South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia.
J Clin Nurs. 2023 Oct;32(19-20):7543-7559. doi: 10.1111/jocn.16841. Epub 2023 Aug 15.
To explore perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty.
A nested qualitative study within a multi-centre, quasi-experimental pilot study comparing usual care weight management to a dietitian-led weight-loss diet.
Semi-structured individual interviews were conducted with adults with end-stage osteoarthritis and a body mass index ≥30 kg/m waitlisted for primary total knee or hip arthroplasty. Participants with diverse sociodemographic characteristics and varied success with weight management in the pilot study were purposively sampled. Interviews were analysed using inductive thematic analysis, underpinned by constructivist-interpretivist epistemology. The Patient Activation Measure and Health Literacy Questionnaire were used for context when interpreting the findings.
Twenty-five participant interviews were conducted with a sociodemographically varied sample (aged 44-80 years, 9 born in Australia, 6 in paid employment and 11 lost ≥5% of their baseline weight). Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Adaptability, the ability to overcome barriers to weight loss, comprised three subthemes; readiness to act, degree of independence and problem-solving skills. Approaches towards navigating healthcare influenced uptake and adherence to weight management recommendations. Importantly, these themes were dependent on social and environmental circumstances, which influenced the type of barriers experienced and resources available to the individual.
Differences in a person's beliefs, their ability to adapt and navigate healthcare and sociocultural context appear to explain successful weight management among people with end-stage arthritis.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Clinicians should allow for individualisation cognisant of the identified themes when providing advice and treatment to promote adherence to weight management interventions.
This study explored perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Understanding and assessing the contribution of each factor may guide weight management from clinicians treating patients with obesity and osteoarthritis.
The data are reported using the COREQ guidelines.
Patients contributed to the data collected.
探讨肥胖症患者在等待全膝关节或全髋关节置换术期间对体重管理的认知障碍和促进因素。
在一项比较常规护理体重管理与营养师指导的减肥饮食的多中心准实验性先导研究中嵌套的定性研究。
对等待接受初次全膝关节或全髋关节置换术的终末期骨关节炎和身体质量指数（BMI）≥30kg/m²的成年人进行半结构式个体访谈。根据在先导研究中体重管理的不同社会人口统计学特征和不同结果，采用目的性抽样选择参与者。采用基于建构主义-解释主义认识论的归纳主题分析方法对访谈进行分析。在解释研究结果时使用患者激活度量和健康素养问卷。
对来自不同社会人口统计学背景的样本（年龄 44-80 岁，9 人出生于澳大利亚，6 人有薪就业，11 人减轻了≥5%的基线体重）进行了 25 次参与者访谈。四个确定的主题为成功的体重管理提供了依据：信念、适应能力、应对医疗保健和社会文化背景。对体重是否被视为问题、减肥的预期以及与治疗相关的信念等方面的信念影响了参与者对减肥的看法。适应能力包括克服减肥障碍的能力，由三个子主题组成：准备采取行动、独立程度和解决问题的能力。应对医疗保健的方法影响了体重管理建议的采纳和坚持。重要的是，这些主题取决于社会和环境情况，这影响了个人所经历的障碍类型和可获得的资源。
个人信念、适应能力和应对医疗保健和社会文化背景的能力的差异似乎解释了终末期关节炎患者的体重管理成功。
对专业人员和/或患者护理的影响：临床医生在提供建议和治疗时，应考虑到所确定的主题，以实现个体化，从而促进对体重管理干预措施的依从性。
本研究探讨了肥胖症患者在等待全膝关节或全髋关节置换术期间对体重管理的认知障碍和促进因素。四个确定的主题为成功的体重管理提供了依据：信念、适应能力、应对医疗保健和社会文化背景。对体重是否被视为问题、减肥的预期以及与治疗相关的信念等方面的信念影响了参与者对减肥的看法。理解和评估每个因素的贡献可能会为治疗肥胖和骨关节炎患者的临床医生提供体重管理指导。
数据按照 COREQ 指南进行报告。
患者为数据收集做出了贡献。
