User Experience and Therapeutic Alliance of Treatment Completers of Clinician-Supported Versus Self-Help Online Intervention for Eating Disorders: A Mixed Methods Approach

BackgroundPoor rates of retention associated with digital interventions necessitate understanding of factors influencing engagement. This study presents a secondary analysis of a three-arm, randomised controlled trial of an online self-help treatment for bulimia nervosa (clinician-supported, self-help and waitlist control).AimsThe study aimed to understand the effect of added clinician-support, or lack of support, upon user experience and therapeutic alliance.MethodAt post-treatment, 61 participants completed a battery of self-report questionnaires assessing user experience and therapeutic alliance. Data were analysed using mixed methods (regression and thematic analyses).ResultsQuantitative analyses indicated clinician-supported participants reported higher levels of treatment satisfaction and therapeutic alliance, however differences were not significant after controlling for covariates. Intervention effectiveness ratings were positively associated with post-treatment reductions in binge episodes and eating disorder psychopathology. Qualitative data were organised into four themes: (1) human support, (2) content, structure and digital set up, (3) process of therapeutic change and (4) positive feedback.ConclusionsOverall, the intervention was found to have positive ratings of user experience and therapeutic alliance in both supported and unsupported versions. The qualitative analyses revealed a strong preference for human support. The findings shed light on the complex interactions between digital and human elements of blended treatment delivery.Trial RegistrationThe trial was pre-registered with the Australia New Zealand Clinical Trials Registry (ACTRN12619000123145p)