حرکت از اثربخشی به کارایی در پیشگیری از اختلالات تغذیه ای : برنامه تصویری بدن
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|31314||2008||10 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Cognitive and Behavioral Practice, Volume 15, Issue 1, February 2008, Pages 18–27
Although eating disorders prevention research has begun to produce programs with demonstrated efficacy, many such programs simply target individuals as opposed to engaging broader social systems (e.g., schools, sororities, athletic teams) as participant collaborators in eating disorders prevention. Yet, social systems ultimately will be responsible for the real-world delivery of eating disorder prevention programs, suggesting that an important issue has yet to be addressed. Namely, it is unclear to what degree efficacious individual-focused eating disorder prevention programs remain effective when incorporated into critical social systems under real-world conditions. Over the past 5 years, we have collaborated with the campus sororities in the development of a sustainable eating disorders prevention program that is based on the prevention efficacy literature. This paper describes both challenges and helpful strategies that we encountered in tailoring an evidence-based eating disorders prevention program to the needs of a relevant social system.
Significant progress has been achieved in the treatment of eating disorders (Wilson, 2005). Despite this, many individuals with eating pathology do not pursue treatment (Becker et al., 2004 and Meyer, 2005), and others fail to respond even when offered empirically supported treatment such as cognitive behavioral therapy for bulimia nervosa (Wilson, 2005). Moreover, efficacious therapies are still needed for both anorexia nervosa and atypical eating disorders (Wilson, 2005 and Wilson and Shafran, 2005). Both the difficulties encountered in treating eating disorders and the substantial medical and psychological complications associated with them (Wilson, Becker, & Heffernan, 2002) have led clinicians and researchers to conclude that prevention of eating disorders is an important goal (Mizes & Bonifazi, 2001). Achievement of this goal, however, has proven somewhat elusive. Numerous papers document the progression of eating disorder prevention efforts (e.g., see Stice & Shaw, 2004, for a meta-analytic review). Although early prevention programs produced improvement in knowledge, such programs typically resulted in limited behavior change (see Pearson, Goldklang, & Striegel–Moore, 2002, for discussion). Recent efforts, however, have produced more impressive findings that extend beyond posttreatment and into follow-up periods (e.g., Franko et al., 2005, McVey et al., 2003, Neumark–Sztainer et al., 1995 and Taylor et al., 2006), indicating that the prevention of eating disorders may be viable. For instance, we now have prevention interventions with sufficient empirical support to meet the American Psychological Association criteria (APA, 1995) for an efficacious intervention (e.g., cognitive dissonance eating disorders prevention, see below). To be considered efficacious according to the APA criteria, a program must produce significantly greater effects than a no-treatment control condition, and this finding must be replicated by an independent researcher. In addition, the program needs to produce superior results compared to a placebo intervention or an alternate efficacious intervention. The development of eating disorder prevention programs with established efficacy is a critical step for the field of eating disorders prevention. Large-scale prevention of eating disorders, however, will require programs that not only produce positive results in highly controlled environments (i.e., efficacy trials) but also in more real-world settings that are less controlled (i.e., effectiveness trials). More specifically, if efficacious eating disorder prevention programs are to be widely utilized, implementation of such programs ultimately will need to be both financially supported and managed by relevant social systems (e.g., schools). In this paper, the term social system refers to structured organizations that endure over time even though the specific individuals who run and participate in the system may change. Social systems may play an important role in the prevention of eating disorders because they often have the organizational, motivational, and, in some cases, financial resources to support sustainable eating disorder prevention programs. Social systems, however, are unlikely to adopt responsibility for administering researcher-developed, efficacious prevention programs unless they can tailor the interventions to fit the unique structure of their social system. Thus, the challenge is to determine whether efficacious programs remain effective when such programs are repeatedly modified in new settings to meet the individualized needs of specific social systems. Assessing the effectiveness of empirically supported prevention programs that have been tailored for specific social systems poses several challenges. Such systems may have unique norms and priorities, and often are suspicious of people outside the system (Kramer, 1998). In addition, many of the priorities of social systems (e.g., mandatory participation, low desire for random assignment, need to accommodate other scheduling demands and priorities of the system) diverge from the needs of empirical methodology (e.g., voluntary participation, random assignment, multiple controls, etc.). Finally, many relevant eating disorder prevention social systems (e.g., sororities, athletic departments) have minimal experience with psychological interventions and may have limited access to natural providers with clinical skills. Thus, various types of nonclinical providers (e.g., teachers, peers) may need to be trained to implement interventions that were originally developed by and for clinicians. Over the past 5 years, we have conducted a series of eating disorder prevention studies in partnership with the campus sororities. In these studies, we sought to determine if we could (a) tailor an eating disorders prevention program with significant empirical support to meet the needs of an existing social system under naturalistic conditions while (b) retaining its effectiveness. Regarding the naturalistic conditions that we faced, these studies were not grant funded, were conducted with only the limited resources available at a small university, and were staffed by one faculty member (C.B.) and undergraduate research assistants (RAs). In addition to these resource challenges, we also faced other typical challenges associated with naturalistic conditions. For example, we had to modify the number of sessions, change the providers from doctoral level to undergraduate, and we eventually had to separate the “program” from the “study” because the sororities wanted “their program” implemented in a manner that was incompatible with ethical research. More specifically, the sororities decided to implement the program on a semimandatory basis, and it is unethical to mandate research participation. This paper describes our experiences developing a sustainable eating disorders prevention program that was based on the efficacy literature. We first discuss why we believe that sororities are an example of an important social system to recruit as a collaborator in eating disorders prevention. Next, we provide a brief overview of the research supporting the cognitive dissonance eating disorder prevention intervention that we use in our program, along with a description of the individual sessions. We then offer an overview of the history of the Sorority Body Image Program (SBIP), including specific implementation strategies. The remainder of the paper describes some challenges that we encountered and strategies that we used to address these problems.
نتیجه گیری انگلیسی
Levine and Smolak (2006) recently laid out five guiding principles for eating disorders prevention. Among these, they note that prevention requires a collaborative approach and that prevention must move beyond an individual focus. The SBIP represents one attempt to translate an empirically supported individual-focused prevention intervention into a sustainable, collaborative program aimed at an entire social system. More specifically, it demonstrates one way in which the literature can be used to both engage social systems in the prevention of eating disorders and to help those same systems implement effective prevention programs. This latter point is critical given that eating disorders prevention efforts have historically produced a number of ineffective programs. Thus, it is important to develop models for both implementing efficacious programs and testing such programs when they are modified to meet the needs of relevant social systems. Although the challenges of assessing the effectiveness of modified programs can be viewed as a burden, in our experience complete integration of science and practice can help sustain programs for the long term in resource-limited situations.