Exploring barriers and facilitators in eating disorders treatment among Latinas in the United States.

Abstract

The purpose of this study was to explore facilitators and barriers that may contribute to, or prevent, the engagement and retention of Latinos in eating disorders (EDs) treatment. Objective The main objective of this investigation was to explore more fully the facilitators and barriers that may contribute to or prevent the engagement and retention of Latinos/as in EDs treatment. Methods A qualitative design based on grounded theory was used to guide in-depth interviews with 5 Latinas (mean age 31.2 years) with history of EDs and with 5 Latino mental health providers (mean age 36.4 years). Results Six main themes were found in the discussion with patients and mental health providers: immigration stress, treatment experience in the U.S., facilitators of help seeking, barriers to help seeking, treatment needs, and facilitators of treatment retention. For patients, lack of information about EDs and lack of bilingual treatment were identified as practical barriers. Other emotional factors such as stigma, fear of not being understood, family privacy and not being ready to change were identified as barriers to seeking help. Among facilitator factors that encouraged patients to seek help, the most salient were the perception of the severity of the ED and emotional distress. For treatment retention, family support was a key element among patients. For providers, offering short-term treatment and directive treatment were seen as relevant factors for treatment retention in Latinos. Conclusions A culturally sensitive intervention model for Latinas with EDs in the U.S. is discussed addressing four levels: patient; family; providers; and system.

Development of fotonovelas to raise awareness of eating disorders in Latinos in the United States

“…Having materials that catch the attention of the population that they are intended to educate, therefore motivating the potential reader to engage with the psychoeducational material is an initial and important step in the education and awareness process. Also, the self-identification of the readers with the story or with the characters could have an impact in reducing stigma, which is a barrier that has been associated with seeking care for EDs (Becker et al, 2010), especially in the Latino population (Reyes-Rodríguez et al, 2013). If an individual self-identifies with a character in a story, they might be more likely to view the character in the story as a role model, which would increase the changes of the individual engaging in the targeted behavior changes (Hernandez & Organista, 2013).…”

“…The topics included in fotonovela scripts were based on a previous formative study conducted with Latinas with a history of EDs (Reyes-Rodríguez et al, 2013). The purpose of the scripts was to enhance literacy about EDs by providing basic knowledge about EDs, reduce stigma by emphasizing that EDs occur in all races and ethnic groups including Latinos, and highlight the importance of seeking professional help.…”

“…The use of photographic design was considered, especially for the adult versions; however, factors such as budget and time limitations and the final intention to convey a casual tone over a very sensitive topic for Latinos, were considered in the final decision to use cartoons. The stigma of having an ED in the Latino population is greater than the stigma of having depression or other mental health condition (Cachelin & Striegel-Moore, 2006; Reyes-Rodríguez et al, 2013), and cartoons have the ability to assuage anxiety about sensitive topics while disclosing valuable medical information (Moll, 1986). A rough draft of the graphic design for each fotonovela version was revised by the research team to ensure that each character was properly represented.…”

“…Latinos/as with a history of EDs are less likely to use mental health services (Marques et al, 2011) and to be referred for further evaluation by physicians (Becker et al, 2003; Franko et al, 2007) than non-Latino whites. Several barriers to seeking treatment for mental health problems generally and EDs specifically have been identified in the Latino population, including lack of knowledge (Britigan, Murnan, & Rojas-Guyler, 2009), financial and language barriers, lack of information about EDs, shame, not knowing where to go for treatment, believing that one can get better on their own, believing that eating problems are not serious enough to seek help (Cachelin & Striegel-Moore, 2006; Reyes-Rodríguez et al, 2013), family privacy, and not being ready to change (Cachelin & Striegel-Moore, 2006; Reyes-Rodríguez et al, 2013). Barriers to treatment are further exacerbated by the stigma associated with seeking care for EDs (Becker et al, 2010).…”

“…Psychoeducation about EDs was identified as one of the areas that should be addressed in Latinas living in the United States as part of a multilevel and culturally sensitive intervention model (Reyes-Rodríguez et al, 2013). The integration of culture and context has been recommended as a standard practice in clinical intervention, research, and education (see the American Psychological Association guidelines) to inform psychologists about issues of diversity (APA, 2003).…”