Subscribe to RSS
DOI: 10.1055/s-0043-117878
Implementation evidenzbasierter Präventionsprogramme für Essstörungen: PriMa und Torera im Schulalltag
Implementation of Evidence-Based Prevention Programs for Eating Disorders: PriMa and Torera in Daily School LifePublication History
eingereicht 27 June 2017
akzeptiert 18 July 2017
Publication Date:
28 September 2017 (online)
![](https://www.thieme-connect.de/media/ppmp/201808/lookinside/thumbnails/0918_10-1055-s-0043-117878-1.jpg)
Zusammenfassung
Hintergrund Obwohl eine Reihe effektiver Präventionsstrategien für Essstörungen existieren, bleiben die Prävalenzzahlen konstant. Es ist somit von einer Lücke zwischen Forschung und Praxis auszugehen, die sich darin äußert, dass wissenschaftliche Erkenntnisse nicht in vollem Umfang zur Versorgung von Risikogruppen genutzt werden. Die schulbasierten Programme PriMa und Torera zur Primärprävention von Essstörungen werden seit 2004 an Thüringer Schulen durchgeführt. Eine aktuelle Befragung gibt Auskunft über Barrieren und Chancen für eine langfristige Implementation in den Schulalltag.
Fragestellung und Methode Unter Verwendung des „Consolidated Framework for Implementation Research“ werden Faktoren diskutiert, die Einfluss auf den Implementationsprozess nehmen.
Ergebnisse Besonders hinderlich für eine langfristige Implementation erscheinen fehlende feste Rahmenbedingungen für die Präventionsdurchführung, Mitarbeiterfluktuation und mangelnde finanzielle Unterstützung durch politische Entscheidungsträger. Lösungsansätze umfassen die Schaffung zeitlicher Möglichkeiten im Lehrplan, den Einsatz von Präventionsverantwortlichen sowie die stärkere Vernetzung aller Präventionsbeteiligter mit regelmäßigen Weiterbildungen.
Diskussion Gemäß den Richtlinien der Society for Prevention Research, bildet die Diskussion implementationsrelevanter Faktoren den letzten Bestandteil einer umfassenden Programmevaluation. Sie verdeutlicht die Schwierigkeiten der Integration evidenzbasierter, praxisbewährter Präventionsprogramme in den Schulalltag. Damit stellt sich nicht zuletzt die Frage, wie viele Ressourcen noch in die Entwicklung von Präventionsprogrammen investiert werden sollen, bevor Strukturen geschaffen werden, die eine langfristige Durchführung ermöglichen, um bedeutsamen Einfluss auf die Zielgruppen zu nehmen.
Abstract
Background Prevalence rates for eating disorders remained stable over the years despite the implementation of numerous prevention strategies. This may be due to discrepancies between research and practice and scientific findings are not fully applied to the care of risk groups. The school-based programs PriMa and Torera for primary prevention of eating disorders have been delivered in Thuringian schools since 2004. A current survey provides information on barriers and facilitators for a long-term implementation in the school routine.
Objectives and Methods Using the “Consolidated Framework for Implementation Research”, factors which impact the implementation process are discussed.
Results Impeding factors for a long-term implementation are missing framework conditions, staff turnover and a lack of financial support from politicians. Possible solutions could be the establishment of extra time in the curriculum, the employment of individuals responsible for prevention and a close network between all people involved.
Conclusion According to the Society for Prevention Research, discussing implementation factors builds the last part of comprehensive program evaluations. We illustrate the barriers for the integration of evidence-based prevention programs in daily school life. It is important to implement new structures prior to the implementation of resource-intensive new prevention programs in order to increase the effectiveness of said programs and enable long-term implementation.
-
Literatur
- 1 Klump KL, Bulik CM, Kaye WH. et al. Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 2009; 42: 97-103
- 2 Smink FRE, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012; 14: 406-414
- 3 Jacobi F, Höfler M, Strehle J. et al. Psychische Störungen in der Allgemeinbevölkerung: Studie zur Gesundheit Erwachsener in Deutschland und ihr Zusatzmodul Psychische Gesundheit (DEGS1-MH). Nervenarzt 2014; 85: 77-87
- 4 Nagl M, Jacobi C, Paul M. et al. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry 2016; 25: 903-918
- 5 Swanson SA, Crow SJ, Le Grange D. et al. Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry 2011; 68: 714-723
- 6 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet 2010; 375: 583-593
- 7 Stice E, Marti CN, Rohde P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 2013; 122: 445-457
- 8 Herpertz-Dahlmann B, Wille N, Holling H. et al. Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: results of the BELLA study. Eur Child Adolesc Psychiatry 2008; 17 (Suppl. 01) 82-91
- 9 Halmi KA. The multimodal treatment of eating disorders. World Psychiatry 2005; 4: 69-73
- 10 Hart LM, Granillo MT, Jorm AF. et al. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psychol Rev 2011; 31: 727-735
- 11 Stuhldreher N, Konnopka A, Wild B. et al. Cost-of-illness studies and cost-effectiveness analyses in eating disorders: A systematic review. Int J Eat Disord 2012; 45: 476-491
- 12 Noordenbos G. How to block the ways to eating disorders. Eat Disord 2016; 24: 47-53
- 13 Ciao AC, Loth K, Neumark-Sztainer D. Preventing eating disorder pathology: common and unique features of successful eating disorders prevention programs. Curr Psychiatry Rep 2014; 16: 453
- 14 Stice E, Shaw H. Eating disorder prevention programs: a meta-analytic review. Psychol Bull 2004; 130: 206-227
- 15 Stice E, Shaw H, Marti CN. A meta-analytic review of eating disorder prevention programs: encouraging findings. Annu Rev Clin Psychol 2007; 3: 207-231
- 16 Yager Z, Diedrichs PC, Ricciardelli LA. et al. What works in secondary schools? A systematic review of classroom-based body image programs. Body image 2013; 10: 271-281
- 17 Pickhardt M, Richter F, Adametz L et al. Deutschsprachige Präventionsprogramme für Essstörungen - Ein systematisches Review. Psychother Psychosom Med Psycho (under review)
- 18 Gottfredson DC, Cook TD, Gardner FEM. et al. Standards of evidence for efficacy, effectiveness, and scale-up research in prevention science: next generation. Prev Sci 2015; 16: 893-926
- 19 Ogden T, Fixsen DL. Implementation science a brief overview and a look ahead. Z Psychol 2014; 222: 4-11
- 20 McLennan JD, MacMillan HL, Jamieson E. Canada’s programs to prevent mental health problems in children: the research-practice gap. Can Med Assoc J 2004; 171: 1069-1071
- 21 Storck C, Dupree T, Dokter A. et al. Zwischen Wunsch und Wirklichkeit: Die langfristige Umsetzung schulbasierter Präventionsprogramme in der Praxis am Beispiel Klasse2000. Prävention und Gesundheitsförderung 2007; 2: 19-25
- 22 Beelmann A, Karing C. Implementationsfaktoren und -prozesse in der Präventionsforschung: Strategien, Probleme, Ergebnisse, Perspektiven. Psychol Rundsch 2014; 65: 129-139
- 23 Damschroder LJ, Aron DC, Keith RE. et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009; 4: 50
- 24 Kirk MA, Kelley C, Yankey N. et al. A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci 2016; 11: 72
- 25 Shaw H, Stice E. The implementation of evidence-based eating disorder prevention programs. Eat Disord 2016; 24: 71-78
- 26 Berger U. Essstörungen wirkungsvoll vorbeugen: die Programme „PriMa“, „TOPP“ und „Torera“ zur Prävention von Magersucht, Bulimie, Fressanfällen und Adipositas. Stuttgart, Germany: Kohlhammer; 2008
- 27 Festinger L. A Theory of cognitive dissonance. Stanford, CA: Stanford University Press; 1957
- 28 Stice E, Trost A, Chase A. Healthy weight control and dissonance-based eating disorder prevention programs: Results from a controlled trial. Int J Eat Disord 2003; 33: 10-21
- 29 Berger U, Sowa M, Bormann B. et al. Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader dissemination. Eur Eat Disord Rev 2008; 16: 173-183
- 30 Wick K, Brix C, Bormann B. et al. Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls. Prev Med 2011; 52: 152-158
- 31 Berger U, Schaefer JM, Wick K. et al. Effectiveness of reducing the risk of eating-related problems using the german school-based intervention program, „Torera“, for preadolescent boys and girls. Prev Sci 2014; 15: 557-569
- 32 Adametz L, Richter F, Strauss B. et al. Long-term effectiveness of a school-based primary prevention program for anorexia nervosa: A 7-to 8-year follow-up. Eat Behav 2017; 25: 42-50
- 33 Berger U, Ziegler P, Strauß B. PriMa für Barbie: Formative Evaluation eines Programms zur Primärprävention von Magersucht bei Mädchen ab der sechsten Klasse. Z Psychosom Med Psychother 2008; 54: 32-45
- 34 Adametz L, Richter F, Preusser J et al. Implementation and dissemination of primary prevention programs for eating disorders in schools: a long-term qualitative analysis of barriers and facilitators. Mental Health and Prevention (in press) https://doi.org/10.1016/j.mhp.2017.08.004
- 35 Berger U, Joseph A, Sowa M. et al. The Barbie-Matrix: effectiveness of a school-based German program for the primary prevention of anorexia nervosa developed for girls up to the age of 12. Psychother Psychosom Med Psycho 2007; 57: 248-255
- 36 Franko DL. Rethinking prevention efforts in eating disorders. Cogn Behav Pract 2001; 8: 265-270
- 37 Moessner M, Özer F, Minarik C. et al. ProYouth - ein Online-Programm zur Prävention und frühen Intervention bei Essstörungen. PiD 2013; 14: 74-76
- 38 Jacobi C, Völker U, Trockel MT. et al. Effects of an Internet-based intervention for subthreshold eating disorders: A randomized controlled trial. Behav Res Ther 2012; 50: 93-99
- 39 Metz A, Albers B. What does it take? How federal initiatives can support the implementation of evidence-based programs to improve outcomes for adolescents. J Adolesc Health 2014; 54: S92-S96
- 40 Kultusministerkonferenz. Empfehlung zur Gesundheitsförderung und Prävention in der Schule. 2012; Im Internet http://www.kmk.org/fileadmin/veroeffentlichungen_beschluesse/2012/2012_11_15-Gesundheitsempfehlung.pdf [12.06.2017]
- 41 Kilpela LS, Hill K, Kelly MC. et al. Reducing eating disorder risk factors: A controlled investigation of a blended task-shifting/train-the-trainer approach to dissemination and implementation. Behav Res Ther 2014; 63: 70-82
- 42 Diedrichs PC, Atkinson MJ, Steer RJ. et al. Effectiveness of a brief school-based body image intervention ‚Dove Confident Me: Single Session‘ when delivered by teachers and researchers: Results from a cluster randomised controlled trial. Behav Res Ther 2015; 74: 94-104
- 43 Frantz I, Heinrichs N. Implementation von in der Forschung untersuchten Präventionsprogrammen in die Praxis. Z Klin Psychol Psychother 2015; 44: 56-61
- 44 Domitrovich CE, Bradshaw CP, Berg JK. et al. How do school-based prevention programs impact teachers? Findings from a randomized trial of an integrated classroom management and social-emotional program. Prev Sci 2016; 17: 325-337
- 45 Varnado-Sullivan PJ, Parr F, O’Grady MA. et al. Educators’ views of eating disorder prevention programs. Eat Weight Disord 2013; 18: 143-150
- 46 Bulik CM, Sullivan PF, Tozzi F. et al. Prevalence, heritability, and prospective risk factors for anorexia nervosa. JAMA Psychiatry 2006; 63: 305-312
- 47 Bauer S, Kindermann SS, Moessner M. Prävention von Essstörungen: Ein Überblick. Z Kinder Jugendpsychiatr Psychother 2016; 44: 1-9
- 48 Bertram RM, Blase KA, Fixsen DL. Improving programs and outcomes. Res Soc Work Pract 2015; 25: 477-487