“We might be making mistakes, but we’re learning, we’re trying, and we’re listening”: embedding qualitative methods within the plan-do-study-act cycle to support the development of a pilot multidisciplinary ARFID pathway

BACKGROUND: Avoidant restrictive food intake disorder (ARFID) was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 and current guidelines recommend multidisciplinary care, however there are few evaluations of such pathways. This study aims to enhance the study stage of the plan-do-study-act (PDSA) cycle using qualitative methods to improve the development, refinement, and implementation of a novel pilot ARFID pathway in a community eating disorder service. METHODS: Semi-structured interviews were conducted with 17 participants with experience of the pathway (7 service users:10 staff members) according to an interview schedule. Reflexive, codebook thematic analysis was used to analyse the interview data. RESULTS: Gaps in understanding and treating ARFID were revealed, leading to feelings of uncertainty and frustration. The establishment of a specialist multidisciplinary team (MDT) improved knowledge and efficiency but created challenges related to team integration and resource allocation. Barriers for service user engagement and communication demonstrated the need for service user consultation and pathway co-creation. CONCLUSIONS: Service user consultation, treatment adaptations for neurodiversity and cross-service working were identified to improve the pathway as part of the act stage of the PDSA cycle. Future ARFID pathways should prioritise service user agency and access to multidisciplinary care and incorporate consultation from external eating disorder service, as well as lived experience experts.