Healthcare professionals' perspectives on minoritised ethnic young people's access to eating disorder services in the West Midlands, United Kingdom: a qualitative study.

内容摘要

Minoritised ethnic individuals have comparable eating disorder rates to White populations in the United Kingdom (UK) yet face inequalities in treatment access and experiences. Understanding healthcare professional perspectives is essential for addressing these disparities. This study explores health care professional views on the access of minoritised ethnic young people to specialist eating disorder services through Levesque's bidirectional access framework, which considers both supply and demand factors. Semi-structured qualitative interviews were conducted with 12 health care professionals from diverse personal and professional backgrounds, recruited from four National Health Service (NHS) community specialist eating disorder services in the West Midlands - the UK's second most ethnically diverse region. Participants completed sociodemographic questionnaires and online interviews via Microsoft Teams. Transcripts were analysed using reflexive thematic analysis. Health care professionals observed that young people of minoritised ethnic backgrounds accessed specialist eating disorder services less frequently than White British peers. Analysis revealed six interconnected themes spanning service-level and service-user-level factors. At the service level, systemic barriers included gatekeeping mechanisms (particularly GP referral requirements), service invisibility within minoritised ethnic communities, and inaccessible locations. Cultural and linguistic barriers were prominent, with communication challenges extending beyond language proficiency to fundamental differences in expressing distress. Health care professionals identified critical gaps in developing culturally sensitive services, citing limited resources, lack of workforce diversity, top-down organizational constraints, and insufficient cultural humility training. At the service-user level, education and awareness emerged as key barriers, with lower mental health literacy and limited eating disorder knowledge within minoritised ethnic communities as hindering recognition and help-seeking. Shame and stigma compounded these challenges, driven by eating disorder stereotypes and cultural beliefs about mental health that discouraged disclosure and treatment-seeking. Health care professionals noted that these barriers disproportionately affected minoritised ethnic individuals compared to their White British peers. Findings highlight multilevel barriers to accessing eating disorder services requiring comprehensive system changes including removing gatekeeping barriers, enhancing workforce diversity and cultural competency, developing targeted educational initiatives, and challenging eating disorder stereotypes. Culturally responsive services integrating these interventions are essential to improve access and outcomes for minoritised ethnic young people. Eating disorders affect people from all ethnic backgrounds equally, but young people from minoritised ethnic communities in the United Kingdom face significant challenges accessing specialist eating disorder treatment services. This study interviewed 12 healthcare professionals working in eating disorder services across the West Midlands to understand these access barriers. Healthcare professionals identified problems at two levels. At the service level, barriers included requiring GP referrals to access treatment, services being unknown within minoritised ethnic communities, inconvenient locations, and language difficulties that went beyond simple translation issues. Services also lacked resources, diverse staff, and training in cultural awareness. At the community level, barriers included limited knowledge about eating disorders, difficulty recognising symptoms, and greater shame and stigma around mental health within some minoritised ethnic communities. Healthcare professionals emphasised that while accessing specialist eating disorder services is challenging for everyone, these barriers disproportionately affect minoritised ethnic young people. Improving access requires multiple changes: making services more visible and easier to access, recruiting diverse staff, providing cultural awareness training, increasing eating disorder education in minoritised ethnic communities, and addressing mental health stigma. Services must adapt to meet the cultural needs of the diverse communities they serve.