Is this the ‘new normal’? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic

Abstract

Introduction Prior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare. This study explored the experience of young people, parents and clinicians when therapy was transitioned to virtual provision as a result of the UK lockdown in March 2020. Methods A mixed-method approach was used in this study. Online questionnaires that included a mixture of rating (Likert scale) and free-text response questions were completed by 53 young people with any eating disorder, 75 parents and 23 clinicians. Questions focused on the experience of online treatment as well as the impact on engagement, perceived treatment efficacy and preferences around treatment mode in the future. Likert scale questions were analysed using a summary approach. Free-text responses were analysed qualitatively using reflexive thematic analysis. Results Responses to rating scale questions indicate satisfaction with treatment, good engagement and ability to manage technology. Young people who had transitioned care, rather than started care virtually in lockdown, rated therapy as less effective. However, individual accounts of experience were more varied. Reflexive thematic analysis of free-text responses identified key themes of 1) Making it work, 2) Home as a therapeutic space, and 3) Disrupted connection and 4) Into the future. Conclusions These results have implications for ongoing care during the pandemic and for future implementation of virtual care in the treatment of young people with eating disorders. Particular issues arising are the trade-off between accessibility and therapeutic engagement and depth and need for consideration of equal access to treatment in socially unequal societies.

A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

“…Nine studies gathered data on patient perceptions of treatment during the pandemic period (Brothwood et al, 2021 ; Fernandez‐Aranda et al, 2020 ; Lewis et al, 2021 ; Raykos et al, 2021 ; Schlegl, Maier, et al, 2020 ; Schlegl, Meule, et al, 2020 ; Spigel et al, 2021 ; Stewart et al, 2021 ; Termorshuizen et al, 2020 ). Five studies (55%) found that a sizeable percentage of participants (28–74%) reported that the pandemic had significantly disrupted or negatively impacted their treatment (Lewis et al, 2021 ; Schlegl, Maier, et al, 2020 ; Schlegl, Meule, et al, 2020 ; Spigel et al, 2021 ; Termorshuizen et al, 2020 ).…”

“…A handful of small sample (participant n s = 14–73) studies also gathered data on patient perceptions of transitioning to online treatment. While two studies (50%) found ~65% of patients to rate online treatment as good as face‐to‐face treatment (Raykos et al, 2021 ; Spigel et al, 2021 ), two other studies (50%) found fewer than 10% of patients wanting to remain in online treatment after the pandemic (Lewis et al, 2021 ; Stewart et al, 2021 ). None of these studies reported prior experience with, nor expectations of, digital or telehealth treatment options that might help contextualize these findings.…”

Psychosoziale Versorgung von Kindern und Jugendlichen im ersten Corona-Lock-Down unter Zuhilfenahme von Telefon und Online-Tools. Möglichkeiten und Grenzen

“…Dies deckt sich mit anderen Forschungsergebnissen, welche von weniger Verbindung zwischen Behandler_innen und Patient_innen berichteten, als auch einem verringerten „Containment“ (Stewart et al. 2021 ). Zusätzlich zeigten sich Grenzen in der Behandlung von unzureichend Deutsch sprechenden Personen, sowohl mit Klient_innen selbst, aber auch unter zu Hilfenahme eines_einer Sprachmittler_in.…”

“…Die aktuelle Möglichkeit in verunsichernden Zeiten weiterhin ein Behandlungsangebot setzen zu können wurde als positiv bewertet (Stewart et al. 2021 ). Das digitale Format bzw.…”

Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden

“…In addition, clinical services were disrupted in many countries due to social distancing policies as well as quarantine of infected patients and care providers. Access to care was disrupted and initially, virtual care was rated as less satisfactory than typical faceto-face treatment (Termorshuizen et al, 2020;Weissman et al, 2020), although others suggest virtual treatment can be effective for some patients at certain stages of their illness (Shaw et al, 2021;Stewart et al, 2021). Evidence of exacerbation of ED symptoms in individuals with an ED during the COVID-19 pandemic, including increased restricting, binge eating, and exercise behaviors, was documented in studies from Spain (Fernández-Aranda et al, 2020), Australia (Phillipou et al, 2020), Germany (Giel et al, 2021;Schlegl et al, 2020), the United States and the Netherlands (Termorshuizen et al, 2020).…”