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 “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.

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 Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes

2019 ◽  
Vol 15 (6) ◽  
pp. 935-941 ◽  
Author(s):  
Jordana B. Cohen ◽  
Mary Ann Lim ◽  
Colleen M. Tewksbury ◽  
Samuel Torres-Landa ◽  
Jennifer Trofe-Clark ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Kidney Transplantation ◽  
Before And After

scholarly journals Behaviour change opportunities at mother and baby checks in primary care: a qualitative investigation of the experiences of GPs

2018 ◽  
Vol 68 (669) ◽  
pp. e252-e259 ◽  
Author(s):  
Hannah Talbot ◽  
Emily Strong ◽  
Sarah Peters ◽  
Debbie M Smith
Keyword(s):  
Behaviour Change ◽  
Postnatal Period ◽  
Lifestyle Changes ◽  
Lifestyle Behaviour ◽  
Telephone Interviews ◽  
Health Related ◽  
The Uk ◽  
Health Related Behaviour ◽  
Potential Opportunity

BackgroundPregnancy is widely recognised as a ‘teachable moment’ for healthy behaviour change and the postnatal period has been identified as the opportune time to initiate this change. In the UK, all women are offered a routine health check at 6–8 weeks postpartum with their GP. This provides a potential opportunity to facilitate long-term behaviour change discussions.AimTo explore GPs’ views and experiences of using the postnatal check as a health-related behaviour change opportunity.Design and settingA qualitative, inductive study in general practice.MethodSemi-structured telephone interviews were conducted with 18 GPs. Audiorecorded interviews were transcribed verbatim and analysed using thematic analysis.ResultsOne theme emerged from the data: the postnatal check is an unrealised opportunity to facilitate health-related behaviour change. This theme was organised into three subthemes: opportunity for health-related behaviour change; role responsibility; and patient-led versus GP-led behaviour change.ConclusionAlthough GPs recognise the postnatal check as a potential opportunity for health-related behaviour change, it is underutilised as they do not perceive this to be the purpose of the check and are uncertain as to their role in facilitating lifestyle changes. To enable this long-term lifestyle behaviour change opportunity to be utilised more fully, further research is needed to understand women’s expectations of the postnatal checks and the scope for further recommendations, guidance, and communication training around behaviour change.

scholarly journals Designing the optimal digital health intervention for orthopedic patients: a qualitative exploration of digital technology design and functionality for patient use before and after elective surgery. (Preprint)

2020 ◽  
Author(s):  
Anna Robinson ◽  
Robert D Slight ◽  
Andrew K Husband ◽  
Sarah P Slight
Keyword(s):  
Behaviour Change ◽  
Health Behaviour ◽  
Digital Health ◽  
Digital Technologies ◽  
Patient Perspectives ◽  
Health Technologies ◽  
Surgical Success ◽  
Orthopaedic Patients ◽  
Behaviour Changes

BACKGROUND Health behaviour changes made by patients during the perioperative period can impact on the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopaedic surgery patients is central to motivating healthier behaviour change, improving recovery and optimizing overall surgical success in the short- and long-term. OBJECTIVE This qualitative investigation explores patient perspectives on the key technology features that would help support them to change their lifestyle behaviours during the pre- and post-operative periods, and that could potentially maintain long-term healthy lifestyles following recovery. METHODS Semi-structured interviews with pre- and post-operative elective orthopaedic patients were conducted between May and June 2020, via telephone and video call-based software. Patient perspectives of using digital technologies to complement current surgical care and support with lifestyle behaviour change were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with NVivo (version 12) software facilitating data management. Ethical approval was obtained from the NHS Health Research Authority. RESULTS Eighteen participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the elective perioperative journey. These center around an intervention’s ability to: 1) deliver both general and specific surgical advice in a timely manner, 2) direct a descriptive and structured recovery, 3) enable customizable, patient-controlled settings, and 4) incorporate interactive, user-centered features. Pre-operative initiation of interventions, and post-operative continuation, were sought after by this cohort. Interventions designed with personalized milestones for patients were found to better guide through a structured recovery. Individualised tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity prior to surgery. Use of apps with personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behaviour change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery. CONCLUSIONS Specific intervention design and functionality features can provide better, structured support for elective orthopaedic patients across the whole perioperative journey, and beyond. This work provides much needed evidence relating to the optimal design and timing of digital interventions for elective orthopaedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behaviour changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored and targeted digital health technologies within modern healthcare settings.

Abstract #240 Weight Loss Trajectory Following Randomization to Bariatric Surgery on Long-Term Diabetes Outcomes

2018 ◽  
Vol 24 ◽  
pp. 49
Author(s):  
Keren Zhou ◽  
Kathy Wolski ◽  
Ali Aminian ◽  
Steven Malin ◽  
Philip Schauer ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Outcomes ◽  
Trajectory Following

Long-Term Weight Loss and Psychological Functioning in Bariatric Surgery Patients

2012 ◽  
Author(s):  
Leslie M. Schuh ◽  
David B. Creel ◽  
Joseph Stote ◽  
Katharine Hudson ◽  
Karen K. Saules ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Psychological Functioning

scholarly journals Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Obesity Facts ◽  
2021 ◽  
pp. 1-14
Author(s):  
R. James Stubbs ◽  
Cristiana Duarte ◽  
António L. Palmeira ◽  
Falko F. Sniehotta ◽  
Graham Horgan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Behaviour Change ◽  
Digital Health ◽  
Self Regulation ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behavioural Science ◽  
Digital Architecture

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

scholarly journals Long-Term Iron and Vitamin B12 Deficiency Are Present after Bariatric Surgery, Despite the Widespread Use of Supplements

2021 ◽  
Vol 18 (9) ◽  
pp. 4541
Author(s):  
Mauro Lombardo ◽  
Arianna Franchi ◽  
Roberto Biolcati Rinaldi ◽  
Gianluca Rizzo ◽  
Monica D’Adamo ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Ideal Body Weight ◽  
Excess Weight ◽  
Nutritional Deficiencies ◽  
Average Percentage ◽  
Nutritional Studies

There are few long-term nutritional studies in subjects undergoing bariatric surgery that have assessed weight regain and nutritional deficiencies. In this study, we report data 8 years after surgery on weight loss, use of dietary supplements and deficit of micronutrients in a cohort of patients from five centres in central and northern Italy. The study group consisted of 52 subjects (age: 38.1 ± 10.6 y, 42 females): 16 patients had Roux-en-Y gastric bypass (RYGB), 25 patients had sleeve gastrectomy (SG) and 11 subjects had adjustable gastric banding (AGB). All three bariatric procedures led to sustained weight loss: the average percentage excess weight loss, defined as weight loss divided by excess weight based on ideal body weight, was 60.6% ± 32.3. Despite good adherence to prescribed supplements, 80.7% of subjects (72.7%, AGB; 76.7%, SG; 93.8 %, RYGB) reported at least one nutritional deficiency: iron (F 64.3% vs. M 30%), vitamin B12 (F 16.6% vs. M 10%), calcium (F 33.3% vs. M 0%) and vitamin D (F 38.1% vs. M 60%). Long-term nutritional deficiencies were greater than the general population among men for iron and among women for vitamin B12.

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