Development of a participant-centred and evidence-based intervention to address eating psychopathology in athletes

Background: Symptoms of eating psychopathology are prevalent among athletes and carry risks for athlete health and wellbeing. A key priority is therefore to support athletes in reducing symptoms. However, few interventions have been tested with athletes and evidence for the acceptability and relative efficacy of these is lacking. There is a need to carefully develop, deliver and evaluate future interventions for athletes, and specifically to address mild eating psychopathology symptoms to mitigate against the development of clinical eating disorders.

Aim: The overarching aim of this programme of doctoral research was to adopt a participant-centred and evidence- and theory-based approach for the development of an intervention to support athletes with mild eating psychopathology symptoms.

Methods: The six intervention development steps of the Intervention Mapping protocol for adaptation was followed. In Step 1 (needs assessment), a systematic review was first conducted to evaluate existing athlete eating psychopathology interventions and identify key gaps in the literature. One qualitative study with athletes (the target group) and sport professionals (stakeholders) and one quantitative study with sport professionals were then conducted to further inform decisions around the format and focus of the intervention. In Steps 2–4 (intervention development), the novel athlete intervention was developed, and initial feedback on the intervention was sought from athletes and sport professionals in one mixed-methods study. In Steps 5 and 6 (implementation and evaluation), the intervention was implemented and evaluated in a feasibility study with athletes with mild eating psychopathology symptoms.

Main findings: In Step 1, the review revealed that existing interventions have all been delivered face-to-face in group settings and with variable efficacy. A lack of reported participant evaluation data with existing intervention studies suggested a gap in knowledge around intervention acceptability. Findings from Step 1 further suggested athletes and sport professionals emphasised a need for more accessible and flexible interventions that can effectively support athletes, particularly in the early stages of an eating problem. They highlighted the need for future interventions to consider athlete confidentiality, independence, and control over the pace of engagement (e.g., a preference for self-help approaches was apparent). Sport professionals observed a range of eating psychopathology symptoms among their athletes, confirming the value of future interventions in targeting a variety of symptoms.

Steps 2–4 used the findings from Step 1 to shape the development and systematic adaptation of a novel self-help intervention for athletes with mild eating problems; and initial feedback from athletes and sport professionals suggested the interventions’ format and content was relevant and appropriate within sport settings. Findings from Steps 5 and 6 revealed the novel self-help intervention was feasible to implement, acceptable to athletes with mild eating problems and resulted in large, significant reductions in athletes’ symptoms immediately after the six week intervention and at one month follow up.

Conclusions: Taken together, the findings highlight the value of adopting a formal intervention development protocol in the development of a novel intervention for athletes with mild eating problems. The intervention process involved incorporating existing evidence and grounding the intervention according to perspectives from the target population and stakeholders. The resulting intervention is acceptable to athletes and shows promise for reducing eating psychopathology symptoms. The self-help intervention developed and evaluated here now requires further, larger-scale testing to determine its suitability for widespread use among athletes with mild eating problems.