IJPM articles: Eating Disorders – Treatment & Services in Ireland
Stigma and treatment of eating disorders in Ireland: healthcare professionals’ knowledge and attitudes
F. McNicholas, C. O’Connor, L. O’Hara and N. McNamara
Objectives: This study examines aspects of healthcare professionals’ knowledge and attitudes about eating disorders (EDs), which might impede the effective detection or treatment of EDs in Ireland.
Methods: A total of 1,916 healthcare professionals were invited to participate in a web-based survey. Participants were randomly allocated to view one of five vignettes depicting a young person with symptoms consistent with anorexia nervosa, bulimia nervosa, binge-eating disorder, depression or type 1 diabetes. Study-specific questions examined participants’ responses to the vignettes and ED knowledge and experience.
Results: In total, 171 clinicians responded (9% response rate). Participants had an average of 15.8 years of clinical experience (S.D. = 9.2) and included psychiatrists, GPs, psychologists and counsellors. Although participants’ knowledge of EDs was moderately good overall, responses showed poor recognition of the symptoms of EDs compared with depression [χ 2 (4, n = 127) = 20.17, p<0.001]. Participants viewed EDs as chronic disorders that primarily affected females. Participants believed that clinicians like working with patients with depression and diabetes more than with AN patients [F (4,101) = 5.11, p = 0.001]. Among the professionals surveyed, psychiatrists were the most knowledgeable about EDs [F (4,82) = 9.18, p< 0.001], and were more confident in their ability to diagnose and treat EDs than professionals of all other disciplines, except psychologists [F (4,85) = 8.99, p<0.001]. Psychiatrists were also the most pessimistic about ED patients’ long-term life prospects [χ2 (4, n = 65) = 15.84, p = 0.003].
Conclusions: This study recommends that specific attention should be given to EDs in professional educational programmes across healthcare disciplines. This training should not be restricted to improving healthcare professionals’ knowledge of EDs, but should also strive to increase service-providers’ awareness of how their own potentially stigmatising attitudes can undermine engagement with treatment.
Eating disorder services for young people in Ireland: perspectives of service providers, service users and the general adolescent population
F. McNicholas, C. O’Connor, N. McNamara and L. O’Hara
Objectives: This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them.
Methods: A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n = 8), their parents (n = 5) and their healthcare professionals (n = 3); (ii) a national survey of health professionals’ perspectives on existing ED services (n = 171); (iii) a nationwide survey of secondary-school students’ eating concerns and patterns of help-seeking (n = 290).
Results: The qualitative interviews with young people and their parents revealed feelings of isolation and helplessness. Young people expressed interest in patient support groups, while parents desired greater support for the family unit. Parents were highly critical of available services, particularly in relation to access. These criticisms were echoed in the survey of healthcare professionals, who reported many barriers to delivering effective care. Clinicians were almost unanimous in calling for care pathways to be clarified via a standardised treatment protocol. The survey of adolescents indicated widespread reluctance to seek help regarding eating concerns: over one-third expressed concern about their own eating habits, but half of these had not divulged their concerns to anyone. Participants’ preferred pathways of help-seeking revolved around family and friends, and adolescents were unsure about routes of access to professional support.
Conclusions: The research demonstrates that many aspects of national ED policy have not been implemented in practice. The paper highlights specific gaps and suggests ways they can be redressed.