A structure for personalized self-management support and stepped follow-up care in bariatric surgery

Norway has the highest obesity rate in the Nordic countries, with around 23% of adults affected. Obesity is a complex condition increasing the risk of a range of diseases such as cardiovascular diseases, type 2 diabetes, certain cancers, and musculoskeletal diseases. Bariatric surgery is considered the most effective treatment, but it can lead to new clinical issues including nutritional deficiencies, bowel symptoms and mental health disorders, and a substantial subset of patients experience weight regain over time. This is detrimental for both patients and society, adding to the individual, economic and societal burden of obesity. In Norway, bariatric surgery is primarily delivered by public hospitals, and approximately 13,000 patients are scheduled for bariatric follow-up care at any given time. A key element to succeed in the long-term is the patients’ ability to self-manage and cope with their condition within the context of their daily living.

In the project, we will a) use existing best practice evidence on self-management processes with detailed qualitative studies of obesity patients’ and healthcare providers perspectives and experiences to frame a bespoke self-management knowledge for this context, and b), use the e-Delphi method to determine feasible checklist items. A checklist has the potential to standardize and provide a framework for assessing self-management capacity and needs and delivering personalized self-management support across the continuum of care in bariatric surgery.

First, we will provide new knowledge about stakeholders experiences and perspectives on self-management processes and support following bariatric surgery. This will be done trough qualitative research involving individual and focus group interviews with patients and healthcare providers. This insight together with existing knowledge will be used to generate potential checklist items, which will be further refined by a stakeholder advisory group with expertise and experience as clinicians and service users in bariatric surgery care. Finally, an eDelphi process will be conducted to assess comprehensibility and comprehensiveness of candidate checklist items and achieve consensus on items to be included in the final version of the checklist.