Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Clin Nurs. 2019 Apr;28(7-8):1156-1163. doi: 10.1111/jocn.14719. Epub 2018 Dec 10.
To examine perceived social and environmental barriers and facilitators for healthy eating and activity before and after knee replacement.
Many patients undergoing knee replacement surgery are overweight or obese. While obesity treatment guidelines encourage diet and activity modifications, gaps exist in understanding social and environmental determinants of these behaviours for knee replacement patients. Identifying these determinants is critical for treatment, as they are likely amplified due to patients' mobility limitations, the nature of surgery and reliance on others during recovery.
This qualitative study used semi-structured interviews.
Twenty patients (M = 64.7 ± 9.8 years, 45% female, 90% Caucasian, body mass index 30.8 ± 5.5 kg/m ) who were scheduled for or had recently undergone knee replacement were interviewed. Participants were asked to identify social and environmental factors that made it easier or harder to engage in healthy eating or physical activity. Deidentified transcripts were analysed via constant comparative analysis to identify barriers and facilitators to healthy eating and activity. This paper was written in accordance with COnsolidated criteria for REporting Qualitative research standards.
Identified social and environmental healthy eating barriers included availability of unhealthy food and attending social gatherings; facilitators included availability of healthy food, keeping unhealthy options "out of sight," and social support. Weather was the primary activity barrier, while facilitators included access to physical activity opportunities and social support.
Results provide salient factors for consideration by clinicians and behavioural programmes targeting diet, activity, and weight management, and patient variables to consider when tailoring interventions.
Practitioners treating knee replacement patients would be aided by an understanding of patients' perceived social and environmental factors that impede or facilitate surgical progress. Particularly for those directly interacting with patients, like nurses, physiotherapists, or other professionals, support from health professionals appears to be a strong facilitator of adherence to diet and increased activity.
在膝关节置换前后，检查患者对健康饮食和活动的感知社会和环境障碍及促进因素。
许多接受膝关节置换手术的患者超重或肥胖。尽管肥胖治疗指南鼓励饮食和活动的改变，但对于膝关节置换患者这些行为的社会和环境决定因素仍存在认识差距。确定这些决定因素对于治疗至关重要，因为由于患者的行动能力受限、手术性质以及在康复期间依赖他人，这些因素可能会放大。
这项定性研究使用了半结构化访谈。
共对 20 名患者（平均年龄 64.7±9.8 岁，45%为女性，90%为白种人，体重指数 30.8±5.5kg/m2）进行了访谈，这些患者计划接受或刚刚接受了膝关节置换手术。参与者被要求识别出更容易或更难进行健康饮食或体育活动的社会和环境因素。对匿名转录本进行了持续比较分析，以确定健康饮食和活动的障碍和促进因素。本文的撰写符合凝聚性报告定性研究标准。
确定的健康饮食社会和环境障碍包括不健康食物的可及性和参加社交聚会；促进因素包括健康食物的可及性、将不健康的选择“藏起来”，以及社会支持。天气是主要的活动障碍，而促进因素包括获得体育活动机会和社会支持。
研究结果为临床医生和针对饮食、活动和体重管理的行为计划提供了重要因素，并且为患者变量提供了考虑因素，以便在定制干预措施时进行调整。
了解患者对阻碍或促进手术进展的感知社会和环境因素，将有助于治疗膝关节置换患者的从业者。特别是对于那些与患者直接互动的人，如护士、物理治疗师或其他专业人员，来自健康专业人员的支持似乎是促进患者坚持饮食和增加活动的有力促进因素。
