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PATIENTS’ PERSPECTIVES OF BARIATRIC SURGICAL CARE IN THE DEEP SOUTH: A QUALITATIVE STUDY
Alfonsus Adrian H. Harsono
*1, Gurudatta Naik
1, Ivan I. iherbey
1, Gina Kim
1, Dinakar S. Velagala
1, Nathan C. English
2,1, Kristen Wong
1, Richard Stahl
1, Jayleen Grams
1, Daniel I. Chu
1, Margaux N. Mustian
11Department of Surgery, Div. of Gastrointestinal Surgery, The University of Alabama at Birmingham Department of Surgery, Birmingham, AL; 2University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
Introduction: Bariatric surgery utilization in the Deep South is low despite the high prevalence of obesity in the region. The challenges experienced by patients to access bariatric surgery in this region are poorly understood. Therefore, this study aimed to explore patients’ perspectives on barriers to bariatric surgical care in the Deep South.
Methods: Participants were enrolled during preoperative clinical evaluations at a tertiary care hospital in the Deep South. Using the socioecological model of health, semi-structured interview guides were developed to elucidate barriers and facilitators to undergoing bariatric surgery at the patient, provider, institutional, community, and policy levels. Interviews were recorded, transcribed, and analyzed using inductive thematic and content analysis approaches with NVivo 14 software. Intercoder agreement was reached at 90%.
Results: A total of 10 participants were recruited with a mean age of 40 (±10.8) years. The majority (90%) of participants were female, 80% were Black, and 100% lived in urban areas. Five of the 10 participants underwent bariatric surgery. Themes for barriers and facilitators to seeking bariatric surgery were identified across socioecological domains (
Table 1). The barriers to undergoing bariatric surgery included a lack of primary care physician (PCP) involvement or presence of mental health issues (patient level); miscommunication or poor communication about bariatric surgery evaluation (provider level); a lack of professionalism or inattention towards patients (organizational level); a lack of social support groups to share evaluation experiences with, or stigma about the procedure (community level); and poor communication about insurance providers’ requirements (policy level). The facilitators to undergoing bariatric surgery included active participation of PCP and knowledge of other patients’ surgical experience (patient level); open and active communication with staff (provider level); the benefits of dietary classes and tele-communicative applications (organizational level); availability of social worker and community support (community level); and awareness of insurance providers’ requirements about the bariatric surgery evaluation (policy level).
Conclusions: In the Deep South, barriers and facilitators to bariatric surgery existed along all socioecological domains. In addition to the well-studied insurance barriers, multi-level targetable interventions were identified, including improvement in communication and education for patients and their primary care providers. Moreover, community-based outreach and education may be needed in order to improve access to quality bariatric surgical care.
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