Designing a Mobile Obesity & Binge Eating Intervention for Implementation in Clinical Settings

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Two in five U.S. adults have obesity, and up to 30% of treatment-seeking adults with obesity engage in binge eating. With my K01 Research Scientist Development Award, I am designing and pilot testing FoodSteps, an intervention that addresses both obesity and binge eating, delivered via mobile device to increase scalability. My ultimate goal for this program of research is to establish FoodSteps as an evidence-based intervention that can be broadly implemented in routine clinical practice. To achieve this goal, I need to design the intervention (focus of my K01), understand how to implement it in practice (focus of this R03 proposal), and validate its effectiveness and implementation in a hybrid trial (future R01 proposal). Thus, my overarching aim for this R03 small grant program is to apply service design methods to understand how to implement the intervention in diverse clinics. Because embedding a new intervention into existing workflows is challenging, service design focuses on improving the process of how patients and clinicians engage with each other and technologies when delivering an intervention in practice. However, digital intervention research has largely ignored service design, creating interventions that are not designed for the users and contexts in which they are implemented. To ensure FoodSteps is maximized for clinical impact, I must attend to service design so the intended users are positioned to and will use the intervention when it is delivered in practice. I will partner with three clinics that are typical settings where people with obesity and binge eating present for treatment, and are the planned sites of the future R01 trial: a primary care clinic, a lifestyle medicine weight management program, and an outpatient eating disorders program. Using the 4-phase Double Diamond Model design process, I will apply service design methods to create two design products that describe how FoodSteps will be embedded in each setting: service blueprints (Aim 1) and implementation roadmaps (Aim 2). Service blueprints are diagrams of the touchpoints when person-to-person and person-to-technology transactions occur throughout the intervention delivery process. Implementation roadmaps will specify the implementation strategies and adaptations to the intervention and settings that are needed to support FoodSteps delivery. Dedicated attention to service design in advance of a R01 trial will (a) strengthen partnerships with the clinics to enhance readiness for longer-term collaboration; (b) accelerate the timeline to deliver the intervention to patients due to already completing implementation-preparation activities that are necessary before initiating data collection; and (c) address potential challenges that could occur when conducting research in real-world settings so they are avoided later. I am well suited to lead this study given my K01 progress learning and applying design methods, including service design. Taken together, designing for the delivery of a mobile intervention for obesity and binge eating will accelerate my science from a K01 to R01 trial, and propel digital intervention research toward improved engagement and impact by aligning digital tools with their implementation contexts.