Castañeda Felipe, Cerda Jaime, Jara Raúl, Riestra Francisca, Urrejola Pascuala, Vogel Melina, Gumucio María Elena, Irribarra Verónica, Álvarez Jorge, Díaz María Alejandra, Kompatzki Paula, Costa Daniela
School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Department of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Eat Disord. 2024 Oct 12;12(1):160. doi: 10.1186/s40337-024-01104-x.
Eating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals.
Qualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software.
40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient's ego-syntonic behaviors. The main facilitators were patients' and relatives' psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment.
This study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions. Eating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile. Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED's duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.
饮食失调（EDs）与高发病率和死亡率相关，主要影响年轻人和女性。治疗开始延迟与慢性及更严重的临床病程相关；然而，拉丁美洲关于获得医疗服务的障碍和促进因素的证据很少。我们旨在从患者、亲属和卫生专业人员的角度确定智利饮食失调治疗的障碍和促进因素。
通过对患者、其亲属和卫生专业人员进行半结构化访谈的定性方法。参与者从智利圣地亚哥的两个饮食失调中心招募（一个公立和一个私立）。分析主要基于扎根理论，使用MAXQDA软件。
共进行了40次访谈（n = 22名患者、10名亲属和8名卫生专业人员）。患者的平均年龄为21.8岁，而未治疗的饮食失调平均持续时间为91.4个月（中位数70个月）。出现了五个类别，它们之间存在交叉：患者（P）、家庭和社会环境（FSE）、卫生专业人员（HP）、医疗保健系统（HCS）以及社会和文化背景（SCC）。这些类别及其交叉点中出现了相关障碍，突出了缺乏专业知识或专业技能、对饮食失调的文化无知或错误信息以及患者的自我和谐行为。主要促进因素是患者和亲属的心理教育、家庭成员对症状的识别以及父母主动寻求治疗。
本研究提供了有关智利饮食失调患者获得治疗的信息。一种切实可行的公共卫生方法应考虑治疗延迟的多因果关系并促进早期干预。饮食失调（EDs）可能严重影响忍受这些疾病的人的日常功能。治疗开始延迟与更难治疗的疾病相关。据我们所知，拉丁美洲尚未发表过探索影响饮食失调患者治疗启动因素的研究。本研究旨在确定智利饮食失调患者治疗的促进因素和障碍。我们采访了来自智利圣地亚哥一个私立和一个公立中心的患者（n = 22）、他们的亲属（n = 10）和卫生专业人员（n = 8）。我们的分析表明，开始治疗的主要障碍是饮食失调方面缺乏专业知识、疾病的金钱成本以及文化错误信息。促进因素与家庭在认识和应对疾病同时接受专业人员饮食失调教育方面的作用有关。本研究有助于提供关于发展中国家治疗可及性的数据。虽然促进因素和障碍与文献中报道的其他因素相似，但未治疗的饮食失调持续时间更长。解决这些障碍对于更有效地提供治疗并预防严重和持久的疾病形式至关重要。
