The Binge Eating Genetics Initiative (BEGIN) is a multipronged investigation examining the interplay of genomic, gut microbiota, and behavioral factors in bulimia nervosa and binge-eating disorder.
Background: Engagement with digital mental health interventions is often measured as a summary-level variable and remains under-researched despite its importance for meaningful symptom change. The current study deepens understanding of engagement in a digital eating disorder intervention, Recovery Record, by measuring engagement with unique components of the app, on two different devices (phone and watch), and at a summary-level. Objective: The current study describes and models how individuals engaged with the app across a variety of measures of engagement and identifies baseline predictors of engagement. Methods: Participants with current binge-eating behavior were recruited as part of the Binge Eating Genetics Initiative (BEGIN study) to use a digital eating disorder intervention for 4 weeks. Demographic and severity of illness variables were captured in the baseline survey at enrollment, and engagement data were captured through both an iPhone and Apple Watch version of the intervention. Engagement was characterized by log type (urge, behavior, mood, or meal), device type (logs on phone or watch), and overall usage (total logs) and averaged each week for four weeks. Descriptives were tabulated for demographic and engagement variables, and multilevel growth models were conducted for each measure of engagement with baseline characteristics and time as predictors. Results: Participants (n=893) self-reported as primarily White (n=743, 85%), non-Hispanic (n=801; 90%), females (n=772, 87%) with a mean age of 29.6 years (SD=7.4) and mean current BMI of 32.5 kg/m2 (SD=9.8) and used the app for a mean of 24 days. Most logs were captured on phones (96%), and mood logs were the most used app component (62% of logs). All measures of engagement declined over time, as illustrated by the visualizations, but each measure of engagement illustrated unique participant trajectories over time. Time was a significant negative predictor in every multilevel model. Sex and ethnicity were also significant predictors across several measures of engagement, with female and Hispanic participants demonstrating greater engagement than male and non-Hispanic counterparts. Other baseline characteristics (age, current BMI, and binge episodes in the past 28 days) were significant predictors of one measure of engagement each. Conclusions: This study highlighted that engagement is far more complex and nuanced than is typically described in research, and that specific components and mode of delivery may have unique engagement profiles and predictors. Future work would benefit from developing early engagement models informed by baseline characteristics to predict intervention outcomes, thereby tailoring digital eating disorder interventions at the individual level.