Exploring barriers to South Asian help-seeking for eating disorders

Pages40-50
DOIhttps://doi.org/10.1108/MHRJ-09-2016-0017
Published date13 March 2017
Date13 March 2017
AuthorJackie Wales,Nicola Brewin,Raghu Raghavan,Jon Arcelus
Subject MatterHealth & social care,Mental health
Exploring barriers to South Asian
help-seeking for eating disorders
Jackie Wales, Nicola Brewin, Raghu Raghavan and Jon Arcelus
Abstract
Purpose Referrals to specialist eating disorder (ED) services from the South Asian (SA) community are
under-represented, despite research suggesting that disordered eating attitudes and behaviours of SA
people are similar to the population in general. The purpose of this paper is to identify the reasons for this and
sought to inform ways to encourage help-seeking.
Design/methodology/approach A qualitative methodology was used to investigate barriers to
help-seeking for EDs among the SA community. A key informant focus group was conducted with clinicians
working within the local specialist ED service (participants n ¼16, 12 female, 4 male). Six focus groups were
conducted with members of the SA community in Leicester, UK (participants n¼28, 23 female, 5 male),
recruited from a local university, two charities and Children, Young People and Family Centres.
Findings A number of themes emerged as possible factors for delaying early access to help: lack of
knowledge about EDs and their potential seriousness, ideals regarding body shape, family living
circumstances and the role of food in the community. Participants acknowledged stigma among their
community associated with mental health issues, including EDs and concerns about confidentiality when
approaching services, particularly primary care.
Originality/value General practitioners and specialist services need to be aware of the potential barriersto
help-seeking for EDs as early specialist help is recommended for effective treatment. An educational
campaign around EDs specifically designed with the SA community in mind may improve awareness, reduce
stigma and promote early help-seeking.
Keywords Ethnicity, Mental health, Eating disorders, Barriers, Help-seeking, South Asian
Paper type Research paper
1. Introduction
Disordered eating (DE) refers to a wide range of abnormal eating behaviours that include
excessive dieting and unhealthy weight control practices (Neumark-Sztainer et al., 2011).
The severity and frequency of behaviours is not enough to fulfil a diagnostic criteria for an eating
disorder (ED), hence the use of subclinical EDs or DE in the literature. DE has been shown to be
an important risk factor for the development of EDs and a target for early prevention of ED
development (Neumark-Sztainer et al., 2011). EDs is a term covering the broad categories of
anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder as defined by the
Diagnostic and Statistical Manual of the American Psychiatric Association (American Psychiatric
Association, 2013).
Historically EDs were thought to be Western culture-bound syndromes(Soh and Walter,
2013); however, EDs are increasingly documented in diverse countries and cultures worldwide
and appear to be increasing in, for example, the Asian regions with rising industrialisation,
urbanisation and globalisation (Pike et al., 2014). Pike and Dunne (2015) in their review of the rise
of EDs in Asia suggest that EDs are not culture-bound or culture-specific, but culture-reactive.
Soh and Walter (2013) found that African, Latin American and Hispanic groups were the most
studied cultural groups with all other ethnic groups, including South Asian (SA) (those who
originate from the Indian subcontinent), having few articles published on EDs. They concluded
further research was required in this area to remove barriers to accessing care.
Received 21 September 2016
Revised 7 December 2016
Accepted 20 December 2016
Jackie Wales is a Service
Evaluation and Research
Associate at the Leicestershire
Adult Eating Disorder Service,
Leicestershire NHS Partnership
Trust, Leicester, UK.
Nicola Brewin is based at the
Leicestershire Adult Eating
Disorder Service, Leicestershire
NHS Partnership Trust,
Leicester, UK.
Raghu Raghavan is a Professor
of Mental Health at the Mary
Seacole Research Centre,
Faculty of Health and Life
Sciences, De Montfort
University, Leicester, UK.
Jon Arcelus is based at the
Institute of Mental Health,
University of Nottingham,
Nottingham, UK.
PAG E 40
j
MENTALHEALTH REVIEW JOURNAL
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VOL. 22 NO. 1 2017, pp. 40-50, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-09-2016-0017

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