This document outlines a study examining barriers to eating disorder treatment among women. The study will use Anderson's Behavioral Model framework to identify predisposing, enabling, and need factors that influence barriers. The dependent variable is barriers to inpatient and intensive outpatient treatment. Independent variables include demographic, clinical, social, and system-related factors. The study aims to compare barriers across eating disorder subtypes to address disparities in access and utilization of treatment. Key hypotheses predict financial barriers will impact bulimia and OSFED most while shame will impact anorexia most.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
Presentation at PHABC Public Health Reducing Health Inequities Conference, Vancouver, British Columbia, Canada.
Also see several additional slideshares of mine about males and eating disorders and an excerpt from Global National TV 16x9 news documentary, Canadian national television.
Brief excerpt (2.5 minutes) here: https://www.youtube.com/watch?v=ctlGqM0ekOY
Full 23 mins show here: https://www.youtube.com/watch?v=OwhyB8mR-U8
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
Presentation at PHABC Public Health Reducing Health Inequities Conference, Vancouver, British Columbia, Canada.
Also see several additional slideshares of mine about males and eating disorders and an excerpt from Global National TV 16x9 news documentary, Canadian national television.
Brief excerpt (2.5 minutes) here: https://www.youtube.com/watch?v=ctlGqM0ekOY
Full 23 mins show here: https://www.youtube.com/watch?v=OwhyB8mR-U8
Developmental Disabilities and Community LifeRoss Finesmith
This manuscript describes the move of the developmentally disabled from institutions into our communities, and the need for doctors to care for this "new" population in the waiting room.
Senior Citizens need to have comprehensive medical evaluations that are readily available to emergency providers. Electronic Medical Recording is ideal for having much needed information at the proper person's finger tips. The hesitancy of primary care physicians to employ EMR/EHR systems places a heavy burden on emergency departments in the United States. Senior citizens often have special needs that are not readily known by first responders and in a crisis situations, the care provided is based on standard of care and not special needs. Innovative alternatives to the current data taking, storage and retrieval process.
Informed Consent for the Treatment of Adolescents and Young Adults with CancerMethodist HealthcareSA
Author: Conrad Fernandez, MD., IWK Health Centre, Halifax, NS
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October 2010
Adolescents and Young Adults With Cancer Treatment and Transition to An Adult...Methodist HealthcareSA
David J Friedman, MD, Phd
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October, 2010
Psychological and Behavioral Implications in Older Adults with CancerSpectrum Health System
Through Case Presentation and Dydactics, participants will gain an understanding of the psychological and behavioral impact cancer has on older adults.
Gender Difference in Response to Preventative Health Careiowafoodandfitness
Luther College Students prepared the following community assessments as part of their Psychology of Health and Illness class in the Fall Semester 2008.
Tackling the Top 5 Barriers to Medication AdherenceHealth Dialog
A lack of medication adherence can lead to poor clinical outcomes, higher hospital admissions and rising spend for your organization. On top of that, CMS Star point rates are also increasing year after year, making it increasingly difficult to obtain a 5 Star rating. It can be tough thinking about how to start building an effective strategy to increase adherence in your population.
We will overview the top struggles with medication adherence in populations and how to use predictive analytics, tailored outreach and patient engagement, and behavior change programs to overcome them.
Developmental Disabilities and Community LifeRoss Finesmith
This manuscript describes the move of the developmentally disabled from institutions into our communities, and the need for doctors to care for this "new" population in the waiting room.
Senior Citizens need to have comprehensive medical evaluations that are readily available to emergency providers. Electronic Medical Recording is ideal for having much needed information at the proper person's finger tips. The hesitancy of primary care physicians to employ EMR/EHR systems places a heavy burden on emergency departments in the United States. Senior citizens often have special needs that are not readily known by first responders and in a crisis situations, the care provided is based on standard of care and not special needs. Innovative alternatives to the current data taking, storage and retrieval process.
Informed Consent for the Treatment of Adolescents and Young Adults with CancerMethodist HealthcareSA
Author: Conrad Fernandez, MD., IWK Health Centre, Halifax, NS
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October 2010
Adolescents and Young Adults With Cancer Treatment and Transition to An Adult...Methodist HealthcareSA
David J Friedman, MD, Phd
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October, 2010
Psychological and Behavioral Implications in Older Adults with CancerSpectrum Health System
Through Case Presentation and Dydactics, participants will gain an understanding of the psychological and behavioral impact cancer has on older adults.
Gender Difference in Response to Preventative Health Careiowafoodandfitness
Luther College Students prepared the following community assessments as part of their Psychology of Health and Illness class in the Fall Semester 2008.
Tackling the Top 5 Barriers to Medication AdherenceHealth Dialog
A lack of medication adherence can lead to poor clinical outcomes, higher hospital admissions and rising spend for your organization. On top of that, CMS Star point rates are also increasing year after year, making it increasingly difficult to obtain a 5 Star rating. It can be tough thinking about how to start building an effective strategy to increase adherence in your population.
We will overview the top struggles with medication adherence in populations and how to use predictive analytics, tailored outreach and patient engagement, and behavior change programs to overcome them.
Young girls in developed countries are primarily affected with eating disorders. Persons with anorexia are honest, do not disobey, and hide their inner feeling, tend to be good in whatever they do and often excellent athletes. Research says that anorexia people eat less to gain a sense of control over their lives.
Men with Eating Disorders: Deepening Our Understanding to Improve CaringPaul Gallant
This invited presentation was part of the 2020 6th Annual Interior Region Eating Disorder (Virtual) Forum, September 2020. The presentation addresses recent research, community and clinical experiences of men with eating disorders to deepen our understanding to improve caring. Stories, stats, questions, video clips and polls were included to seek input from those participating.
For example: Do males comprise 33-40% of those we are caring for? If NO, WHY NOT?
You may find use for some of these in future presentations or team discussions.
Tips to Improve Caring include:
*Team based interest/working groups to plan better for
males; include cross site/jurisdiction knowledge
exchange/peer support for clinicians/mentorship
*Include male former patients/MWED in planning/advising
*Include males in research AND disseminate this research to honor their contribution
rather than “the number of males were insufficient to report on”
*Include retrospective reviews on past males for quality improvement
*Review non-published findings on males in your own research
*Demonstrate that you’re informed/comfortable working with MWED
*Know the literature/resources & limits of both for males with eating disorders
*Use your creativity & planning to consider all-male therapeutic groups including online therapeutic or support groups?
*Schedule male appointments back to back/same time. Males see they are not the only male in treatment/care
*Seize the moment to engage the person who is seeking support (hope, optimism and repeat check-in)
A take away team or self-reflection exercise asks:
What are we doing in our own practice or setting to__
-Demonstrate a “male friendly” welcoming environment for
boys/men with Eating Disorders?
-Better understand… boys/men with Eating Disorders?
-Better support/treat/demonstrate caring … boys/men with
Eating Disorders?
Running head PROJECT MILESTONE TWO 1.PROJECT MILESTONE.docxtodd581
Running head: PROJECT MILESTONE TWO
1.
PROJECT MILESTONE TWO
6.
Running head: FINAL PROJECT MILESTONE
3.
Southern New Hampshire University
January 6th, 2019
Research question: “Does self-disclosure of the therapist improve eating disorder treatment.”
Hypothesis: Self-disclosure of the therapist improves eating disorder treatment.
Information On Research
The key variables for this research are self-disclosure of the therapist and eating disorder treatment. This research will focus on online research whereby participants will be recruited from an eating disorder charity database. The participants will be asked about the status of their condition and how they feel about having the disorder. The neutral condition will be that the therapists will disclose their sexuality and their feelings towards the patients’ conditions and personality (Marziliano, Pessin, Rosenfeld, & Breitbart, 2018).
Process of Study
The study will continue for two months with the therapists making contact with the participants once every week. These conditions will form the independent variables. The dependent variable would be participants continued to receive positive self-disclosures from the therapist leading to a greater level of patient self-disclosure, which lowered their shame, and encouraged the participants to continue with the treatment process. The participants will also be asked if they have been involved in any treatment before, and how they could describe their therapeutic alliance (Fuertes, Moore, & Ganley, 2018).
A longitudinal study and the rate of drop-out will be used to gather more information about the participants. The collected data will then be analyzed in relation to the independent variables by the end of the study. One of the ethical issues, which will be looked into while conducting the study, is informed consent. Participants will be informed about the purpose of the research and will have the right to participate or not participate in it. Secondly, the research will ensure the privacy and confidentiality of every participant.
Annotated Bibliography:
Secrecy and concealment are typical behaviors in individuals with eating problems. In the article titled “ Self-Disclosure in eating disorders,” researchers examined women with greater related eating issues and determined whether or not, these women would be willing to disclose information. In this study, different types of disclosure were calculated considering the body appearance of the individual and to restrained eating. This article would benefit my research because it provides great information that will confirm my theory and test my hypothesis.
Abstract 1.
Those who suffer from eating disorders are very emotional beings. Often times, some may not feel a need to express their need to not eat foods. Many women become self-conscious about their weight and find it hard to share th.
3. Introduction
Formally recognized in the Diagnostic and
Statistical Manual of Mental Disorders, fifth
edition (DSM-5)
Mental and physical characteristics
Estimated 24 million people in the US
suffer from an eating disorder
Have the highest mortality rates of any
psychiatric diagnosis
4. Introduction
Only 1 in 10 people living with eating disorders
receive clinical treatment
Only 35% of those who receive treatment
specifically designed for eating disorders
Onset occurs for a variety of reasons
Top 3: sexual/physical abuse
death of family member/partner
major life change (moving, child, etc.)
5. Literature Review
Personality
Anorexics score low on novelty seeking,
suggesting that they may avoid risk and be
reluctant to engage in new activities in which
success in not guaranteed
Comparatively, bulimics tend to score high in
novelty seeking
Anorexics may avoid treatment for fear of failure
and being uncomfortable in a new situation
Claes, L., Vandercycken, W., & Vertommen, H. Impulsive and compulsive traits in eating disordered patients
compared with controls. Personality and Individual Differences 2002; 32, 707-714.
6. Literature Review
Ethnicity-Race & Culture
Perception of clinician sensitivity to cultural background,
including racial discrimination and stereotyping,
influences treatment seeking
Ethnic minorities also have a lower percentage of
anorexia cases compared to Caucasians (weight issues
not as prevalent)
This may contribute to why ethnic minorities are less
likely to be referred for treatment and also less likely to
seek treatment
Cachelin, F.M, Veisel, C., Barzegarnazari, E., Strigel-Moore, R.H. Disordered eating, acculturation, and treatment seeking in
a community sample of Hispanic, Asian, Black and White women. Psychology of Women Quarterly 2000; 24: 244-253.
National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/.
Becker, A.E., Arrindell, A.H., Perloe, A., Fay, K., Striegel-Moore, R.H. A Qualitative Study of Perceived Social Barriers to
Care for Eating Disorders: Perspectives from Ethnically Diverse Health Care Consumers. International Journal of Eating
Disorders 2010, 43: 633-647.
7. Literature Review
Health Beliefs
Those who perceive themselves relatively well-off in
comparison to others are more likely to forego seeking
treatment
Feelings of shame and the belief that one should be able
to help herself have been identified as important barriers to
treatment
Those with anorexia in particular tend to use avoidant
strategies designed to shield people from the reality of
their illness
Akey, J., Rintamaki, L., Kane, T. Health Belief Model deterrents of social support seeking among people coping with eating disorders. Journal of
Affective Disorders 2013, 145; 246-252.
Becker, A.E., Arrindell, A.H., Perloe, A., Fay, K., Striegel-Moore, R.H. A Qualitative Study of Perceived Social Barriers to Care for Eating
Disorders: Perspectives from Ethnically Diverse Health Care Consumers. International Journal of Eating Disorders 2010, 43: 633-647.
8. Literature Review
Financial Barriers
Inpatient treatment is about $30,000 a month on
average. Intensive outpatient costs range
demographically, average is $200-$500 per day
Insurance requires treatment to be “medically
necessary”- problematic for bulimia and OSFED
May not be “in-network” or appropriate facility
for eating disorders
National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/.
National Association of Insurance Commissioners, 2015. https://eapps.naic.org/cis/.
9. Literature Review
Physician’s Beliefs
Numerous reports indicate that eating disorders are
frequently unrecognized in clinical settings
Misperceptions regarding the types of people who suffer
from eating disorders often prevent their detection, which
places non-stereotypical individuals at risk for long-term,
adverse effects from these conditions
Found that physicians lack complete understanding of the
various physical ramifications of eating disorders
Mond, J.M., Hay, P.J., Rodgers, B., Owen, C. Health service utilization for eating disorders: Findings from a community-based study.
International Journal of Eating Disorders 2007; 40: 399-408.
Becker, A.E., Thomas, J.J., Franko, D.L., Herzog, D.B. Interpretation and use of weight information in the evaluation of eating disorders:
Counselor response to weight information in a national eating disorders educational and screening program. International Journal of Eating
Disorders 2005; 37: 38-43.
Currin, L., Waller, G., Schmidt, U. Primary Care Physicians’ Knowledge of and Attitudes Toward the Eating Disorders: Do They Affect Clinical
Actions? International Journal of Eating Disorders 2009; 42:5, 452-458.
10. Literature Review
Social Stigma
It has been found that many people fear losing control of
information pertaining to the onset of their eating
disorder; causing them to conceal their illness
Bulimia has been shown to be perceived as more under
the control of the individual and associated with more
blame directed toward the individual
Those who are from lower socioeconomic classes tend
to feel like their condition is more socially unacceptable
than those from higher socioeconomic classes
Schmidt, U.H., Tiller, J., Andrews, B., Blanchard, M. Treasure, J. Is there a specific trauma precipitating onset of anorexia nervosa? Psychological
Medicine 1997; 27, 523-530.
Ebneter, D.S., Latner, J.D. Stigmatizing attitudes differ across mental health disorders: A comparison of stigma across eating disorders, obesity,
and major depressive disorder. Journal of Nervous and Mental Disease 2013; 201: 281-285.
Mond, J.M., Hay, P.J., Rodgers, B., Owen, C. Health service utilization for eating disorders: Findings from a community-based study.
International Journal of Eating Disorders 2007; 40: 399-408.
11. Literature Review
Distance, Work, Family
Few treatment centers, primarily located in
metropolitan areas
Most common length of stay 26-30 days
Those with anorexia tend to be younger with a
mean age of 25.08; bulimia mean age of 28;
and OSFED have a mean age of 30.50
Therefore, those with bulimia or OSFED are
more likely to have permanent job, family, kids.
National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/.
Noordenbox, G. Characteristics and Treatment of Patients with Chronic Eating Disorders. International Journal of Eating Disorders 2002, Volume
10: 15-29.
12. Previous studies have looked at barriers specific to
anorexia or bulimia, but no studies have been found
that explicitly compare and contrast various barriers
of eating disorder subtypes.
Information on the barriers of OSFED are also few
and not well understood.
This study will help indentify the most prevalent
barriers specific to eating disorder subtypes in order
to help address specific issues in access and
utilization to treatment.
Gaps & Significance
13. The purpose of this study is to identify the
most common barriers among each eating
disorder subgroup in order to address how
to increase access and utilization of
inpatient and intensive outpatient
treatment.
Objective
14. Framework-
Anderson’s Initial Behavior Model
Predisposing Enabling Need
Eating Disorder
Subgroup
Age
Ethnicity/Race
Education level
Health Beliefs
Family Status
Insurance Status
Income
Physician’s Beliefs
Social Stigma
Distance
Work Status
Family Status
Evaluated need is
already determined
Perceived need is
included in health
beliefs
15. Variables and Hypothesis
Dependent variable: barriers to intensive
outpatient and inpatient eating disorder treatment.
Independent variables: various factors associated
with the barriers.
There are no control variables in this study.
Those with bulimia will have the highest amount of
barriers collectively, followed by OSFED, with
anorexia having the lowest amount of barriers.
16. Methods
Physician Beliefs, Social Stigma, Health Beliefs,
Distance/Family, Work
1
No
impact at
all
5
Moderately
impactful
10
Extremely
impactful
Insurance status (including treatment center being out of network)
Out of pocket expenses (including travel and time off work)
Insurance claimed treatment was not medically necessary
Physician did not believe my ED was valid or required intensive
treatment
Physician’s lack of identifying the ED
Wanted to keep reason for onset of ED secret
Lack of ability to get time off work for treatment
Distance of treatment facility
Your health beliefs(ex: I should be able to get over this on my own)
17. Expected Findings
Financial issues will be a more significant barrier for those
with bulimia and OSFED due to lack of insurance coverage.
Those with anorexia will have a more significant guilt/shame
barrier than those with bulimia or OSFED primarily due to
their people pleasing personality trait and fear of
disappointing others.
Those with bulimia or OSFED will have a higher prevalence
of health beliefs being a barrier to treatment primarily due to
the belief that their illness is something they should be able to
overcome.
Those with bulimia and OSFED will have more distance,
work, and family barriers because, on average, they tend to
be older than those with anorexia.
Culture and ethnicity barriers will be more prevalent among
those with bulimia or OSFED due to the higher rate of those
disorders among ethnic groups.