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Taylor TA, Beban G, Yi E, Veukiso M, Sang-Yum G, Dewes O, Wrapson W, Taufa N, Campbell ART, Siegert RJ, Shepherd P. Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study. Obes Surg 2024; 34:959-966. [PMID: 38345730 PMCID: PMC10899268 DOI: 10.1007/s11695-024-07084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023. MATERIALS AND METHODS This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences. RESULTS Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward. CONCLUSION This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.
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Affiliation(s)
- Tamasin Ariana Taylor
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Building 507, Room 1090, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Grant Beban
- General Surgery Department, Auckland City Hospital, Te Whatu Ora, Te Toka Tumai, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Elaine Yi
- General Surgery Department, Auckland City Hospital, Te Whatu Ora, Te Toka Tumai, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Michael Veukiso
- School of Social Work, College of Health, Massey University, Albany, North Shore, Auckland, 0745, New Zealand
| | - Genevieve Sang-Yum
- School of Social Work, College of Health, Massey University, Albany, North Shore, Auckland, 0745, New Zealand
| | - Ofa Dewes
- Centre of Methods and Policy Application in the Social Sciences, The Faculty of Arts, University of Auckland, 12 Grafton Road, Auckland, 1010, New Zealand
- Langimalie Research Centre, Tongan Health Society, M20 Business Park, 86F Plunket Avenue, Manukau, Auckland, 2104, New Zealand
| | - Wendy Wrapson
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Auckland, 0627, New Zealand
| | - Nalei Taufa
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Building 507, Room 1090, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Andrew R T Campbell
- Department of Anthropology, The Faculty of Arts, The University of Auckland, 22 Symonds Street, Auckland, 1010, New Zealand
| | - Richard J Siegert
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Auckland, 0627, New Zealand
| | - Peter Shepherd
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Building 507, Room 1090, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
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Taylor T, Wrapson W, Dewes O, Taufa N, Siegert RJ. Preoperative bariatric surgery programme barriers facing Pacific patients in Auckland, New Zealand as perceived by health sector professionals: a qualitative study. BMJ Open 2019; 9:e029525. [PMID: 31678938 PMCID: PMC6830665 DOI: 10.1136/bmjopen-2019-029525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Minority ethnic patient groups typically have the highest bariatric surgery preoperative attrition rates and lowest surgery utilisation worldwide. Eligible patients of Pacific Island ethnicity (Pacific patients) in New Zealand (NZ) follow this wider trend. OBJECTIVES The present study explored structural barriers contributing to Pacific patients' disproportionately high preoperative attrition rates from publicly-funded bariatric surgery in Auckland, NZ. SETTING Publicly-funded bariatric surgery programmes based in the wider Auckland area, NZ. DESIGN Semi-structured interviews with health sector professionals (n=21) were conducted.Data were analysed using an inductive thematic approach. RESULTS Two primary themes were identified: (1) Confidence negotiating the medical system, which included Emotional safety in clinical settings and Relating to non-Pacific health professionals and (2) Appropriate support to achieve preoperative goals, which included Cultural considerations, Practical support and Relating health information. Clinical environments and an under-representation of Pacific staff were considered to be barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families. Additionally, economic deprivation and lower health literacy impacted preoperative goals. CONCLUSIONS Health professionals' accounts indicated that Pacific patients face substantial levels of disconnection in bariatric surgery programmes. Increasing representation of Pacific ethnicity by employing more Pacific health professionals in bariatric teams and finding novel solutions to implement preoperative programme components have the potential to reduce this disconnect. Addressing cultural competency of staff, increasing consultancy times and working in community settings may enable staff to better support Pacific patients and their families. Programme structures could be more accommodating to practical barriers of attending appointments, managing patients' preoperative health goals and improving patients' health literacy. Given that Pacific populations, and other patients from minority ethnic backgrounds living globally, also face high rates of obesity and barriers accessing bariatric surgery, our findings are likely to have broader applicability.
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Affiliation(s)
- Tamasin Taylor
- Faculty of Heath and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Wendy Wrapson
- Faculty of Heath and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ofa Dewes
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Nalei Taufa
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Richard J Siegert
- Faculty of Heath and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Taylor T, Dewes O, Taufa N, Wrapson W, Siegert R. Factors associated with preoperative attrition in bariatric surgery: a protocol for a systematic review. Syst Rev 2018; 7:212. [PMID: 30486899 PMCID: PMC6262965 DOI: 10.1186/s13643-018-0855-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bariatric surgery results in substantial medical and economic benefits; however, independent studies typically report high patient preoperative attrition rates. Studies have identified individual characteristics and sociodemographic variables of those who complete the surgery compared to those who do not. The aim of the present protocol is to outline a systematic review focussed on identifying the sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who were enrolled in bariatric surgery programmes. METHODS/DESIGN The databases Scopus, CINAHL, PsycINFO, Web of Science, and MEDLINE will be searched for retrospective, prospective, and cross-sectional observational studies that have identified any sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who are enrolled in a bariatric surgery programme. English-language articles published between 1997 to 2020, inclusive of adults 18 years or older, will be included in the review. This protocol has been registered in PROSPERO, registration number; CRD42017068557. DISCUSSION Presently, there are studies and reviews investigating population-based utilisation and access to bariatric surgery; however, there is a need to review the reasons behind preoperative bariatric surgery patient attrition once selected for bariatric surgery. The results of the review will highlight potential systematic disparities in patient attrition, where gaps in knowledge remain for further investigation, and suggest areas where countermeasures may be focussed for decreasing attrition rates. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017068557.
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Affiliation(s)
- Tamasin Taylor
- Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627 New Zealand
| | - Ofa Dewes
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Nalei Taufa
- University of Auckland, Auckland, New Zealand
| | - Wendy Wrapson
- Auckland University of Technology, Auckland, New Zealand
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