Facilitators and barriers in anorexia nervosa treatment initiation (FABIANA): study protocol for a mixed-methods and multicentre study

Kästner, Denise; Buchholz, Ines; Weigel, Angelika; Brunner, Romuald; Voderholzer, Ulrich; Gumz, Antje; Löwe, Bernd

doi:10.1192/bjo.2019.77

Cited by 6 publications

(12 citation statements)

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“…The present manuscript reports sub-study I. A detailed overall description can be found within the study protocol [ 24 ]. In brief, sub-study I is a qualitative multi-informant study exploring the perspectives of triads of female patients with AN, their carers and referring professionals on facilitators and barriers to treatment initiation using semi-structured interviews.…”

Section: Methodsmentioning

confidence: 99%

“…The first part sought to check inclusion and exclusion criteria and to retrospectively determine the month of AN onset. The procedure is described in detail within the study protocol [ 24 ]. The second part of the patient interviews and the interviews with the carers and professionals were concerned with facilitators and barriers for the treatment initiation.…”

Section: Methodsmentioning

confidence: 99%

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

Kästner¹,

Weigel²,

Buchholz³

et al. 2021

J Eat Disord

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Kästner¹,

Weigel²,

Buchholz³

et al. 2021

J Eat Disord

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“…Psychotherapeutic treatments were defined by a minimum duration of seven days in an inpatient setting or five consecutive sessions in an outpatient setting. We planned to include at least four participants for each item of the FABIANA-checklist [ 30 , 33 ].…”

Section: Methodsmentioning

confidence: 99%

“…In view of the limitations of the existing measures, the aim of the FABIANA-study (Facilitators and barriers in anorexia nervosa treatment initiation, [ 30 ]) was to develop, in a first step, a checklist to assess factors (facilitators and barriers) of treatment initiation in patients with AN using a multi-method and multi-informant approach.…”

Section: Introductionmentioning

confidence: 99%

The development and psychometric evaluation of FABIANA-checklist: a scale to assess factors influencing treatment initiation in anorexia nervosa

et al. 2021

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Background A long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa (AN) and is associated with chronic illness progression. Although previous preventive measures aimed at reducing DUI and thus improving short- and long-term treatment outcomes have been partially successful, a better understanding of the factors involved in the sensitive phase prior to treatment initiation is needed. To date, there is no validated instrument available to assess these factors specifically for patients with AN. The FABIANA-project (Facilitators and barriers in anorexia nervosa treatment initiation) aims at identifying predictors of the DUI in order to target preventive measures better in the future. As part of this project, the FABIANA-checklist was developed, based on a multi-informant perspective and a multimodal bottom-up approach. The present study focusses on the process of item generation, item selection and psychometric validation of the checklist. Methods Based upon a previous qualitative study, an initial set of 73 items was generated for the most frequently mentioned facilitators and barriers of treatment initiation in AN. After a process of consensual rating and cognitive pre-testing, the resulting 25-item version of the FABIANA-checklist was provided to a sample of female patients (N = 75), aged ≥ 14 years with AN that underwent their first psychotherapeutic treatment in the last 12 months. After item analysis, dimensionality of the final version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). We evaluated construct validity assuming correlations with related constructs, such as perceived social support (F-SozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ). Results We included 54 adult and 21 adolescent patients with AN, aged on average 21.4 years. Average BMI was 15.5 kg/m2, age of onset was 19.2 years and average DUI was 2.25 years. After item analysis, 7 items were excluded. The PCA of the 18-item-FABIANA-checklist yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach’s α = .76) and construct validity was satisfactory for 14 out of 18 items. Two consistent components emerged: “primary care perceived as supportive and competent” (23.33%) and “emotional and practical support from relatives” (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and in part ambiguous interpretability. Conclusions The FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are main components. The results indicate that a differentiated assessment at item level is appropriate. In order to quantify the relative importance of the factors and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers. Trial registration Clinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541.

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“…Una propuesta elocuente en esa dirección es el Protocolo de Estudio FABIANA (Facilitators And Barriers In Anorexia Nervosa treatment initiation), puesto en marcha a partir de fines de 2019, enfocado en la Anorexia. Dicho estudio, de naturaleza multicéntrica, se propone identificar abordajes tempranos que tengan pruebas de evidencia para mejorar nuestros estándares terapéuticos (Kästner et al, 2019).…”

Section: Propuestas Y Conclusionesunclassified

Obstáculos en el tratamiento de los Trastornos Alimentarios: Propuestas para superarlos

Kirszman

2020

rdp

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Los Trastornos de la Conducta Alimentaria (TCA) conforman un conjunto de cuadros complejos, en muchos casos discapacitantes y que tienden en un alto porcentaje a la cronicidad (Klump, Bulik, Kaye, Treasure y Tyson, 2009), con altas tasas de mortalidad y suicidio (Fichter y Quadflieg, 2016; Hoang, Goldacre y James, 2014). Diversas fuentes informan que en la actualidad contamos con suficiente evidencia de las pocas oportunidades en la mayoría de los pacientes con TCA para lograr una recuperación plena en sus tratamientos (Murray, 2019). Necesitamos mejorar nuestras intervenciones terapéuticas y un punto fundamental en esa dirección es conocer con más profundidad cuáles son los obstáculos que se presentan y cómo abordarlos. En el presente trabajo nos enfocaremos en barreras que son particularmente significativas durante el proceso de la intervención terapéutica: la cronicidad, que tiene fundamental importancia respecto de la naturaleza del trastorno y alimenta fuertemente las creencias negativas (no sólo del paciente) respecto a la expectativa de posibles logros terapéuticos; la elevada comorbilidad, que hace particularmente difícil en muchos casos la elaboración de un diagnóstico preciso y, por consiguiente, de un adecuado diseño de tratamiento; y la Resistencia que presenta un conjunto de mecanismos que dificultan los procesos de cambio.

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Facilitators and barriers in anorexia nervosa treatment initiation (FABIANA): study protocol for a mixed-methods and multicentre study

Cited by 6 publications

References 45 publications

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

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

The development and psychometric evaluation of FABIANA-checklist: a scale to assess factors influencing treatment initiation in anorexia nervosa

Obstáculos en el tratamiento de los Trastornos Alimentarios: Propuestas para superarlos

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