Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals

Abstract

Background An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed. Objective Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach. Method To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis. Results In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were ‘recognizing and addressing’ by close others, ‘waiting times and availability’ and ‘recommendations and referrals’ by health care professionals. ‘Positive role models for treatment’ were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability. Conclusion Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients. Trial registration ClinicalTrials.gov Identifier: NCT03713541.

Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation

“…These experiences are consistent with the Arts et al Study that showed that AN online information was often of variable quality and difficult to read [ 64 ]. Even more, and especially for adolescents, not understanding the disorder and the need for treatment is a real obstacle in implementing appropriate treatment [ 9 ]. It was therefore expected that having a single source of reliable data on the disorder or on dietary facts would limit this risk and facilitate communication with caregivers.…”

“…Social influence, as was discussed earlier, is a major parameter in building the intent to use [ 32 , 33 ]. It can therefore be influenced negatively by shame and disorder-related stigmas, which are well-known barriers to the search for help and treatment in EDs [ 8 , 9 ], and more generally in mental health care. We can thus see how important it would be that the app felt safe and “without judgement”.…”

“…Despite the severity of this disorder and while many studies have highlighted the importance of early diagnosis and interventions to improve recovery prospects [ 6 , 7 ], there are many barriers that may delay AN’s diagnosis and treatments. These barriers include the lack of training and resources of primary care professionals about eating disorders (EDs) or limited access to EDs services because of geographical barriers, long waiting lists and rigid admission rules [ 8 , 9 ]. Moreover, the impact of COVID-19 has exacerbated these problems of access to care.…”

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

“…Instrument and item generation were based on a recommended procedure for mixed-methods studies [31]. Key facilitators and barriers of treatment initiation were identi ed based on 22 qualitative interviews with AN-patients, their relatives and referring health care professionals (sub-study 1 [32]). From this pool, items for the FABIANA-Checklist were derived based on prototypical illustrating quotes from the interviews.…”

“…As the FABIANA-Checklist explicitly refers to the time that preceded the rst psychotherapeutic treatment, it will not allow conclusions on correlates of treatment-seeking in general. The FABIANA-Checklist is based on a large sample compared to qualitative studies [32], which should guarantee that many signi cant factors were included. It is, however, conceivable that less frequently mentioned aspects might have a particularly large impact on the DUI.…”