UBCO researchers are exploring how a modified behaviour-change app can help support and motivate people who are living with eating disorders while they wait for care.
When UBC Okanagan researchers decided to test a behaviour modification app for people living with eating disorders who were waiting for care, the first thing they had to do was modify an existing app.
Dr. Maya Libben, Associate Professor of Psychology in the Irving K. Barber Faculty of Arts and Social Sciences, studies issues around eating disorders and body image. Her research now includes digital interventions that can act as interim support for people on waitlists.
Wait times for people with eating disorders can be extensive, sometimes up to five years. There are several reasons for this, including the need for specialized services, travel barriers, cost and limited coverage, Dr. Libben explains.
She also notes that some people are not fully ready to engage in treatment when they are first referred.
“There can be a lot of ambivalence, shame and uncertainty, which can make it harder to take that next step,” Dr. Libben says. “Longer wait times can mean higher dropout, lower engagement once treatment starts, and in some cases more serious risks, particularly for individuals with anorexia nervosa. Waiting can take an emotional toll, with people often describing worsening symptoms and feeling less motivated over time.”
Due to the waitlists, Dr. Libben, along with doctoral student Amané Halicki-Asakawa, decided to explore app-based support. They immediately came across a roadblock.
“We realized that there weren’t any existing apps designed specifically for people with eating disorders who are waiting for care,” Halicki-Asakawa says.
They partnered with Resiliens, a company that had developed MI-Coach, a motivational interviewing–based app designed to support general behavioural change. Together, they adapted the platform to create MI-Coach: ED, which is specifically tailored to the needs of individuals with eating disorders.
“The goal of the modified app is to offer structured and accessible support while people are on waitlists,” Halicki-Asakawa says. “It helps people stay engaged, reflect on their motivation, and feel more prepared for treatment when it becomes available.”
Once the app was up and running, the research team ran several studies to validate whether the app was making a difference. In the first, they interviewed patients and clinicians working in eating disorder services. Halicki-Asakawa says both groups emphasized how problematic waiting for care can be.
“People described it as emotionally draining and demotivating due to the limited contact with services which led to a growing sense of feeling stuck,” she adds. “Clinicians echoed this, describing feeling stretched and frustrated that they were limited in their ability to provide meaningful support during that time.”
Within that context, MI-Coach: ED was viewed as a helpful interim support. Both users and clinicians described it as accessible, structured and helpful with recovery. In particular, the app seemed to help people reflect on their own reasons for change, reconnect with their values, and feel some momentum while waiting for services.
The research, published in the International Journal of Eating Disorders, was initiated due to a sense among clinicians who are feeling burnt out and aren’t well equipped to manage the increase in demand for people with eating disorders, particularly when trying to support people while they are waiting.
“The goal of our research was to try to address both sides. On one hand, providing something meaningful and supportive for those waiting for care, and creating something that could be integrated into clinical workflows without adding additional burden to already stretched services.”
A subsequent study with women on waitlists, published in JMIR Research Protocols, examined the feasibility, engagement and early outcome patterns. While the study group was small, participants used the app consistently, and the overall acceptability of the app was high, with most participants reporting they found it useful and would recommend the app.
“In this study, most participants remained relatively stable over the four-week period, which is meaningful in this context given how much symptoms can fluctuate during waitlist periods,” says Halicki-Asakawa. “There were also some early signals that motivation may be an important area to target, though larger studies are needed to better understand clinical outcomes.”
The researchers are now looking at the efficacy of the app, moving beyond feasibility and acceptability to better understand how it impacts motivation and clinical outcomes. It is now being used in programs in BC with support from Interior Health, Vancouver Coastal Health, Island Health, and Fraser Health. This phase is focused on how the app works in real-world settings, including how it integrates into existing workflows, how clinicians experience using it, and how effective it is when embedded within the healthcare system.
“Though MI-Coach: ED was acceptable for the participants, this project has also highlighted some important considerations for implementation on a broader scale, such as the variability in waitlist procedures and service demand across different clinical settings,” says Halicki-Asakawa. “However, we feel that by offering structured support during a neglected phase of care, MI-Coach: ED shows promise as a complementary model to existing stepped-care approaches.”
