquo; perspectives in app adoption: 63% of mental health clinicians discuss apps with patients, yet many remain uncertain about which apps are appropriate, safe, and evidence-based [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Research also highlights users\u0026rsquo; desire for accessible, empowering, personalised, and non-judgmental digital ED resources [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], while engagement studies highlight early drop-off in use among individuals seeking support for binge eating [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Collectively, these findings highlight the need for ongoing evaluation of real-world mHealth tools developed using best-practice co-production methods.\u003c/p\u003e \u003cp\u003eGiven the prevalence of unregulated and potentially harmful ED-related content online, the importance of co-production, and the limited evidence on user experiences of ED-specific apps developed to recognised quality standards, systematic evaluation is essential. This study therefore uses a mixed-methods approach to examine user engagement, acceptability, perceived impact, and opportunities for refinement. By integrating insights from people with lived experience, supporters, and healthcare professionals, the evaluation aims to support the ongoing development and optimisation of safe, acceptable, and evidence-informed digital support tools for eating disorders.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA mixed-methods evaluation was conducted to explore user experiences and the perceived impact of the Eating Disorder Support App. The study combined an online cross-sectional survey with qualitative semi-structured interviews. This design enabled integration of quantitative indicators of satisfaction and perceived usefulness with in-depth qualitative insights into app experiences [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The evaluation followed a pragmatic, critical-realist approach, recognising both observable outcomes and the contextual meaning-making of participants [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and intervention\u003c/h3\u003e\n\u003cp\u003eThe Eating Disorder Support App was co-produced by the Eating Disorder Health Integration Team (EDHIT) and Expert Self Care Ltd., with sustained involvement from people with lived experience, carers, and clinicians. The app provides evidence-informed, information-based support including psychoeducation, signposting to services, recovery and wellbeing content, and resources for families and healthcare professionals. It is not designed to deliver therapy or structured self-help and does not replace clinical care. Content development was informed by established behavioural and social models (Health Belief Model [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]; Transtheoretical Model/Stages of Change [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]; Social Cognitive Theory [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]; Social Ecological Model [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]) and underwent iterative user testing, stakeholder workshops and clinical review. The app meets national health information quality standards and holds the PIF TICK quality mark. As of October 3036, it has been downloaded over 23,000 times, and is the only eating disorder app recommended by the national British mental health charity Mind.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSurvey respondents\u003c/h3\u003e\n\u003cp\u003eAn opportunity sample of 16 survey respondents was recruited. Eligibility criteria were: aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; able to understand English; and previous use of, or engagement with, the app. Participants represented three stakeholder groups: (a) individuals with lived experience of an eating disorder or disordered eating; (b) supporters (family, friends, or carers); and (c) healthcare professionals (HCPs). Participants\u0026rsquo; ages ranged from \u0026lt;\u0026thinsp;25 to 55\u0026ndash;64 years. The sample included 14 women and one participant who did not disclose gender (one response was missing/withheld).\u003c/p\u003e \u003cp\u003eThe survey was sent out between January\u0026ndash;March 2024 via the EDHIT newsletter, social-media posts (Instagram and X), community partners, and an in-app invitation. To support engagement, respondents could enter a random draw for a \u0026pound;20 Asda voucher. A subset of four volunteers (two with lived experience and two HCPs) subsequently completed qualitative interviews.\u003c/p\u003e\n\u003ch3\u003eMeasures and materials\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSurvey\u003c/h2\u003e \u003cp\u003eA bespoke Qualtrics survey was developed to explore participants\u0026rsquo; demographic characteristics, stakeholder role, and patterns of app use, including frequency, sections accessed, and duration of engagement. The survey also assessed usability, accessibility, and satisfaction using Likert-scale items, and examined perceived impacts on knowledge, confidence, help-seeking, and wellbeing. In addition, participants were invited to comment on inclusivity, tone, and areas for improvement through open-text responses.\u003c/p\u003e \u003cp\u003eSurvey development was informed by established mHealth and app-evaluation frameworks, including the System Usability Scale (SUS) [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], the Mobile Application Rating Scale (MARS) [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], and the Client Satisfaction Questionnaire-8 (CSQ-8) [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], which have been applied in previous evaluations of eating-disorder\u0026ndash;related digital tools [\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. As no single validated instrument specific to ED mHealth addressed the full scope of our evaluation aims, items were adapted to reflect the target population and the informational nature of the app. Item pools and wording were refined in collaboration with Patient and Public Involvement and Engagement (PPIE) advisors and the clinical team to enhance clarity, relevance, and acceptability. The full survey instrument is provided in Additional File 1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInterview schedules\u003c/h2\u003e \u003cp\u003eSemi-structured interviews explored first impressions, perceived usefulness/impact, tone and inclusivity, accessibility/usability, and enhancement priorities. Questions were co-developed with PPIE contributors and clinicians; who contributed expert input to both the survey questionnaire and interview schedules. Interviews were conducted via Microsoft Teams, audio-recorded with consent, and transcribed verbatim. Quantitative analysis used IBM SPSS Statistics v29. Qualitative data management and coding used NVivo (release 1.5). The full interview schedule is provided in Additional File 1.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eSurvey adverts directed potential participants to the study information and consent page hosted in Qualtrics. After e-consent, participants completed the 10\u0026ndash;15-minute survey. At the end, they could volunteer for an interview by submitting contact details through a separate, unlinked form (maintaining anonymity of survey responses). Interview volunteers were contacted to arrange a Teams appointment; interviews lasted 30\u0026ndash;60 minutes. All participants were informed that participation was voluntary, data would be anonymised, and they could withdraw without giving a reason up to the point of data analysis.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThis evaluation was conducted under the governance of the Eating Disorder Health Integration Team (EDHIT) within the Bristol, North Somerset and South Gloucestershire region. According to the Health Research Authority (HRA) decision tool, it was classified as a service or product evaluation and therefore did not require formal research ethics committee review. Procedures adhered to the British Psychological Society (BPS) Code of Human Research Ethics (2014) and the Declaration of Helsinki (1964 and subsequent amendments) [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], and were consistent with Health and Care Professions Council (HCPC) professional standards. Participants received information about the survey purpose, confidentiality, and their right to withdraw, and provided informed electronic consent before participation. Data were stored on secure, encrypted university systems; transcripts were anonymised prior to analysis.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eQuantitative\u003c/h2\u003e \u003cp\u003eDescriptive statistics (frequencies, percentages, means and standard deviations) were generated for demographic variables, app-use patterns, usability and satisfaction ratings, and perceived impacts. Where useful for interpretation, simple cross-tabulations were conducted to explore variation across stakeholder groups. Extended quantitative results are available in Additional File 1.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQualitative\u003c/h2\u003e \u003cp\u003eInterview transcripts were analysed using thematic analysis, following the six-phase approach outlined by Braun and Clarke [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. The analytic process involved: (1) familiarisation with the data; (2) systematic coding; (3) initial theme development; (4) review and refinement of candidate themes; (5) naming and defining themes; and (6) producing an analytic narrative accompanied by a thematic map. Coding was led by the first author (VR) who is trained in qualitative and health-psychology methods, with regular peer discussion and supervisory review to support reflexive rigour. An audit trail, memoing and codebook documented analytic decisions throughout. The coding framework, including themes, subthemes, boundaries and verbatim participant extracts, is provided in Additional File 1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eReflexivity and patient and public involvement and engagement\u003c/h2\u003e \u003cp\u003eThe lead author (VR), a trainee health psychologist with experience in digital health and behaviour-change services, engaged in reflexive practice throughout, considering positionality and potential influence on data interpretation. Reflexive activities included journalling and regular supervisory meetings (CR-W, CT). PPIE contributors informed the development of survey and interview materials, advised on language and tone, and provided feedback on preliminary themes, which was incorporated iteratively.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of survey respondents\u003c/h2\u003e \u003cp\u003eA total of 16 respondents completed the online survey. Of these, seven (43.8%) reported personal experience of an eating disorder, four (25.0%) had experience supporting someone with an eating disorder, and five (31.3%) reported both personal and supportive experience. Participants represented a range of ages (under 25 to 55\u0026ndash;64 years), gender identities (93.8% female), and locations across the United Kingdom (UK) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Ten participants (62.5%) identified as healthcare professionals.\u003c/p\u003e \u003cp\u003eFour participants subsequently took part in qualitative interviews: two healthcare professionals (a mental-health nurse specialising in eating disorders and a weight-management practitioner) and two individuals with lived experience (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and relevant sample characteristics of the survey group of those with lived experience and healthcare professionals; n\u0026thinsp;=\u0026thinsp;16.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder 25 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;54 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u0026ndash;64 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15 (93.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to say (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite other (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHealth professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBath and North East Somerset (BANES)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBristol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Gloucestershire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e9 (56.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eED-related experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have a personal experience with an eating disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7 (43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have supported someone with an eating disorder.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have both personal and supportive experiences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterviewees and relevant description.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterview transcript\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMental health nurse specialising in EDs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeight management practitioner\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerson with lived experience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerson with lived experience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eApp usage patterns\u003c/h2\u003e \u003cp\u003ePatterns of app engagement varied across respondents (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Most respondents reported using the app rarely (37.5%) or several times per month (25.0%), while one participant reported daily use (6.3%). Half of the sample (50.0%) had used the app for less than one month, whereas one quarter (25.0%) had used it for more than a year.\u003c/p\u003e \u003cp\u003eParticipants selected multiple reasons for using the app. The most commonly reported purposes included accessing resources (17.6%), supporting someone with an eating disorder (17.6%), and seeking general information about eating disorders (17.6%). A smaller proportion reported using the app primarily for self-help (14.7%). Other motivations included learning about symptoms, understanding treatment options, and identifying risk factors. Reasons for use were assessed through a multiple-choice format; percentages therefore reflect the proportion of total selections rather than participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eApp usage profiles of the survey respondents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp usage profile\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eApp usage frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeveral times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeveral times a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eApp usage length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eReasons for using the app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo gain knowledge about eating disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo understand symptoms and effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (8.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo find out more about treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (8.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo access resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo provide support to an individual with lived experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor self-help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (14.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo find out who is at risk of getting an eating disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (2.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eOverview of themes and subthemes\u003c/h2\u003e \u003cp\u003eFour overarching themes were identified through thematic analysis, integrating insights from both survey comments and interview data (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These were: (1) supporting understanding, confidence and empowerment; (2) navigating and engaging with the app; (3) areas for development and concerns; and (4) creating an inclusive, sensitive and emotionally safe space. The themes and subthemes are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and discussed in detail in the sections that follow, alongside relevant quantitative survey findings. Some themes spanned multiple conceptual domains, and this is noted where applicable. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the thematic map illustrating how the themes and subthemes relate to one another. While many experiences were shared across individuals with lived experience and healthcare professionals, some themes were more pronounced within particular stakeholder groups, highlighting both convergence and divergence in perspectives.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of the themes and subthemes across the data set.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Supporting understanding, confidence and empowerment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.1 Easy access, satisfaction and integration with care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRespondents experienced the app as easy to access and navigate, felt satisfied with its use, and perceived it as a supportive complement to existing ED care or support pathways.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.2 Trustworthy information offering something \u0026ldquo;extra\u0026rdquo;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceptions that the app provides reliable, evidence-informed information that adds value beyond routine clinical support, informal advice or typical online sources.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.3 Increased confidence, mindset shifts and behavioural support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperiences of greater confidence, reassurance, and shifts in thinking or behaviour linked to engaging with the app.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.4 Feeling supported, validated and empowered\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccounts of the app fostering feelings of support, emotional validation and empowerment through its tone, content and availability at times of need.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Navigating and engaging with the app\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.1 Clear structure, layout and navigation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eViews on the organisation, clarity and intuitive navigation of the app, contributing to a smooth user experience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.2 Engagement features, delivery style and interactivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReflections on engaging elements (e.g., design, content features, delivery style) and suggestions for strengthened interactivity or visual appeal.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Areas for development and concerns\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.1 Desire for personalisation and broader resource options\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSuggestions for increased tailoring (e.g., personalised pathways or targeted content) and expansion of the resource base available within the app.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.2 Managing information load and expectations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConcerns about information density or complexity, and reflections on the importance of clearly communicating the app\u0026rsquo;s purpose and limits to avoid overwhelm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Creating an inclusive, sensitive and emotionally safe space\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.1 Inclusivity and sensitivity to diverse experiences\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceptions of how well the app acknowledges and respects diverse identities, lived experiences and needs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.2 Clear, warm and non-judgemental communication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eViews on the clarity, warmth and non-judgemental tone of the language used, contributing to emotional safety and ease of engagement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Supporting understanding, confidence and empowerment\u003c/h2\u003e \u003cp\u003eThis theme reflects how participants experienced the app as a trustworthy, accessible and supportive resource that complemented existing care, strengthened understanding, increased confidence and reassurance, and helped users feel better equipped to manage challenges or support others.\u003c/p\u003e \u003cp\u003e \u003cb\u003e1.1 Easy access, satisfaction and integration with care\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme highlights how accessibility, usability and alignment with clinical care underpin users\u0026rsquo; overall satisfaction and confidence in recommending the app. Participants consistently described the app as easy to access, straightforward to use and valuable alongside clinical care. Both individuals with lived experience and healthcare professionals appreciated having reliable, evidence-informed information available immediately:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;My clients find it useful\u0026hellip; having that information readily available is really important.\u0026rdquo;\u003c/em\u003e (Participant 1) \u003cem\u003e\u0026ldquo;You can access it whenever you need it.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eHealthcare professionals noted that the app fit well with treatment pathways and acted as consistent support between appointments: \u003cem\u003e\u0026ldquo;It crosses over nicely with our treatment pathways.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eSurvey findings aligned strongly: 93.8% rated the app as good or excellent, 75% said it met their information needs, and 87.5% would recommend it to someone experiencing eating difficulties. Seventy-five percent reported they would use the app again. One participant summarised: \u003cem\u003e\u0026ldquo;A very innovative idea that could help a lot of people\u0026hellip; providing carers or loved ones with information and easy signposting.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eApp satisfaction ratings and percentages of the survey participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp satisfaction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow would you rate the quality of the app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7 (43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eDid the app offer the type of support/information you were looking for?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot particularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI'm not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, generally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7 (43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, definitely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTo what extent has the app met your needs?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlmost all of my needs have been met\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of my needs have been met\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly a few of my needs have been met\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone of my needs have been met\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eIf a friend was dealing with eating disorders, would you recommend this app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot particularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI'm not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, I think so\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, definitely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e9 (56.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eIf you were to seek help again, would you choose this app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot particularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI'm not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, I think so\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7 (43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, definitely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.2 Trustworthy information offering something \u0026ldquo;extra\u0026rdquo;\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme reflects how the app fulfilled an important informational gap by offering credible, well-organised content, something that users saw as an improvement over general online searches and a meaningful addition to clinical practice. Participants valued having comprehensive, credible information in one place, reducing the need to search online, which they described as overwhelming or unreliable: \u003cem\u003e\u0026ldquo;The information is factual\u0026hellip; they don\u0026rsquo;t have to go searching for it.\u0026rdquo;\u003c/em\u003e (Participant 1); \u003cem\u003eYou don\u0026rsquo;t have to panic-Google\u0026hellip; sometimes you go down a rabbit hole.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eHealthcare professionals viewed the app as a meaningful enhancement to their practice:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;A really nice resource\u0026hellip; something extra I can advise people to look at.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eThe thoroughness of the content also contributed to trust: \u003cem\u003e\u0026ldquo;It looks very genuine because it\u0026rsquo;s so comprehensive\u0026hellip; effort has been put into this app.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eSurvey responses strongly supported these views: 62.5% found the information very or extremely useful, 75% rated it as accurate and reliable, and 93.8% as mostly or highly relevant. Only one participant noted that some content felt less applicable to a longstanding illness.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding the information usefulness, accuracy, reliability, relevance, and comprehensiveness.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow useful is the information about eating disorders in the app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all useful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly useful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately useful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery useful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely useful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow accurate and reliable is the information presented in the app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery inaccurate/unreliable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInaccurate/unreliable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccurate/reliable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery accurate/reliable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow relevant is the information on the app to eating disorders?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot relevant at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly relevant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMostly relevant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly relevant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow would you rate the comprehensiveness of the provided information?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot comprehensive at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.3 Increased confidence, mindset shifts and behavioural support\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme illustrates how the app contributed to increased confidence, positive mindset shifts and supportive behavioural patterns, while also highlighting variation in impact across individuals. Participants described increases in confidence, motivation and emotional security following app use. For some, the app reduced anxiety in social contexts and encouraged re-engagement in activities they previously avoided: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s given me motivation\u0026hellip; made me more confident to engage in situations I wouldn\u0026rsquo;t have before.\u0026rdquo;\u003c/em\u003e (Participant 3) The app also prompted reflection on relationships, boundaries and wellbeing: \u003cem\u003e\u0026ldquo;It made me think about people I no longer engaged with\u0026hellip; it forced you to look at maintaining good relationships.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eSelf-help materials, journaling tools and emotional-expression resources were described as especially valuable: \u003cem\u003e\u0026ldquo;Journaling\u0026hellip; really helped with the management of it.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eHealthcare professionals also drew on the app to support discussions about thinking styles, realistic goals and symptom recognition: \u003cem\u003e\u0026ldquo;The information about unhelpful thinking styles\u0026hellip; they found that really helpful.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eSurvey findings strongly reflected the positive qualitative accounts. Most respondents reported that the app increased their awareness of eating disorders (62.5%), enhanced their knowledge (62.5%), and was likely to increase their motivation to address or overcome disordered eating (81.3%). Many anticipated that the app would encourage help-seeking (87.5%) and contribute to positive behaviour change (68.8%), with only a small minority perceiving little impact (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding the impact of the app on awareness, knowledge, motivation, help-seeking, and behaviour change.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow impactful has the app been in raising your awareness about eating disorders?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery impactful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately impactful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly impactful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all impactful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow effective has the app been in increasing your knowledge/understanding of eating disorders?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot effective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow likely do you think the use of this app is to increase intentions/motivation to address/overcome disordered eating habits?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly likely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly Unlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow likely do you think the use of this app is to encourage further help seeing for individuals dealing with eating disorders?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly likely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e9 (56.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly Unlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow likely do you the use of this app is to contribute to positive behaviour changes in managing and overcoming disordered eating?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly likely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly Unlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.4 Feeling supported, validated and empowered\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme shows that the app helped to facilitate feelings of emotional safety and empowerment, acting as a supportive companion for both individuals with lived experience and those who care for them. Participants frequently described the app as offering a sense of ongoing support and emotional safety, particularly when professional care was not immediately accessible. Healthcare professionals valued the app as a safe, reliable tool to signpost clients and maintain continuity: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s something I signpost clients to\u0026hellip; peace of mind for me as well.\u0026rdquo;\u003c/em\u003e (Participant 2) Individuals with lived experience described the app as a secure, private companion: \u003cem\u003e\u0026ldquo;You always need that security\u0026hellip; having this on your phone is different.\u0026rdquo;\u003c/em\u003e (Participant 3) \u003cem\u003e\u0026ldquo;There\u0026rsquo;s a sense of security\u0026hellip; it\u0026rsquo;s not going to disappear.\u0026rdquo;\u003c/em\u003e (Participant 3) Participants also described feeling more validated, less dismissed and more positive: \u003cem\u003e\u0026ldquo;It made me more positive\u0026hellip; you wouldn\u0026rsquo;t feel dismissed.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eSurvey findings reinforced these qualitative insights. Most respondents believed the app made them feel more equipped or knowledgeable about supporting someone with an eating disorder (81.3%), and many felt it helped them deal more effectively with related challenges (43.8%). Importantly, none of the respondents reported that the app made things worse (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). Participants also described the app as reassuring: \u0026ldquo;\u003cem\u003eIt provides me with a sense of security\u0026rdquo;\u003c/em\u003e (Survey) and valued its supportive tone and resources for both themselves and loved ones.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding the impact of the app on feeling equipped to support or deal more effectively with related challenges.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow likely do you think the use of this app is to contribute to feeling more equipped or knowledgeable about supporting someone with an eating disorder?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly likely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly Unlikely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHas the app helped you to deal more effectively with related challenges?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, it helped a great deal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, it helped somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, it really didn\u0026rsquo;t help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, it seemed to make things worse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Navigating and engaging with the app\u003c/h2\u003e \u003cp\u003eThis theme captures participants\u0026rsquo; experiences of using the app, focusing on the clarity of its layout, ease of navigation and perceptions of engagement. While users generally found the design intuitive and helpful, a minority noted areas for enhancement in visual appeal and interactivity.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.1 Clear structure, layout and navigation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme shows that participants generally found the app\u0026rsquo;s layout intuitive, clearly structured and easy to navigate, though a small number highlighted opportunities to improve visual appeal and readability. Participants consistently described the app\u0026rsquo;s structure and layout as clear, well-organised and easy to navigate. The ability to quickly locate relevant information, particularly during moments of distress, was viewed as highly important:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If you're looking for crisis stuff, you can find that in two buttons\u0026hellip; it\u0026rsquo;s structured really well and easy to read.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eUsers appreciated the organisation of sections and subsections, which improved clarity and reduced cognitive load: \u003cem\u003e\u0026ldquo;It was very well laid out\u0026hellip; you were able to click into what you thought you needed.\u0026rdquo;\u003c/em\u003e (Participant 3). Features such as colour-coded highlights, bullet points and recognisable icons supported navigation and readability: \u003cem\u003e\u0026ldquo;I like that important information is flagged\u0026hellip; the colours break up the text.\u0026rdquo;\u003c/em\u003e (Participant 2) \u003cem\u003e\u0026ldquo;The icons were good\u0026mdash;exactly what people would associate with those things.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eSurvey findings largely mirrored these accounts (see Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e). Most respondents rated the navigation as \u003cem\u003emostly\u003c/em\u003e or \u003cem\u003eextremely intuitive\u003c/em\u003e (87.5%) and found the visual design appealing (62.5%). However, a small number found the layout less intuitive or visually engaging:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It was more like an ebook than an app\u0026hellip; not very well spaced out\u0026hellip; not visually appealing.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding the app\u0026rsquo;s navigation and visual appeal.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp navigation and appeal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow intuitive is the app\u0026rsquo;s navigation and screen changes?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery confusing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomewhat confusing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMostly intuitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely intuitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow visually appealing do you find the app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot appealing at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly appealing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately appealing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery appealing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely appealing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.2 Engagement features, delivery style and interactivity\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme reflects participants\u0026rsquo; experiences of the app\u0026rsquo;s engagement features, with users valuing the breadth and usefulness of content while identifying a need for more modern interactivity and a more visually engaging interface. Participants valued the app\u0026rsquo;s breadth of content and the range of features designed to support varying needs. Many emphasised its relevance for younger users and those accustomed to digital formats: \u003cem\u003e\u0026ldquo;Apps are proving very useful, particularly for our younger clients.\u0026rdquo;\u003c/em\u003e (Participant 1) Several participants appreciated being able to \u0026ldquo;check in\u0026rdquo; with the app regularly, noting that its structure supported both brief use and deeper engagement: \u003cem\u003e\u0026ldquo;There are a lot of sections\u0026hellip; I do check in on it, and I know it\u0026rsquo;s always there.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eThe self-help section was consistently described as especially helpful, with content closely aligned with clinical practice: \u003cem\u003e\u0026ldquo;The self-help stuff is particularly useful\u0026hellip; especially Overcoming Binge Eating, which we use in clinic.\u0026rdquo;\u003c/em\u003e (Participant 1) Participants valued the app\u0026rsquo;s guided ideas for self-care, managing overwhelming thoughts and supporting emotional regulation: \u003cem\u003e\u0026ldquo;There\u0026rsquo;s a whole section on what to do if you\u0026rsquo;re struggling\u0026hellip; knowing I can check that is really useful.\u0026rdquo;\u003c/em\u003e (Participant 4) However, some felt that the interface could be updated to enhance engagement: \u0026ldquo;\u003cem\u003eThe user interface is quite outdated\u0026hellip; not very person-friendly.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eSurvey data reflected a similar spread of views (see Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e). While many respondents found the app useful for identifying risk factors and signposting clients, others reported limited engagement: \u003cem\u003e\u0026ldquo;Great for understanding risk and red flags\u0026hellip; lots of links for signposting.\u0026rdquo;\u003c/em\u003e (Survey); \u003cem\u003e\u0026ldquo;Didn\u0026rsquo;t work to engage me.\u0026rdquo;\u003c/em\u003e (Survey). Ratings of interest varied widely, from \u003cem\u003enot interesting at all\u003c/em\u003e (18.8%) to \u003cem\u003eextremely interesting\u003c/em\u003e (12.5%), though overall functionality was rated positively, with 81.3% describing it as \u003cem\u003egood\u003c/em\u003e or \u003cem\u003eexcellent\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding the impact of the app engagement, functionality and specific app\u0026rsquo;s features.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp engagement and features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow interesting is the app in capturing and maintaining your interest?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot interesting at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly interesting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately interesting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery interesting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely interesting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eOverall, how would you rate the functionality of the app (i.e., how well it does what is supposed to)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eWhich area(s) of the app do you find most useful?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal page\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbout ED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e12 (17.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalm zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e9 (12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupporting others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Areas for development and concerns\u003c/h2\u003e \u003cp\u003eParticipants identified opportunities to strengthen the app, particularly through greater personalisation, broader and more diverse resources, and enhanced accessibility features. While the comprehensive content was appreciated, some users described initial information overload, highlighting the need for clear signposting and realistic expectations about the app\u0026rsquo;s role.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.1 Desire for personalisation and broader resource options\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme reflects participants\u0026rsquo; desire for greater personalisation and a wider range of resources within the app, including more diverse formats, tailored content and localised information to meet different needs and recovery contexts. While participants valued the existing resources, many felt that additional tailoring could better support different learning preferences, clinical pathways and cultural contexts. Healthcare professionals noted that although regional information was helpful, expanding national resources would improve relevance across locations: \u003cem\u003e\u0026ldquo;The wider resources are really useful\u0026hellip; but the resources aren\u0026rsquo;t national yet.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eUsers also highlighted the benefit of geographical tailoring, explaining that people often want information specific to their own country or local services: \u003cem\u003e\u0026ldquo;Even just seeing to people in your own country\u0026hellip; what\u0026rsquo;s available in your country.\u0026rdquo;\u003c/em\u003e (Participant 3) Participants suggested integrating more varied media formats to accommodate different learning styles and enhance engagement. Audio options, videos and podcasts were frequently mentioned as ways to support accessibility: \u003cem\u003e\u0026ldquo;Videos and podcasts\u0026hellip; some people learn better or understand information differently.\u0026rdquo;\u003c/em\u003e (Participant 2) Another consistent suggestion was for more content focused on maintenance of wellbeing rather than crisis alone, acknowledging that eating disorder recovery is often cyclical: \u003cem\u003e\u0026ldquo;Resources around maintaining your wellness\u0026hellip; because with an eating disorder you will relapse and have periods of wellness.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eSurvey data reinforced these needs. Respondents requested content on interoception, neurodiversity, ADHD, menopause-related eating changes, and support for those beyond initial assessment stages. They also emphasised a desire for enhanced accessibility, including audio descriptions and customisable colour schemes, as well as more visual elements and built-in reflective activities rather than relying solely on external links:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;More images\u0026hellip; a space to journal or share thoughts\u0026hellip; less wordy.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Provide an audio description\u0026hellip; different colour schemes.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;More downloadable resources\u0026hellip; activities built into the app would be useful.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Managing information load and expectations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme captures participants\u0026rsquo; reflections on the balance between comprehensive information and potential overwhelm, highlighting the importance of managing expectations around the app\u0026rsquo;s purpose while ensuring clarity and emotional safety for users.\u003c/p\u003e \u003cp\u003eParticipants described mixed initial reactions to the volume of information within the app. While many eventually appreciated its comprehensiveness, some reported feeling overwhelmed when first opening it. One participant explained: \u003cem\u003e\u0026ldquo;When I first downloaded the app, I was a little bit overwhelmed\u0026hellip; there was so much information. Over time it became a positive because it\u0026rsquo;s very comprehensive.\u0026rdquo;\u003c/em\u003e (Participant 3) Others noted that the density of content could feel confusing, particularly if someone was unsure what they were looking for or using the app during distress: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s a very busy app\u0026hellip; I can imagine if you weren\u0026rsquo;t quite sure what you were accessing, it could be confusing.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eParticipants emphasised that the app itself was not harmful, but unrealistic expectations of what it could deliver might lead to disappointment. As one person reflected: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s done me no harm\u0026hellip; the only harm would be if I thought this app would do everything. If I unrealistically looked at it as the be-all and end-all.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eSurvey responses largely echoed these experiences. While one respondent reported feeling overwhelmed by the amount of information, others praised the app\u0026rsquo;s clarity and balance:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Overwhelmed by information.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Informative without being too overwhelming or wordy.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Good balance between being informative but not overwhelming.\u0026rdquo;\u003c/em\u003e (Survey)\u003c/p\u003e \u003cp\u003eQuantitative findings showed that the majority of users (68.8%) were \u0026ldquo;not concerned at all\u0026rdquo; about the information provided, suggesting that although a minority initially experienced overload, most felt the app maintained an appropriate level of detail and clarity (see Table\u0026nbsp;\u003cspan refid=\"Tab11\" class=\"InternalRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab11\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 11\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding concerns about the app.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp concerns\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eDo you have any concerns about the information provided by the app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighly concerned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConcerned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot very concerned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot concerned at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11 (68.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Creating an inclusive, sensitive and emotionally safe space\u003c/h2\u003e \u003cp\u003eRespondents viewed the app as inclusive, sensitive and emotionally safe, noting that it addressed diverse identities and experiences often overlooked in eating-disorder resources. The language was consistently described as clear, accessible and non-judgemental, offering reassurance without medical jargon or patronising tones.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.1 Inclusivity and sensitivity to diverse experiences\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme illustrates how the app\u0026rsquo;s inclusive design and sensitive framing contributed to feelings of recognition, safety and relevance across diverse user groups. They valued that the content acknowledged groups often overlooked in eating-disorder resources, including ethnic minorities, LGBTQ+ individuals, dancers, pregnant people, men and people with disabilities. This breadth was viewed as thoughtful, intentional and reflective of real-world diversity:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There are sections on all the things we might come across\u0026hellip; different ethnic minorities, LGBTQI, dancers, men, pregnant people. Although they\u0026rsquo;re minorities, the information is there, which is very inclusive.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eParticipants also felt the app addressed areas commonly omitted in clinical conversations, describing the content as \u0026ldquo;genuine\u0026rdquo; and recognising experiences that are \u003cem\u003e\u0026ldquo;so often left out\u0026rdquo;\u003c/em\u003e (Participant 3). This inclusivity contributed to trust and emotional safety, with some users expressing hope that the app would continue to involve diverse communities in its development and feedback processes: \u003cem\u003e\u0026ldquo;It covers different cultures\u0026hellip; it\u0026rsquo;d be great if you were getting feedback from those groups. It definitely doesn\u0026rsquo;t discriminate.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It comes from specialists, but also from a community of people with lived experience\u0026hellip; people have had a voice.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eSurvey findings reinforced these perceptions. Respondents noted the inclusion of neurodiversity, ADHD and interoceptive impairment as important areas of representation, while a small number raised questions about language accessibility, such as availability in additional languages. Overall, 87.5% rated the app as moderately to extremely inclusive and sensitive (Table\u0026nbsp;\u003cspan refid=\"Tab12\" class=\"InternalRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab12\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 12\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; ratings regarding sensitivity, inclusivity, and diversity.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp inclusivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow sensitive is the information presented to the needs and concerns of individuals with eating disorders?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sensitive at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly sensitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately sensitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery sensitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely sensitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTo what extent do you feel the app includes a diverse range of perspectives and experiences about eating disorders?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all inclusive of diverse perspectives and experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSlightly inclusive of diverse perspectives and experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately inclusive of diverse perspectives and experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery inclusive of diverse perspectives and experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremely inclusive of diverse perspectives and experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2 Clear, warm and non-judgemental communication\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis subtheme highlights how the app\u0026rsquo;s clear, warm and non-judgemental communication style supported emotional safety and accessibility, helping users feel informed without feeling overwhelmed or judged. Participants described the app\u0026rsquo;s language as clear, accessible and non-judgemental, highlighting it as one of the most supportive aspects of the user experience. Individuals with lived experience valued the absence of medical jargon and the use of straightforward, compassionate language that felt inclusive rather than alienating:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It\u0026rsquo;s easy to understand\u0026hellip; there\u0026rsquo;s no jargon. It\u0026rsquo;s not going to alienate people who aren\u0026rsquo;t familiar with medical terms.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cp\u003eMany contrasted the app\u0026rsquo;s tone with some previous experiences of feeling dismissed or blamed in healthcare settings. The app\u0026rsquo;s factual yet sensitive communication style was described as validating and respectful: \u003cem\u003e\u0026ldquo;The tone is not judgmental\u0026hellip; you don\u0026rsquo;t feel as if you\u0026rsquo;re being given out to. It\u0026rsquo;s very inclusive.\u0026rdquo;\u003c/em\u003e (Participant 3). Respondents appreciated that the tone struck a balance, neither overly clinical nor overly informal, providing information in a way that felt appropriate, steadying and emotionally attuned: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s not condescending, it\u0026rsquo;s not too medical\u0026hellip; it tells you exactly what you need to know, and it hits the tone so well.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eSurvey responses strongly echoed these impressions. Users described the language as \u0026ldquo;neutral and informative,\u0026rdquo; \u0026ldquo;professional but caring,\u0026rdquo; and \u0026ldquo;factual yet comforting.\u0026rdquo; Others emphasised its accessibility, describing it as \u0026ldquo;inclusive,\u0026rdquo; \u0026ldquo;understandable without being patronising,\u0026rdquo; and \u0026ldquo;supportive and non-judgemental.\u0026rdquo; Most respondents (68.8%) rated the language as \u003cem\u003every clear and easy to understand\u003c/em\u003e, and none described it as unclear or difficult.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab13\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 13\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants ratings regarding the language used in the app.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApp language\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSurvey sample n\u0026thinsp;=\u0026thinsp;16 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHow would you rate the understandability of the language used in the app?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery clear and easy to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11 (68.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClear and mostly understandable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeither clear nor unclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomewhat unclear and challenging to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery unclear and difficult to understand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eSummary of findings\u003c/h2\u003e \u003cp\u003eThis evaluation provides insight into how people with lived experience, supporters and healthcare professionals engaged with a co-produced, evidence-informed mHealth app for eating disorders. The people who took part in this evaluation consistently described the app as accessible, trustworthy and easy to navigate, reporting high satisfaction with its clarity, organisation and alignment with existing care pathways. Survey data supported these accounts, with most users rating the app as high quality, relevant and useful. Across groups, respondents reported positive impacts on confidence, understanding and emotional reassurance. Many described the app as a supportive resource between appointments, noting that it fostered feelings of safety, empowerment and validation. The app\u0026rsquo;s language was widely experienced as clear, warm and non-judgemental, and its inclusive representation of diverse identities and experiences was viewed as a key strength.\u003c/p\u003e \u003cp\u003eRespondents also identified opportunities for improvement. These included greater personalisation, expanded content relating to neurodiversity, interoception and menopause, additional multimedia formats (e.g., audio, video), and clearer signposting to help users manage initial information overload. A small number of respondents noted that some content felt less relevant to long-standing illness or later stages of recovery. These findings suggest that a co-produced, quality-assured mHealth tool can offer meaningful support to individuals affected by eating disorders, while highlighting areas for continued refinement to enhance relevance, personalisation and long-term engagement, and the challenges of meeting the needs and preferences of all users. Lived experience input guided the design of the app in an e-book style, with no registration requirements and no gathering of personal information, to keep the app simple and usage confidential; these app features preclude greater personalisation. Since the completion of this evaluation, a link to a tested, video-based mindful eating micro-intervention has been embedded in the app in response to requests for more accessible and various information formats.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eComparison with existing literature\u003c/h2\u003e \u003cp\u003eThe evaluation findings align closely with existing literature on digital mental-health and eating-disorder interventions. Respondents\u0026rsquo; emphasis on accessibility, clarity and ease of navigation reflects a broader evidence base demonstrating that user-centred, intuitive design is essential for engagement and acceptability in mHealth tools [\u003cspan additionalcitationids=\"CR64\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Prior work similarly highlights the importance of simple layouts, clear signposting and minimal cognitive burden, particularly during periods of distress, when sustained engagement is most fragile [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. The strong sense of safety and trustworthiness reported by users directly addresses well-established concerns about the prevalence of misleading, unregulated or harmful ED-related information online [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. This is consistent with reviews demonstrating that many existing ED apps lack clinical oversight, are not co-produced with people with lived experience, and show considerable variability in informational accuracy and quality [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. In contrast, the co-produced and quality-assured model underpinning the present app appears to mitigate these risks and contribute to positive user perceptions of credibility and reliability.\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; appreciation of the app\u0026rsquo;s non-judgemental, warm and inclusive tone aligns with evidence that tone, empathy and stigma-sensitive language are central to building digital therapeutic alliance and supporting engagement in mental-health apps [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. The value placed on diverse representation, including content relevant to different identities, stages of life and cultural contexts, mirrors calls in ED research for more inclusive, intersectional digital resources that reflect the heterogeneity of people affected by eating disorders [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe finding that users experienced the app as a supportive resource between appointments is consistent with literature highlighting the role of digital tools in bridging gaps caused by limited specialist provision, long waiting lists and geographical barriers to care [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. While clinical outcomes were not evaluated in this study, previous research suggests that digital psychoeducation and self-support tools may promote early help-seeking, improve confidence in symptom management, and enhance treatment engagement [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; desire for greater personalisation echoes longstanding evidence that adaptive and tailored digital interventions are more likely to maintain relevance and improve engagement over time [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. Requests for expanded content relating to neurodiversity, interoception and menopause-related changes align with emerging ED literature that highlights the importance of attending to these specific experiences [\u003cspan additionalcitationids=\"CR77\" citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Likewise, preferences for multimedia formats (e.g., audio, video) are consistent with studies showing that multimodal delivery supports different learning preferences and improves accessibility for users with cognitive or attentional challenges [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. Finally, mixed experiences related to information overwhelm parallel findings on cognitive load in digital interventions, where initial overload is common and can be mitigated through clearer orientation, pacing and expectation management [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. This reinforces the need for carefully structured content and personalised pathways, particularly in early stages of engagement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eFuture evaluations\u003c/h2\u003e \u003cp\u003eFuture studies should examine how engagement, perceived usefulness and behavioural impacts evolve over time, particularly given the natural fluctuations and relapse\u0026ndash;recovery cycles that characterise many eating-disorder experiences [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]. Longitudinal designs would help clarify whether the initial benefits reported here are sustained and how users draw on the app during different phases of their recovery journey. Evaluating clinical outcomes, such as help-seeking, treatment adherence, emotional regulation and symptom trajectories, would further strengthen understanding of the app\u0026rsquo;s effectiveness and its potential role within treatment pathways. Given the clear preference for personalisation, future work could explore adaptive or modular content, potentially using machine learning or decision-support algorithms to tailor material to individual needs, neurodiverse profiles and stages of recovery. Recruiting more diverse samples is essential to improve cultural relevance and ensure the app meets the needs of populations disproportionately affected by structural barriers to ED care. Research exploring implementation within real-world services, including blended-care and stepped-care models, would also provide insight into feasibility, sustainability and optimal integration with existing clinical systems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003ePractical implications\u003c/h2\u003e \u003cp\u003eFor clinicians, these findings highlight the value of co-produced digital tools as adjunctive supports within care pathways. The app may help bridge gaps between appointments, enhance health literacy, support difficult conversations, and encourage early help-seeking, particularly among younger users or those hesitant to approach services. Managing expectations and guiding users on how to engage with the app may be important to reduce the risk of information overload and ensure that digital support complements, rather than replaces, evidence-based treatment. For developers, the results point to opportunities to strengthen usability through greater personalisation, a broader range of media formats, enhanced accessibility features and clearer signposting tailored to different stages of recovery. The consistent value that users placed on trustworthy information and inclusive, non-judgemental language reinforces the importance of continued clinical oversight, meaningful co-production, and fidelity to recognised quality standards. At a service and commissioning level, evidence-informed digital tools offer a scalable means to support early identification, provide safer alternatives to harmful online content, and extend continuity of support for individuals and families affected by eating disorders. Integrating such tools within stepped-care and blended-care models may help widen access, particularly in contexts of long waiting times and limited specialist provision.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA key strength of this study is its mixed-methods design, which enabled triangulation between survey data and in-depth interviews with individuals with lived experience, supporters and healthcare professionals. This integration strengthened the interpretation of findings by allowing convergent and divergent perspectives to be explored. Credibility was further enhanced by the analysis being conducted by a health psychologist who was not involved in the app\u0026rsquo;s development, reducing the likelihood of developer bias.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be considered. The sample was small and predominantly White British/White Other, which constrains the transferability of findings to more diverse populations. Participation was voluntary, raising the possibility that individuals with more positive experiences or higher engagement were overrepresented. Survey and interview participants may also differ in characteristics from the wider app user base. The cross-sectional design limits insight into how perceptions and engagement might change over time, and no clinical outcomes were measured. These limitations indicate the need for larger, more diverse and longitudinal studies to better understand the app\u0026rsquo;s effectiveness, acceptability and sustained use across different user groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eReflexivity\u003c/h2\u003e \u003cp\u003eThe analysis was shaped by the first author\u0026rsquo;s position as a trainee health psychologist with experience in digital health and behaviour-change interventions. This background informed their interest in user experience, engagement and accessibility, and may have influenced the interpretation of participants\u0026rsquo; accounts. To support reflexive awareness, the first author engaged in ongoing reflection through journalling and supervisory discussions, considering how their assumptions, training and professional identity might shape coding decisions and theme development. The analytic process followed the principles of thematic analysis, acknowledging the active, interpretative role of the researcher rather than aiming for neutrality or objectivity. Attention was given to alternative interpretations throughout, and emergent insights were sense-checked in discussion with supervisors to enhance clarity and coherence while retaining the researcher\u0026rsquo;s interpretative voice.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis evaluation demonstrates that a co-produced, evidence-informed, nationally recommended and quality-assured mHealth app can offer accessible, trustworthy and emotionally supportive resources for people affected by eating disorders and those who support them. Participants valued the app\u0026rsquo;s clarity, inclusivity and alignment with clinical guidance, and reported benefits for confidence, understanding and reassurance. Stakeholders can use the app to bridge gaps between appointments, enhance health literacy, support difficult conversations, and encourage early help-seeking with confidence. Areas for further refinement include personalisation, accessibility features and expanded content for diverse experiences. Further work and ongoing co-production will be crucial in ensuring digital tools are safe, equitable and responsive to the needs of individuals at different stages of their eating disorder journey.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADHD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAttention-Deficit/Hyperactivity Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBioMed Central\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBritish Psychological Society\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBT-E\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnhanced Cognitive Behavioural Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSQ-8\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClient Satisfaction Questionnaire-8\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEating Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEDHIT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEating Disorder Health Integration Team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealthcare Professional\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth and Care Professions Council\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Research Authority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cem\u003eJournal of Eating Disorders\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMANTRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMaudsley Model of Anorexia Nervosa Treatment for Adults\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003emHealth\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMobile Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMARS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMobile Application Rating Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNIHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute for Health and Care Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePIF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient Information Forum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPIE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient and Public Involvement and Engagement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReflexive Thematic Analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystem Usability Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUWE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of the West of England\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis evaluation was conducted under the governance of the Eating Disorder Health Integration Team (EDHIT) of Bristol Health Partners within the Bristol, North Somerset and South Gloucestershire NHS Integrated Care Board. According to the Health Research Authority (HRA) decision tool, it was classified as a product or service evaluation and therefore did not require formal NHS Research Ethics Committee review. All procedures followed the British Psychological Society (BPS) Code of Human Research Ethics (2014) and the Declaration of Helsinki (1964 and subsequent amendments). Survey respondents received information about the study purpose, confidentiality, and their right to withdraw, and provided informed consent electronically prior to participation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Participants gave consent for anonymised quotations to be used in academic and professional dissemination. No identifying details have been included.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received no external funding. It was supported in kind by the Eating Disorder Health Integration Team (EDHIT) and completed as part of a doctoral programme of study at the University of the West of England (UWE Bristol).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eVR conceptualised and designed the study, collected and analysed data, and drafted the manuscript. CR-W supervised the project and contributed to study design, interpretation, and manuscript revision. SN and CT contributed to manuscript review, offering clinical and lived-experience perspectives. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge the support of Hester Careless and Dr Knut Schroeder, who provided expert input in developing the questionnaire and interview schedules, and Hannah Davies, who provided support with literature searches. We thank all participants for their time and openness in sharing experiences, and the Eating Disorder Health Integration Team (EDHIT) for their collaboration and commitment to improving digital support for individuals affected by eating disorders. Appreciation is also extended to the lived-experience contributors whose insights informed the survey design and interpretation.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analysed during this study are not publicly available to preserve anonymity but may be obtained from the corresponding author on reasonable request for verification.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVan Eeden AE, Van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. 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Clin Psychol Psychoth. 2025;32:e70101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/cpp.70101\u003c/span\u003e\u003cspan address=\"10.1002/cpp.70101\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Eating disorders, mHealth, digital intervention, mobile application, lived experience, co-production, mixed-methods, app evaluation","lastPublishedDoi":"10.21203/rs.3.rs-8900696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8900696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMobile health (mHealth) interventions offer opportunities to improve access to safe, evidence-informed support for people affected by eating disorders (EDs). However, challenges remain around sustained engagement, inclusivity, and integration with care. The co-produced Eating Disorder Support App, developed by the Eating Disorder Health Integration Team (EDHIT) from Bristol Health Partners, aims to provide trusted, accessible information for individuals with lived experience, supporters, and healthcare professionals. This evaluation evaluated user engagement, acceptability, and the perceived impact of the app on knowledge, confidence and support-seeking, while identifying opportunities for refinement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA mixed-methods evaluation was conducted using an online survey and follow-up semi-structured interviews. Sixteen participants (people with lived experience, supporters, and healthcare professionals) completed a survey assessing app use, usability, satisfaction, and perceived impact; four took part in qualitative interviews exploring experiences in depth. Quantitative data were analysed descriptively, and qualitative data were analysed using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e Participants reported high satisfaction with the app\u0026rsquo;s accessibility, clarity, and non-judgemental tone. Four themes were identified: (1) \u003cem\u003eSupporting understanding, confidence and empowerment\u003c/em\u003e: participants described improved knowledge, reassurance, and confidence; (2) \u003cem\u003eNavigating and engaging with the app\u003c/em\u003e: clear layout, navigation and practical features supported use; (3) \u003cem\u003eAreas for development and concerns\u003c/em\u003e: participants noted initial information overwhelm and a desire for greater personalisation and expanded media formats; and (4) \u003cem\u003eCreating an inclusive, sensitive and emotionally safe space\u003c/em\u003e: participants valued the warm, sensitive, and inclusive approach, while recommending further representation of neurodiversity. Respondents highlighted the value of the app as a trusted, accessible adjunct to care.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis evaluation suggests that the Eating Disorder Support App is an acceptable and useful digital resource that complements clinical care and supports self-management. Future evaluations should include larger and more diverse samples, longitudinal follow-up, and assessment of clinical outcomes to strengthen the understanding of impact. Continued co-production and lived-experience involvement are likely to enhance inclusivity, relevance, and sustained engagement in digital ED support tools.\u003c/p\u003e","manuscriptTitle":"User experience and perceived impact of the Eating Disorder Support App: a mixed- methods evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 17:23:52","doi":"10.21203/rs.3.rs-8900696/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T03:37:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-16T13:34:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297353827700438845425039919243814871299","date":"2026-03-16T06:52:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T18:13:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1559952792863691158599469371096253710","date":"2026-03-02T12:23:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T00:11:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-20T13:57:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-20T13:56:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Eating Disorders","date":"2026-02-17T11:13:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ded54db1-eca2-4a8c-b5b4-50a8f03d35cb","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T03:55:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 17:23:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8900696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8900696","identity":"rs-8900696","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}