Incorporating stakeholder engagement into the development of a disordered eating intervention

Developing a new clinical intervention is a complex process and one that I am embarking on as part of my PhD at the University of Derby. I am aiming to create and evaluate the first (to my knowledge) nature connection intervention for disordered eating. The complexity of developing an intervention is reflected in the number of intervention development approaches (O'Cathain et al., 2019). However, a commonality across most approaches is the importance of including stakeholders throughout the intervention development process.

A stakeholder in this context refers to anyone who has an interest or concern in the intervention being developed. There are multiple ways of engaging stakeholders in this process and a variety of terms used e.g., co-design, co-production, patient and public involvement. The benefits, limitations and overlaps between these activities has been discussed a lot in the literature (Louise & Annette, 2019) but this article's purpose article is not to add to this discussion, rather to share how I plan to involve stakeholders throughout my project. Therefore, I will use the term 'stakeholder engagement' throughout for simplicity.

I have chosen to follow the 'Person Based Approach' in my project as it involves maximal stakeholder engagement by basing the intervention development on an in-depth understanding of the perspectives and experiences of people who will use it (as well as other relevant individuals), through iterative qualitative research (Yardley et al., 2015). This considers the target users' context and behavioural needs from the very start of the design process, maximising the likelihood of the intervention being enjoyable, motivating, practical, meaningful as well as effective in changing chosen behaviours. I decided to use this approach not only because of the abovementioned benefits but also due to the importance of increasing the involvement of people with lived experience of disordered eating in research and intervention development (Radunz et al., 2023).

Disordered eating research has limited resource, and recovery rates from eating disorders are low. Therefore, it is essential that research which improves outcomes in real-world settings is conducted  (Wade et al., 2021). Evidence shows that disordered eating interventions developed in collaboration with people with lived experience of disordered eating are more likely to be implemented in the real world (Becker et al., 2009). Lewis and Foye (2022) rightfully pointed out in their recent review on involving people with eating disorders in interventions that "we as researchers have the responsibility to embed co-production in our practices".

How am I planning on engaging stakeholders?

Below, I have outlined how I intend to involve stakeholders at each stage of my project, although I acknowledge that these plans are subject to change due to the very nature of a PhD.

1. My first study will involve conducting interviews and focus groups with a range of relevant people to explore experiences and views, which will inform the intervention design. First, I will conduct semi-structured interviews with individuals with previous experience of disordered eating. I aim to recruit a mix of males and females due to the underrepresentation of men in disordered eating research. In addition, the goal is to recruit people of varying ages, ethnicities, and socio-economic backgrounds, to ensure the intervention meets the needs of the broad population who live with disordered eating. Following this, focus groups will be conducted with professionals who support people with disordered eating, people who deliver nature connection interventions to support mental health and social prescribers (as I plan for the intervention to be accessed through social prescribing). Questions across sessions will ask about personal experiences of nature to inform the intervention content, views on the format and delivery of the intervention and where it should sit in the care pathway. Overall, this qualitative study will provide these stakeholder groups with the opportunity to share their valuable experiences and perspectives. This is a vital step in designing an intervention that is informed by the specific needs of this population, and to ensure it is as accessible and engaging as possible. 
2. The first prototype of the intervention will be shared with all relevant stakeholders in a variety of formats e.g., trialling parts of the intervention with target users and running an engagement event with other key stakeholders (including those mentioned above). Feedback gathered will be used to refine the intervention, ensuring that the relevant people have had the opportunity to share their views on the intervention design before it is tested.
3. The intervention will then be trialled with individuals with disordered eating to determine its acceptability, feasibility, and initial effectiveness. Outcome measures will be collected as well as qualitative feedback using both open-ended surveys and semi-structured interviews. These will explore participants' views on topics including enjoyment and satisfaction, practicality, perceived benefits, relevance, preferences and refinements. The findings from this small-scale trial will be used to make any necessary amendments before a Randomised Control Trial is (potentially) carried out following my PhD.  
4. In addition to the abovementioned studies, I have set up a consultation group who will meet at various points of my PhD to discuss and advise on different elements of the project, including patient facing materials, interview schedules, intervention ideas and dissemination strategies. This group currently includes five people - someone with lived experience of disordered eating, and people working in a variety of relevant disciplines: a disordered eating charity, nature-based organisations, social prescribing and healthcare. I believe this group will help improve the real-world acceptability of the intervention and I hope that group membership will continue to grow throughout the project. 

I am very lucky to have First Step ED, a Derby based disordered eating charity, as an external collaborator on the project. They are providing valuable support around recruitment and facilitating opportunities to incorporate rich stakeholder engagement throughout my project.

Hints and Tips for connecting and engaging stakeholders in your project

1. Attend relevant conferences even if you are not presenting and introduce yourself and an outline of your project to other attendees! Also, be proactive in seeking out and approaching people that might be interested in your work. This can all be achieved at online events through the chat box function. Always remember to follow any conversations up with an email, to keep connections alive and ensure they have your contact details. 
2. Be visible on online platforms such as Twitter! Twitter is a great way to make stakeholder connections with people all over the world, so tweet about your project (as well as other related activities and achievements) as much as possible. 
3. Offer to meet with people! When you are forming connections put yourself out there and ask if they would be happy to meet to chat about your project. In my experience most people will be willing to meet, and this is a great way to build rapport and get people excited about your project which will make them more likely to want to be involved. If you can meet in person, grabbing a coffee in a more informal setting (e.g., coffee shop) can allow you to get to know someone a little more and build a stronger connection. It is amazing what can come out of these meetings! 
4. Keep in contact with existing connections! Many of the stakeholders involved in my project are from connections I made in my previous job, so it can be extremely valuable to keep in touch with people, for example, through emails or attending meetings. 

If you have any questions about my project you are very welcome to email me (it would be great to hear from you!)

Mia Morgan 
Psychology PhD student, University of Derby

Supervisors: Dr Charlotte Scott, Professor Miles Richardson, Dr Fiona Holland
Email: [email protected] 
Twitter: @miamorgan1997 

Take part in Mia's research

I am pleased to say that I have launched recruitment for my first study. This includes an online focus group (lasting approx. 1.5 hours, conducted on Microsoft Teams) with professionals who support people with disordered eating and interviews (lasting approx. 1.5 hours, conducted online or face to face depending on preference and feasibility) with people with previous experience of disordered eating. These sessions will explore people's views and experiences around how nature can support people with disordered eating. Findings will help design the nature connection intervention. 

Please follow the link below for more important details on the study. This also includes the focus group and interview questions, please take the time to read these so you understand what you will be asked during each session. It will then ask you to give consent if you would like to participate in the study and for some demographic information.

Find out more

Sources

• Becker, C. B., Stice, E., Shaw, H., & Woda, S. (2009). Use of empirically supported interventions for psychopathology: Can the participatory approach move us beyond the research-to-practice gap? Behaviour Research and Therapy, 47(4), 265-274. 
• Lewis, H. K., & Foye, U. (2022). From prevention to peer support: a systematic review exploring the involvement of lived-experience in eating disorder interventions. Mental Health Review Journal, 27(1), 1-17.
• Louise, L., & Annette, B. (2019). Drawing straight lines along blurred boundaries: qualitative research, patient and public involvement in medical research, co-production and co-design. Evidence & Policy, 15(3), 409-421. 
• O'Cathain, A., Croot, L., Sworn, K., Duncan, E., Rousseau, N., Turner, K., Yardley, L., & Hoddinott, P. (2019). Taxonomy of approaches to developing interventions to improve health: a systematic methods overview. Pilot and feasibility studies, 5(1), 1-27. 
• Radunz, M., Ali, K., & Wade, T. D. (2023). Pathways to improve early intervention for eating disorders: Findings from a systematic review and meta‐analysis. International Journal of Eating Disorders, 56(2), 314-330. 
• Wade, T. D., Hart, L. M., Mitchison, D., & Hay, P. (2021). Driving better intervention outcomes in eating disorders: A systematic synthesis of research priority setting and the involvement of consumer input. European Eating Disorders Review, 29(3), 346-354. 
• Yardley, L., Morrison, L., Bradbury, K., & Muller, I. (2015). The person-based approach to intervention development: application to digital health-related behavior change interventions. Journal of medical Internet research, 17(1), e4055.