Implementation Research and Practice, Volume 6, Issue , January-December 2025.
BackgroundThe perinatal period is a high-risk time for body dissatisfaction and disordered eating. Evidence-based interventions for disordered eating have not been adapted to address the needs of this population. We describe the process of adapting the Body Project, an evidence-based eating disorder (ED) prevention program, for pregnant individuals with histories of disordered eating behaviors.MethodOur approach is informed by ADAPT, a framework offering guidance for adapting interventions to new contexts, to modify the Body Project for pregnant individuals. Following initial adaptations informed by a needs assessment and stakeholder input, we conducted a pilot trial with individuals who have lived experience relative to our target population (i.e., previously pregnant individuals with ED history, n = 10). Participants provided feedback on the intervention through surveys and a focus group assessing perceptions of the intervention and barriers and facilitators to its implementation as guided by the Consolidated Framework for Implementation Research (CFIR).ResultsEighty percent of enrolled participants attended five or more sessions (out of six). Across sessions, average satisfaction ratings were 9.28 (1 = poor to 10 = excellent). Most participants (89%) reported improvements in body satisfaction. Approximately 33% reported reductions in disordered eating with the remainder reporting no change due to healthy eating behaviors at baseline. Themes from the focus group are reported aligning with CFIR domains and all final modifications are summarized and reported aligning with the Framework for Reporting Adaptation and Modifications-Enhanced.ConclusionsApplying implementation science frameworks to structure our process for making and summarizing planned adaptations, we adapted an empirically supported ED prevention program for pregnant individuals with histories of an ED. We made adaptation decisions based on participant feedback while weighing intervention fidelity and scalability. We will formally test the adapted intervention in a subsequent pilot randomized controlled trial versus a time- and dose-matched educational control.Plain Language Summary Process of adapting an evidenced-based eating disorder prevention program for high-risk perinatal individuals. Pregnant and postpartum individuals experience high rates of disordered eating, body dissatisfaction, and eating disorder (ED) relapse. ED relapse is a concern given the detrimental consequences for both birthing people and their offspring. However, there are to-date no evidence-based programs that address these issues among the perinatal population. Aiming to help address this gap in care, we describe the process for selecting and adapting an evidence-based ED prevention program to fit the needs of pregnant individuals with histories of an ED or disordered eating behaviors. This work applies multiple implementation science frameworks to guide the adaptation process of the program to be delivered during pregnancy. We employed a user-centered design by engaging individuals with lived experience relative to the population of interest in the adaptation process and mapped modifications to an implementation science framework. This intervention has excellent potential for scalability and implementation given that it is group-based, peer-delivered, and conducted virtually. Further research will address the feasibility of the program and explore effectiveness through a randomized control trial.