Implementing Canadian practice guidelines for children and adolescents with eating disorders: a qualitative study on barriers, facilitating factors and implementation strategies

Abstract

Abstract Background In Canada, access to timely, evidence-based care for eating disorders is limited, with long wait times and fragmented services. Clinical practice guidelines can improve consistency and quality of care, but successful implementation remains limited. Canadian practice guidelines and a virtual care addendum have been developed for the treatment of youth with eating disorders (EDs). This study aims to qualitatively seek perspectives on the barriers, facilitating factors and implementation strategies from various interested parties. Methods One semi-structured qualitative focus group was conducted in each of nine Canadian provinces. Focus groups consisted of a combination of clinicians, administrators, and individuals with lived experience who elaborated upon barriers and facilitating factors to guideline uptake as well as possible strategies to enhance implementation. Focus group transcripts were analyzed using conventional content analysis. Results Findings suggested that participants found it difficult to implement guideline recommendations due to a myriad of factors such as a lack of external resources and minimal training in guideline recommended therapies. Facilitating factors of uptake included support from leadership and explicit training on guideline therapies. Potential implementation strategies included the creation of adapted versions for families and healthcare professionals, as well as enhanced education materials. Conclusions The findings of this study indicate areas within healthcare provision that can be enhanced and expanded upon to further enhance the uptake of the Canadian practice guidelines for children and adolescents with eating disorders.

Plain English summary In Canada, many young people with eating disorders face long wait times and uneven access to appropriate care. Although national treatment guidelines have been developed to improve care, these guidelines are often not commonly used in practice. This study explored how these guidelines could be better implemented across the country. Researchers held one focus group discussion in each of nine provinces with clinicians, healthcare administrators, and people with lived experience of eating disorders. Participants shared what makes it difficult or easier to use the guidelines in real-world settings, as well as ideas for improving their use. Participants reported several barriers, including limited resources, long waitlists, and a lack of training in guideline-recommended treatments. Factors that helped implementation included strong support from organizational leadership and eating disorder training. Participants also suggested that the guidelines could be more widely used if they were adapted for different audiences, such as families and various healthcare professionals, and supported by clearer educational materials. Overall, the study highlights practical ways the Canadian eating disorder guidelines could be better supported and more effectively used to improve care for young people.