Exploring barriers and facilitators in eating disorders treatment among Latinas in the United States.

The lifetime prevalence of anorexia nervosa (AN) among Latinos is .08% in women and .03% in men, of bulimia nervosa is (BN) 1.9% in women and 1.3% in men, and of binge eating disorder (BED) is 2.3% in women and 1.6% in men (Alegria, Woo, Cao, Torres, Meng et al., 2007). The medical consequences of these disorders range from minor to severe and in some cases can lead to death (Mitchell, Pomeroy, & Adson, 1997). Despite a common misconception that women of minority groups do not typically develop eating disorders (EDs), data from college and community samples indicate that EDs are equally prevalent in minority groups as in the non-Latino White population (Cachelin, Rebeck, Veisel, & Striegel-Moore, 2001; Franko, Becker, Thomas, & Herzog, 2007). Furthermore, although the prevalence of AN and BN in Latinos/as and non-Latino Whites is similar, some studies have shown that the prevalence of BED is higher among Latinos/as (Alegria et al., 2007; Marques, Alegria, Becker, Chen, Fang et al., 2011). Some specific factors such as consumption of fat (Wilson, O’Connor, Kaplan, Bode, Mama et al., 2012), overweight, and obesity (Sanchez-Johnsen, Hogan, Wilkens, Fitzgibbon, 2008) are associated with increasing risk for developing binge eating or bulimic symptoms in this population. In Latino males, elevated rates of EDs are associated with homosexuality (Carlat, Camargo, & Herzog, 1997; Hospers, 2005), athletes (Petrie, Greenleaf, Reel, & Carter, 2008) and trauma history (Olivardia, Pope, Mangweth, & Hudson, 1995). However, high frequencies of disordered eating behaviors have also been documented in male Latino college populations (Reyes-Rodriguez, Sala, Von Holle, Unikel, Bulik et al., 2011). Health disparities among Latinos are well documented (Cabassa, Zayas, & Hansen, 2006) and they are associated with cultural specific factors, such as a mental health stigma (Nadeem, Lange, Edge, Fongwa, Belin et al., 2007), ethnic identity, language preference and barriers, economics, and treatment seeking-patterns including avoidance of specialized services (Alegria, Canino, Rios, Vera, Calderon, Rusch, Ortega, 2002; Keyes, Martins, Hatzenbuehler, Blanco, Bates et al., 2011; Snowden & Yamada, 2005). For Latinos/as with limited English proficiency, practitioners who must use an interpreter constitute another challenge (Bourhis, Roth, & MacQueen, 1989; Dodd, 1984; Seijo, 1991). Some studies indicate that few interpreters provide accurate translations for practitioners, and even with accurate interpretations, practitioners may still fail to fully understand the nature and extent of presenting symptoms (Elderkin-Thompson, Silver, & Waitzkin, 2001). In particular, limited access to health care can be a barrier to the utilization of services for EDs (Snowden & Yamada, 2005). Additionally, Latinos/as with a history of EDs are less likely to utilize mental health services (Marques et al., 2011) and to be referred for further evaluation (Becker, Franko, Speck, & Herzog, 2003; Franko et al., 2007) in comparison to non-Latino Whites. The development of culturally sensitive intervention models is a key component to reducing health disparities in the Latino population (Reyes-Rodriguez & Bulik, 2010). The recognition of cultural values is important for providing adequate treatment for EDs in the Latino population (Kempa & Thomas, 2000). Specific protocols and guidelines that integrate culture and context in evidence-based care could contribute to engagement in treatment and ultimately enhance treatment outcomes (Miranda, Bernal, Lau, Kohn, Hwang et al., 2005). In the case of Latinos/as, it is necessary to develop models that would inform investigators about the specific procedures involved in making and documenting adaptations to treatments. In part, the challenge is to identify key cultural and contextual factors that can be adapted within a given treatment (Reyes-Rodriguez & Bulik, 2010). In addition, it is important to specify the ways in which the key elements that are postulated to be essential for positive treatment outcomes are transformed and/or sustained during the treatment process (Bernal & Reyes-Rodriguez, 2008). The incorporation of culture and context into interventions leads to the development of multicultural guidelines for clinical practice, research, and education. For example in the Latino population it is important to consider the role of family, migration, language, and specific cultural values (e.g., familismo, personalismo, fatalismo, ethnic identity, dependence, independence), which differ depending on the length of time an individual has spent in the U.S., and on the migration experience and the relationship to the dominant culture (Bernal & Reyes-Rodriguez, 2008). Considering the prevalence of EDs in Latinos/as, the current underutilization of mental health services and the barriers to treatment access, it is crucial to identify specific factors that could enhance service utilization for ED treatment in the Latino population. The main objective of this investigation was to explore more fully the facilitators and barriers that may contribute to or prevent the engagement and retention of Latinos/as in EDs treatment.