The Worth Warrior app by stem4 helps young people manage low self-worth that is focussed around body dissatisfaction. The app focuses on four main areas: Thoughts, Emotions, Behaviours and Body Image and there are activities to carry out for each of these.

Developed by Dr Nihara Krause, a Consultant Clinical Psychologist, in collaboration with young people, the Worth Warrior app is based on a treatment called Cognitive Behavioural Therapy that is adapted for Eating Disorders (CBT-E).

It is not a substitute for the assessment and individualised treatment by a health/mental health professional.

The Worth Warrior app is recommended for the ages of 12 years and above. If a younger child would like to use it, it is recommended that this is done under the guidance of a responsible adult.

Please note that the Worth Warrior app is not a substitute for assessment and intervention by a mental health professional. It is recommended a GP should be consulted in the first instance to ensure physical health is not at risk.In addition to the age criteria above, the Worth Warrior app has been developed (if used for self-guided use) with individuals who have low self-worth/self-esteem and body image concerns leading to possible early-stage eating difficulties. If you have been diagnosed with a current moderate-severe eating disorder, please talk to a responsible adult and see a health professional first to find out if the app is suitable for your use.

Please do not hesitate to call emergency services if your physical health is compromised. If you are under the supervision of a mental health team, you may use the app under their guidance.

Overview

 “To hit a target of worth takes practice and courage.

Believe you can do it, keep trying and you can get there.”

More detail

Worth Warrior aims to help young people manage negative thoughts, feelings and behaviours leading to low self-worth, body dissatisfaction and possible eating disorders. It follows a treatment called Cognitive Behaviour Therapy for Eating Disorders (CBT-E) which encourages the user in the ‘Change the’ section to work on changing thoughts, emotions, behaviours and negative body image assumptions. ‘Change the Story’ helps identify negative self thought and learn how to substitute positive self-thoughts. ‘Change the Action’ focuses on identifying negative behaviours and altering them. In ‘Change the Emotion’ users are provided with alternative, self soothing behaviours to manipulate their eating and in ‘Change the way I view my Body’ users are taught how to separate fact from assumption.   

Please refer to the user guide outlining how to use the app.  

Keep yourself safe at all times when using the app. If you feel unable to use the app, or feel unsafe at the time of use, then please seek the support of a responsible adult, a friend, emergency or other suitable services. Please remember that the Worth Warrior app has not been developed to help manage moderate-severe eating disorders, especially those associated with increased physical risk.

We also have a Clinician guide and a Parent/Carer guide.

To develop an evidence-based, widely accessible digital tool to help young people (12 years and over) manage low self-worth that is focussed around body dissatisfaction.

To be universally acceptable – It can be helpful for young people who are unlikely to accept traditional treatment, whose behaviours do not meet the threshold for help, are waiting for treatment or alongside treatment.

To devise an anonymised analytical model to evidence effectiveness and inform future development.

To comply with NHS digital technology standards.

To raise the profile of stem4 and its work to support teenage mental health.

Research study

A clinical research study is currently underway.

A passcode (and optional touch ID/facial recognition) can be set to protect the Worth Warrior app. We advise that you keep your information secure by setting the passcode along with a passcode or touch access to your device to prevent unauthorised access.

Please do note that as the Worth Warrior app does not create user accounts, we are unable to provide you with your passcode should you forget this or retrieve any of your data.

The Worth Warrior app data can be reset in the App Settings section. This action will reset the app back to its initial state, deleting all app data. Please note that once data is reset, this action cannot be undone.

Unfortunately, as we don’t create user accounts for data privacy reasons, we are unable to restore any content/data from your previous use if you have forgotten your password, reset your data, deleted the app or switched to a new device. We recommend that you take screenshots of any content that is to be saved, so that you can still view them if your data is lost.

The Worth Warrior app was developed co-collaboratively with young people. Co-collaborative workshops with young people explored desired outputs, user journeys, visual concepts, security/privacy, user experience, and tone of voice.

Clinical and professional groups provided input on safety, user characteristics, strengths, potential barriers, referrer experience and tone of voice.

stem4 regularly monitors user feedback via emails, social media and reviews on the App Store/Google Play. In addition, we talk to small user groups to obtain feedback when updating the Worth Warrior app.

We aim for all our user groups to be diverse and inclusive and represent a cross-section of our youth user community.

We welcome user feedback which can be emailed to worthwarrior@stem4.org.uk

A number of standards were used. These included:

• NHS Digital DCB0129 standards. Developed by the NHS, this standard is designed to help manufacturers of health IT software evidence the clinical safety of their products.
• User Needs design based on workshop feedback from young people.
• Design with data using existing app data.
• Iteration – New updates depending on things that have (or haven’t) worked or new functionality.

stem4 wants as many people as possible to be able to use our apps and is committed to improving the accessibility of these by building accessibility best practices into our app development process.

AbilityNet has advice on making your device easier to use if you have a disability.

We have used the following W3C guidelines for mobile accessibility and the Worth Warrior app is partially compliant with these guidelines:

https://w3c.github.io/Mobile-A11y-TF-Note/

The Worth Warrior app is fully compliant with these guidelines:

1.4 Non linear screen layouts – conventional top-down screen designs are used.

3.2 Consistent layout – repeated screen components are displayed in a consistent manner throughout the app.

3.5 Provide clear indication that elements are actionable – conventional button shapes and iconography are used where relevant. Links within text are underlined and coloured, and conventional positioning is used.

4.1 Set the virtual keyboard to the type of data entry required.

4.2 Provide easy methods for data entry.

The Worth Warrior app is partially compliant with these guidelines:

1.1 Small screen size – the design and layout of the app has been specifically designed for mobile devices and the majority of text content is 16px but some is smaller.

1.2 Zoom magnification – the app does not allow pinch to zoom but does support OS level accessibility zoom or magnification features.

2.2 Touch target size and spacing – most touchpoints are at least 9mm by 9mm in size.

2.5 Placing buttons where they are easy to access – most action buttons are placed towards the bottom of the screen.

3.3 Positioning important elements before the page scroll – most screens contain all content with a few exceptions.

3.4 Grouping operable elements that perform the same action – this is done throughout the app with the exception of the Let’s Go button on the homescreen and footer navigation.

4.3 Support the characteristic properties of the platform – the Worth Warrior app does not fully support the inbuilt screen readers VoiceOver (iOS) and TalkBack (Android). This includes an inability for screen readers to read out the information displayed in the Tracker graphs found within Self Monitoring.

The Worth Warrior app is not compliant with these guidelines:

1.3 Contrast – the app brand colours mean we do not meet the guidelines for colour contrast within the app.

2.1 Keyboard control for touchscreen devices – the Worth Warrior app does not support keyboard navigation.

3.1 Changing screen orientation – the Worth Warrior app can only be used in portrait mode.

These guidelines are not applicable to the Worth Warrior app:

2.3, 2.4, 3.6 – the Worth Warrior app does not use gestures

We’re always looking to improve the accessibility of our apps so if you would like to report any accessibility issues then please contact worthwarrior@stem4.org.uk.

Using activities that work can be helpful in making change. However, always check with the young person if they find re-using the activity helpful in order not to over-use them, thereby losing their impact.

stem4 has put a number of measures in place to ensure that the Worth Warrior app is clinically safe to use.

The Worth Warrior app has been developed by a Consultant Clinical Psychologist and validated by the group it is for. The Worth Warrior app complies with the clinical safety standard DCB0129. Developed by the NHS, this standard is designed to help manufacturers of health IT software evidence the clinical safety of their products.

stem4 has a Clinical Risk Management Plan. A Clinical Safety Review with a range of clinical professionals was undertaken for the Worth Warrior app and a Clinical Safety Case Report and Hazard Log created. The clinical risk is monitored and laid out in the Hazard Log. A flow chart of hazard mitigation and response is available which outlines how issues will be addressed together with target response times.  

Clinical safety documents are available on request from enquries@stem4.org.uk.

The target response time for urgent issues is 24 hours, for high priority issues 72 hours, medium priority 7 working days and low priority 14 working days.

The Clinical Safety Officer (CSO) is Dr Nihara Krause.

stem4 regularly monitors user feedback via emails, social media and reviews on the App Store/Google Play.

The Worth Warrior app is reviewed on a quarterly basis during which app efficacy, including the efficacy of the activities, is reviewed, and the app updated as necessary to ensure it is clinically valid.

Users wanted an app with a small digital footprint that was private. No personally identifiable data is collected.

Users are given the option of setting a passcode for the Worth Warrior app. However, since no email address is taken, if the passcode cannot be remembered we are unable to reset it. Users are notified of this when setting the passcode.

Whilst some of the Change the Emotion tasks are helpful for some users, others may be ‘triggering’ for others. We have therefore provided the option for users to hide particular activities they might find triggering in order to personalise the Worth Warrior app for their safety.

If the user has completed three activities in a row that have not helped, an automatic message is generated that suggests the user contacts a medical professional or emergency support and also directs the user to their Safety Net.

Users are signposted to National resources and emergency numbers.

The Worth Warrior app is reviewed every three months and updated as required.

We do not collect any personal information, that is any information that could allow you to be identified as an individual. We do collect some anonymous or non-personally identifiable information (non-PII) – this is data that cannot be used on its own to track, or identify a person. At the time you start using the App, we ask you which country you are in, so that if you need further support, the App will give you accurate information for the country you are in. The additional non-PII data that we can collect, if you agree to share this with us, is county (if in UK), year of birth, gender, ethnicity, and whether you are receiving treatment or advice for an eating disorder from a health professional. This information is used to help us develop our Apps and understand basic information on who is using the App. 

It is important to know that you do not have to share any information about yourself, apart from letting us know which country you are in at the beginning of your use, and you can still use the whole App without telling us anything that you don’t want to share.

You can read our full Privacy Policy here.

stem4 is working towards the Children’s code (or the Age appropriate design code) – find out more about this here: Demystifying the Age Appropriate Design Code | 5Rights Foundation.

The Worth Warrior app does not create user accounts. This was based on user research, with young people telling us they valued privacy. This means that if the Worth Warrior app is deleted or the device is changed, any app data is lost. stem4, therefore, recommends that screenshots of any data that is to be saved are taken.

To report an issue with the Worth Warrior app please email worthwarrior@stem4.org.uk providing as many details about the issue as you can, including the device you are using (e.g. iPhone 11, Android Galaxy S20, etc.) and the version of Operating System it is running (e.g. iOS 15, Android 12, etc.); this information can be found within your device’s Settings.

The developers of the Worth Warrior app, stem4, endeavour to respond within target response times. The target response time for urgent issues is 24 hours, for high priority issues 72 hours, for medium priority 7 working days and for low priority 14 working days.

stem4 assesses and records any clinical risk. The Worth Warrior app is reviewed quarterly and updates are made where necessary.

stem4 will resolve major bugs that prevent the intended Worth Warrior app functionality from working for devices and operating systems supported.

The Worth Warrior app uses an evidence-based approach but it does not substitute for the assessment and treatment of a suitably qualified mental health professional. Please contact your GP or physician before use or if you are uncertain of whether the Worth Warrior app is for you. As the saying goes ‘no one size fits all’ and digital approaches help some and not others.

If you feel your body image related eating difficulties need more support than is offered through the Worth Warrior app, please try another approach or use the Worth Warrior app alongside another approach. The Worth Warrior app provides signposting to further help. In the UK you can call Beat (refer to their website for helpline numbers), SEED or Eating Disorders Support. 

stem4 does not offer a counselling service. For any concerns please contact a GP and also the signposts in the Worth Warrior app. In an emergency please contact 111 or 999 (UK).