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Decision-making processes for the uptake and implementation of family-based therapy by eating disorder treatment teams: A qualitative study

Authors

  • Melissa Kimber MSW,

    Corresponding author
    1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    • Correspondence to: M. Kimber, Health Research Methodology Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Health Sciences Centre, Room: 2C1, Hamilton, Ontario L8S 4K1, Canada. E-mail: Kimberms@mcmaster.ca

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  • Jennifer Couturier MD,

    1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    2. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
    3. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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  • Susan Jack PhD,

    1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    2. School of Nursing, McMaster University, Hamilton, Ontario, Canada
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  • Alison Niccols PhD,

    1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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  • Sherry Van Blyderveen PhD,

    1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
    2. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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  • Gail McVey PhD

    1. Department of Community Health Systems Resource Group, the Hospital for Sick Children, Toronto, Ontario, Canada
    2. Dalla Lana School of Public Health, the University of Toronto, Toronto, Ontario, Canada
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  • This study was supported by a research grant from the Hamilton Academic Health Sciences Organization. Dr. Susan Jack is supported by a New Investigator Personnel Award from the Institute of Human Development (Child and Youth Health, Reproduction and Child Health) within the Canadian Institutes of Health Research (CIHR). Dr. Gail McVey is supported by a Mid-Career Personnel Award from CIHR.

ABSTRACT

Objective

To explore the decision-making processes involved in the uptake and implementation of evidence-based treatments (EBTs), namely, family-based treatment (FBT), among therapists and their administrators within publically funded eating disorder treatment programs in Ontario, Canada.

Method

Fundamental qualitative description guided sampling, data collection, and analytic decisions. Forty therapists and 11 administrators belonging to a network of clinicians treating eating disorders completed an in-depth interview regarding the decision-making processes involved in EBT uptake and implementation within their organizations. Content analysis and the constant comparative technique were used to analyze interview transcripts, with 20% of the data independently double-coded by a second coder.

Results

Therapists and their administrators identified the importance of an inclusive change culture in evidence-based practice (EBP) decision-making. Each group indicated reluctance to make EBP decisions in isolation from the other. Additionally, participants identified seven stages of decision-making involved in EBT adoption, beginning with exposure to the EBT model and ending with evaluating the impact of the EBT on patient outcomes. Support for a stage-based decision-making process was in participants' indication that the stages were needed to demonstrate that they considered the costs and benefits of making a practice change. Participants indicated that EBTs endorsed by the Provincial Network for Eating Disorders or the Academy for Eating Disorders would more likely be adopted.

Discussion

Future work should focus on integrating the important decision-making processes identified in this study with known implementation models to increase the use of low-cost and effective treatments, such as FBT, within eating disorder treatment programs. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:32–39)

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