“Stepping outside the red line": An exploration of two co-design methodologies exploring lived experiences of remote support for eating disorders throughout COVID-19 and beyond (Design4Health Conference, 2024)

The COVID-19 pandemic necessitated the rapid transition to online support for eating disorders (Brothwood et al. 2021; Lewis et al. 2021). Beyond the context of the pandemic, remote support continues to be widely adopted and requested. The benefits of online support include its role as a virtual lifeline during the pandemic, its subsequent ability to provide a wider range of support methods, the convenience for recipients being able to access support at home and, for service providers, its cost-effectiveness and flexibility (Murphy-Morgan and Branley-Bell, 2022). Remote support also presents challenges in terms of accessibility, issues of digital self-efficacy and potentially problematic affordances of platforms. Examples include the potential anxiety of the recipient seeing their own self-image on camera during a video call, or a therapist's concern regarding individuals being able to hide behind the camera to mask the severity of their symptoms (Murphy-Morgan and Branley-Bell 2022: Waller et al. 2020). However, online services can provide an accessible form of support, including for individuals without diagnosis who are often left with no access to clinical services (Yim et al. 2021). Through interactive workshops, semi-structured interviews and a national survey, our research programme has gathered a range of perspectives about the challenges and opportunities presented by online support for eating disorders. Currently, there is little research exploring the diverse narratives of lived experiences of such support, what future interventions could be considered in improving provision, and how these decisions can be made. Co-design methodologies allow for a phenomenological approach in considering these questions, and the opportunity to redress potential power imbalances through allowing lived experience narratives to shape the interpretation and dissemination of research findings (Çarçani et al. 2023). It allows for a range of perspectives to be explored and is valuable in aiding identification of any overlooked aspects of new interventions (Marion and Cornish 2023). Creative approaches to co-design can provide new ways of understanding and articulating lived experiences (Vaart, Hoven, and Huigen 2018). In this paper, we explore, and reflect upon, two creative co-design approaches we have used: generating an animation portraying online support experiences, and a good practice toolkit for online support.