Patterns of Uptake, Engagement, and Attrition in Randomized Controlled Trials of Digital Interventions for Eating Disorders: A Systematic Review and Meta‐Analysis.
Objective: This review aimed to quantify rates of uptake (treatment initiation), adherence (program completion), and attrition (study dropout) in randomized trials of digital eating disorder (ED) interventions, and to synthesize engagement reporting practices, their consistency, and associations wit...
| Published in: | International Journal of Eating Disorders Vol. 59; no. 5; pp. 854 - 864 |
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| Main Authors: | , , , , |
| Format: | Article |
| Published: |
Wiley-Blackwell
May2026
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| Subjects: | |
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=193520802&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193520802 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 02763478 IJD jtl: International Journal of Eating Disorders issn: 02763478 maglogo: Y pubinfo: dt: May2026 vid: 59 iid: 5 pid: 480 pub: Wiley-Blackwell artinfo: ui: 193520802 10.1002/eat.70046 ppf: 854 ppct: 10 formats: tig: atl: Patterns of Uptake, Engagement, and Attrition in Randomized Controlled Trials of Digital Interventions for Eating Disorders: A Systematic Review and Meta‐Analysis. aug: au: Liu, Claudia Anderson, Cleo Messer, Mariel McClure, Zoe Linardon, Jake affil: School of Psychology, Faculty of Health, Deakin University, Geelong Victoria, , Australia su: Treatment of eating disorders Patient compliance World Wide Web Self-evaluation Therapeutics Human research subjects Randomized controlled trials Patient participation Patients' attitudes Diagnosis of eating disorders Mobile apps Digital health Treatment effectiveness Meta-analysis Descriptive statistics Systematic reviews MEDLINE Odds ratio Computers in medicine Confidence intervals Chatbots Psychology information storage & retrieval systems sug: subj: Treatment of eating disorders Patient compliance World Wide Web Self-evaluation Therapeutics Human research subjects Randomized controlled trials Patient participation Patients' attitudes Internet Publishing and Broadcasting and Web Search Portals Diagnosis of eating disorders Mobile apps Digital health Treatment effectiveness Meta-analysis Descriptive statistics Systematic reviews MEDLINE Odds ratio Computers in medicine Confidence intervals Chatbots Psychology information storage & retrieval systems keyword: digital health dropout eating disorders engagement meta‐analysis randomized controlled trial systematic review digital health dropout eating disorders engagement meta‐analysis randomized controlled trial systematic review ab: Objective: This review aimed to quantify rates of uptake (treatment initiation), adherence (program completion), and attrition (study dropout) in randomized trials of digital eating disorder (ED) interventions, and to synthesize engagement reporting practices, their consistency, and associations with clinical outcomes. Methods: Randomized trials of digital interventions (web, app, computerized, chatbots, etc.) delivered to people with diagnostic, subthreshold, or self‐reported EDs were included. Random‐effects meta‐analyses were conducted to compute absolute rates of uptake, adherence, and attrition, while a narrative synthesis summarized engagement patterns and reporting. Results: Forty‐eight trials were included. The weighted mean uptake rate from 44 intervention conditions was 89.7% (95% PI = 67.0–97.0) and the weighted mean adherence rate from 14 intervention conditions was 41.8% (95% PI = 0.9–83.3). These estimates remained similar in a series of sensitivity analyses that adjusted for biases, outliers, and when limiting to specific clinical population groups. The weighted trial attrition rate was 23.3% (95% PI = 0.8–54.4); for intervention arms specificially it was 29.7% (95% PI = 9.7–62.3) and for waitlist arms it was 18.7% (95% PI = 4.6–52.3). Attrition was lower in trials that had human‐participant interaction, offered therapeutic guidance, provided monetary reimbursement, tested a web/computer program (compared to a smartphone application), and had a longer follow‐up (> 6 weeks). Reporting of engagement was inconsistent and heterogeneous, with nearly 90 different metrics recorded across trials. There was some evidence linking sustained user engagement to greater clinical benefit. Conclusion: Findings offer practical benchmarks to inform future trial planning and highlight design elements that could be leveraged to enhance user engagement and retention. Key Points: Nearly 9 in 10 participants initiated digital eating disorder interventions, yet fewer than half completed the full program, highlighting a gap between uptake and sustained engagement.Trial attrition averaged 20%–30% and was lower in studies incorporating human support, therapeutic guidance, monetary reimbursement, web‐based delivery, and longer follow‐up periods, pointing to actionable strategies for improving retention.Engagement was measured inconsistently across trials using nearly 90 different metrics, highlighting the importance of improved reporting standards. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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