School of Public Health, University of Texas Health Science Center at Houston, Dallas, TX, USA.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Obes Surg. 2020 Jun;30(6):2233-2242. doi: 10.1007/s11695-020-04454-y.
Metabolic and bariatric surgery (MBS) is currently the only clinically proven method of weight loss that is effective in treating severe obesity and its related comorbidities. However, only about 36% of MBS-eligible patients complete MBS. This qualitative study used the psychosocial framework to identify barriers and facilitators to MBS utilization among patients who had been referred to, or were considering MBS, but had not completed it.
A combination of focus groups and in-depth interviews were utilized (Spring 2019) among ethnically diverse patients (N = 29, 82% female, 62% non-Hispanic Black, 10% Hispanic) who were considering MBS. All data was audio recorded, transcribed, and coded. Interview questions were grouped by the four psychosocial model domains (intrapersonal, interpersonal, organization/clinical interaction, societal/environmental) within the context of why patients would/would not follow through with MBS. The analysis included a combination of deductive and inductive approaches to generate the final codebook. Then, each code was input into Dedoose to identify overarching themes and sub-themes.
A total of 9 themes and 17 subthemes were found. Two major intrapersonal themes and four subthemes were identified as facilitators to MBS utilization and included a desire for improvement in existing comorbidities, mobility, and anticipated changes in physical appearance. Primary barriers to MBS completion included concerns about potential change in dietary behaviors post-MBS and safety of procedure.
Providing educational materials to address MBS common fears and misconceptions may increase utilization rates. Providing community-based pre- and post-support groups for this patient population may also increase MBS completion rates.
代谢与减重手术（MBS）是目前唯一被临床证实的有效减重方法，可治疗严重肥胖及其相关合并症。然而，仅有约 36%的 MBS 适应证患者完成了 MBS。本定性研究采用心理社会框架，旨在确定已被转介或正在考虑 MBS 但尚未完成 MBS 的患者在利用 MBS 时的障碍和促进因素。
在 2019 年春季，我们对考虑接受 MBS 的不同种族患者（N=29，82%为女性，62%为非西班牙裔黑人，10%为西班牙裔）进行了焦点小组和深入访谈。所有数据均进行了音频记录、转录和编码。访谈问题按心理社会模型的四个领域（个体内、人际间、组织/临床互动、社会/环境）分组，内容为患者是否会继续接受 MBS 及其原因。分析包括演绎和归纳方法的结合，以生成最终的代码本。然后，将每个代码输入到 Dedoose 中，以确定总体主题和子主题。
共发现 9 个主题和 17 个子主题。两个主要的个体内主题和四个子主题被确定为 MBS 利用的促进因素，包括改善现有合并症、移动能力和预期的身体外观变化的愿望。MBS 完成的主要障碍包括对 MBS 后饮食行为潜在变化和手术安全性的担忧。
提供针对 MBS 常见恐惧和误解的教育材料可能会提高利用率。为这一患者群体提供基于社区的术前和术后支持小组也可能会提高 MBS 的完成率。
