Abstract
BackgroundAn 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.ObjectiveAgainst this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach.MethodTo 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.ResultsIn 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.ConclusionOverall, 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 registrationClinicalTrials.gov Identifier: NCT03713541.
Highlights
Anorexia nervosa (AN) is a serious illness characterized by self-induced underweight, body image distortions and fear of weight gain [1]
Overall, the findings suggest that early intervention approaches for AN should address patients and the health care system, but may involve carers and successfully treated former patients
We aim to identify facilitators and barriers to specialized AN treatment from the perspective of adolescent and adult patients, carers and referring professionals
Summary
Anorexia nervosa (AN) is a serious illness characterized by self-induced underweight, body image distortions and fear of weight gain [1]. The long-term outcome of AN is highly variable, but it was estimated that about 20% of all individuals with AN remain chronically ill [2, 3]. Over time, eating disorder pathology can become a learned self-perpetuating rewarding process [8] and various medical complications may emerge [9]. In order to avoid hospital admissions, poor treatment outcomes and chronic courses, it is crucial to treat AN at early illness stages [6, 7]. 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
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