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doi:10.1093/fampra/cmm029Family Practice Advance Access published on 24 June 2007
Feasibility and acceptability of screening for eating
disorders in primary care
Johnston O, Fornai G, Cabrini S and Kendrick T. Feasibility and acceptability of screening for
eating disorders in primary care. Family Practice 2007; 24: 511–517.
Background. Earlier diagnosis of disordered eating is linked to improved prognosis, but
detection in primary care is poor.
Objectives. To assess the feasibility of screening for disordered eating within primary care, in
terms of the proportion of patients accepting screening, yield of cases, action taken by staff and
staff views on screening.
Methods. Data were collected in open GP surgeries, midwife (MW) antenatal clinics and health
visitor (HV) child health surveillance clinics in two GP practices, using face-to-face surveys and
semi-structured interviews. Female patients aged 16–35 were asked to complete the SCOFF
questionnaire, which was scored by researchers and taken by the patient into their consultation.
If the result indicated possible disturbed eating, the health professional (HP) running the surgery/
clinic was asked to complete a questionnaire and interview. One hundred and eleven women
were screened and 11 HPs (GPs, MWs, HVs) were interviewed.
Results. Forty-six percent of patients agreed to be screened. Of these, 16% produced a positive
result. The staff survey suggested that HPs found screening acceptable. However, concerns
arose in the interviews, principally over what action to take in response to positive results. Pos-
itive results were rarely recorded in medical notes, and treatment was rarely offered.
Conclusion. In order for a screening programme for eating disorders to be implemented in
primary care, HP concerns about options for dealing with positive results would need to be ad-
dressed. Feasibility of screening would be enhanced by production of a protocol to be followed
in the case of positive results.
Keywords. Acceptability, attitudes, eating disorders, feasibility, screening.
Disordered eating is one of the three most common
mental health difficulties (along with depression and
anxiety disorders).1Eating disorders are particularly
common in young women, and are a significant cause of
morbidity and mortality.2,3Luck et al.4note that ‘health
care workers in primary care are at the forefront of
screening and managing these disorders’ (p. 755). Ear-
lier diagnosis of eating disorders is linked to improved
prognosis,5but detection of eating disorders in primary
care is poor.6The National Institute for Clinical Excel-
lence (NICE) guidelines on the management of eating
disorders7point to the need for improved identification
and screening of eating disorders in primary care set-
tings. A survey by the Eating Disorders Association8in-
dicated that 42% of GPs did not make an early
diagnosis, suggesting that services are failing to meet
the NICE7recommendation that ‘People with eating
disorders seeking help should be assessed and receive
treatment at the earliest opportunity’.
A number of factors are likely to contribute to these
low rates of detection. Patients may be slow to present,
or may not present to services at all. Individuals with
diagnoses of disordered eating are renowned for their
high levels of secrecy and denial, and are often reluctant
to disclose information.9Patients with bulimic symptoms
are oftenof normal weight or slightly overweight, causing
Received 29 September 2006; Revised 9 April 2007; Accepted 30 April 2007.
aOJ is now at the Department of Psychology, Institute of Psychiatry, King’s College London, PO78, Addiction Sciences Building,
4 Windsor Walk, London SE5 8AF, UK.bCommunity Clinical Sciences Division, School of Medicine, University of Southampton,
Aldermoor Health Centre, Aldermoor Close, Southampton, Hampshire SO16 5ST, UK. Correspondence to: Tony Kendrick, Com-
munity Clinical Sciences Division, School of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close,
Southampton, Hampshire SO16 5ST, UK; Email: email@example.com
by guest on June 1, 2013
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stream. Strategic Development of Mental Health Care for
Women. London: Department of Health, 2002.
7National Institute for Clinical Excellence. Eating Disorders: Core
Interventions in the Treatment and Management of Anorexia
Nervosa, Bulimia Nervosa and Related Eating disorders.
London: National Institute for Clinical Excellence, 2004
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Treatment for Eating Disorders in the UK Getting Better?.
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Appendix Topic guide for HP interviews
Responses to positive screening results in this study
During the course of this study, you have been asked
to fill in a staff survey form for any patient producing a
positive result on the SCOFF screening questionnaire.
I would like to start off by asking you a bit more about
your thoughts on these positive screening results. [Fol-
lowing questions repeated for each positive screening
result received by the HP]:
? When you were told about this result, what did it
mean to you?
? How did the screening result compare to your
own perception of whether or not the patient was
experiencing disordered eating?
? On the survey form you indicated [what you
planned to do in response to this positive screen-
ing result]. Can you tell me a bit about what influ-
enced that choice?
? Why did you decide not to ... [choose the other
options listed on the survey form, such as ...]?
? Probe around whatinfluencedany decisions or plans
about action before receiving screening result.
General responses to suspecting disordered eating
? In general, what influences how you will respond if
you suspect that a patient has disordered eating?
? What options do you feel are open to you if you
suspect that a patient has disordered eating?
? How do you feel about these options?
Views on screening in general
? Do you ever ask patients screening questions if
you suspect they have disturbed eating?
? If no: Can you tell me a bit about why you tend
not to do this?
? If yes: Can you tell me a bit about the circumstan-
ces in which you would ask these questions? What
sort of questions do you ask? How do you find
asking about this?
? How do you feel about the use of screening for
disturbed eating in primary care?
? How do you feel screening for disturbed eating
fits with your role as a GP/MW/HV?
? What do you think are the advantages and disad-
vantages of screening? If you envisage any prob-
lems with screening, how do you think these
could be overcome?
? What method of screening, if any, do you think
would be best (e.g. targeting specific groups/blan-
ket screening, screening in general waiting rooms
or in specific clinics, face to face or postal, oral or
written, different instrument/questions)? Can you
tell me a bit more about this?
accepting screening, producing positive results, etc)
? Now that you have heard about these results,
what do you think about the use of screening for
disturbed eating in primary care?
? Does this change any of your views? If so, how
have your views changed?
Screening for eating disorders
by guest on June 1, 2013