Pre‐surgical, surgical and post‐surgical experiences of weight loss surgery patients: a closer look at social determinants of health

Abstract

Using a novel qualitative approach, Photovoice, researchers assessed social, psychological, physical and economic barriers encountered by patients of weight loss surgery. Applying the Photovoice approach and Williams' theory of narrative reconstruction for qualitative interviewing, the research team set out to investigate the bariatric patient experience from pre-surgery to hospitalization to post-surgery. Fifteen participants were given digital cameras and asked to take photographs that represented their weight loss journeys. Photographs and qualitative interviews were used to theorize the role played by comorbidities, social determinants of health, provider communication experiences and understanding of insurance coverage in patient outcomes. Several themes emerged from the interviews and photographs including themes centred around: (i) racial/ethnic standards of beauty; (ii) gender expectations; (iii) comorbidities, depression/disordered eating and obesity discrimination and (iv) financial hardship impacting adherence. Photographs also illuminated the impact of hospital and state-wide policies on patient lives. Results suggest that Photovoice may be a useful adjunct to standard-of-care to help patients identify barriers, and to identify shortcomings in health services. Additional screening tools for gender- and income-related barriers (and concomitant referrals to support services) provide an opportunity to improve patient care and reduce post-operative readmissions.

The patient experience of bariatric surgery: a longitudinal qualitative study

“…It is anticipated that each of these levels will be explored and interpreted in relation to the study findings and experiences of the participants' experiences of the journey pre-and post-surgery. Furthermore, other studies with bariatric surgery patients have explored issues using the SEM Beltrán-Carrillo et al (2019), Johnson et al (2018) and Lynch et al (2018), some of these using the layers of the model to frame the findings and recommendations.…”

“…A sample of eighteen was chosen as a result of: my capacity to collect and analyse the data (Clarke, 2013) and because previous qualitative studies with bariatric surgery patients have used similar numbers of participants (Johnson et al, 2018;Ogden et al, 2006;Ogden et al, 2005;Wysoker, 2005). The longitudinal element of the study provided in depth rich data and this was considered as more imperative than a large number of participants (Patton, 2015).…”

“…The longitudinal element of the study provided in depth rich data and this was considered as more imperative than a large number of participants (Patton, 2015). Other International longitudinal studies on bariatric surgery have used similar numbers (n=9-30) (Engström & Forsberg, 2011;Faccio, Nardin, & Cipolletta, 2016;Johnson et al, 2018;Knutsen, Terragni, & Foss, 2013;Zabatiero et al, 2018).…”

“…Some studies use the methods to enable people to record communities, discuss the issues in groups and reach policymakers (Wang & Burris, 1997). Others use a modified version of Photovoice aiming to elicit information from individual participants during interviews about their everyday lives but not seeking to generate changes in policy (Johnson et al, 2018). All methods allow photographs to provide rich descriptive data that can be triangulated with data in interview transcripts.…”

“…During the telephone call and recruitment visit it was stressed that the research was external to the bariatric surgery pathway and MDT. The reason for this was two-fold; first, to ensure that the patients knew that their participation in the study would not affect their outcome of being approved for bariatric surgery or not and, second, to gain trust in my role as an independent researcher and encourage free and open dialogue about their experiences of obesity and the bariatric surgery pathway (Johnson et al, 2018).…”