Impact of Education Level on Patient Perception of Surgical Weight Loss Postoperative Support Needs: A Qualitative Analysis
Rachel J. Reindorf1, Sara Tortorici2, David M. Brams2
1Tufts University School of Medicine, Boston, Massachusetts, United States, 2Division of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
Objectives. Determine if level of education impacts patient perspectives of postoperative support resources following surgical weight loss (SWL).
Design. Semi-structured telephone interview. Transcribed manually. Coded with NVivo to create a framework for thematic analysis. Interviews ranged from 5 to 40 minutes.
Setting. Large tertiary care hospital with an MBSAQIP accredited Comprehensive Center for SWL care.
Patients. 228 SWL patients between June 1, 2019 and May 31, 2020 divided into: high school and college. Patients greater than a year out from surgery were excluded to reduce recall bias. Every third patient contacted via phone. Of 97 contacted, 30 interviewed (8 high school and below, 22 college/above).
Main Outcome measures. No primary outcome measure. This was an exploratory study of patients" perceived support needs. Secondary outcome measures included weight loss and percentage of dietitian follow-up visits attended.
Results. Both cohorts attended similar percentages of their dietitian visits and lost similar amounts of weight following surgery at 1, 6 and 12 months post-op. Of 18 qualitative themes identified most robust differences between cohort support preferences were: group visits, psychological support needs, perceptions, improvements.
Conclusion. Patients with higher levels of education were more likely to suggest that group visits or psychological support were valuable resources, but not needed because these patients perceive that they have the knowledge and resources for self-help. Patients with lower levels of education enjoyed the psychological support and dynamic of group visits - hearing others thoughts and experiences offered another resource to these patients. Patients with higher levels of education were more likely to suggest programmatic changes and advocate for themselves than their counterparts with lower level of education. Providing resources for health advocacy may improve support of patients in the lower education group. Implementing postop group visits could provide an environment in which the patients with a higher level of education and a propensity to self-advocate could directly enhance the support of those with a lower level of education. Patients with a higher level of education might raise questions or concerns that those with a lower level of education might not be empowered to ask. Participation in group visits could be later used to determine if there is any difference in weight loss or postop patient outcomes between groups.
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