A Scale to Assess Factors Influencing Treatment Initiation in Patients With Anorexia Nervosa. Development and Evaluation of the FABIANA-Checklist.

Abstract

BackgroundA long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa and often associated with chronic illness progression. The FABIANA- checklist, developed using a qualitative multi-informant approach, includes factors influencing treatment initiation which are potentially modifiable and are mentioned as being relevant by patients with AN. The study focusses on the development and evaluation of the FABIANA-Checklist and aims at providing descriptive data on DUI in a German sample.MethodsAfter cognitive pretest and revision, dimensionality of the 18-item version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). For item validation we assessed support from social environment (FSozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ).ResultsWe included a sample of female patients (N=75), aged >14 years ( M = 21.4 years) with AN. Average BMI was 15.5 kg/m 2 , age of onset was 19.2 years and average DUI was 2.25 years. PCA yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach’s α= .76) and construct validity was satisfactory for 14 items. Two consistent components emerged: primary care perceived as supportive and competent (23.33%) and emotional and practical support from relatives (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and partly ambiguous interpretability. Analysis on item level indicated that practical and emotional support from the social environment seems to be particularly important for treatment initiation.ConclusionsThe FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are strongly involved factors. Nevertheless, the results point out that a differentiated consideration on item level is useful. To quantify the relative importance of the factors assessed and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers in addition to the patient perspective.Trial registrationClinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541