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Qualitative research
Original research
Patients’ experiences of life after bariatric surgery and follow-up care: a qualitative study
  1. Karen D Coulman1,
  2. Fiona MacKichan1,
  3. Jane M Blazeby1,2,
  4. Jenny L Donovan1,3,
  5. Amanda Owen-Smith1
  1. 1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Karen D Coulman; Karen.Coulman{at}bristol.ac.uk

Abstract

Objectives Bariatric surgery is the most clinically effective treatment for people with severe and complex obesity, however, the psychosocial outcomes are less clear. Follow-up care after bariatric surgery is known to be important, but limited guidance exists on what this should entail, particularly related to psychological and social well-being. Patients’ perspectives are valuable to inform the design of follow-up care. This study investigated patients’ experiences of life after bariatric surgery including important aspects of follow-up care, in the long term.

Design A qualitative study using semistructured individual interviews. A constant comparative approach was used to code data and identify themes and overarching concepts.

Setting Bariatric surgery units of two publicly funded hospitals in the South of England.

Participants Seventeen adults (10 women) who underwent a primary operation for obesity (mean time since surgery 3.11 years, range 4 months to 9 years), including Roux-en-Y gastric bypass, adjustable gastric band and sleeve gastrectomy, agreed to participate in the interviews.

Results Experiences of adapting to life following surgery were characterised by the concepts of ‘normality’ and ‘ambivalence’, while experiences of ‘abandonment’ and ‘isolation’ dominated participants’ experiences of follow-up care. Patients highlighted the need for more flexible, longer-term follow-up care that addresses social and psychological difficulties postsurgery and integrates peer support.

Conclusions This research highlights unmet patient need for more accessible and holistic follow-up care that addresses the long-term multidimensional impact of bariatric surgery. Future research should investigate effective and acceptable follow-up care packages for patients undergoing bariatric surgery.

  • organisation of health services
  • quality in health care
  • qualitative research
  • adult surgery
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-035013

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    Footnotes

    • Twitter @FionaMacKichan

    • Contributors KDC led the study design, data collection and data analysis as part of her PhD research, and drafted this manuscript. AO-S, FM and JMB were KDC’s PhD supervisors and advised on study design, data collection and analysis, and provided comments on this manuscript. JLD advised and contributed to data analysis and provided comments on this manuscript. All authors approved the final submitted manuscript.

    • Funding KDC was funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship for this research project. This work was also supported by the Medical Research Council (MRC) ConDuCT-II Hub (Collaboration and innovation for Difficult and Complex randomised controlled Trials In Invasive procedures—MR/K025643/1). This publication presents independent research funded by the NIHR and the MRC. JMB is an NIHR senior investigator.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the study was obtained from Northwest - Preston Research Ethics Committee (Ref 12/NW/0844).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Anonymised participant data can be made available on reasonable request to the corresponding author at karen.coulman@bristol.ac.uk.