OPEN

Qualitative Approach and Methods

Aim of the qualitative component

To explore the acceptability and meaning of olanzapine treatment for young people with anorexia nervosa and their families, and to examine clinician perspectives and service-level factors influencing trial recruitment and implementation.

Qualitative methodology

A qualitative interview study embedded within a feasibility-trial framework to inform intervention and trial optimisation.  Interviews were conducted and analysed by lived experience research assistants who drew on survivor research methodology.

Which qualitative methods were used?

• Individual interviews with young people participating in or declining the feasibility trial and parents or carers.
• Individual interviews with clinicians involved in recruitment and prescribing.

Sampling & recruitment

Participants were purposively sampled across participating NHS eating-disorder services to capture variation in age, treatment setting, participation decisions, and professional roles.

Data analysis: how the team made sense of the data

Reflexive thematic analysis led by lived experience research assistants who drew on survivor research methodology.

Findings, Learning & Impact

Summary of main findings

Qualitative findings highlighted the importance of trust in clinical relationships, concerns about medication effects, and family involvement in treatment decision-making for young people considering olanzapine. Clinician interviews identified organisational pressures, prescribing practices, and service-level constraints as key influences on recruitment and implementation.

Why were qualitative methods used in this project, and what did they enable?

Qualitative research enabled the study to:

• Understand treatment decision-making among young people and families.
• Identify acceptability factors influencing medication uptake.
• Examine service-level barriers to recruitment and implementation.
• Inform optimisation of trial design and recruitment procedures.

Lessons learnt / reflections?

• Recruitment to pharmacological trials in eating-disorder populations is strongly shaped by treatment beliefs, family dynamics, and service context.
• Embedding qualitative research within feasibility trials strengthens interpretation of quantitative recruitment and acceptability outcomes.

Impact & influence

The integrated qualitative programme provides critical feasibility and implementation evidence informing the design of a future definitive trial evaluating pharmacological adjuncts for anorexia nervosa, and contributes to methodological learning on embedding qualitative research within feasibility trials of complex mental health interventions.

Links, Outputs & Resources

Links to publications

• Said, O., Sengun Filiz, E., Stringer, D., Applewhite, B., Kellermann, V., Mutwalli, H., Bektas, S., Akkese, M. N., Kumar, A., Carter, B., Simic, M., Sually, D., Bentley, J., Young, A. H., Madden, S., Byford, S., Landau, S., Lawrence, V., Treasure, J., … Himmerich, H. (2024). Olanzapine for young PEople with aNorexia nervosa (OPEN): A protocol for an open-label feasibility study. European Eating Disorders Review, 32(3), 532–546. Available here.
• Olive, R. R., Kellermann, V., Said, O., Filiz, E. S., Treasure, J., Schmidt, U., Bentley, J., Khor, J. W. T., Simic, M., Nicholls, D., Himmerich, H., & Lawrence, V. (2025). What does taking olanzapine mean to young people with anorexia nervosa and their families? Findings from the OPEN feasibility trial. Journal of Eating Disorders, 13(1), 228. Available here.
• Kellermann, V., Sengun Filiz, E., Said, O., Bentley, J., Khor, J. W. T., Simic, M., Nicholls, D., Treasure, J., Schmidt, U., Himmerich, H., & Lawrence, V. (2024). A feasibility trial of olanzapine for young people with Anorexia Nervosa (OPEN): Clinicians’ perspectives. Journal of Eating Disorders, 12(1), 146. A feasibility trial of olanzapine for young people with Anorexia Nervosa (OPEN): clinicians' perspectives