MUMMIEBODIES Eating Disorders, Pregnancy and Postpartum. A Qualitative Study of Women With Eating Disorders in Pregnancy and Post Partum Period.

The epistemological approach is empirical realism (not constructivist) where the investigators assume that experiences are real and that the informants is an expert on her own experience. The strategy is to utilize the informant's experience as a source of knowledge. The point of view is the informants's, where the investigators try to formulate, categorize, characterize and analyze dimensions in eating problems in the face of pregnancy and childbirth as the informants sees it.

There are three reasons for this choice: (1) The woman's experience is an underused source of knowledge in this area. (2) Therapeutic and indicated preventive measures are dependent on an alliance with the woman. Alliance formation is normally based on the woman's experience. (3) The woman's subjective presentation of the course may deviate from what an external observer would have reported. The measures the women themselves launch may run counter to what research and experienced clinicians recommend. But objective measures that neglect the user's own experience are unlikely to have a particularly lasting effect.

The issues require two qualitative research designs. For the first problem, the investigators will use the method Grounded Theory (25, 26) because the purpose is to model processes. Grounded Theory is a method for developing concepts and theoretical understandings that are rooted in data through theoretical sampling, identification of similarities and differences between categories, open coding and focused coding. The aim is to construct a theoretical model for characteristic processes, anchored in empirical data from informants in the study. For the other two issues, the method Interpretative Phenomenological Analysis (IPA) will be used. IPA is a qualitative research method that is particularly suitable for psychological topics (27). The aim of IPA is to analyze and systematize the informants' experience and understanding of a phenomenon. Through this method, overall meaningful themes can be identified. At the same time, one can bring out nuances and variation in the material and look for any dimensions in the experiences.

Informants. The investigators will use a heterogeneous sample. This has several causes. We currently know too little scientific to identify one scientifically and clinically interesting homogeneous group. Our clinical experience indicates that there can be great variation between different women in this life situation. In this round, the investigators seek to identify different experiences one may have. Varied diagnoses have been chosen because the investigators want to describe different courses, because these diagnoses are often unstable, and because the investigators want to identify possible measures with different experiences and courses. Such diversity has great clinical relevance and has not been previously described scientifically. In practice, it facilitates the recruitment of informants. A disadvantage of using a heterogeneous sample is that each individual informant becomes relatively important. This is a small problem as long as the purpose is to identify different experiences. The limitation lies in the cases where a supposedly important experience is described in only one or very few informants and at the same time there is basically little depth and nuance in the descriptions. This is compensated to some extent by very high demands on the quality of the way the investigators interview the informants. The investigators define the group of informants in pregnancy and follow longitudinally with two measurement times: in pregnancy and after birth.

The number of informants for problem 1 will be determined on the basis of a saturation criterion where we include informants until after at least ten interviews, three subsequent interviews follow which do not add anything significantly new to the answer to the problems (30). Based on previous experience with similar surveys, the number of informants for each issue is expected to be somewhere around 20 informants, ie about 40 informants. From these, a strategic choice will be made on issues 2 and 3. Strategic choice can mean looking for differences in order to obtain different prototype experiences. Recruitment of informants will take place continuously from the start of the project via a network.The project period has been extended to four years to get a sufficient number of informants.