Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives

Abstract

ObjectiveA significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals.MethodThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies.ResultsA total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help‐seeking.DiscussionPatients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti‐stigma campaigns and positive peer‐support interventions.

The urgent need for greater parent support and better health system experiences to enhance outcomes for pediatric anorexia nervosa: A Commentary on Marchetti & Sawrikar (2023)

“…While parents reported that treatment improved family dynamics and mental health symptoms, many believed that it could only help with short-term improvements and viewed relapse as likely over the longer term (perhaps due to including parents of adults with AN). Competence of clinicians was a further concern of parents, a result that is consistent with another review where carers rated negative treatment experiences (e.g., low confidence in clinician) as the greatest barrier to treatment uptake (Daugelat et al, 2023).…”

The role of self‐reliance and denial in the help‐seeking process for eating disorders among university students

“…This is particularly important as previous studies showed that students are more likely to refer a friend to a psychologist than themselves (Raviv et al, 2009). The finding that students prefer to be self-reliant presents an opportunity to empower students to use evidence-based resources independently (e.g., self-help materials) to enable them to make positive changes as a first step (Gulliver et al, 2010), followed up by a supportive network to promote and facilitate help-seeking (Daugelat et al, 2023).…”

“…A shift from increasing ED literacy and changing attitudes towards help-seeking to addressing the firm believe that help is not required (i.e., denial) is necessary to enhance help-seeking. Despite the challenges of uptake and engagement, digital interventions should be considered to address help-seeking barriers (Ali et al, 2022;Daugelat et al, 2023). Further, it may be beneficial to increase students' self-awareness and recognition of their own (and others') ED symptoms and their impact on valued life domains in order to instil a perceived need for treatment (Gulliver et al, 2010;.…”

“…Recent overviews of barriers to treatment in eating disorders summarise several factors that may prevent individuals from seeking help for ED symptoms including individual/person related (e.g., stigma) and system/ healthcare related barriers (e.g., cost) Daugelat et al, 2023;Radunz et al, 2022). While the broader research on barriers to help-seeking for eating disorders has identified a variety of factors with stigma and shame often reported as the most prominent barrier (Ali et al, 2017;Daugelat et al, 2023), barriers differ depending on the population.…”

“…Recent overviews of barriers to treatment in eating disorders summarise several factors that may prevent individuals from seeking help for ED symptoms including individual/person related (e.g., stigma) and system/ healthcare related barriers (e.g., cost) Daugelat et al, 2023;Radunz et al, 2022). While the broader research on barriers to help-seeking for eating disorders has identified a variety of factors with stigma and shame often reported as the most prominent barrier (Ali et al, 2017;Daugelat et al, 2023), barriers differ depending on the population. Research has found that self-reliance (the belief that one should solve one's own problems), and denial or believing the problems are not severe enough to warrant treatment seem particularly prominent barriers among university students with ED concerns (Ali et al, 2020;Becker et al, 2004;Fitzsimmons-Craft et al, 2020;.…”