A systems thinking perspective on the barriers to treatment access for people with eating disorders

Abstract

Treatment access remains low for people with eating disorders. In addressing the complexity inherent in this challenge, this article introduces systems thinking and argues that it could provide new insights. Systems thinking views behavior as an emergent property of a system and considers the relationships between technical, organizational, and social components. Several methods used in safety science incorporate this thinking. For example, AcciMap draws focus to the influence of decisions and actions made across hierarchical levels of a system, including those by government, regulatory bodies, management, services, and individuals. By examining the findings of the existing literature on barriers to eating disorder treatment access according to these levels, it is evident that most identified barriers relate to individuals and that further research is needed to consider the influence of high‐level stakeholders. Research using systems thinking should consider the causal networks of influence from government, regulatory, and organizational decisions and actions through to outcomes for clinicians and individuals. The understanding of how barriers operate within specific healthcare systems also warrants investigation. Systems thinking is yet to be formally applied in the area of eating disorders and thus represents an opportunity to inform the development and implementation of more effective, system wide interventions.

Approaches used in secondary prevention of eating disorders: review of the evidence and effectiveness

“…), factores individuales y procesos (estigma y vergüenza, miedo al cambio, autosuficiencia, etc. ), tal como se describe en AcciMap sobre la jerarquía de niveles (23).…”

Shining a light on ideas worth researching in the field of eating disorders: Introduction to a Virtual Issue of the International Journal of Eating Disorders

“…The third Spotlight encourages the field to adopt a systems' thinking perspective to reduce barriers to improving individual and population outcomes. Specifically, Lane, Read, Cook, and Salmon (2020) remind readers that eating disorders need to be understood (and interventions need to be developed based on this understanding) as the function of interrelating systems, which include governmental agencies, regulatory bodies, local institutions and organizations, service delivery systems, people's immediate social and physical environments, and the individuals themselves. A detailed grid with examples of important variables within each system provides a guide for identifying stakeholders who may be helpful in overcoming barriers; suggests potential interaction effects among barriers; and points to potential leverage points that, if barriers are altered at those points, will likely have system‐wide effects.…”

“…The third Spotlight encourages the field to adopt a systems' thinking perspective to reduce barriers to improving individual and population outcomes. Specifically, Lane, Read, Cook, and Salmon (2020) remind readers that eating disorders need to be understood…”

Eating disorders treatment experiences and social support: Perspectives from service seekers in mainland China

“…Aspects of the Chinese societal context may also influence perceptions of, treatment seeking, and treatment experiences for EDs at individual (e.g., stigma, shame, and ED literacy; Ali et al, 2017; Griffiths, Rossell, Mitchison, Murray, & Mond, 2018; Grillot & Keel, 2018; Innes, Clough, & Casey, 2017) and environmental/interpersonal (e.g., family/peer attitudes; Lane et al, 2019) levels. For example, prior to psychotherapy being introduced to China in the 1980s, there was no language to describe psychological concerns (Zhang, 2020), and although improving (Xu, Li, Zhang, & Wang, 2018), psychiatric conditions are still heavily stigmatized (Chang, Tong, Shi, & Zeng, 2005).…”

“…Nevertheless, Western definitions of EDs are commonly portrayed to the Chinese public (Sun, He, Fan, Chen, & Lu, 2020). Furthermore, psychotherapists in mainland China typically prioritize symptoms other than those indicating EDs (Ma, Capobianco, Buchanan, Hu, & Oakman, 2019) and may not be fully knowledgeable about EDs (Lane, Read, Cook, & Salmon, 2019). Specialized care for EDs is only available in two major hospitals in Shanghai and Beijing (see Ma et al, 2019 for descriptions), making specialized care inaccessible for most people in China.…”