Introduction
While bariatric surgery is widely accepted and may be considered medically necessary, operations intended for the treatment of obesity and its comorbidities have long been misunderstood. Partly due to misconceptions about safety and effectiveness and the stigma associated with undergoing bariatric surgery, less than 1% of eligible patients pursue this potentially life-saving operation. Prior works have highlighted how patient perceptions may affect their willingness to undergo surgery. However, far less attention has been paid to how social support influences patients’ decision-making and experiences prior to surgery.
Methods
We are currently conducting semi-structured qualitative interviews with patients who have recently undergone bariatric surgery. The interview guide includes the following domains: information sources, communication, types of support, barriers to support, decision-making, and application questions. Data collection and analysis are ongoing. Using MAXQDA software to assist with data management, interview transcripts are being analyzed using an inductive approach to identify key themes related to social support and patient decision-making prior to surgery.
Results
Preliminary analysis (n = 11, 82% female, median age 53 years) reveals that patients differ in the types of social support they receive from others. As shown in Table 1, examples of types of support from others include practical help (e.g., grocery shopping for healthy food), role modeling (e.g., learning from others who previously underwent bariatric surgery), and “showing up” (e.g., accompanying patients to their clinic appointments). Interviews with patients also demonstrated various barriers to support, including the stigma associated with bariatric surgery, concerns about the safety or efficacy of surgery, and practical barriers to obtaining support, such as physical distance from relatives. These types of support and barriers to support had variable effects on patients’ decisions to undergo surgery. Some found the motivation to pursue surgery from the support of others, some delayed or hesitated to pursue surgery due to concerns of loved ones, and still, others made the decision fully independently.
Conclusion
The diversity of experiences highlighted in these interviews may inform how bariatric surgery centers can include loved ones in the pre-operative process. Efforts may include more family-friendly activities to educate children, providing support groups for loved ones, and addressing concerns and misconceptions through educational literature. By incorporating these resources, patients’ loved ones could, in turn, provide greater support for patients, leading to improved patient experiences and outcomes.
Table 1: Examples of Support from Others and Barriers to Support Among Bariatric Surgery Patients
| Theme | Definition | Example Quote | |
|---|---|---|---|
| Types of Support | Practical Help | Completing practical tasks that support the patient through the pre-operative process | “I talked to my sister and my niece and they were all in. ‘We’re here for you, whatever you need. If you need us to watch the kids’…, they was all in. ‘We’re proud of you. Whatever you decide to do, we’re here for you. If you need us to walk with you, need us to exercise with you… we here.’” ID20 |
| Role Modeling | Experiences with people wo had considered or had undergone bariatric surgery before them | “I don’t reach out to my people that have already had the surgery that often, but just knowing they’re there is wonderful. Also knowing, they reach out to me, “Hey, I ain’t heard from you in a while. What’s going on? How you doing? We know you had it. What’s going on? What are you doing?” That kind of support is invaluable.” ID16 | |
| Showing Up | Being available for the patient as someone to lean on | “Discussing spouse’s attendance at clinic visits: “It was good because I feel like he will ask questions that maybe I won’t or like I didn’t think of. I wanted him to be fully confident in the decision as well. Yes, it was me, but it was going to impact him too. ‘You’re welcome to come if you want to. You don’t have to.’ He was like, ‘Of course I’m going to go.’ So, it was nice.” ID2 | |
| Barriers to Support | Stigma | Comments about stigmas associated with bariatric surgery and weight loss | “Both of my sisters were a little negative about having the surgery. One of them…had that negative experience with a neighbor, and then my other sister was just convinced that I could do it with diet and that somehow, I hadn't tried hard enough.” ID17 |
| Concerns About Safety & Efficacy | Hesitancy or questioning about undergoing a surgery or its effectiveness |
“My mom, I had told her and she was happy for me but not happy for me. She was more worried because she had done no research on it. I could be going in for any surgery and it just kind of makes her nervous and so she wasn't all that excited about it.” ID9 |
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| Practical Barriers | Lack of support for practical needs related to surgery | “…My sister, I would have loved it if she would have been able to come. I usually would talk with my sister before the appointment and after the appointment and it's like almost like she was there but she lives in Florida.” ID11 |