Reimagining eating disorder spaces: a qualitative study exploring Māori experiences of accessing treatment for eating disorders in Aotearoa New Zealand

Abstract

Background Health, illness, and the body are conceptualized within the cultural context of a society. The values and belief systems of a society, including media portrayals, shape how health and illness present. Traditionally, Western portrayals of eating disorders have been prioritized over and above Indigenous realities. This paper explores the lived experiences of Māori with eating disorders and their whānau (family/support system) to identify the enablers and barriers to accessing specialist services for eating disorders in New Zealand. Method Kaupapa Māori research methodology was used to ensure the research supported Māori health advancement. Fifteen semi-structured interviews were completed with Māori participants including; those with an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, and binge eating disorder), and/or their whānau. Structural, descriptive, and pattern coding was undertaken within the thematic analysis. Low’s spatializing culture framework was used to interpret the findings. Results Two overarching themes identified systemic and social barriers to accessing treatment for Māori with eating disorders. The first theme, was space, that described the material culture within eating disorder settings. This theme critiqued eating disorder services, including idiosyncratic use of assessment methods, inaccessible service locations, and the limited number of beds available in specialist mental health services. The second theme, place, referred to the meaning given to social interactions created within space. Participants critiqued the privileging of non-Māori experiences, and how this makes a place and space of exclusion for Māori and their whānau in eating disorder services in New Zealand. Other barriers included shame and stigma, while enablers included family support and self-advocacy. Conclusion More education is needed for those working in the space of primary health settings about the diversity of those with eating disorders to enable them to look beyond the stereotype of what an eating disorder looks like, and to take seriously the concerns of whaiora and whānau who present with disordered eating concerns. There is also a need for thorough assessment and early referral for eating disorder treatment to ensure the benefits of early intervention are enabled for Māori. Attention given to these findings will ensure a place for Māori in specialist eating disorder services in New Zealand. Graphical Abstract

Exploration of Barriers to Treatment for Patients with Eating Disorders in Chile

“…The barriers and facilitators found in the analysis are relatively similar to those found in other studies, such as the systematic review by Ali et al [36] and the Scoping review by Nicula et al [8]. The geographic barrier, which did not appear in these but was found in our study, was addressed in three studies from Australia and New Zealand [37][38][39]. Another barrier found in this study was the existence of a longstanding ED (45% of the interviews).…”

Avoidant/restrictive food intake disorder (ARFID) in New Zealand and Australia: a scoping review

“…Excluding Indigenous populations, such as Māori, Pasifika, and Aboriginal and Torres Strait Islanders, from research has detrimental effects, perpetuating health inequalities and hindering effective interventions in these communities. It also limits understanding of their unique experiences and cultural perspectives, including food practices and beliefs [ 60 , 61 ], impeding progress towards health equity.…”

‘E koekoe te Tūī, e ketekete te Kākā, e kuku te Kererū, The Tūī chatters, the Kākā cackles, and the Kererū coos’: Insights into explanatory factors, treatment experiences and recovery for Māori with eating disorders – A qualitative study

“…The results reported in this article build on previous work reported from the ‘Tangata Kōmuramura, Māori Experiences of Eating Disorders’ study. In phase 1, we used national administrative data to investigate specialist ED service use in Aotearoa-New Zealand and highlighted an underrepresentation of Māori within ED services (Clark et al, 2023; Lacey et al, 2020). Our earlier qualitative paper reported on access to ED treatment for Māori and identified clinician bias in the form of outdated stereotypes, idiosyncratic use of ED assessment methods and service location as barriers to ED diagnoses and treatment for Māori, while enablers included family support and self-advocacy (Clark et al, 2023).…”