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June 14, 2026Diabetic Medicine0 citationsOpen Access

Experiences of receiving and delivering a novel complex intervention for type 1 diabetes and disordered eating: Process evaluation of the Safe management of people with Type 1 diabetes and EAting Disorders studY ( STEADY )

NZNatalie ZarembaRadboud University Nijmegen AHA.J. HarrisonKing's College London JBJennie BrownKing's College London

Key Points

The evaluation aims to assess the acceptability, appropriateness, and feasibility of the STEADY intervention.
Mixed-method process evaluation involving participants (n=13) and healthcare professionals (n=3).
Person-reported outcome measures (PROMs) were used to gauge acceptability, appropriateness, and feasibility.
Semi-structured interviews analyzed through thematic analysis explored experiences and therapeutic processes.
High PROM scores indicated strong acceptability (AIM = 18.36, IAM = 18.18, FIM = 18.00) among participants.
Therapists also showed positive ratings (AIM = 17.67, IAM = 17.33, FIM = 17.67), suggesting high likelihood of implementation success.
Thematic analysis revealed themes on the need for tailored delivery and therapist expertise in T1DE.

Abstract

AIM: The Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) intervention is a novel cognitive behaviour therapy (CBT) intervention for individuals with type 1 diabetes and disordered eating (T1DE). The aim of this mixed-method process evaluation is to assess the acceptability, appropriateness and feasibility of STEADY, and explore experiences of both participants and healthcare professionals during therapy delivery. METHODS: Participants who received STEADY (n = 13) and healthcare professionals delivering STEADY therapy (n = 3) completed person-reported outcome measures (PROMs) to assess the acceptability (AIM), appropriateness (IAM) and feasibility (FIM) of STEADY and took part in semi-structured interviews to explore experiences, therapeutic processes and implementation considerations. Interviews were analysed using thematic analysis. RESULTS: PROM scores indicated high ratings across participants (AIM = 18.36 ± 2.01; IAM = 18.18 ± 2.64; FIM = 18.00 ± 2.32) and healthcare professionals (AIM = 17.67 ± 2.08; IAM = 17.33 ± 2.31; FIM = 17.67 ± 2.08), suggesting high likelihood of implementation success. Thematic analysis showed significant overlap in participant and therapist experiences. Key themes included integrated T1DE-specific CBT delivery, specialist knowledge of T1DE and a strong therapeutic alliance. Both groups emphasised the need for tailored delivery, therapist expertise in T1DE and structural adaptations to standard CBT models. Participant's experiences also included a clear path of therapeutic growth and expectations of therapy. Therapists' experiences included considerations for clinical safeguarding and organisational factors impacting wider implementation. CONCLUSIONS: Our findings demonstrate that STEADY is acceptable, appropriate and feasible for individuals with mild to moderate severity T1DE. The substantial alignment between participant and therapist perspectives offers clear directions for refining the intervention and support implementation in a full-scale RCT.

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