Table 6.
Qualitative and mixed-methods studies
| References | Population focus | Focus | Key data collected | Sample n | Gender | Age | Ethnicity | Summary findings |
|---|---|---|---|---|---|---|---|---|
| Allison [202]* | NC | Feminist approach exploring issues related to young women’s body perception and eating behaviours | Thematic analysis of journal entries | 15 | F | 14–16 | 10 European, 1 Samoan, 1 South American, 1 Irish-English, 1 Chinese-European-Eurasian, 1 not stated | Identified Western cultural influences on eating behaviours and body image |
| Barry [202]* | NC | Issues with eating, weight, and body image in women with type 1 diabetes and health professionals | Semi-structured interviews | 17 (12 with type 1 diabetes, 5 health professionals) | F | 16–25 | Not stated | Different perceptions of health professionals versus young women with Type 1 diabetes. Eating and weight related disturbance (including insulin omission) reported |
| Batenburg [203]* | AN | Experiences and opinions of those who had experienced and recovered from anorexia nervosa | Semi-structured interviews | 8 | F | 17–27 | 5 NZ European, 1 Māori/European, 1 Indian, 1 Belarusian | Model of AN aetiology developed, based on categories of perceived causes of relapse |
| Bellingham [204]* | AN | Parental perspective on experiences of having a child with AN | Semi-structured interviews | 12 | 50% M, 50% F | Not stated | Not stated | Identified three stages from parental accounts, termed the insidious, tenacious, and recovery stages |
| Carne [205]* | NC (OPIC Project) | Included examination participants' attitude toward own weight | PedsQL, AQoL, semi-structured interviews | Quantitative: 4429, qualitative: 36 (drawn from quantitative sample) | Quantitative: 48% F, 52% M, qualitative: 50% M, 50% F | 13–18 |
Quantitative: 59% Pasifika, 20% Māori, 11% European, 10% Asian Qualitative: 33.3% Māori, 33.3% European, 33.3% Pasifika |
Lower physical QOL linked to higher weight status, high QOL for those who were obese (relative to previous findings), sociocultural factors protective against internalised stigma, friendships related to perception of own weight |
| Chisholm [206]* | NC | Examined relationship between dieting and factors within romantic relationships in a sample of heterosexual couples | PRQC, AAQ, RSES, BDI-21, WCBS, EDI-2, WMSI, weight-loss support helpfulness, BMI, body satisfaction (Likert scale) | 88 | 50% F, 50% M | F: M 29.43, (SD 11.87), M: M 31.61 (SD 11.87) | Not stated | More disordered eating attitudes where lower perceived partner support. Higher levels of unhealthy dieting with lower self-esteem (mediated by disordered eating attitudes). Partner support appears protective for those with low self-esteem |
| Conder [207]* | NC | Explored body image and how this was constructed among women with intellectual disabilities | Semi-structured qualitative interviews | 25 | F | 21–65 | 88% NZE, 8% Māori, 4% Pasifika | Themes identified were 'beauty and the body', 'a fit and functional body' and 'a gendered body' |
| Easter [208]* | NC | Problematic behaviours among elite athletes. Includes topic of disordered eating | Semi-structured qualitative interviews | 10 | 50% F, 50% M | Early 20s to late 40s | 80% European/Pakeha, 10% Māori, 10% Other European | A number of behaviours reported, including disordered eating. Potential influences on this behaviour included comments/criticism from others, unrealistic sociocultural standards, and media influence |
| Gunn [209]* | BN, AN, EDNOS, self-diagnosed | Experiences of mothers who became pregnant after having recovered from an eating disorder | Qualitative interviews |
10 women with past ED, 8 without |
F | 27–46 | European | Reported healthy pregnancies among recovered women, no difficulties with infant feeding, no tendency for undue anxiety about weight gain |
| Hall [210] | AN | Family factors and their association with AN | Interviews with parents of those with AN | 50 (AN) | F | Not stated | European | Possible aetiological factors included socioeconomic status, and family factors such as a parental history of psychiatric and medical illness |
| Hammond [211]* | NC, ED | Examined body image appraisals, self-esteem, body related esteem, weight locus of control, and figure ratings in groups of women: normal weight, overweight, had ED or were body builders. Qualitative study examined self-esteem and experience of teasing | RSES, BES, WLOCS, figure rating scale, silhouette rating scale, qualitative interviews | 122 | F | Normal weight: M 31.14 (SD 10.40), overweight: M 38.84 (SD 12.50), ED: M 27.48 (SD 10.23), body builders: M 28.81 (SD 6.31) | 89% European, 3% Maori, 4% Pasifika, 3% Other | Positive description for normal and muscular, but not thin or overweight body types. Difference between groups regarding ideal figures. Self-esteem and body esteem did not correlate for body builders. ED reported feeling bigger compared to what they thought. Similar ratings for figures seen as likely to be attractive for males |
| Jones [43]* | NC | Body image dissatisfaction in males involved in weight training, and potential influences and impacts on wellbeing | Semi-structured interviews | 12 | M | 18–29 | 83.33% NZ European, 8.33% NZE/Māori, 8.33% Cook Island/Māori/Tahitian/Scottish | Weight training exercise related to both positive and negative body image/evaluation, observed sociocultural influences on body image Behavioural indications that participants were downplaying impact of body image dissatisfaction |
| Kleinbichler [212]* | AN, NC | Elaborating on knowledge surrounding metacognitive processes in AN, compared with dieting and non-dieting women | BMI, DASS, EAT-26, PSWQ, PBRS, NBRS, RRQ, TCQ, MCQ-30, EDE-Q4 | 131 | F | Non-diet: M 21.38, diet: M 23.44 (SD 8.06), AN: M 24.0 (SD 6.00) | 70% NZ European, 3% Māori, 5% Chinese, 2% Indian, 11% other, 8% multi-ethnicity | Maladaptive cognitive styles among those with AN, compared with dieting and non-dieting women. Evidence supports presence of cognitive attentional syndrome in those with AN |
| McClintock [213]* | NC | Influences on body image dissatisfaction/disturbance, examined in three different ways | Focus group data | Study 1: 23, Study 2: 190, Study 3: 33 | F | 14–18 | Study 1: 73.9% Pakeha, 17.4% Māori, 8.7% other minority cultures. Study 2: 74% Pakeha, 14.5% Māori, 2, 3% Pasifika, 6.9% Asian, 1.2% South African, 1.2% other minority. Study 72.7% Pakeha, 15.2% Māori, 3% Pasifika | Identified important role of social evaluation for influencing body image and unhealthy dieting behaviour, and interrelationships between sociocultural and interpersonal influences |
| Poulter [214] | NC | Explore perspectives of female undergraduate students with positive body image | Body image questions, BAS, BESAA, SATAQ, focus group | n = 139 for screening. N = 19 for focus analysis | F | 18–30 | Predominantly European | Themes included body positivity with age, mindfully engaging with media content, functional conceptualisation of the body, and role of religious and cultural identities. Women with positive body image utilise a body-protective filter, favouring body-positive information from environment |
| Schofield [215]* | NC | Low energy availability and associated factors (e.g. body image, nutrition) in athletes | Qualitative data, physiological data, food record |
Study 1: 15, Study 2: 11 |
Study 1 67% F, 33% M, Study 2: 64% F, 36% M | 22.8 ± 3.8 | European | Highlighted complex nature of LEA, risk impacted by sociocultural environment and type of sport |
| Snell [216] | Clinicians | Investigating the nurse experience in an ED inpatient service | Interview | 7 | Not stated | 30–50 | Not stated | Nurses have crucial role in ED unit with unique challenges, and therapeutic relationship with these professionals can help engage clients in treatment/recovery. At times felt that this important role was invisible |
| Stiles [217]* | BN, AN | Assessing which eating behaviours were perceived as being normal by clinicians, dieticians, and healthy women | EDE-Q, ONE, eating behaviour, ratings of eating behaviours shown in video (Likert scales), eating style questions, qualitative interview | 67 | F | 18–60 | Not stated | Key theme was flexibility (e.g. not having strict rules). Themes also eating in response to physiological hunger, meeting nutritional needs, eating in socially acceptable manner, eating for pleasure, and regular eating) |
| Surgenor [218] | AN | Identify how patients view their AN with respect to self | Semi-structured interview | 5 | F | 17–late 20s | Not stated | Patient's 'selves' have strategically different implications for therapeutic interventions. Individual therapy could be improved by establishing an authentic basis |
| Surgenor [219] | AN | Can treatment drop-out for AN be predicted from routine admission data collection? | BDI, EAT-26, EDI-2, RSES | 213 (treatment episodes) | F | Drop out: M 22.3, regular discharge: M 21.2 | Not stated | Lower BMI, AN purging subtype, and active fluid restriction make significant independent contributions to drop-out risk |
| Stanley [220]* | BN, AN | Risk and protective factors for those who were identified as being at-risk of negative life outcomes, and who had originally been interviewed as 12 years prior (when they were aged 11–12 years) | Semi-structured interview | 9 (1 AN and BN history) | 33.3% F, 66.6% M | 21–22 | 56% Māori, 33% Pasifika, 11% Pakeha | Identified protective factors for AN participant included intrapersonal ability (e.g. self-awareness) and external supports (e.g. family). Risk factors were self-identified aberrant cognitions, physical health, adoption, and secondary schooling |
| Swain-Campbell [221] | BN, AN, 'other EDs' | Satisfaction with specialist eating disorders services | Custom questionnaire (structured and open-ended questions) | 120 | 4% M | M 27 | 94% European | Overall high approval, but negative commentary on some aspects of treatment (e.g. being weighed, gaining weight, stopping purging as compensatory strategy) |
| Teevale [222]* | NC (OPIC) | Views about eating, physical activity, and body image in Pasifika Island adolescents and parents |
Study 1 Questionnaire Study 2 Qualitative individual interviews |
Study 14,215 Study 2 68 | Study 1 52% F, 48% M Study 2 68% F, 32% M (qualitative) | Study 1 12–20 Study 2 13–17 (qualitative) | Study 1 55.4% Pasifika, 20.2% Māori, 12.3% Asian, 12.1% European, Study 2: Pasifika | Socio-environmental influences (e.g. occupational type, health education) more relevant to health behaviours than socio-cultural factors. Qualitative study: Beliefs about eating, physical activity, and body image similar between obese and healthy-weight Pasifika participants |
| Thabrew [223] | AN | Exploring inpatient AN treatment experience | Semi-structured interview | 9 | F | 15–17 |
7 NZ European 2 Asian |
Themes identified included admission benefits (safe space, support from staff), stress (e.g. being re-fed, being away from supports and regular life), control/power (e.g. compulsory treatment), being heard, and comparison with others in treatment |
| Tozzi [224] | AN (Sullivan et al. [84] sample) | Subjective accounts of causes of AN and recovery | DIGS, open ended questions | 69 | F | M 32.3 (SD 7.8) | 98.6% European | Family dysfunction most commonly cited as causal, in addition to dieting/weight loss and stress. Factors contributing to recovery included relationships and maturation |
| Watterson [225]* | BN, AN, BED (COSTS) | Mixed methods study of factors associated with ED maintenance and recovery, and perceptions of what contributed to successful treatment and recovery | Qualitative interview, online survey based on existing surveys by BEAT charity and Butterfly Foundation | 358 (quantitative), 18 of whom also participated in qualitative interviews | F | 28.2 (SD 12.2) | 88.7% NZ European, 6% Māori, 1.1% Pasifika, 13.2% other (includes Chinese, European, Australian, Middle Eastern, and Indian) | Multiple causal factors endorsed across EDs, most frequent were low self-esteem, perfectionism and difficulty managing negative emotions. Need for control was higher for those with AN |
| Waugh [25] | BN, AN | Comparing children of those with current or past AN or BN on factors such as eating behaviours, health, development, and psychometric variables | EDI, Toddler Temperament Scale, maternal report and interviews, food diaries, videoed mealtimes | 20 mothers (10 cases, 10 NC controls) | F (Children: 5 M and 5 F per group) |
Cases M 30.1 (SD 3.1), NC M 30.8 (SD 3.6). Children 12–48 months |
Not stated | Difficulties in children of the ED group include low birth weight, difficulties with breast feeding, and non-interactive mealtimes |
| Webb [226]* | AN | Features of AN as indicated by those with current or past AN | Interviews available notes and documents | 7 | F | 18–35 | Not stated | Identifies issues relating to control/ self-concept, continued concerns around food/exercise, reluctance to develop sexual relationships, and concerns around relationships with others |
NC non-clinical, PedsQL Pediatric Quality of Life Inventory, AQoL Assessment of Quality of Life, PRQC Perceived Relationship Quality Components, AAQ Acceptance and Action Questionnaire, RSES Rosenberg Self-Esteem Scale, BDI Beck Depression Inventory, WCBS Weight Control Behaviours Scale, BMI body mass index, BES Binge Eating Scale, WLOCS Weight Locus of Control Scale, DASS Depression Anxiety and Stress Scale, EAT Eating Attitudes Test, PSWQ Penn State Worry Questionnaire, PBRS Positive Beliefs about Rumination Scale, NBRS Negative Beliefs about Rumination Scale, RRQ Rumination and Reflection Questionnaire, TCQ Thought Control Questionnaire, MCQ-30 Metacognitive Questionnaire 30, EDE Eating Disorder Examination, BAS Body Appreciation Scale, BESAA Body Esteem Scale for Adolescents and Adults, SATAQ Sociocultural Attitudes Towards Appearance Questionnaire, ONE Opinions on Normalised Eating, DIGS Diagnostic Interview for Genetic Studies, EDI Eating Disorders Inventory
*Identifies that the record is a thesis