Help-seeking and accessing treatment for eating disorders: a systematic review of qualitative studies with a focus on ethnic differences

Background
Eating disorders (ED) are serious mental health conditions characterised by disordered eating behaviour and associated emotional distress. EDs are associated with high rates of mortality and morbidity, yet rates of help-seeking remain low. There is a misconception that EDs only affect “skinny, white, affluent girls” (SWAG) although anyone can be affected. Likewise, despite similar rates in minoritised ethnic communities, studies suggest that help-seeking from these populations remain low. The aim of this review was to identify key barriers and facilitators to accessing ED treatment in the United Kingdom (UK) and explore whether experiences vary by ethnicity.

Subjects and methods
A systematic review of qualitative and mixed methods studies was conducted following PRISMA guidelines. PsycINFO, Embase, Medline and CINAHL databases were searched for relevant studies published since 2013. Two independent reviewers screened titles/abstracts and reviewed full texts. Eligible articles were coded in NVivo to generate themes following Braun and Clarke’s thematic analysis framework.

Results
Out of 14 included studies, two focused exclusively on experiences of minoritised ethnic individuals. Across the studies, commonly shared barriers to accessing care included rigid ED guidelines, negative healthcare professional experiences, difficulty in self-recognising ED, low accessibility and awareness of services, and negative social relationships. Reported facilitators included improving education and recognition of EDs, informed and accessible delivery of care, and supportive communities. Two studies with participants of South Asian heritage highlighted additional barriers, such as concerns about doctor-patient confidentiality, and marriage-related pressures linked to beauty standards. Unique facilitators included suggestions for raising awareness of EDs through culturally relevant platforms.

Conclusion
A more holistic approach is required from services and guidelines to tackle stigma associated with EDs and make services more accessible. There is a lack of primary research focusing on minoritised ethnic communities, and further research is required.