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This study sought to inform future adaptation of evidence\u2010based eating disorder interventions to improve accessibility, acceptability, and engagement among this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Participants (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20099) were adults with public insurance or no insurance coverage who endorsed \u2265\u20096 binge eating episodes, \u2265\u20096 vomiting episodes, and\/or \u2265\u20096 laxative\/diuretic episodes in the past 3\u2009months, had a BMI \u2265\u200918.5\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , with annual household income \u2264\u2009200% of the federal poverty level. Participants completed 4\u2009weeks of intervention usability testing, followed by a semi\u2010structured interview examining barriers and facilitators to intervention engagement. Interviews were analyzed using inductive qualitative thematic analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants identified barriers and facilitators related to intervention accessibility, acceptability, and engagement. Barriers included psychosocial and structural stressors, treatment readiness, and concerns about representation and intervention fit. Facilitators included feeling understood and supported, perceived symptom improvement, and hopefulness. Participants emphasized the importance of tailoring interventions to individual identity and lived experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings highlighted the need for continued adaptation of digital interventions to better meet the specific needs of lower\u2010income individuals with eating disorders. Incorporating flexibility, representation, and personalization may enhance engagement and support more equitable access to care. This study increased representation of the lived experiences of this underrepresented population and contributed to ongoing efforts to reduce disparities in eating disorder treatment through expanded access to evidence\u2010based care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/eat.70010","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T09:54:46Z","timestamp":1765360486000},"page":"704-714","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding Engagement Experiences in an Adapted Digital Cognitive Behavioral Intervention for Lower\u2010Income Adults With Eating Disorders With Binge Eating and\/or Purging: A Qualitative Analysis of Barriers and Facilitators"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-998X","authenticated-orcid":false,"given":"Kimberly","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0577-727X","authenticated-orcid":false,"given":"Siena","family":"Vendlinski","sequence":"additional","affiliation":[{"name":"Department of Psychology University of South Florida  Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6710-5017","authenticated-orcid":false,"given":"Hannah","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-0674","authenticated-orcid":false,"given":"Nancy Jacquelyn","family":"P\u00e9rez\u2010Flores","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University in St. Louis School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3177-0433","authenticated-orcid":false,"given":"Catherine R.","family":"Drury","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Montefiore Einstein Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7064-3835","authenticated-orcid":false,"given":"Ellen E.","family":"Fitzsimmons\u2010Craft","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University in St. Louis School of Medicine  St. Louis Missouri USA"},{"name":"Department of Psychological &amp; Brain Sciences Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-6381","authenticated-orcid":false,"given":"Erin C.","family":"Accurso","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"},{"name":"Philip R. 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