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Cited by 44Eating Disorders and BehaviorsDigital Mental Health InterventionsNutrition, Health and Food Behavior

Recruitment, adherence and attrition challenges in internet-based indicated prevention programs for eating disorders: lessons learned from a randomised controlled trial of ProYouth OZ

Open access
Ali, Kathina, Fassnacht, Daniel B., Farrer, Louise M., Rieger, Elizabeth, Moessner, Markus, Bauer, Stephanie, Griffiths, Kathleen M.·2022·Journal of Eating Disorders
DOI 10.1186/s40337-021-00520-7PMC PMC8725518
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Abstract

Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders, but the adjunctive benefit of synchronous peer support has yet to be investigated. In the current study, a randomised controlled trial was conducted to evaluate the effectiveness of an indicated Internet-based prevention program (ProYouth OZ)with and without peer-to-peer support in reducing disordered eating behaviours and attitudes. Method: Fifty young adults (18–25 years) with eating disorder symptoms were randomised to one of three study conditions: (1)ProYouth OZ(without peer-to-peer support), (2)ProYouth OZ Peers(with peer-to-peer support), and (3) a waitlist control group. Outcomes were assessed at three different time points. Eating disorder symptoms (primary outcome) were measured with the Eating Disorder Examination Questionnaire. Results: Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms. Fifteen participants (30%) completed the post-intervention survey. Of the two intervention groups, 20.6% failed to access any component of the program. Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions. Due to limited outcome data, it was not possible to statistically examine between-group differences in outcomes. Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ. Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community. The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs. offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology but may not be ready or able to seek professional face-to-face treatment. Trial registration: ACTRN12615001250527, Registered 16 November 2015,https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527

AI snapshot

Written from the paper’s full text.

TL;DR

This three-arm RCT of the Internet-based indicated eating disorder prevention program ProYouth OZ, with and without synchronous peer support, was unable to test between-group outcomes because of very low assessment completion. The paper’s main contribution is documenting recruitment, adherence, and attrition challenges: only 17.6% of screened participants were eligible, 30% completed post-intervention measures, and 20.6% of intervention participants accessed no program component.

Key findings

  • Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) were excluded due to severe eating disorder symptoms or a current eating disorder diagnosis; 50 completed the pre-intervention assessment and were randomised.
  • Post-intervention assessment completion was 15/50 (30%); 20.6% of the two intervention groups failed to access any ProYouth OZ component, 13/34 (38.2%) never logged in, and participants completed 42% of scheduled monitoring assessments.
  • In ProYouth OZ Peers, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions; overall chat satisfaction was high (M = 5.00, SD = 1.24, n = 14).
  • Due to limited outcome data, between-group differences could not be statistically examined; visual inspection showed both ProYouth OZ Peers post-intervention completers had decreased disordered eating, compared with only one of six ProYouth OZ completers.

Methods

  • Three-arm RCT in Australian residents aged 18–25 at risk for eating disorders, randomised to ProYouth OZ, ProYouth OZ Peers, or waitlist control; recruitment occurred over 12 months from October 2016 via universities, social media, mental health organisations, and lived-experience promotion.
  • Primary outcome was the Eating Disorder Examination Questionnaire (EDE-Q), assessed pre-intervention, post-intervention (6 weeks), and 3- and 6-month follow-up; the planned sample size was 201 (67 per group) based on Cohen’s f = 0.15, alpha 0.05, power 0.80, and 30% dropout.
  • Analyses used descriptive and inferential statistics for participant flow, Fisher’s exact tests, one-way ANOVAs, Mann–Whitney U tests, and individual outcome profiles; the initially planned between-group outcome analyses were not possible due to low statistical power.

Limitations

  • Stated by the paper: the small sample and low power prevented the planned between-group outcome analyses; online self-report screening may have overdiagnosed eating disorders; no monetary incentives and no face-to-face assessments likely reduced assessment completion; the unstructured program may have contributed to low adherence.
  • Evident from the text: post-intervention outcome data were available for only 2 ProYouth OZ Peers participants and 6 ProYouth OZ participants, making outcome comparisons anecdotal; high attrition and low engagement limit generalisability.
  • Stated by the paper: the inclusion criteria may have been too specific, producing very low eligibility, and findings may not generalise beyond help-seeking Australian young adults recruited through online and offline strategies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s40337-021-00520-7

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 94 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Of 17 ProYouth OZ Peers participants, 11.8% attended all six chat sessions.

    “Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions.”
    Quote in the paperSubstantial claim
  • Findingown data

    Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session.

    “Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Of the two intervention groups, 20.6% failed to access any component of the program.

    “Of the two intervention groups, 20.6% failed to access any component of the program.”
    Quote in the paperSubstantial claim
  • Findingown data

    Fifteen participants (30%) completed the post-intervention survey.

    “Fifteen participants (30%) completed the post-intervention survey.”
    Quote in the paperSubstantial claim
  • Findingown data

    Of 17 ProYouth OZ Peers participants, 20% attended 2-5 chat sessions.

    “Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 40
  • Classified as probably not a substantial claim. 25

  • May combine two claims.

    Findingown data

    Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) were excluded due to severe eating disorder symptoms.

    “Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ.

    “Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The number of logins ranged from 1 to 17 (Median = 3), with five participants accessing the program only once.

    “The number of logins ranged from 1 to 17 (Median = 3), with five participants accessing the program only once”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no statistically significant differences in eating disorder severity or the perceived need for help between participants who did and did not access the intervention (p > 0.150).

    “There were no statistically significant differences in eating disorder severity or the perceived need for help between participants who did and did not access the intervention (p > 0.150).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 34 participants who were randomised to one of the two intervention groups, nine (26.5%) did not complete any monitoring assessments, whereas 25 participants completed at least one monitoring assessment.

    “Of the 34 participants who were randomised to one of the two intervention groups, nine (26.5%) did not complete any monitoring assessments, whereas 25 participants completed at least one monitoring assessment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Some participants completed the weekly monitoring assessments (n = 6) without accessing the program or accessed the program without completing the monitoring (n = 2).

    “Some participants completed the weekly monitoring assessments (n = 6) without accessing the program or accessed the program without completing the monitoring (n = 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Completion rates for the two intervention groups were not statistically significantly different at either the 3-month or 6-month follow-up (Fisher's exact tests, χ2 (1) = 0.07, p = 1.00 and χ2 (1) = 0.25, p = 0.335).

    “Completion rates for the two groups were not statistically significant different at either time point; Fisher’s exact tests, χ2 (1) = 0.07, p = 1.00 and χ2 (1) = 0.25, p = 0.335.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no association between recruitment modality and pre-intervention assessment completion (χ2 (1) = 0.08, p = 0.779), with 69.8% (n = 30) of the eligible offline-recruited participants completing the pre-intervention assessment compared to 66.7% (n = 20) of the online-recruited participants.

    “There was no association between recruitment modality and pre-intervention assessment completion (χ2 (1) = 0.08, p = 0.779), with 69.8% (n = 30) of the eligible offline-recruited participants completing the pre-intervention assessment compared to 66.7% (n = 20) of the online-recruited participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most participants completed only one monitoring (n = 11, 44%), whereas a minority completed all six assessments (n = 2, 8%).

    “Most participants completed only one monitoring (n = 11, 44%), whereas a minority completed all six assessments (n = 2, 8%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the 34 participants who were randomised to one of the two intervention groups, 13 (38.2%) failed to log in to the program at all, whereas 21 participants logged in to the program at least once.

    “Of the 34 participants who were randomised to one of the two intervention groups, 13 (38.2%) failed to log in to the program at all (three participants due to overseas travel plans during the trial, 10 for reasons unknown), whereas 21 participants logged in to the program at least once”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There were no significant differences in demographic characteristics or eating disorder symptoms between eligible participants who completed and those who failed to complete the pre-intervention assessment.

    “There were no significant differences between those two groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Amongst the 25 participants who completed at least one monitoring assessment, in total 63 assessments were completed, equating to 42% of the six scheduled monitoring assessments for each participant.

    “Amongst the 25 participants who completed at least one monitoring assessment, in total 63 assessments were completed. This equates to 42% of the six scheduled monitoring assessments for each participant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only seven (20.6%) and five participants (14.7%) from the two intervention groups combined completed the 3- and 6-month follow-up assessments, respectively.

    “Only seven (20.6%) and five participants (14.7%) from the two intervention groups combined (ProYouth OZ and ProYouth OZ Peers) completed the 3- and 6-month follow-up assessments, respectively.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Six participants accessed the program more than five times, including five participants from the ProYouth OZ Peer group and one participant from the ProYouth OZ group.

    “Six participants accessed the program more than five times, including five participants from the ProYouth OZ Peer group and one participant from the ProYouth OZ group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The total number of times participants viewed a web page of the program in the two ProYouth OZ intervention groups was 403, ranging from 3 to 83.

    “The total number of times participants viewed a web page of the program in the two ProYouth OZ intervention groups was 403, ranging from 3 to 83.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In total, 13 (76.5%) were scheduled for weekly chat sessions; however, two participants informed the trial manager that they were not able to attend any sessions due to conflicting commitments, and another participant failed to attend but offered no explanation.

    “In total, 13 (76.5%) were scheduled for weekly chat sessions; however, two participants informed the trial manager that they were not able to attend any sessions due to conflicting commitments (e.g., travelling), and another participant failed to attend but offered no explanation for their absence”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 17 participants randomised to the ProYouth OZ Peers condition, three were not able to attend any chat session on the scheduled dates, and one did not reply to the chat invitation email.

    “Of the 17 participants randomised to the condition, three participants were not able to attend any chat session on the scheduled dates, and one participant did not reply to the chat invitation email.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Five participants provided open ended qualitative feedback about the sessions.

    “Furthermore, five participants provided open ended qualitative feedback about the sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only 20% attended more than two out of six sessions, and only two participants (11.8% of 17 eligible participants) attended all six sessions.

    “Only 20% attended more than two out of six sessions, and only two participants (11.8% of 17 eligible participants) attended all six sessions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The two participants who attended all chat sessions in ProYouth OZ Peers and completed the post-intervention assessment reported that they would use the program again in the future, would definitely recommend it to friends, and were overall very satisfied with their experience.

    “The two participants who attended all chat sessions in ProYouth OZ Peers and completed the post-intervention assessment reported that they would use the program again in the future, would definitely recommend it to friends, and were overall very satisfied with their experience.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants who attended chat sessions valued the safe and supportive environment, the interesting and relatable content, and the benefits gained from discussion with others who were experiencing similar problems.

    “qualitative feedback indicating that they valued the safe and supportive environment, the interesting and relatable content, and the benefits gained from the discussion with others who were experiencing similar problems”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Overall, one participant was very satisfied, one participant was not satisfied with the program, and four participants were neither satisfied nor dissatisfied.

    “Overall, one participant was very satisfied, one participant was not satisfied with the program, and four participants were neither satisfied nor dissatisfied.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Assessment completion in the current trial was low: 30% of participants completed post-intervention measures (24% from the intervention groups vs. 44% from the control group).

    “Assessment completion in the current trial was low, with only 30% of participants completing post-intervention measures (i.e., 24% from the intervention groups vs. 44% from the control group).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The study pointed to a large group of interested young adults with high levels of unmet need who respond to simple recruitment advertisements.

    “the study pointed to the large group of interested young adults with high levels of unmet need who, although ineligible for an indicated prevention trial due to their elevated symptomatology, respond to simple recruitment advertisements”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The onset of eating disorders most often occurs during adolescence and early adulthood.

    “The onset of eating disorders most often occurs during adolescence and early adulthood [1–4].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [1] Stice E, Marti CN, Shaw H, Jaconis M. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol. 2009;118(3):587–97. source

      Not checked in the free run.

    • cites [2] Favaro A, Caregaro L, Tenconi E, Bosello R, Santonastaso P. Time trends in age at onset of anorexia nervosa and bulimia nervosa. J Clin Psychiatry. 2009;70(12):1715–21. source

      Not checked in the free run.

    • cites [3] Keel PK, Baxter MG, Heatherton TF, Joiner TE Jr. A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms. J Abnorm Psychol. 2007;116(2):422–32. source

      Not checked in the free run.

    • cites [4] Schmidt U, Adan R, Böhm I, Campbell IC, Dingemans A, Ehrlich S, et al. Eating disorders: the big issue. Lancet. 2016;3(4):313–5.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A variety of Internet-based programs for eating disorders have been developed with overall evidence suggesting that they offer a promising approach to preventing and treating eating disorders.

    “A variety of Internet-based programs for eating disorders have been developed with overall evidence suggesting that they offer a promising approach to preventing and treating eating disorders [19–24].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [19] Aardoom JJ, Dingemans AE, Spinhoven P, Van Furth EF. Treating eating disorders over the internet: a systematic review and future research directions. Int J Eat Disord. 2013;46(6):539–52. source

      Not checked in the free run.

    • cites [20] Bauer S, Moessner M. Harnessing the power of technology for the treatment and prevention of eating disorders. Int J Eat Disord. 2013;46(5):508–15. source

      Not checked in the free run.

    • cites [21] Dölemeyer R, Tietjen A, Kersting A, Wagner B. Internet-based interventions for eating disorders in adults: a systematic review. BMC Psychiatry. 2013. https://doi.org/10.1186/1471-244X-13-207. source

      Not checked in the free run.

    • cites [22] Loucas CE, Fairburn CG, Whittington C, Pennant ME, Stockton S, Kendall T. E-therapy in the treatment and prevention of eating disorders: a systematic review and meta-analysis. Behav Res Ther. 2014;63:122–31. source

      Not checked in the free run.

    • cites [23] Melioli T, Bauer S, Franko DL, Moessner M, Ozer F, Chabrol H, et al. Reducing eating disorder symptoms and risk factors using the internet: a meta-analytic review. Int J Eat Disord. 2016;49(1):19–31. source

      Not checked in the free run.

    • cites [24] Wade TD, Wilksch SM. Internet eating disorder prevention. Curr Opin Psychiatry. 2018;31(6):456–61. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need.

    “The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Internet-based interventions have the potential to overcome some barriers to help-seeking by offering anonymity, privacy, accessibility, availability, and cost-effectiveness, and may be perceived as less stigmatising than face-to-face treatments.

    “Internet-based interventions have the potential to overcome some of these barriers by offering anonymity, privacy, accessibility, availability, and cost-effectiveness, and may be perceived as less stigmatising than face-to-face treatments [15–18].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [15] Bauer S, Papezova H, Cherecheş R, Caselli G, McLoughlin O, Szumska I, et al. Advances in the prevention and early intervention of eating disorders: the potential of Internet-delivered approaches. Ment Health Prev. 2013;1:26–32. source

      Not checked in the free run.

    • cites [16] Griffiths KM, Christensen H. Internet-based mental health programs: a powerful tool in the rural medical kit. Aust J Rural Health. 2007;15(2):81–7. source

      Not checked in the free run.

    • cites [17] Lal S, Adair CE. E-mental health: a rapid review of the literature. Psychiatr Serv. 2014;65(1):24–32. source

      Not checked in the free run.

    • cites [18] Aardoom JJ, Dingemans AE, van Ginkel JR, Spinhoven P, Van Furth EF, Van den Akker-van Marle ME. Cost-utility of an internet-based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial. Int J Eat Disord. 2016;49(12):1068–76. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The randomisation was conducted manually by an independent researcher not involved in the delivery of the intervention using a randomisation schedule created with a random number generator.

    “The randomisation was conducted manually by an independent researcher not involved in the delivery of the intervention using a randomisation schedule created with a random number generator.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There is evidence of ProYouth's acceptability and effectiveness, and its potential to facilitate access to traditional care.

    “Originally developed in Germany and implemented in nine European countries, there is evidence of its acceptability and effectiveness [33–37], and its potential to facilitate access to traditional care [38, 39].”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [33] Lindenberg K, Moessner M, Harney J, McLaughlin O, Bauer S. E-health for individualized prevention of eating disorders. Clin Pract Epidemiol Ment Health. 2011;7:74–83. source

      Not checked in the free run.

    • cites [34] Bauer S, Moessner M, Wolf M, Haug S, Kordy H. ES[S]PRIT—an Internet-based programme for the prevention and early intervention of eating disorders in college students. Br J Guid Counsel. 2009;37(3):327–36. source

      Not checked in the free run.

    • cites [35] Lindenberg K, Kordy H. Wirksamkeit eines gestuften, internetvermittelten ansatzes zur prävention von essstörungen bei schülern der 7. Bis 10. Klasse. [Efficacy of an internet-delivered tiered strategy for eating disorder prevention in high school students.]. Kindh Entwickl Z Klin Kinderpsychol. 2015;24(1):55–63. source

      Not checked in the free run.

    • cites [36] Minarik C, Moessner M, Ozer F, Bauer S. Implementation and dissemination of an internet-based program for prevention and early intervention in eating disorders. Psychiatr Prax. 2013;40(6):332–8. source

      Not checked in the free run.

    • cites [37] Moessner M, Özer F, Minarik C, Bauer S. ProYouth—ein Online-Programm zur Prävention und frühen Intervention bei Essstörungen [ProYouth—an online prevention and early intervention program for eating disorders]. Psychother Dialog. 2013;14:74–6. source

      Not checked in the free run.

    • cites [38] Kindermann S, Ali K, Minarik C, Moessner M, Bauer S. Enhancing help-seeking behavior in individuals with eating disorder symptoms via Internet: a case report. Ment Health Prev. 2016;4(2):69–74. source

      Not checked in the free run.

    • cites [39] Moessner M, Minarik C, Ozer F, Bauer S. Can an Internet-based program for the prevention and early intervention in eating disorders facilitate access to conventional professional healthcare? J Ment Health (Abingdon, Engl). 2016;25(5):441–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Ethics approval was obtained from the Australian National University Human Ethics Research Committee (protocol number 2015/742).

    “Ethics approval was obtained from the Australian National University Human Ethics Research Committee (protocol number 2015/742).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Eating Disorder Examination Questionnaire demonstrates good internal consistency and test-retest reliability.

    “The EDE-Q demonstrates good internal consistency and test–retest reliability [50–52].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [50] Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJ. Temporal stability of the eating disorder examination questionnaire. Int J Eat Disord. 2004;36(2):195–203. source

      Not checked in the free run.

    • cites [51] Luce KH, Crowther JH. The reliability of the eating disorder examination-self-report questionnaire version (EDE-Q). Int J Eat Disord. 1999;25(3):349–51. source

      Not checked in the free run.

    • cites [52] Berg KC, Stiles-Shields EC, Swanson SA, Peterson CB, Lebow J, Le Grange D. Diagnostic concordance of the interview and questionnaire versions of the eating disorder examination. Int J Eat Disord. 2012;45(7):850–5. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Blinding of the participant's group allocation was not possible due to the nature of the study.

    “Blinding of the participant’s group allocation was not possible due to the nature of the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Stratified randomisation was used to minimise differences in gender distributions.

    “Stratified randomisation was used to minimise differences in gender distributions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    High dropout rates are commonly reported in trials of Internet-based programs for eating disorders, with one systematic review reporting dropouts ranging from 9 to 47.2%.

    “High dropout rates (i.e., not starting or finishing the intervention or not completing assessments) are commonly reported in trials of these programs with one systematic review of Internet-based interventions for eating disorders reporting dropouts ranging from 9 to 47.2% [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Dölemeyer R, Tietjen A, Kersting A, Wagner B. Internet-based interventions for eating disorders in adults: a systematic review. BMC Psychiatry. 2013. https://doi.org/10.1186/1471-244X-13-207. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One study of Student Bodies with and without asynchronous peer discussion groups found that peer support did not enhance weight, shape or eating-related outcomes.

    “Although one study of Student Bodies with and without asynchronous peer discussion groups found that peer support did not enhance weight, shape or eating-related outcomes [31]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Low KG, Charanasomboon S, Lesser J, Reinhalter K, Martin R, Jones H, et al. Effectiveness of a computer-based interactive eating disorders prevention program at long-term follow-up. Eat Disord. 2006;14(1):17–30. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All studies of indicated Internet-based eating disorder prevention programs used face-to-face assessments and two used external rewards (i.e., monetary compensation) which may prove difficult to implement in real-world settings.

    “In addition, all studies used face-to-face assessments and two used external rewards (i.e., monetary compensation) [27, 29] which may prove difficult to implement in real-world settings.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Taylor CB, Kass AE, Trockel M, Cunning D, Weisman H, Bailey J, et al. Reducing eating disorder onset in a very high risk sample with significant comorbid depression: a randomized controlled trial. J Consult Clin Psychol. 2016;84(5):402–14. source

      Not checked in the free run.

    • cites [29] Stice E, Rohde P, Shaw H, Gau JM. Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: acute effectiveness of these delivery modalities. J Consult Clin Psychol. 2017;85(9):883–95. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12615001250527).

    “The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12615001250527).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The Weight Concerns Scale demonstrates good test-retest reliability and predictive validity.

    “The questionnaire demonstrates good test–retest reliability and predictive validity [40, 41].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Killen JD, Taylor CB, Hayward C, Haydel KF, Wilson DM, Hammer L, et al. Weight concerns influence the development of eating disorders: a 4-year prospective study. J Consult Clin Psychol. 1996;64(5):936–40. source

      Not checked in the free run.

    • cites [41] Killen JD, Taylor CB, Hayward C, Wilson DM, Haydel KF, Hammer LD, et al. Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. Int J Eat Disord. 1994;16(3):227–38. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies have shown that 10% of girls in the highest quartile of the Weight Concerns Scale (> 57) develop subclinical or full eating disorders.

    “Previous studies have shown that 10% of girls in the highest quartile of the WCS (> 57) develop subclinical or full eating disorders [40, 41].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Killen JD, Taylor CB, Hayward C, Haydel KF, Wilson DM, Hammer L, et al. Weight concerns influence the development of eating disorders: a 4-year prospective study. J Consult Clin Psychol. 1996;64(5):936–40. source

      Not checked in the free run.

    • cites [41] Killen JD, Taylor CB, Hayward C, Wilson DM, Haydel KF, Hammer LD, et al. Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. Int J Eat Disord. 1994;16(3):227–38. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Short Evaluation of Eating Disorders demonstrates moderate construct validity, good criterion validity, and good sensitivity to change.

    “The SEED demonstrates moderate construct validity, good criterion validity, and good sensitivity to change [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Bauer S, Winn S, Schmidt U, Kordy H. Construction, scoring and validation of the short evaluation of eating disorders (SEED). Eur Eat Disord Rev. 2005;13(3):191–200. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All studies of indicated Internet-based eating disorder prevention programs recruited only young females and mainly university students, with only two recruiting a very small percentage of members of the community, thus limiting the external validity of findings.

    “However, all studies recruited only young females and mainly university students, with only two recruiting a very small percentage of members of the community [25, 28], thus limiting the external validity of findings.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Jacobi C, Volker U, Trockel MT, Taylor CB. Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial. Behav Res Ther. 2012;50(2):93–9. source

      Not checked in the free run.

    • cites [28] Vollert B, von Bloh P, Eiterich N, Beintner I, Hütter K, Taylor CB, et al. Recruiting participants to an Internet-based eating disorder prevention trial: impact of the recruitment strategy on symptom severity and program utilization. Int J Eat Disord. 2020;53(5):476–84. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Participants were randomised to one of the three study conditions after having completed the pre-intervention assessment.

    “Participants were randomised to one of the three study conditions after having completed the pre-intervention assessment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    It has been suggested that highly specific inclusion criteria may result in difficulties identifying suitable participants, especially for low prevalence conditions and hard-to-reach populations.

    “It has been suggested that highly specific inclusion criteria may result in difficulties identifying suitable participants, especially for low prevalence conditions and hard-to-reach populations [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Fogel DB. Factors associated with clinical trials that fail and opportunities for improving the likelihood of success: a review. Contemp Clin Trials Commun. 2018;11:156–64. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bauer et al. [59] reported a similar trend, arguing that participants recruited online are subject to greater self-selection.

    “Bauer et al. [59] reported a similar trend, arguing that participants recruited online are subject to greater self-selection.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bauer et al. [59] Bauer S, Bilić S, Ozer F, Moessner M. Dissemination of an Internet-based program for the prevention and early intervention in eating disorders. Z Kinder Jugendpsychiatr Psychother. 2019;48(1):25–32. source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    The development of inclusion and exclusion criteria to identify participants at risk is complex and has been applied differently across studies.

    “the development of inclusion and exclusion criteria to identify participants at risk is complex and has been applied differently across studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The online screening approach used in the current study is not without its limitations.

    “although also employed in other indicated eating disorder prevention trials [25, 26, 29] the online screening approach used in the current study is not without its limitations.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25] Jacobi C, Volker U, Trockel MT, Taylor CB. Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial. Behav Res Ther. 2012;50(2):93–9. source

      Not checked in the free run.

    • cites [26] Saekow J, Jones M, Gibbs E, Jacobi C, Fitzsimmons-Craft E, Wilfley D, et al. StudentBodies - eating disorders: a randomized controlled trial of a coached online intervention for subclinical eating disorders. Internet Interv. 2015;2(4):419–28. source

      Not checked in the free run.

    • cites [29] Stice E, Rohde P, Shaw H, Gau JM. Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: acute effectiveness of these delivery modalities. J Consult Clin Psychol. 2017;85(9):883–95. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Recruitment challenges, low adherence, and high rates of attrition commonly compromise randomised controlled trials.

    “Recruitment challenges, low adherence, and high rates of attrition commonly compromise randomised controlled trials [55, 56]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55] Fogel DB. Factors associated with clinical trials that fail and opportunities for improving the likelihood of success: a review. Contemp Clin Trials Commun. 2018;11:156–64. source

      Not checked in the free run.

    • cites [56] Carlisle B, Kimmelman J, Ramsay T, MacKinnon N. Unsuccessful trial accrual and human subjects protections: an empirical analysis of recently closed trials. Clin Trials. 2015;12(1):77–83. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It is possible that due to the use of a brief self-report screener, the present study may have overdiagnosed eating disorders.

    “It is possible that due to the use of a brief self-report screener, the present study may have overdiagnosed eating disorders.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Studies of other programs (Healthy Body Image, Student Bodies) found that higher adherence was associated with higher perceived need for help and higher eating pathology, respectively.

    “studies of other programs, such as the Healthy Body Image program [61] and Student Bodies [28], which found that higher adherence was associated with higher perceived need for help and higher eating pathology, respectively”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [61] Lipson SK, Jones JM, Taylor CB, Wilfley DE, Eichen DM, Fitzsimmons-Craft EE, et al. Understanding and promoting treatment-seeking for eating disorders and body image concerns on college campuses through online screening, prevention and intervention. Eat Behav. 2017;25:68–73. source

      Not checked in the free run.

    • cites [28] Vollert B, von Bloh P, Eiterich N, Beintner I, Hütter K, Taylor CB, et al. Recruiting participants to an Internet-based eating disorder prevention trial: impact of the recruitment strategy on symptom severity and program utilization. Int J Eat Disord. 2020;53(5):476–84. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telephone or face-to-face interview processes have the advantage of accurately excluding those with full syndrome eating disorders and may increase participant commitment.

    “Telephone or face-to-face interview processes [25–27] have the advantage of accurately excluding those with full syndrome eating disorders and may increase participant commitment.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25] Jacobi C, Volker U, Trockel MT, Taylor CB. Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial. Behav Res Ther. 2012;50(2):93–9. source

      Not checked in the free run.

    • cites [26] Saekow J, Jones M, Gibbs E, Jacobi C, Fitzsimmons-Craft E, Wilfley D, et al. StudentBodies - eating disorders: a randomized controlled trial of a coached online intervention for subclinical eating disorders. Internet Interv. 2015;2(4):419–28. source

      Not checked in the free run.

    • cites [27] Taylor CB, Kass AE, Trockel M, Cunning D, Weisman H, Bailey J, et al. Reducing eating disorder onset in a very high risk sample with significant comorbid depression: a randomized controlled trial. J Consult Clin Psychol. 2016;84(5):402–14. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other studies of indicated prevention programs have broadened their criteria to include individuals with lower levels of weight concerns (e.g., WCS > 47) or body dissatisfaction only without any additional behavioural criteria.

    “other studies of indicated prevention programs have broadened their criteria to include individuals with lower levels of weight concerns (e.g., WCS > 47; [25, 26]) or body dissatisfaction only without any additional behavioural criteria [29].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [25] Jacobi C, Volker U, Trockel MT, Taylor CB. Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial. Behav Res Ther. 2012;50(2):93–9. source

      Not checked in the free run.

    • cites [26] Saekow J, Jones M, Gibbs E, Jacobi C, Fitzsimmons-Craft E, Wilfley D, et al. StudentBodies - eating disorders: a randomized controlled trial of a coached online intervention for subclinical eating disorders. Internet Interv. 2015;2(4):419–28. source

      Not checked in the free run.

    • cites [29] Stice E, Rohde P, Shaw H, Gau JM. Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: acute effectiveness of these delivery modalities. J Consult Clin Psychol. 2017;85(9):883–95. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Our results are not unique in showing recruitment challenges, low adherence, and high attrition.

    “in this respect our results are not unique.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    It is important to report 'failed' trials as well as trials with negative or null results.

    “it has been argued that it is important to report “failed” trials as well as trials with negative or null results [57, 58].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] Andersson G. Internet interventions: past, present and future. Internet Interv. 2018;12:181–8. source

      Not checked in the free run.

    • cites [58] Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry. 2019;18(1):20–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Outcome data in the current study suggests that future research on peer-to-peer support is warranted.

    “the outcome data in the current study suggests that future research on peer-to-peer support is warranted”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A previous meta-analysis of StudentBodies highlighted that the provision of incentives may be essential for assessment completion.

    “a previous meta-analysis of the findings from StudentBodies has highlighted that the provision of incentives may be essential for assessment completion [66]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [66] Beintner I, Jacobi C, Taylor CB. Effects of an Internet-based prevention programme for eating disorders in the USA and Germany—a meta-analytic review. Eur Eat Disord Rev. 2012;20(1):1–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Prevention programs have maximal potential to reduce disease burden.

    “prevention programs have maximal potential to reduce disease burden [68]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Moessner M, Bauer S. Maximizing the public health impact of eating disorder services: a simulation study. Int J Eat Disord. 2017;50(12):1378–84. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    No conclusions can be drawn about the effectiveness of ProYouth OZ and the additional effect of online peer support.

    “Although no conclusions can be drawn about the effectiveness of ProYouth OZ and the additional effect of online peer support”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Monetary incentives have been found to increase enrolment and assessment completion in online interventions.

    “Monetary incentives have been found to increase enrolment and assessment completion in online interventions [64, 65].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [64] Khadjesari Z, Murray E, Kalaitzaki E, White IR, McCambridge J, Thompson SG, et al. Impact and costs of incentives to reduce attrition in online trials: two randomized controlled trials. J Med Internet Res. 2011;13(1):e26-e. source

      Not checked in the free run.

    • cites [65] Alexander GL, Divine GW, Couper MP, McClure JB, Stopponi MA, Fortman KK, et al. Effect of incentives and mailing features on online health program enrollment. Am J Prev Med. 2008;34(5):382–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Other factors including the timing or length of assessments may have further impacted completion rates.

    “It may be that other factors including the timing or length of assessments (duration of 30 min) further impacted completion rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The absence of monetary payments in combination with the lack of face-to-face assessments may account for the low completion of assessments in the current trial.

    “The absence of such payments in combination with the lack of face-to-face assessments may account for the low completion of assessments [67].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Rodgers RF, Franko DL. Eating disorder prevention on college campuses: recruitment challenges. Eur Rev Appl Psychol. 2015;65(3):125–31. source

      Not checked in the free run.

61 of 61

  • The paper relies on this without support.

    Financial incentives are a useful strategy to promote healthy and discourage unhealthy behaviours.

    “In the broader field of behavioural economics, financial incentives have been found to be a useful strategy to promote healthy and discourage unhealthy behaviours.”

  • The paper relies on this without support.

    The majority of Internet-based programs for eating disorders were developed as prevention programs (universal, selective, or indicated) rather than treatment programs.

    “the majority of Internet-based programs for eating disorders were developed as prevention programs (universal, selective, or indicated) rather than treatment programs”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(2) = 4.36reported p = .113 · recomputed p = .113

    “χ2 (2) = 4.36, p = .113”

  • Consistentχ²(1) = 0.07reported p = 1 · recomputed p = .791

    “χ2 (1) = 0.07, p = 1.00”

    The paper states an exact test

  • Consistentχ²(1) = 0.25reported p = .335 · recomputed p = .617

    “χ2 (1) = 0.25, p = .335”

    The paper states an exact test

  • Consistentt(410) = 2.83reported p = .005 · recomputed p = .005

    “t(410) = 2.83, p = .005”

  • Consistentχ²(1) = 4.78reported p = .029 · recomputed p = .029

    “χ2 (1) = 4.78, p = .029”

  • Consistentχ²(1) = 4.42reported p = .036 · recomputed p = .036

    “χ2 (1) = 4.42, p = .036”

  • Consistentχ²(1) = 15.75reported p < .001 · recomputed p < .001

    “χ2 (1) = 15.75, p < .001”

  • Consistentχ²(1) = 0.08reported p = .779 · recomputed p = .777

    “χ2 (1) = 0.08, p = .779”

8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Online recruitment did not attract 60% of eligible participants

    Major

    The reported completion counts and rates imply 43 eligible offline recruits (30/69.8%) and 30 eligible online recruits (20/66.7%). Online recruits therefore accounted for about 41% of the 73 eligible participants, not a majority or 60%.

  • Reported diagnosis rates exceed the total excluded for severe symptoms or diagnosis

    Major

    The recruitment counts give 223 online participants and at least 182 offline participants. Applying the stated current-diagnosis rates yields approximately 168 online and 107 offline participants with diagnoses-about 275 in total-yet only 213 participants were reportedly excluded for severe symptoms or a current diagnosis combined.

  • Page-hit total includes the control group despite being described as intervention-only

    Minor

    Table 3 reports 208 page hits for ProYouth OZ Peers and 176 for ProYouth OZ, totaling 384. The stated 403 includes the control group's 19 page hits.

    Reported 403 · recomputed 384

  • The paper gives three and four outcome-assessment time points

    Minor

    The abstract says outcomes were assessed at three time points, but the methods specify pre-intervention, post-intervention, 3-month follow-up, and 6-month follow-up-four time points.

  • Post-intervention control-group vomiting percentage is inconsistent with its count

    Minor

    Table 4 lists seven control participants at post-intervention and reports seven with no vomiting. That is 100%, not 86.7%; the vomiting-category counts in that column also sum to nine rather than seven.

    Reported 86.7 · recomputed 100

5 of 5

Cites

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Cited by

Sorted by citations

Related

Authors
Ali, K., Fassnacht, D. B., Farrer, L. M., Rieger, E., Moessner, M., Bauer, S., & Griffiths, K. M.
Affiliations
  • Australian National University (AU)
  • University Hospital Heidelberg (DE)
Corresponding author
Ali, Kathina
ORCID
Venue
Journal of Eating Disorders
Publisher
Springer Science and Business Media LLC
Published
2022-01-04
Volume
10
Issue
1
Pages
1-1
ISSN
2050-2974 (ISSN-L)
DOI
10.1186/s40337-021-00520-7
PMC
PMC8725518
OpenAlex
W4205140471
Semantic Scholar
23036805b7a69ac6d5405f3b5d2e7e68b98334e1
Cited by
44
References
77
Citations by year
2026: 5 · 2025: 6 · 2024: 13 · 2023: 13 · 2022: 7
FWCI
8.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Eating Disorders (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • young and well crc
  • australia–germany joint research cooperation scheme
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
eating disorders, peer support, indicated prevention, emerging adults, disordered eating, recruitment (clinical trials), participant adherence, attrition, program engagement, digital mental health interventions, Eating Disorder Examination Questionnaire, Australia and New Zealand

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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