Virtual Help for a Real-World Problem

In the years prior to joining the Northwestern University faculty in 2018, Andrea Graham began studying digital interventions as a tool to combat eating disorders and support weight management. For Graham, digital interventions held particularly compelling potential given the ubiquity, privacy, and accessibility of mobile apps among the U.S. populace.

“Ultimately, I want to make sure people get access to care when they need it,” says Graham, a trained clinical psychologist and associate professor at Northwestern’s Feinberg School of Medicine.

The work was invigorating and important, especially as four out of five Americans battling eating disorders do not receive care, whether by circumstance or choice.

And though Graham enjoyed progress in her research and earned notable achievements, including a Rising Star Award from the Association for Psychological Science, she was convinced her research could do more. She envisioned wider impact and reach and imagined greater adherence to sound interventions repelling eating disorders, which often ignite physical complications as well as mental health issues, such as depression and anxiety.

Then, came the unlock: Graham discovered human-centered design, a cornerstone of work at Northwestern-based entities like the McCormick School of Engineering and the Farley Center for Entrepreneurship and Innovation.

“I jumped right in and began leveraging human-centered design and it absolutely transformed my way of thinking about how we do our science,” Graham says. “It’s not just about what is grounded in clinical and behavior change theory. It’s how those things are then delivered to people.”

 Confronting binge eating among teens

To increase impact, relevance, and use, Graham determined she needed to center the digital tools she created on the needs, preferences, and goals of end users – the core strategy of human-centered design. By combining human-centered design with proven clinical methods, Graham saw a way to scale her work and expand its impact.

“I have clinical expertise, but that’s not what’s going to create an engaging, beneficial tool for people,” she says. “My focus turned to engaging with the people who are going to use our tools and thinking about how we apply these design methods to both the tools themselves and to the strategies we use to get them out into the world.”

In 2022, Graham and her University of Pittsburgh-based colleague Andrea Goldschmidt began an ambitious project to develop a scalable digital tool for teenagers struggling with binge eating.

The project, called Virtual Intervention for Binge Eating for Teens, or VIBE, aims to teach teens the evidence-based clinical skills to combat binge eating while promoting healthy behaviors like physical activity and stress management. It also seeks to help teens develop methods to practice these relevant skills in particularly vulnerable moments.

Centering the VIBE project on teens was an intentional move – and a novel one.

Adolescence and college are two periods of life with peak onset of binge eating. By creating support and building skills early, Graham says youth are better positioned to have a positive relationship with food, achieve their health goals, and avoid the distress and long-term adverse conditions eating disorders can create.

In addition, Graham continues, most existing interventions to address teen binge eating were simply scaled-down versions of adult treatments. As a result, they failed to consider the developing mind and adolescent-era obstacles like executive functioning and self-regulation.

“We needed to account for things unique to adolescents and really understand how their experiences can be shaped,” says Graham, who also serves as co-director of the Center for Behavioral Intervention Technologies at Feinberg and chief of the Division of Implementation Science in the Department of Medical Social Sciences.

 Building a relevant intervention

Powered by a three-year grant from the National Institute of Diabetes and Digestive and Kidney Diseases, Graham and Goldschmidt launched their effort with foundational human-centered design work. They surveyed target users about how binge eating impacted their daily lives and inquired about a mobile app’s potential to help them curb negative eating behaviors. The collaborators also created a teen advisory board to understand teens’ general perspectives on the look and feel of successful mobile apps.

Those collective insights spurred the VIBE app’s initial design. The researchers made visual depictions of the app and conducted prototyping interviews, collecting feedback on both the app’s appearance and usability as well as the digestibility of its content. The feedback fueled new iterations packaging therapeutic processes in an engaging and user-friendly way.

After a brief beta field test, Graham and Goldschmidt have entered the three-year project’s final phase: a clinical trial.

“We’re looking to really understand feasibility. Are teens using this? Do they like it? What can we do differently?” says Graham, who recently joined the team at Northwestern’s newly established Institute for Adolescent Mental Health and Well-Being.

The trial’s results will inform future development and, according to Graham, a capable, engaging, and accessible marketplace intervention delivering proven therapeutic strategies and a path to improved personal health.

“We can’t keep doing the same thing of building apps that people aren’t going to use,” Graham says. “We’ve tried to learn and learn quickly on the VIBE project, so we can create a clinical option in the healthcare landscape that can meet the needs of teens who are not getting the care they need.”