We spoke with Capella Meurer about conducting qualitative research for eating disorders. Capella is a member of the NEDC and PhD candidate at Monash University, currently investigating the treatment of eating disorders and individual experiences of recovery. We asked Capella to provide insight into her research focus and qualitative study design.
Can you tell us a bit about your study and why you chose recovery as a focus?
When I finished my undergraduate degree, I was employed for nine months as a mental health worker on an eating disorders unit in the United States. Watching the patients there relapse so quickly, sometimes within a matter of weeks, made me wonder how this situation could be improved. Then, as I started to look at the literature in the early stages of devising my research question, I found that eating disorders had a relatively low prevalence (Hoek, 2006; Hudson, Hiripi, Pope, & Kessler, 2007; Keski-Rahkonen et al., 2008; Smink, van Hoeken, & Hoek, 2012; Wade, Bergin, & Tiggemann, 2006), but alarmingly high mortality (Arcelus, Mitchell, Wales, & Nielsen, 2011; Birmingham, Su, Hlynsky, Goldner, & Gao, 2005; Franko et al., 2013), which added weight and urgency to the concern I felt. This concern was essentially that people appeared to be experiencing several treatment difficulties when recovering from an eating disorder, along with high rates of relapse and risk involved. So, through my research I want to find ways that practitioners can improve outcomes to reduce relapse and improve the chance of recovery.
Recovery is a relatively broad scope for eating disorders. How are you conducting your study and what methods are you using to collect and analyse responses?
I am conducting two studies that focus on the experiences of those in recovery. Both studies are qualitative, as such research is becoming increasingly important in evaluating the effectiveness of treatment.
The first study involves an online focus group. The purpose of this focus group is to understand and compare experiences of recovery across Australia. I am also very interested in exploring the use of an online focus group for this population. Online focus groups have been used previously by Williams and Reid (2007; 2009) with some success. I believe that this method may be useful in encouraging the discussion of topics and themes that would not normally be discussed due to the anonymous nature of the medium. I discuss the safety measures in place for the online focus group below.
The second study involves a series of one-on-one interviews, which will be based in Melbourne. The findings from these interviews will be compared with the information gained in the online focus group and allow for additional analysis and insight. I will be analysing the data from both the focus group and the interviews using interpretive phenomenological analysis in order to understand personal experiences of recovery, particularly what has helped and hindered it. This understanding will add to existing literature about how treatment can be improved from the standpoint of those who undergo it (Arthur-Cameselle & Quatromoni, 2014; Pemberton & Fox, 2011; Savukoski, Uusiautti, & Määttä, 2013; Tierney, 2008; Vanderlinden, Buis, Pieters, & Probst, 2007; Westwood & Kendal, 2011).
What are some of the challenges you are facing in conducting qualitative research for eating disorders?
A major challenge faced when conducting this research has been ensuring participants meet the selection criteria for the study, whilst also minimising risk. While the majority of participants are identified as being in recovery according to the measures being used (self assessment, the Stages of Recovery Instrument (Andresen, Caputi, & Oades, 2006) and the Revised Suicide Behaviors Questionnaire (Osman, et al 2001)), some are also identified as being at risk for suicide. For these participants to be included in the study, further ethical clearance is required to conduct additional screening. What this indicates to me is that suicidal risk and thoughts may still be present through recovery from an eating disorder. This is supported by the recovery model, which encourages wellbeing and identity development over complete symptom cessation (Davidson & Roe, 2007; Slade et al., 2014).
For my research, however, it is crucial to balance risk associated with including participants who are at an increased risk for suicide in a study that is being conducted online. Because of this, I have safety measures around the online focus group. Firstly, participants are screened to ensure that they are suitable to participate (measures mentioned above). They are provided with the contact information for the Butterfly Foundation and Lifeline in the explanatory statement, during the actual group, and at the end of the group. Participants have to provide the researchers with a phone number that they can be contacted during the focus group should there be any concerns about their wellbeing. At the end of the focus group, records of these phone numbers are destroyed. Should there be any concern for a participant, they will be contacted, checked on, and asked to contact a support person or a helpline.
Have you had any significant findings so far?
Although this study is currently in the recruitment phase, I’ve already started to find some interesting results. As I discussed above, there appears to be a continuation of suicidal symptoms through recovery for some participants. This is something I wish to further examine within the online focus group and interviews, as appropriate. The response has also been impressive, with more people than expected being eager to participate. This level of interest highlights a need for such research and the desire for those with lived experience to share their story. I am hoping that this study will contribute to improved treatment approaches and a better understanding of eating disorders for clinicians and the community.
There seems to be an increase in qualitative research on eating disorders, why do you think this is?
I find the growth in qualitative research on eating disorders, and in general, very exciting. Similar to myself, it appears that researchers are noticing a gap in evidence that needs filling. Tanenbaum (2006) acknowledges that those using services are in a unique position to know what works, and hence their insight and feedback is needed. In relation to eating disorders, gaps in treatment needs and recovery experiences have been identified in previous research (Butterfly Foundation, 2016). Qualitative research works towards filling these identified gaps so that we, as practitioners and researchers, have a more comprehensive understanding of how to help those with eating disorders. This is both exciting and invigorating, as it indicates that we are on the cusp of change in the field.
If you are interested in participating in this study, please visit our Current Australian Studies page.
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Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders. Archives of General Psychiatry, 6(7), 724–731.
Arthur-Cameselle, J. N., & Quatromoni, P. A. (2014). A Qualitative Analysis of Female Collegiate Athletes’ Eating Disorder Recovery Experiences. The Sport Psychologist, 28(4), 334–346.
Birmingham, C. L., Su, J., Hlynsky, J. A., Goldner, E. M., & Gao, M. (2005). The mortality rate from anorexia nervosa. International Journal of Eating Disorders, 38(2), 143–146.
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Davidson, L., & Roe, D. (2007). Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health, 16(4), 459–470. http://doi.org/10.1080/09638230701482394.
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Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358.
Keski-Rahkonen, A., Hoek, H. W., Linna, M. S., Raevouri, A., Sihvola, E., Bulik, C. M., et al. (2008). Incidence and outcomes of bulimia nervosa: a nationwide population-based study. Psychological Medicine, 39(05), 823–9.
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Pemberton, K., & Fox, J. R. E. (2011). The Experience and Management of Emotions on an Inpatient Setting for People with Anorexia Nervosa: A Qualitative Study. Clinical Psychology & Psychotherapy, 20(3), 226–238.
Savukoski, M., Uusiautti, S., & Määttä, K. (2013). Ex-anorectic Patients’ Perceptions on Treatments: Less weighing, more talking. Addictive Disorders & Their Treatment, 12(2), 67–75.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., et al. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1), 12–20.
Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates. Current Psychiatry Reports, 14(4), 406–414.
Tanenbaum, S. J. (2006). The Role of “Evidence” in Recovery from Mental Illness. Health Care Analysis, 14(4), 195–201.
Tierney, S. (2008). The Individual Within a Condition: A Qualitative Study of Young People's Reflections on Being Treated for Anorexia Nervosa. Journal of the American Psychiatric Nurses Association, 13(6), 368–375.
Vanderlinden, J., Buis, H., Pieters, G., & Probst, M. (2007). Which elements in the treatment of eating disorders are necessary ‘ingredients’ in the recovery process?—A comparison between the patient‘s and therapist’s view. European Eating Disorders Review, 15(5), 357–365.
Wade, T. D., Bergin, J. L., & Tiggemann, M. (2006). Prevalence and Long-term Course of Lifetime Eating Disorders in an Adult Australian Twin Cohort. Australian and New Zealand Journal of Psychiatry, 40(2), 8–128.
Westwood, L. M., & Kendal, S. E. (2011). Adolescent client views towards the treatment of anorexia nervosa: a review of the literature. Journal of Psychiatric and Mental Health Nursing, 19(6), 500–508.
Williams, S., & Reid, M. (2007). A grounded theory approach to the phenomenon of pro-anorexia. Addiction Research & Theory, 15(2), 141–152.
Williams, S., & Reid, M. (2009). A grounded theory approach to the phenomenon of pro-anorexia. Addiction Research & Theory, 15(2), 141–152.
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