"In Their Own Words": A Qualitative Exploration of Lived Experience and Healthcare Professional Perspectives on Evaluating a Digital Intervention for Binge Eating.

Objective: Eating disorders characterized by binge eating are prevalent yet under-recognized, limiting access to effective care. The digital, programme-led (self-help) version of Enhanced Cognitive Behavior Therapy (CBT-E) offers a potentially scalable treatment. This study gathered insights from individuals with lived experience of binge eating (LE) and healthcare professionals (HCPs) to inform the design of a randomized controlled trial evaluating the intervention's effectiveness and to support early-stage implementation planning.

Method: Four focus groups were conducted with 20 participants (8 with LE, 12 HCPs). Discussions explored recruitment strategies, participant engagement, meaningful outcome measures, and barriers to implementation. Data were analyzed using thematic analysis.

Results: Two overarching themes were identified: (1) Reach People in Accessible and Supportive Ways, and (2) Be Open to Different Experiences of Progress. Participants emphasized inclusive recruitment and compassionate, hopeful messaging. Stigma and limited recognition of binge eating were cited as recruitment barriers in healthcare settings. Both groups recommended community and online platforms to enhance reach. Participants stressed the importance of outcomes beyond symptom reduction (e.g., emotional well-being) and qualitative methods to capture recovery narratives. Findings also highlighted implementation-relevant factors, including how interventions are framed and delivered, and how engagement can be optimized.

Discussion: Perspectives from individuals with LE and HCPs support a person-centred trial aligned with the needs of those experiencing binge eating and those providing care, while considering both evaluative and implementation priorities. Findings inform strategies to enhance reach and understanding of digital intervention outcomes, contributing to trial designs that are consistent with real-world care and meaningful to participants.