Date of Award

Spring 5-18-2023

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Deborah A. DeLuca, MS, JD

Committee Member

Terrence F. Cahill, EdD

Committee Member

Genevieve Pinto Zipp, EdD

Committee Member

James Greenblatt, MD

Keywords

Binge eating disorder, Behavioral Factors Influencing Assessment of Binge Eating Disorder survey, healthcare providers, integrated behavioral model

Abstract

Background and Purpose of the Study. Binge eating disorder (BED) is the most prevalent eating disorder in adolescents and adults, both nationally and internationally. It is highly comorbid with other psychiatric conditions and obesity. Lifetime prevalence rates for the general population in the United States range between 0.4–2.0% for males and 1.3–3.5% for females, respectively. BED prevalence rates are higher in the obese population at 4.5% and up to 27% in obese adults seeking treatment. Despite its prevalence, only 11% of adolescents and 44% of adults with lifetime BED in the United States receive treatment. As general healthcare providers are usually the first point of contact for patients, it is important that they play a greater role in the assessment and diagnosis of BED.

This study had three purposes: to create a novel survey instrument to examine the behavioral factors that influence whether healthcare providers assess for BED, to validate the instrument, and to test the reliability of that instrument in the population of interest. The survey that was created—the Behavioral Factors Influencing Assessment of Binge Eating Disorder (BFIA-BED) survey—was created based on the eight constructs of the integrated behavioral model. The survey has 51 items, and participants completed it online using SurveyMonkey.

Methods. The validity and reliability of the BFIA‑BED were established using the Delphi technique, Cronbach’s alpha, and exploratory factor analysis. Participants were solicited through Facebook, email, and postings on national eating disorder websites. The results were analyzed using Hotelling’s T2multivariate analysis of variance, follow‑up univariate t‑tests, the Mann‑Whitney U test, and the inductive approach to create themes for the qualitative data. The study used a correlational research design that is descriptive, non-experimental, exploratory, and cross-sectional. A sample of 267 general and psychiatric healthcare providers participated in the study.

Results. Reliability for the BFIA‑BED representing all eight dependent variables was excellent (Cronbach’s alpha α = .901). Individually, for each factor of the BFIA‑BED, reliability ranged from unacceptable to excellent: saliency of the behavior (α = .407), personal agency (α = .411), perceived norm (α = .548), environmental constraints (α = .643), attitude (α = .764), knowledge and skills (α = .872), habit (α = .908), and intention (α = .920). Psychiatric healthcare providers scored higher for each variable. Results of Hotelling’s T2 indicated a statistically significant (psaliency of the behavior (p = .068).

Conclusion. The results indicate 1) that there is a difference between general and psychiatric healthcare providers in the behavioral factors that influence whether they assess for BED, and 2) that more focus is needed on educating general healthcare providers about BED. It is recommended that general healthcare providers receive formal education to recognize the signs and symptoms of BED and its comorbidities.

Keywords: Binge eating disorder, Behavioral Factors Influencing Assessment of Binge Eating Disorder survey, healthcare providers, integrated behavioral model

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