ABSTRACT
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
ABSTRACT
BACKGROUND: Eating disorders (EDs) are disabling, potentially fatal, and costly mental disorders. According to recent data, Chile has the highest prevalence of both anorexia nervosa (AN) and bulimia nervosa (BN) in Latin America. However, there is no published data regarding the barriers experienced by patients with EDs in Chile until they start treatment. AIM: To review and synthesize the literature regarding barriers to access to treatment for patients with EDs. METHODS: A search was conducted through PubMed/ Medline, PsychInfo, Web of Science, Scopus, Embase, Scielo, and Google Scholar. Seventy-two studies were selected for full-text reading. RESULTS: 53 studies were included, all conducted in developed countries. A wide range of barriers was found, which can be classified according to their role. These barriers were predominantly at the level of the patient with an ED, the family and social environment, the health professionals, the sociocultural context, and the healthcare system. The barriers most commonly found in studies were the patient's ego-syntonic behaviors and the social stigma associated with EDs. DISCUSSION: The national context calls for discussing access problems in patients with EDs in Chile. The barriers found in this study should be considered when designing public policies, although the role of the cost of treatment should be more emphasized in Chile.