Reprinted from Eating Disorders Review
September/October 2003 Volume 13, Number 5
©2002 Gürze Books
Computer-assisted health education programs have been effective for treating a number of problems, including anxiety, depression, and phobias. More recently eating disorders researchers have investigated how they might put the computer to work to help students at risk of developing an eating disorder.
“Student Bodies,” a multimedia psychoeducational program, is currently being tested at San Diego State University and Stanford University (J Psychiatric Prac 2002;8:14). Since 1995, Student Bodies has been used by hundreds of high school and college students, and it is currently being evaluated in a National Institute of Mental Health-sponsored multi-site, long-term trial to determine if the program can reduce risk in students likely to develop eating disorders.
Components of the program
The main parts of the program are psychoeducational readings on body image, nutrition, exercise, and eating disorders, a body image journal used to track thoughts and feelings, and an asynchronous newsgroup. Female students from the two universities were recruited through campus newspaper ads, flyers on bulletin boards and presentations given in dormitories and sorority houses. Women with a history of bulimia or anorexia nervosa, currently purging or body mass index <18 were excluded from the study.
The design of the program evolved through several stages: first it was delivered via CD-ROM, and discussion messages were sent by e-mail to an e-mail distribution list. A clinical psychologist acted as moderator for the discussion group. Anonymity was assured. However, participants complained that they had to locate a public computer with a CD drive and load the program each time they wanted to use it, and felt the sound called attention to them in public places. Self-reported compliance was 53%. The second and third models of the program became more structured, and compliance improved though the course content was unchanged.
Structure improved compliance
Currently, participants are given clearly stated assignments online, and receive a reminder call from research assistants when an assignment is missed. A set number of group postings with predetermined topics are also required each week, and participants are encouraged to post additional messages. The participants’ perception of their progress is tracked with an online questionnaire that appears each time a student logs on to the program. The moderator for the group is a clinical psychology graduate student close in age to the participants.
Students read an article each week from a course reader, and are encouraged to write a one-page critical reflection paper each week. These are sent via e-mail to the moderator, who also serves as the course instructor. In an important change, anonymity within the group was eliminated through implementation of face-to-face meetings three times during the program for orientation and discussion; furthermore, photographs and personal statements from participants are used to introduce participants. Compliance has risen to 84%.
Suggestions for online programs
The authors offered several suggestions for using such an online system:
1.Tracking systems should be implemented in online interventions. These can be used to determine what screens are not being accessed and what levels of compliance are needed to improve participation.
2. Electronic reminders can be programmed to be sent to participants when certain screens haven’t been accessed. Weekly reminders, whether by e-mail or telephone, seem to be helpful.
3. Feedback from participants is essential.
4. Online programs are helped by a clear structure, including explicit expectations about participation and guided assignments.
5. A reward in the form of a grade or monetary payment seems to improve compliance.