Background: Throughout the COVID-19 pandemic, there was a detrimental impact to the symptoms and treatment of eating disorders, causing an increase in medical admissions and visits. Day treatment programs (DTPs), often used to bridge the gap between inpatient and outpatient treatment, were converted to online formats. This study aims to explore the impact of the transition to virtual DTPs on eating disorder treatment from the perspective of adolescents, their caregivers, and program staff.
Methods: Twelve participants (3 adolescents, 4 caregivers, 5 healthcare providers) in a virtual day treatment program were interviewed using a semi-structured interview guide. Interviews were transcribed and managed with qualitative software NVivo 11.0. Conventional analysis was used to inductively identify pertinent themes related to patient, caregiver, and healthcare staff perceptions and experiences of the virtual day treatment. Summative content analysis provided counts of the barriers and benefits of virtual day treatment as identified by participants.
Results: The majority of participants (10/12) had exposure to both virtual and in person settings, most participants (11/12) felt in-person day programs would be superior to virtual programs. Common limitations of the virtual format were feelings of isolation, less support from healthcare providers, parental burnout, and increased disordered eating. Common benefits were increased accessibility, parental involvement, improved communication with healthcare staff, and the ability for participants to be in their home environment and eat home food. Suggestions for improvement included designing a hybrid model of day treatment, increased family involvement, extending the day program to include dinners with family, and screening for patient appropriateness for the virtual setting.
Conclusion: This qualitative study suggests that there are many barriers to effective implementation of virtual day programs. However, the virtual DTP program offers increased accessibility to patients during a period of a health pandemic and to patients in rural/remote areas with limited treatment options. Suggestions provided by participants in this study, such as increased family involvement, frequency of in person check-ins and increased number of meals supported by the program, may help to improve outcomes in virtual day treatment programs.
Keywords: Adolescent; Eating disorder; Qualitative; Virtual day treatment.
Eating disorders are serious psychiatric conditions that are detrimental to many adolescents and their families. The COVID-19 pandemic exacerbated the impact of eating disorders on adolescents due to social isolation, and increased levels of anxiety and depression. In addition, many of the treatment programs were converted to an online format. Day treatment programs, which normally involve patients spending the day at the hospital and returning home for the evening with their families, were converted to an online format. Although there is a lot of evidence supporting in-person day programs, there is limited research on the perspectives of various stakeholders on virtual programs. The goal of this study was to interview adolescents, caregivers and healthcare staff that had participated in a virtual day treatment program during the pandemic to understand their perspective on the pros and cons of the program. The results of this study and interviewee recommendations for program improvement are especially important to help patients who cannot access in-person care during health pandemics, those in rural and remote communities, and to provide support to those awaiting in-person care.
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