scholarly journals “We Need to Be Told What to Do and What to Eat”: A Qualitative Study Exploring Perioperative Patient Desires, Suggestions and Reflections on Using Digital Health Technology Before and After Bariatric Surgery. 

2020 ◽  
Author(s):  
Anna Robinson ◽  
Andy K Husband ◽  
Robert D Slight ◽  
Sarah P Slight
Keyword(s):  
Bariatric Surgery ◽  
Digital Health ◽  
Digital Technologies ◽  
Lifestyle Changes ◽  
Activity Levels ◽  
Structured Interviews ◽  
Lifestyle Behaviour ◽  
Innovative Strategy ◽  
Before And After ◽  
Surgical Pathway

Abstract BackgroundA patient’s capability, motivation, and opportunity to change their lifestyle are significant determinants of successful outcomes following bariatric surgery. Healthier lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been shown to contribute to greater post-surgical weight loss and improved long-term health. Integrating patient-centred digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviours and provide holistic patient support, to improve surgical success. This study explores the desires, suggestions, and reflections of perioperative patients in the context of integrating digital technologies within the surgical pathway. MethodsPatients attending bariatric surgery clinics within one hospital in the North of England were invited to take part in the study. Semi-structured interviews were conducted with pre- and post-operative patients to discuss lifestyle behaviour change and perspectives of using digital technologies to complement current care. Interviews were audio-recorded and transcribed verbatim. Thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the NHS Health Research Authority.ResultsEighteen patients were interviewed. Four overarching themes were identified relating to patient perspectives of optimised technology functionality to: 1) provide tailored content and support, 2) facilitate self-monitoring and goal-setting, 3) deliver information in an accessible, trusted, and usable manner, and 4) meet patient information-seeking and engagement needs. ConclusionsWe make recommendations to address the unmet needs of this patient cohort. These findings have the potential to influence the design of person-centred, perioperative technologies.

Designing digital health technology to support patients before and after bariatric surgery: a qualitative study exploring patient desires, suggestions and reflections to support lifestyle behaviour change. (Preprint)

2021 ◽  
Author(s):  
Anna Robinson ◽  
Andy Husband ◽  
Robert Slight ◽  
Sarah Slight
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Behaviour Change ◽  
Digital Technologies ◽  
Lifestyle Changes ◽  
Lifestyle Behaviour ◽  
Surgical Success ◽  
Before And After ◽  
Surgical Pathway

BACKGROUND A patient’s capability, motivation, and opportunity to change their lifestyle are significant determinants of successful outcomes following bariatric surgery. Healthier lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been shown to contribute to greater post-surgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviours and provide holistic patient support, to improve surgical success. Research has focused on implementing digital technologies and measuring their effectiveness in various surgical cohorts, yet there is limited work concerning the desires, suggestions and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patient perspectives on technology features that would support them to change their lifestyle behaviours during the pre- and post-operative periods, to potentially maintain long-term healthy lifestyles following surgery. OBJECTIVE To understand how digital technologies could be used to better support patients across the perioperative pathway to improve weight-loss outcomes and surgical success. Specifically, the objectives concerned: 1) what do patients want from digital technologies, 2) how do they want to use them, and 3) when would they be of most benefit during their surgical journey? METHODS Patients attending bariatric surgery clinics within one hospital in the North of England were invited to take part. Semi-structured interviews were conducted with purposively sampled pre- and post-operative bariatric surgical patients to discuss lifestyle behaviour change and the use of digital technologies to complement their care. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the NHS Health Research Authority. RESULTS Twenty patients were interviewed. Four overarching themes were developed from the data relating to perspectives of optimised technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal-setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs. Interventions that supported the delivery of personalized feedback and post-operative follow-up were perceived as beneficial. Individualized goal- and target-setting could further support a generation of digitally engaged patients with bariatric conditions. Working towards achievable targets was deemed an effective strategy to successfully motivate behaviour change. The creation of digital ‘package of care’ checklists between patients and clinicians was a novel finding from this research. CONCLUSIONS Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made that relate to the design, content and functionality of digital interventions to best address the needs of this patient cohort. These findings have the potential to influence future co-design and integration of person-centered, perioperative technologies within surgical pathways. CLINICALTRIAL N/A

scholarly journals A qualitative study exploring patient suggestions for the design, functionality and implementation of digital health technologies before and after bariatric surgery

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i6-i7
Author(s):  
A Robinson ◽  
A K Husband ◽  
R D Slight ◽  
S P Slight
Keyword(s):  
Bariatric Surgery ◽  
Health Behaviour ◽  
Participatory Design ◽  
Digital Health ◽  
Digital Technologies ◽  
Structured Interviews ◽  
Health Technologies ◽  
Patient Cohort ◽  
Gastric Bypass Procedure ◽  
Behaviour Changes

Abstract Introduction Health behaviour changes made during the pre-operative period can positively impact on post-operative outcomes and the success of bariatric surgery.(1) Digital technologies present an opportunity to support patients with this. Currently, little is known about the optimal design or delivery of digital technologies for this patient cohort. In order to develop useful and effective digital strategies for this unique patient cohort, it is important to first understand how bariatric surgery patients want to be supported.(2) Aim To understand how digital technologies could be designed and delivered to better support patients with surgical health behaviour changes, specifically: 1) what do patients want from technologies, 2) how do they want to use them, and 3) when should they be implemented? Methods According to the EQUATOR guidelines, the consolidated criteria for reporting qualitative research (COREQ) checklist was followed. Pre- and post-operative patients attending bariatric surgery clinics within one large teaching hospital in the North of England were invited to take part. Purposive sampling was employed to recruit a representative sample of patients. Participants received an information sheet detailing the study purpose and aims. Written informed consent was obtained before conducting semi-structured interviews. Semi-structured interviews took place between February-March 2020 and were audio-recorded and transcribed verbatim. Interviews included questions on participant surgical experience, health behaviour change and perspectives on digital technologies. A reflexive thematic analysis approach enabled the development of themes from the data. NVivo 12 software assisted data organisation. Results Eighteen patients were recruited and interviewed. The average age of participants was 46-years. 55% (n=10) of participants had or were undergoing a gastric bypass procedure. The data analysis enabled the development of four themes which highlighted specific participant desires relating to the design, functionality and implementation of optimal digital technologies to best support them during the pre- and post-operative periods. Specifically, the themes related to an intervention’s ability to: 1) provide structured content and support, 2) facilitate self-monitoring and goal-setting, 3) deliver information in an accessible, trusted and usable manner, and 4) meet patient information-seeking and engagement needs (Figure 1). “In the first couple of weeks (following surgery), we need to be told what to do by the technology” Participant 9. Conclusion This patient-informed research highlighted how interventions could be designed, what functionality would be most useful and when they should be implemented within the NHS pathway for bariatric surgical patients. This study is one of the first in this patient cohort to involve pre- and post-operative participants and provides key insights to fill knowledge gaps relating to the design and optimisation of person-centred digital interventions. We acknowledge some limitations with our work. Whilst we did not sample participants by socioeconomic status, it is possible that different socioeconomic classes may have varied experiences with technologies. Our focus was solely bariatric surgery and thus findings may not be generalisable to other elective surgical procedures. These findings have the potential to shape and influence future work on the co-design and optimisation of person-centred digital health technologies in modern healthcare settings. References 1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology. 2009;28(6):690. 2. Donetto S, Pierri P, Tsianakas V, Robert G. Experience-based Co-design and Healthcare Improvement: Realizing Participatory Design in the Public Sector. The Design Journal. 2015;18(2):227–48.

scholarly journals Nutritional Management in Bariatric Surgery Patients

2021 ◽  
Vol 18 (22) ◽  
pp. 12049
Author(s):  
Andrea Deledda ◽  
Stefano Pintus ◽  
Andrea Loviselli ◽  
Michele Fosci ◽  
Giovanni Fantola ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Life Expectancy ◽  
Diabetes Remission ◽  
Lifestyle Changes ◽  
Nutritional Deficiencies ◽  
Obesity Epidemic ◽  
Sustained Weight Loss ◽  
Before And After ◽  
Reduce Life Expectancy

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

scholarly journals “Food Meant Everything to Me, Now Food Is Something I Eat:” Managing Emotions, Perceptions, and Awareness of Food and Eating After Bariatric Surgery

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1356-1356
Author(s):  
Deema Ujayli ◽  
Isabella Quadrini ◽  
Amanda Lynch
Keyword(s):  
Bariatric Surgery ◽  
Emotional Eating ◽  
Beaumont Hospital ◽  
Food Choices ◽  
Theory Approach ◽  
Structured Interviews ◽  
Cognitive Changes ◽  
Funding Sources ◽  
Post Surgery ◽  
Before And After

Abstract Objectives This study explores the cognitive changes made by bariatric surgery patients, focusing on their perceptions of food, the role of food in their lives, and what drives them to make their food choices. Comparing pre-surgery and post-surgery experiences provides insight into the dietary changes that occur as a result of bariatric surgery. Methods Thirty bariatric surgery patients (24 women, 6 men) completed dietary and behavior questionnaires and participated in semi-structured interviews pre-surgery, and at 6 and 12 months post-surgery. Interview questions covered participants’ weight histories, dietary behaviors, perceptions of food, and surgery experiences. Verbatim interview transcripts were coded and analyzed using a constructivist, grounded theory approach. Emergent themes were compared across time points and within each time point to identify patterns of change and common experiences. Results Relationship to food emerged as a multidimensional phenomenon that included emotional eating, beliefs about the function of food and nutrients, and positive or negative perceptions of food. The majority of participants reported emotional eating before surgery. Post-surgery, half of the participants no longer struggled with emotional eating. The four most common emotions that led to eating were stress, depression, boredom, and happiness. The primary theme relating to the function of food was a shift from “living to eat” to “eating to live.” With this shift came an increased awareness and appreciation of food, nutrients, and health. Participants’ perceptions of food and eating were either positive, encompassing feelings of enjoyment, happiness, and/or appreciation, or negative, expressed by feelings of frustration, anxiety, and fear. Perceptions of food were influenced by pre-surgery relationship to food, dieting history, and current contexts. Conclusions Bariatric surgery patients have strong and multifaceted connections to food before and after surgery. Relationship to food impacts food choices as well as the mental effort and energy put forth in making dietary decisions. Understanding these relationships may be an important aspect of post-surgical counseling, particularly for patients experiencing less than ideal weight loss outcomes. Funding Sources Oakland University and William Beaumont Hospital.

Impact of Fear of Falling for Patients and Caregivers: Perceptions Before and After Participation in Vestibular and Balance Rehabilitation Therapy

2014 ◽  
Vol 23 (1) ◽  
pp. 20-33 ◽  
Author(s):  
Julie A. Honaker ◽  
Laura W. Kretschmer
Keyword(s):  
Family Caregivers ◽  
Fear Of Falling ◽  
Rehabilitation Program ◽  
Lifestyle Changes ◽  
Activity Levels ◽  
Balance Confidence ◽  
Before And After ◽  
Falling Risk ◽  
Balance Rehabilitation ◽  
The Impact

PurposeThe purpose of this study was to investigate the impact of fear of falling (FoF) on older patients with dizziness history and their caregivers to better determine holistic needs when developing a patient-family centered approach to falling risk reduction.MethodA mixed-method design was used, incorporating a phenomenological qualitative approach to explore the impact of FoF in 14 patients and a family member or spouse of each patient. Quantitative analysis was used to further interpret results of interviews conducted before and after participation in a vestibular and balance rehabilitation program designed to reduce falling risk and improve balance confidence.ResultsQualitative analysis of participant interviews pre and post vestibular rehabilitation revealed lifestyle changes for both participants and family caregivers due to FoF and the need for reducing falling concerns. Patient age showed statistically significant differences in levels of balance confidence, with younger participants (≤ 65 years) showing more concerns about the consequences of falling, even after rehabilitation, than older participants (> 65 years).ConclusionThe study highlights the impact of FoF on participation and activity levels of patients and family caregivers, as well as the need to thoroughly evaluate falling fears to achieve a holistic rehabilitation outcome.

scholarly journals COVID-19-Related Lifestyle Changes among Community-Dwelling Older Adult Day-Care Users: A Qualitative Study

2021 ◽  
Vol 19 (1) ◽  
pp. 256
Author(s):  
Akira Teramura ◽  
Yumi Kimura ◽  
Kosuke Hamada ◽  
Yasuko Ishimoto ◽  
Masato Kawamori
Keyword(s):  
Older Adults ◽  
Day Care ◽  
Leisure Activities ◽  
Lifestyle Changes ◽  
Community Dwelling ◽  
Structured Interviews ◽  
Care Needs ◽  
Care Services ◽  
Before And After ◽  
Socially Isolated

In Japan, the community-based comprehensive care system is an important initiative. The purpose of this study was to understand COVID-19-related lifestyle changes experienced by older adults who lived in communities and used day-care services. Using a qualitative inductive research method, semi-structured interviews were conducted with 13 older adults who used day-care services in Kyoto City, which assessed lifestyle changes before and after the spread of COVID-19 during March–April 2021. The extracted lifestyle change codes were classified into six categories and 16 subcategories. The data revealed that older adults felt socially isolated and experienced multiple changes in their lives, including limited leisure activities, changes in roles, decreased interpersonal interaction with family and acquaintances, poor diet and sleep quality, and reduced attention to personal appearance and grooming. The findings suggest that during COVID-19, older adults had difficulty adapting to the various changes in their lives and showed a decline in physical and mental functioning. Thus, it is important for day-care facilities to create sustainable spaces in response to the various care needs of community-dwelling older adults whose lifestyles have changed as a result of the COVID-19 situation.

scholarly journals Using the concept of hubots to understand the work entailed in using digital technologies in healthcare

2017 ◽  
Vol 31 (5) ◽  
pp. 556-566 ◽  
Author(s):  
Catherine Pope ◽  
Joanne Turnbull
Keyword(s):  
Health Care ◽  
Digital Health ◽  
Digital Technologies ◽  
Urgent Care ◽  
Structured Interviews ◽  
Content Type ◽  
Mixed Methods Case Study ◽  
Care Services ◽  
Ethnographic Studies ◽  
Care Technology

Purpose The purpose of this paper is to explore the human work entailed in the deployment of digital health care technology. It draws on imagined configurations of computers and machines in fiction and social science to think about the relationship between technology and people, and why this makes implementation of digital technology so difficult. The term hubots is employed as a metaphorical device to examine how machines and humans come together to do the work of healthcare. Design/methodology/approach This paper uses the fictional depiction of hubots to reconceptualise the deployment of a particular technology – a computer decision support system (CDSS) used in emergency and urgent care services. Data from two ethnographic studies are reanalysed to explore the deployment of digital technologies in health services. These studies used comparative mixed-methods case study approaches to examine the use of the CDSS in eight different English NHS settings. The data include approximately 900 hours of observation, with 64 semi-structured interviews, 47 focus groups, and surveys of some 700 staff in call centres and urgent care centres. The paper reanalyses these data, deductively, using the metaphor of the hubot as an analytical device. Findings This paper focuses on the interconnected but paradoxical features of both the fictional hubots and the CDSS. Health care call handling using a CDSS has created a new occupation, and enabled the substitution of some clinical labour. However, at the same time, the introduction of the technology has created additional work. There are more tasks, both physical and emotional, and more training activity is required. Thus, the labour has been intensified. Practical implications This paper implies that if we want to realise the promise of digital health care technologies, we need to understand that these technologies substitute for and intensify labour. Originality/value This is a novel analysis using a metaphor drawn from fiction. This allows the authors to recognise the human effort required to implement digital technologies.

POSTOPERATIVE COMPLIANCE OF BARIATRIC SURGERY PATIENTS REGARDING THE ASSESSMENT OF SERUM LEPTIN LEVELS AND INSULIN RESISTANCE

2019 ◽  
Vol 49 (1/2019) ◽  
Keyword(s):  
Insulin Resistance ◽  
Bariatric Surgery ◽  
Serum Levels ◽  
Medical Laboratory ◽  
Leptin Resistance ◽  
Obese Patients ◽  
Laboratory Assessment ◽  
Serum Leptin ◽  
Before And After ◽  
Bariatric Patients

Background and aims: Overweight and obese patients who undergo bariatric surgery require a rigorous clinical and paraclinical assessment both before and after the surgery at 3, 6, and 12 months.The present study aims the assessment of serum leptin levels and insulin resistance status in compliant bariatric patients to scheduled medical laboratory assessment at 6 months after surgery. Material and Method: The study included 109 eligible patients selected for bariatric surgery, 48 of whom attended the scheduled visit at 6 months after the surgery. Laboratory assessing regarded the insulin resistance by determining before meal the serum levels of leptin, glucose and insulin, as well as HOMA 1 and HOMA 2 indexes. Results: Patients who underwent bariatric treatment experienced a significant decrease in insulin resistance status. A higher percentage in the preoperative group was recorded in women, feature which was also recorded in the postoperative group that attended the scheduled visit at 6 months after surgery. Age is also an important factor that significantly influences the behavioral adherence to postoperative visits. Conclusions: Insulin resistance status improved significantly in 6 months after bariatric surgery among the fully compliant patients. The percentage of attendance at scheduled visits is higher among women, and decreases with age. Keywords: obesity surgery, leptin resistance, insulin resistance, HOMA index, compliance

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