Anorexia Nervosa in Wales
: Patient Treatment Experience and Healthcare Professional Awareness

  • Laura Rees-Davies

    Student thesis: Doctoral Thesis


    Study one explored the service user experience of treatment for anorexia nervosa in the Welsh healthcare service. Factors such as treatment expectations, satisfaction, therapeutic alliance, motivation to change and engaging in treatment were considered by conducting indepth interviews with participants who had a diagnosis of anorexia nervosa and were receiving secondary care. Qualitative data were analysed using thematic framework analysis revealing six main concepts: service user description of anorexia; expectations of treatment for anorexia; the journey through the health service for anorexia; therapeutic alliance during treatment for anorexia; satisfaction with the health service; and service user recommendations to improve the health service. Mapping and interpretation of the concepts drawn from the interviews resulted in a model exploring the relationship between expectations and satisfaction of treatment for patients with anorexia nervosa, and the effect upon motivation to engage in treatment and recover. Another model describing factors that affect therapeutic alliance was developed. The results are described with particular reference to the Self-Determination Theory (Ryan & Deci, 2000). Study two used a four-stage, mixed-methods approach to develop and evaluate an anorexia nervosa awareness campaign for healthcare professionals. The campaign was developed using an integrative social marketing approach (NSMC: 2013): including formative research, process evaluation and outcome evaluation. Formative research included audience research (interviews and focus groups with healthcare professionals and healthcare professionals in training) in combination with theories of social cognition and persuasion to develop four posters. Process evaluation included campaign evaluation by healthcare professionals using questionnaires (open and closed ended questions). Appropriate modifications to the posters were made following the process evaluation, and two posters were chosen as the final intervention. Outcome evaluation of the campaign was conducted by using a brief, four-item evaluation questionnaire completed by healthcare professionals (General Practitioners and nurses). Results from all phases indicated that the use of posters as the medium of the anorexia Study three included development of a comprehensive audio-visual intervention to increase nursing students’ self-effcacy regarding initial management of patients with anorexia nervosa. The intervention was developed and underpinned using the Transtheoretical Model Framework (Levesque et al., 2001), and then evaluated using a pre-post-test design. The intervention was successful in significantly increasing nursing students’ self-efficacy regarding the initial management of anorexia nervosa. Furthermore, the nursing students’ self-efficacy was high prior to the intervention, indicating that nursing students already feel confident to manage patients with the disorder. The methodological and theoretical implications are discussed. nervosa awareness campaign did not sufficiently raise awareness of anorexia nervosa, and therefore the limitations of the second study were considered.
    Date of AwardMay 2016
    Original languageEnglish
    SupervisorBev John (Supervisor) & Sue Faulkner (Supervisor)


    • Wales
    • Treatment
    • Eating disorders
    • Anorexia Nervosa

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