PETALS

Qualitative Approach and Methods

Aim of the qualitative component

The whole project was qualitative with sub-studies taking different approaches to investigating the overall study aims. The overall aim of the project was to improve understanding of the experience of treatment and recovery in eating disorders from the perspectives of people with lived experience of these, and to explore qualitative digital diaries as a research method to support centring of participant perspectives in eating disorder research.

Qualitative methodology

Different studies within the project used different approaches, with approaches including reflexive thematic analysis, narrative analysis, and narrative synthesis.

Which qualitative methods were used?

Focus groups, qualitative diaries, digital diary methods, app-based data collection.

Findings, Learning & Impact

Summary of main findings

Exploring the use of qualitative digital diaries began with a scoping review of current use of qualitative diary methods in mental health research. This resulted in a checklist of recommendations for research and reporting of qualitative diary methods, aimed at promoting and supporting rigorous use of this method in future research.

Patient experiences of treatment for anorexia nervosa were then explored using a qualitative digital diary approach. Participants kept weekly diaries detailing their experiences of treatment a diary app, over a period of six months. Participants’ data was analysed using narrative analysis, to support an in-depth understanding of each individual’s experience and journey through treatment. The findings across participants highlighted a sense of not knowing how to recover, alongside feeling that treatment teams did not know how to meaningfully support them to recover.

Experiences of recovery from eating disorders were explored using an intensive two-week diary period, in which participants who were recovered from an eating disorder recorded their experiences using a diary app. This study found that participants were managing eating disorder thoughts, struggling with the impact of life stressors and other mental health difficulties, on a daily basis even long into recovery.

Finally, to understand participants’ experiences and preferences for this type of research, interviews and focus groups were conducted with qualitative digital diary study participants. The findings developed six core participant values that qualitative digital diary research must aim to include: self-expression, flexibility, non-judgement, open communication, helpful reflection, and meaningful impact. Meeting these values will support participants to take part in this type of research in ways meaningful to them, and which provide richly detailed, relevant, and timely research data.

Overall, the thesis findings revealed anorexia is enmeshed with identity in different ways at different stages across treatment and recovery. The qualitative digital diary methods enabled new perspectives to be gained on several key issues in eating disorder understanding, including identity, iatrogenic effects of treatment, and impacts of comorbidities. The findings have important implications for research and treatment, and contribute vital understanding of how anorexia is experienced that can support clinicians and researchers to reflect on their approach to treating and collaborating with people with anorexia.

Links, Outputs & Resources

Links to publications

• Vinchenzo, C., Lawrence, V., & McCombie, C. (2022). Patient perspectives on premature termination of eating disorder treatment: A systematic review and qualitative synthesis. Journal of Eating Disorders, 10(1), 39. Available here.
• McCombie, C., Ouzzane, H., Schmidt, U., & Lawrence, V. (2024). ‘Physically it was fine, I’d eat what normal people do. But it’s never like this in my head’: A qualitative diary study of daily experiences of life in recovery from an eating disorder. European Eating Disorders Review, 32(1), 46–55. Available here.
• McCombie, C., Esponda, G. M., Schmidt, U., & Lawrence, V. (2024). Qualitative diary methods in mental health research: A scoping review and recommendations for research and reporting. European Psychologist, 29(1), 3–16. Available here.
• McCombie, C., Miguel Esponda, G., Ouazzane, H., Knowles, G., Gayer-Anderson, C., Schmidt, U., & Lawrence, V. (2024). Qualitative Digital Diary Methods: Participant-Led Values for Ethical and Insightful Mental Health Research. International Journal of Qualitative Methods, 23, 16094069241296189. Available here.
• Article in preparation: “My soul feels crushed to pieces”: A narrative diary study of treatment experiences in anorexia nervosa McCombie, C., Schmidt, U. & Lawrence, V.