Maghsoodlo Maryam, Shakibazadeh Elham, Yaseri Mehdi, Mokhtari Zeinab, Barzin Maryam, Salimi Yahya
Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
PLoS One. 2025 Apr 9;20(4):e0314316. doi: 10.1371/journal.pone.0314316. eCollection 2025.
Bariatric surgery is effective in treating severe obesity. However, surgery alone, without additional behavior change management, may not lead to optimal long-term weight loss and maintenance. This study aimed to evaluate an intervention designed based on the Health Action Process Approach to improve outcomes of obesity surgery in patients who underwent bariatric surgery in Tehran, Iran.
In this randomized controlled trial, a total of 100 patients who had undergone bariatric surgery after the past year were randomly assigned to two intervention (n = 50) and control (n = 50) groups. The intervention group received educational intervention for two months. Health action process approach (HAPA) constructs, the Bariatric Surgery Self-Management Behaviors Questionnaire (BSSQ), dietary recall, blood chemistry parameters, BMI, percentage of body weight loss, and the International Physical Activity Questionnaire (IPAC) were measured at baseline and four months after the intervention. To compare the changes between the two groups before and four months after the educational intervention, the interaction of group and time was analyzed using the generalized estimating equation (GEE). A p-value of less than 0.05 was considered statistically significant.
The educational intervention resulted in improvements in various aspects of self-efficacy, including task and coping self-efficacy constructs (P = 0.02), action planning (P < 0.01) and behavioral intention (P < 0.01) related to diet self-management. There were also statistically significant improvements in action planning (P = 0.02), risk perception (P = 0.01) and Recovery self- efficacy (P = 0.01) related to the self-management of physical activity. There were significant improvements in the iron blood test results (P = 0.01) among the patients.
Our intervention, designed based on the Health Action Process Approach, led to improvements in dietary and physical activity outcomes among patients who underwent bariatric surgery. Trial Registration: Iran Randomized Clinical Trials IRCT20230722058887N1.
减肥手术在治疗重度肥胖方面有效。然而，仅进行手术，若没有额外的行为改变管理，可能无法实现最佳的长期体重减轻和维持。本研究旨在评估一种基于健康行动过程方法设计的干预措施，以改善在伊朗德黑兰接受减肥手术患者的肥胖手术结局。
在这项随机对照试验中，共有100名在过去一年接受过减肥手术的患者被随机分为两个干预组（n = 50）和对照组（n = 50）。干预组接受了为期两个月的教育干预。在基线和干预后四个月测量健康行动过程方法（HAPA）构建、减肥手术自我管理行为问卷（BSSQ）、饮食回忆、血液化学参数、BMI、体重减轻百分比和国际体力活动问卷（IPAC）。为了比较教育干预前后两组之间的变化，使用广义估计方程（GEE）分析组和时间的交互作用。p值小于0.05被认为具有统计学意义。
教育干预导致自我效能感的各个方面得到改善，包括与饮食自我管理相关的任务和应对自我效能构建（P = 0.02）、行动规划（P < 0.01）和行为意向（P < 0.01）。与体力活动自我管理相关的行动规划（P = 0.02）、风险感知（P = 0.01）和恢复自我效能（P = 0.01）也有统计学上的显著改善。患者的铁血液检测结果有显著改善（P = 0.01）。
我们基于健康行动过程方法设计的干预措施，使接受减肥手术的患者在饮食和体力活动结局方面得到改善。试验注册：伊朗随机临床试验IRCT20230722058887N1。
