Help-seeking barriers and online peer-to-peer support for eating disorders
Creators: name: Ali, Kathina
Publisher: name: The Australian National University
Year: 2020

description: Abstract Many individuals with eating disorder symptoms do not seek or receive appropriate help. Understanding the barriers to low help-seeking rates and identifying digital approaches that facilitate help-seeking may improve outcomes. However, little is known about these factors and approaches, especially among emerging adults, who are a particularly vulnerable population for eating disorders. This thesis includes two systematic reviews which examined perceived help-seeking barriers and the effectiveness of online peer-to-peer support for eating disorders, respectively. These served as a framework for three empirical studies which aimed to address identified gaps in the help-seeking literature for eating disorders among emerging adults. The empirical studies were: (1) a large-scale cross-sectional study of perceived help-seeking barriers, (2) a case study of the effects of an Internet-based prevention program on help-seeking barriers and behaviour, and (3) a randomised controlled trial of the effectiveness of online peer support in an indicated Internet-based prevention program. The first systematic review identified a broad range of perceived barriers towards seeking help for eating disorders, of which stigma, shame, denial, and failure to perceive the severity of the illness were the most commonly investigated. However, the review identified a need for more rigorous studies examining younger people and a lack of a multi-factorial assessment tool for measuring help-seeking barriers. The cross-sectional study employed a newly developed, purpose-designed measure (Barriers Towards Seeking Help for Eating Disorders Questionnaire; BATSH-ED) and found that concern for others and self-sufficiency were the most commonly endorsed barriers among emerging adults, suggesting that barriers may manifest differently as a function of age and eating disorder symptomatology. It has been suggested that online peer support may reduce help-seeking barriers. However, the second systematic review identified a lack of studies investigating the role of online peer support for eating disorders, with no study investigating its effect on help-seeking. The case report in this thesis suggested that synchronous peer support in an Internet-based program (ProYouth) may assist in reducing help-seeking barriers such as stigma and facilitate more intensive help-seeking. To address the lack of high-quality studies of the effects of online peer support, we undertook a randomised controlled indicated prevention trial of an adapted version of ProYouth (ProYouth OZ). The trial was designed to compare the effects of ProYouth OZ with and without peer support on eating disorder symptoms, help-seeking barriers, intentions, and behaviour among emerging adults with eating disorder symptoms in Australia. Despite some promising indications, challenges with recruitment resulted in an underpowered study which precluded reliable conclusions. Instead, the study offered novel insight into the challenges of reaching and engaging emerging adults who experience symptoms of an eating disorder without meeting diagnostic criteria. We concluded that there is a need for high quality trials regarding the impact of peer-to-peer support on help-seeking for eating disorder symptoms, and that the design and implementation of these trials should be informed by research that has systematically investigated the most effective methods for reaching, identifying, and engaging emerging adults at risk for eating disorders in Internet-based interventions. In addition to informing the development and tailoring of online interventions, there may be value in educating the community as well as health professionals on the barriers to help-seeking among individuals with eating disorder symptoms, enabling them to identify and address these barriers early.