严重和持久饮食失调治疗的障碍和促进因素:获取、参与和生活经验的混合方法研究。

IF 4.5 3区 医学 Q2 NUTRITION & DIETETICS
Gabriel Lubieniecki, Isabella McGrath, Gemma Sharp
{"title":"严重和持久饮食失调治疗的障碍和促进因素:获取、参与和生活经验的混合方法研究。","authors":"Gabriel Lubieniecki, Isabella McGrath, Gemma Sharp","doi":"10.1186/s40337-025-01393-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>An estimated 20 to 30% of individuals with eating disorders (EDs) experience protracted illness trajectories, often referred to as severe and enduring eating disorders (SEED). Research examining the systemic, relational, and experiential factors that influence access to and engagement with care in this population remains limited. This mixed-methods study aimed to explore the structural, clinical, and interpersonal barriers and facilitators shaping treatment experiences among individuals with longstanding EDs.</p><p><strong>Method: </strong>An explanatory sequential mixed-methods design was employed with 41 participants. Stage One involved an online survey assessing demographic characteristics, diagnostic history, treatment exposure, and symptom severity, with descriptive statistics used to characterise the sample. Stage Two comprised of in-depth semi-structured interviews exploring lived experiences of treatment access and engagement. Qualitative data were analysed using reflexive thematic analysis informed by transcendental phenomenology.</p><p><strong>Results: </strong>All participants reported an illness duration of seven years or more, with heterogeneity observed in diagnostic profiles, overall duration of illness, self-reported recovery stage, and treatment exposure. Two higher-order qualitative themes were identified; \"Barriers to Care\" included diagnostic and conceptual exclusion, weight-based bias, systemic access constraints, coercive practices, and misalignment between treatment models and patient needs. \"Facilitators of Engagement and Recovery\" comprised compassionate, individualised, and trauma-informed care, peer connection, and the integration of lived experience and advocacy.</p><p><strong>Discussion: </strong>Individuals with SEED are a diverse population who report frequent exposure to structural, relational, and treatment-related barriers, while also identifying salient facilitators that support therapeutic engagement and recovery. Findings from this exploratory study suggest that more responsive, inclusive, and person-centred models of care may help address the complex needs of individuals with SEED. Trauma-informed and neurodiversity-affirming approaches, particularly those that integrate lived experience, may help mitigate the systemic and clinical barriers identified across both access and treatment contexts.</p>","PeriodicalId":48605,"journal":{"name":"Journal of Eating Disorders","volume":"13 1","pages":"202"},"PeriodicalIF":4.5000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427117/pdf/","citationCount":"0","resultStr":"{\"title\":\"Barriers and facilitators to treatment in severe and enduring eating disorders: a mixed-methods study of access, engagement, and lived experience.\",\"authors\":\"Gabriel Lubieniecki, Isabella McGrath, Gemma Sharp\",\"doi\":\"10.1186/s40337-025-01393-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>An estimated 20 to 30% of individuals with eating disorders (EDs) experience protracted illness trajectories, often referred to as severe and enduring eating disorders (SEED). Research examining the systemic, relational, and experiential factors that influence access to and engagement with care in this population remains limited. This mixed-methods study aimed to explore the structural, clinical, and interpersonal barriers and facilitators shaping treatment experiences among individuals with longstanding EDs.</p><p><strong>Method: </strong>An explanatory sequential mixed-methods design was employed with 41 participants. Stage One involved an online survey assessing demographic characteristics, diagnostic history, treatment exposure, and symptom severity, with descriptive statistics used to characterise the sample. Stage Two comprised of in-depth semi-structured interviews exploring lived experiences of treatment access and engagement. Qualitative data were analysed using reflexive thematic analysis informed by transcendental phenomenology.</p><p><strong>Results: </strong>All participants reported an illness duration of seven years or more, with heterogeneity observed in diagnostic profiles, overall duration of illness, self-reported recovery stage, and treatment exposure. Two higher-order qualitative themes were identified; \\\"Barriers to Care\\\" included diagnostic and conceptual exclusion, weight-based bias, systemic access constraints, coercive practices, and misalignment between treatment models and patient needs. \\\"Facilitators of Engagement and Recovery\\\" comprised compassionate, individualised, and trauma-informed care, peer connection, and the integration of lived experience and advocacy.</p><p><strong>Discussion: </strong>Individuals with SEED are a diverse population who report frequent exposure to structural, relational, and treatment-related barriers, while also identifying salient facilitators that support therapeutic engagement and recovery. Findings from this exploratory study suggest that more responsive, inclusive, and person-centred models of care may help address the complex needs of individuals with SEED. Trauma-informed and neurodiversity-affirming approaches, particularly those that integrate lived experience, may help mitigate the systemic and clinical barriers identified across both access and treatment contexts.</p>\",\"PeriodicalId\":48605,\"journal\":{\"name\":\"Journal of Eating Disorders\",\"volume\":\"13 1\",\"pages\":\"202\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427117/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Eating Disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40337-025-01393-w\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Eating Disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40337-025-01393-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
引用次数: 0

摘要

目的:估计有20%到30%的饮食失调(EDs)患者经历了长期的疾病轨迹,通常被称为严重和持久的饮食失调(SEED)。对影响这一人群获得和参与护理的系统、关系和经验因素的研究仍然有限。这项混合方法的研究旨在探讨结构、临床和人际障碍以及促成长期ed患者治疗经历的因素。方法:采用解释序贯混合方法设计,共41名被试。第一阶段包括在线调查,评估人口统计学特征、诊断史、治疗暴露和症状严重程度,并使用描述性统计来描述样本的特征。第二阶段包括深入的半结构化访谈,探讨治疗获取和参与的生活经历。定性数据分析使用反身性主题分析通知先验现象学。结果:所有参与者报告的疾病持续时间为7年或更长,在诊断概况、总体疾病持续时间、自我报告的恢复阶段和治疗暴露方面观察到异质性。确定了两个高阶定性主题;“治疗障碍”包括诊断和概念排斥、基于权重的偏见、系统性准入限制、强制性做法以及治疗模式与患者需求之间的不一致。“参与和恢复的促进者”包括富有同情心的、个性化的、创伤知情的护理、同伴联系,以及生活经验和倡导的整合。讨论:患有SEED的个体是一个多样化的人群,他们经常暴露于结构性、关系性和治疗相关的障碍,同时也确定了支持治疗参与和恢复的显著促进因素。这项探索性研究的结果表明,更具响应性、包容性和以人为本的护理模式可能有助于解决SEED患者的复杂需求。创伤知情和神经多样性肯定的方法,特别是那些整合生活经验的方法,可能有助于减轻在获取和治疗环境中确定的系统和临床障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Barriers and facilitators to treatment in severe and enduring eating disorders: a mixed-methods study of access, engagement, and lived experience.

Objective: An estimated 20 to 30% of individuals with eating disorders (EDs) experience protracted illness trajectories, often referred to as severe and enduring eating disorders (SEED). Research examining the systemic, relational, and experiential factors that influence access to and engagement with care in this population remains limited. This mixed-methods study aimed to explore the structural, clinical, and interpersonal barriers and facilitators shaping treatment experiences among individuals with longstanding EDs.

Method: An explanatory sequential mixed-methods design was employed with 41 participants. Stage One involved an online survey assessing demographic characteristics, diagnostic history, treatment exposure, and symptom severity, with descriptive statistics used to characterise the sample. Stage Two comprised of in-depth semi-structured interviews exploring lived experiences of treatment access and engagement. Qualitative data were analysed using reflexive thematic analysis informed by transcendental phenomenology.

Results: All participants reported an illness duration of seven years or more, with heterogeneity observed in diagnostic profiles, overall duration of illness, self-reported recovery stage, and treatment exposure. Two higher-order qualitative themes were identified; "Barriers to Care" included diagnostic and conceptual exclusion, weight-based bias, systemic access constraints, coercive practices, and misalignment between treatment models and patient needs. "Facilitators of Engagement and Recovery" comprised compassionate, individualised, and trauma-informed care, peer connection, and the integration of lived experience and advocacy.

Discussion: Individuals with SEED are a diverse population who report frequent exposure to structural, relational, and treatment-related barriers, while also identifying salient facilitators that support therapeutic engagement and recovery. Findings from this exploratory study suggest that more responsive, inclusive, and person-centred models of care may help address the complex needs of individuals with SEED. Trauma-informed and neurodiversity-affirming approaches, particularly those that integrate lived experience, may help mitigate the systemic and clinical barriers identified across both access and treatment contexts.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Eating Disorders
Journal of Eating Disorders Neuroscience-Behavioral Neuroscience
CiteScore
5.30
自引率
17.10%
发文量
161
审稿时长
16 weeks
期刊介绍: Journal of Eating Disorders is the first open access, peer-reviewed journal publishing leading research in the science and clinical practice of eating disorders. It disseminates research that provides answers to the important issues and key challenges in the field of eating disorders and to facilitate translation of evidence into practice. The journal publishes research on all aspects of eating disorders namely their epidemiology, nature, determinants, neurobiology, prevention, treatment and outcomes. The scope includes, but is not limited to anorexia nervosa, bulimia nervosa, binge eating disorder and other eating disorders. Related areas such as important co-morbidities, obesity, body image, appetite, food and eating are also included. Articles about research methodology and assessment are welcomed where they advance the field of eating disorders.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信