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Table 6 Qualitative and mixed-methods studies

From: Eating disorders, disordered eating, and body image research in New Zealand: a scoping review

References

Population focus

Focus

Key data collected

Sample n

Gender

Age

Ethnicity

Summary findings

Allison [202]*

NC

Feminist approach exploring issues related to young women’s body perception and eating behaviours

Thematic analysis of journal entries

15

F

14–16

10 European, 1 Samoan, 1 South American, 1 Irish-English, 1 Chinese-European-Eurasian, 1 not stated

Identified Western cultural influences on eating behaviours and body image

Barry [202]*

NC

Issues with eating, weight, and body image in women with type 1 diabetes and health professionals

Semi-structured interviews

17 (12 with type 1 diabetes, 5 health professionals)

F

16–25

Not stated

Different perceptions of health professionals versus young women with Type 1 diabetes. Eating and weight related disturbance (including insulin omission) reported

Batenburg [203]*

AN

Experiences and opinions of those who had experienced and recovered from anorexia nervosa

Semi-structured interviews

8

F

17–27

5 NZ European, 1 Māori/European, 1 Indian, 1 Belarusian

Model of AN aetiology developed, based on categories of perceived causes of relapse

Bellingham [204]*

AN

Parental perspective on experiences of having a child with AN

Semi-structured interviews

12

50% M, 50% F

Not stated

Not stated

Identified three stages from parental accounts, termed the insidious, tenacious, and recovery stages

Carne [205]*

NC (OPIC Project)

Included examination participants' attitude toward own weight

PedsQL, AQoL, semi-structured interviews

Quantitative: 4429, qualitative: 36 (drawn from quantitative sample)

Quantitative: 48% F, 52% M, qualitative: 50% M, 50% F

13–18

Quantitative: 59% Pasifika, 20% Māori, 11% European, 10% Asian

Qualitative: 33.3% Māori, 33.3% European, 33.3% Pasifika

Lower physical QOL linked to higher weight status, high QOL for those who were obese (relative to previous findings), sociocultural factors protective against internalised stigma, friendships related to perception of own weight

Chisholm [206]*

NC

Examined relationship between dieting and factors within romantic relationships in a sample of heterosexual couples

PRQC, AAQ, RSES, BDI-21, WCBS, EDI-2, WMSI, weight-loss support helpfulness, BMI, body satisfaction (Likert scale)

88

50% F, 50% M

F: M 29.43, (SD 11.87), M: M 31.61 (SD 11.87)

Not stated

More disordered eating attitudes where lower perceived partner support. Higher levels of unhealthy dieting with lower self-esteem (mediated by disordered eating attitudes). Partner support appears protective for those with low self-esteem

Conder [207]*

NC

Explored body image and how this was constructed among women with intellectual disabilities

Semi-structured qualitative interviews

25

F

21–65

88% NZE, 8% Māori, 4% Pasifika

Themes identified were 'beauty and the body', 'a fit and functional body' and 'a gendered body'

Easter [208]*

NC

Problematic behaviours among elite athletes. Includes topic of disordered eating

Semi-structured qualitative interviews

10

50% F, 50% M

Early 20s to late 40s

80% European/Pakeha, 10% Māori, 10% Other European

A number of behaviours reported, including disordered eating. Potential influences on this behaviour included comments/criticism from others, unrealistic sociocultural standards, and media influence

Gunn [209]*

BN, AN, EDNOS, self-diagnosed

Experiences of mothers who became pregnant after having recovered from an eating disorder

Qualitative interviews

10 women with past ED,

8 without

F

27–46

European

Reported healthy pregnancies among recovered women, no difficulties with infant feeding, no tendency for undue anxiety about weight gain

Hall [210]

AN

Family factors and their association with AN

Interviews with parents of those with AN

50 (AN)

F

Not stated

European

Possible aetiological factors included socioeconomic status, and family factors such as a parental history of psychiatric and medical illness

Hammond [211]*

NC, ED

Examined body image appraisals, self-esteem, body related esteem, weight locus of control, and figure ratings in groups of women: normal weight, overweight, had ED or were body builders. Qualitative study examined self-esteem and experience of teasing

RSES, BES, WLOCS, figure rating scale, silhouette rating scale, qualitative interviews

122

F

Normal weight: M 31.14 (SD 10.40), overweight: M 38.84 (SD 12.50), ED: M 27.48 (SD 10.23), body builders: M 28.81 (SD 6.31)

89% European, 3% Maori, 4% Pasifika, 3% Other

Positive description for normal and muscular, but not thin or overweight body types. Difference between groups regarding ideal figures. Self-esteem and body esteem did not correlate for body builders. ED reported feeling bigger compared to what they thought. Similar ratings for figures seen as likely to be attractive for males

Jones [43]*

NC

Body image dissatisfaction in males involved in weight training, and potential influences and impacts on wellbeing

Semi-structured interviews

12

M

18–29

83.33% NZ European, 8.33% NZE/Māori, 8.33% Cook Island/Māori/Tahitian/Scottish

Weight training exercise related to both positive and negative body image/evaluation, observed sociocultural influences on body image Behavioural indications that participants were downplaying impact of body image dissatisfaction

Kleinbichler [212]*

AN, NC

Elaborating on knowledge surrounding metacognitive processes in AN, compared with dieting and non-dieting women

BMI, DASS, EAT-26, PSWQ, PBRS, NBRS, RRQ, TCQ, MCQ-30, EDE-Q4

131

F

Non-diet: M 21.38, diet: M 23.44 (SD 8.06), AN: M 24.0 (SD 6.00)

70% NZ European, 3% Māori, 5% Chinese, 2% Indian, 11% other, 8% multi-ethnicity

Maladaptive cognitive styles among those with AN, compared with dieting and non-dieting women. Evidence supports presence of cognitive attentional syndrome in those with AN

McClintock [213]*

NC

Influences on body image dissatisfaction/disturbance, examined in three different ways

Focus group data

Study 1: 23, Study 2: 190, Study 3: 33

F

14–18

Study 1: 73.9% Pakeha, 17.4% Māori, 8.7% other minority cultures. Study 2: 74% Pakeha, 14.5% Māori, 2, 3% Pasifika, 6.9% Asian, 1.2% South African, 1.2% other minority. Study 72.7% Pakeha, 15.2% Māori, 3% Pasifika

Identified important role of social evaluation for influencing body image and unhealthy dieting behaviour, and interrelationships between sociocultural and interpersonal influences

Poulter [214]

NC

Explore perspectives of female undergraduate students with positive body image

Body image questions, BAS, BESAA, SATAQ, focus group

n = 139 for screening. N = 19 for focus analysis

F

18–30

Predominantly European

Themes included body positivity with age, mindfully engaging with media content, functional conceptualisation of the body, and role of religious and cultural identities. Women with positive body image utilise a body-protective filter, favouring body-positive information from environment

Schofield [215]*

NC

Low energy availability and associated factors (e.g. body image, nutrition) in athletes

Qualitative data, physiological data, food record

Study 1: 15,

Study 2: 11

Study 1 67% F, 33% M, Study 2: 64% F, 36% M

22.8 ± 3.8

European

Highlighted complex nature of LEA, risk impacted by sociocultural environment and type of sport

Snell [216]

Clinicians

Investigating the nurse experience in an ED inpatient service

Interview

7

Not stated

30–50

Not stated

Nurses have crucial role in ED unit with unique challenges, and therapeutic relationship with these professionals can help engage clients in treatment/recovery. At times felt that this important role was invisible

Stiles [217]*

BN, AN

Assessing which eating behaviours were perceived as being normal by clinicians, dieticians, and healthy women

EDE-Q, ONE, eating behaviour, ratings of eating behaviours shown in video (Likert scales), eating style questions, qualitative interview

67

F

18–60

Not stated

Key theme was flexibility (e.g. not having strict rules). Themes also eating in response to physiological hunger, meeting nutritional needs, eating in socially acceptable manner, eating for pleasure, and regular eating)

Surgenor [218]

AN

Identify how patients view their AN with respect to self

Semi-structured interview

5

F

17–late 20s

Not stated

Patient's 'selves' have strategically different implications for therapeutic interventions. Individual therapy could be improved by establishing an authentic basis

Surgenor [219]

AN

Can treatment drop-out for AN be predicted from routine admission data collection?

BDI, EAT-26, EDI-2, RSES

213 (treatment episodes)

F

Drop out: M 22.3, regular discharge: M 21.2

Not stated

Lower BMI, AN purging subtype, and active fluid restriction make significant independent contributions to drop-out risk

Stanley [220]*

BN, AN

Risk and protective factors for those who were identified as being at-risk of negative life outcomes, and who had originally been interviewed as 12 years prior (when they were aged 11–12 years)

Semi-structured interview

9 (1 AN and BN history)

33.3% F, 66.6% M

21–22

56% Māori, 33% Pasifika, 11% Pakeha

Identified protective factors for AN participant included intrapersonal ability (e.g. self-awareness) and external supports (e.g. family). Risk factors were self-identified aberrant cognitions, physical health, adoption, and secondary schooling

Swain-Campbell [221]

BN, AN, 'other EDs'

Satisfaction with specialist eating disorders services

Custom questionnaire (structured and open-ended questions)

120

4% M

M 27

94% European

Overall high approval, but negative commentary on some aspects of treatment (e.g. being weighed, gaining weight, stopping purging as compensatory strategy)

Teevale [222]*

NC (OPIC)

Views about eating, physical activity, and body image in Pasifika Island adolescents and parents

Study 1 Questionnaire

Study 2 Qualitative individual interviews

Study 14,215 Study 2 68

Study 1 52% F, 48% M Study 2 68% F, 32% M (qualitative)

Study 1 12–20 Study 2 13–17 (qualitative)

Study 1 55.4% Pasifika, 20.2% Māori, 12.3% Asian, 12.1% European, Study 2: Pasifika

Socio-environmental influences (e.g. occupational type, health education) more relevant to health behaviours than socio-cultural factors. Qualitative study: Beliefs about eating, physical activity, and body image similar between obese and healthy-weight Pasifika participants

Thabrew [223]

AN

Exploring inpatient AN treatment experience

Semi-structured interview

9

F

15–17

7 NZ European

2 Asian

Themes identified included admission benefits (safe space, support from staff), stress (e.g. being re-fed, being away from supports and regular life), control/power (e.g. compulsory treatment), being heard, and comparison with others in treatment

Tozzi [224]

AN (Sullivan et al. [84] sample)

Subjective accounts of causes of AN and recovery

DIGS, open ended questions

69

F

M 32.3 (SD 7.8)

98.6% European

Family dysfunction most commonly cited as causal, in addition to dieting/weight loss and stress. Factors contributing to recovery included relationships and maturation

Watterson [225]*

BN, AN, BED (COSTS)

Mixed methods study of factors associated with ED maintenance and recovery, and perceptions of what contributed to successful treatment and recovery

Qualitative interview, online survey based on existing surveys by BEAT charity and Butterfly Foundation

358 (quantitative), 18 of whom also participated in qualitative interviews

F

28.2 (SD 12.2)

88.7% NZ European, 6% Māori, 1.1% Pasifika, 13.2% other (includes Chinese, European, Australian, Middle Eastern, and Indian)

Multiple causal factors endorsed across EDs, most frequent were low self-esteem, perfectionism and difficulty managing negative emotions. Need for control was higher for those with AN

Waugh [25]

BN, AN

Comparing children of those with current or past AN or BN on factors such as eating behaviours, health, development, and psychometric variables

EDI, Toddler Temperament Scale, maternal report and interviews, food diaries, videoed mealtimes

20 mothers (10 cases, 10 NC controls)

F (Children: 5 M and 5 F per group)

Cases M 30.1 (SD 3.1),

NC M 30.8 (SD 3.6). Children 12–48 months

Not stated

Difficulties in children of the ED group include low birth weight, difficulties with breast feeding, and non-interactive mealtimes

Webb [226]*

AN

Features of AN as indicated by those with current or past AN

Interviews available notes and documents

7

F

18–35

Not stated

Identifies issues relating to control/ self-concept, continued concerns around food/exercise, reluctance to develop sexual relationships, and concerns around relationships with others

  1. NC non-clinical, PedsQL Pediatric Quality of Life Inventory, AQoL Assessment of Quality of Life, PRQC Perceived Relationship Quality Components, AAQ Acceptance and Action Questionnaire, RSES Rosenberg Self-Esteem Scale, BDI Beck Depression Inventory, WCBS Weight Control Behaviours Scale, BMI body mass index, BES Binge Eating Scale, WLOCS Weight Locus of Control Scale, DASS Depression Anxiety and Stress Scale, EAT Eating Attitudes Test, PSWQ Penn State Worry Questionnaire, PBRS Positive Beliefs about Rumination Scale, NBRS Negative Beliefs about Rumination Scale, RRQ Rumination and Reflection Questionnaire, TCQ Thought Control Questionnaire, MCQ-30 Metacognitive Questionnaire 30, EDE Eating Disorder Examination, BAS Body Appreciation Scale, BESAA Body Esteem Scale for Adolescents and Adults, SATAQ Sociocultural Attitudes Towards Appearance Questionnaire, ONE Opinions on Normalised Eating, DIGS Diagnostic Interview for Genetic Studies, EDI Eating Disorders Inventory
  2. *Identifies that the record is a thesis