Participant adherence to the Internet-based prevention program StudentBodies™ for eating disorders — A review

Study and treatment dropout and adherence represent particular challenges in studies on Internet-based interventions. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes in online-prevention are scarce. A review of participation in trials investigating a cognitive-behavioral, Internet-based, 8-week prevention program (StudentBodies™) for eating disorders, moderators of participation, and the impact of participation on the relationship of outcome moderators and outcomes was performed. Seven US and three German studies with a total of N = 1059 female participants were included. Two of the U.S. and one of the German trials explicitly addressed high risk samples in a selective prevention approach. Across studies, dropout rates ranged from 3% to 26%. The women who participated in the trials accessed on average between 49% and 83% of the assigned intervention content. None of the study characteristics (universal vs. selective prevention, incentives, country, participants' age) predicted adherence or study dropout. After adjusting for adherence, intervention outcomes (EDI Drive for Thinness and EDI Bulimia) were only moderated by participant's age, with smaller effects in one sample of adolescent girls. Adherence to StudentBodies™ proved to be high across a number of trials, settings and countries. These findings are promising, but it is likely that adherence will be distinctly lower in the general public than in research settings, and intervention effects will turn out smaller. However, the intervention is readily available at minimal cost per participant, and the public health impact may still be notable.