Improving understanding and access to treatment for eating disorders among British South Asian females

OF THESIS submitted by Bushra Nazir for the degree of Doctor of Philosophy (PhD) and entitled: Improving understanding and access to treatment for eating disorders among young British South Asian females: a qualitative study. Month and Year of submission September 2015 Introduction: Eating disorders were previously regarded as a Western culture-bound syndrome affecting only young Western women. However they have been described in the UK and in across the world. Research has highlighted the prevalence of disordered eating among South Asian females. However little is known about the process of how this comes about, and little qualitative research has been conducted in this area. This research aimed to understand the issues relating to the development and maintenance of eating disorders among South Asian females and their help seeking behaviour, as well as the barriers to accessing treatment. Methods: Three main studies were carried out; two systematic reviews, a review of prevalence (study 1), a qualitative review (study 2) and a qualitative study (study 3). For study 1, the review was planned and reported with reference to MOOSE guidelines (Stroup et al 2000) for systematic reviews of observational studies. For study 2, the quality of the studies was appraised in accordance with Critical Appraisal Skills Programme Criteria (CASP 2013), qualitative research check list. For both reviews, a systematic literature search was conducted across four data basis, Psychinfo, Medline, CINAL and EMBASE. All articles were screened against inclusion/exclusion criteria. The data extracted from the selected studies was tabulated in a way that demonstrated the methodological robustness and cultural quality of each study was also reported. For the qualitative study (study 3), semistructured interviews were carried out with three groups of participants, ten South Asian females with eating disorders, seven parents and siblings and eighteen health care professionals. Results: For study 1, thirteen studies were initially selected. Overall, these studies reported higher prevalence of Bulimia among Asian females in the UK compared to Caucasian females. Studies conducted in Pakistan and India reported a lower prevalence rate of diagnosable eating disorders than reported in Western countries. In study 2, three studies were selected. They identified important themes; cultural conflict and controlling families. In study 3, two overarching themes were identified with corresponding sub-themes; development and maintenance of eating disorders in the context of family and cultural conflict; barriers and facilitators to accessing treatment. Conclusions: Reviewed prevalence study findings highlighted a need to consider the adaptation of measuring tools, as eating disorders may present differently in different cultures, and diagnostic criteria based on Western norms may not always be appropriate. There was a lack of qualitative studies and those available were of poor quality. The main aetiology and maintenance of Eating Disorders reported by South Asian females were focused on conflict with family and culture. Seeking treatment was difficult for these women due to stigma, shame, issues of confidentiality and lack of training and understanding in cultural competence among health care professionals.