Designing Digital Health Technology to Support Patients Before and After Bariatric Surgery: Qualitative Study Exploring Patient Desires, Suggestions, and Reflections to Support Lifestyle Behavior Change

Abstract

Background A patient’s capability, motivation, and opportunity to change their lifestyle are determinants of successful outcomes following bariatric surgery. Lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been associated with greater postsurgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviors, and provide holistic patient support, to improve surgical success. Previous research focused on implementing digital technologies and measuring effectiveness in surgical cohorts. However, there is limited work concerning the desires, suggestions, and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patients’ perspectives on technology features that would support behavior changes during the pre- and postoperative periods, to potentially maintain long-term healthy lifestyles following surgery. Objective This study aims to understand how digital technologies can be used to support patient care during the perioperative journey to improve weight loss outcomes and surgical success, focusing on what patients want from digital technologies, how they want to use them, and when they would be of most benefit during their surgical journey. Methods Patients attending bariatric surgery clinics in one hospital in the North of England were invited to participate. Semistructured interviews were conducted with purposively sampled pre- and postoperative patients to discuss lifestyle changes and the use of digital technologies to complement their care. The interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the National Health Service Health Research Authority. Results A total of 20 patients were interviewed (preoperative phase: 40% (8/20); postoperative phase: 60% (12/20). A total of 4 overarching themes were developed and related to the optimization of technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs during the surgical pathway. Functionalities that delivered personalized feedback and postoperative follow-up were considered beneficial. Individualized goal setting functionality could support a generation of digitally engaged patients with bariatric conditions as working toward achievable targets was deemed an effective strategy for motivating behavior change. The creation of digital package of care checklists between patients and clinicians was a novel finding from this study. Conclusions Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made relating to the design, content, and functionality of digital interventions to best address the needs of this cohort. These findings have the potential to influence the co-design and integration of person-centered, perioperative technologies.

Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study

“…The mentioned topics to be included in the HB are strongly related to everyday life, such as how to specifically plan a meal or which food product is suitable in which situation. This is consistent with the findings of the study by Robinson et al [64], in which specific tips for meals and support in everyday life were identified as benefits that patients with obesity desired from digital tools. Overall, the perception of the HB is positive in terms of trust and strengths, which can be underlined for general eHealth use in the preoperative and postoperative bariatric setting [69].…”

“…This coincides with the idea behind the HB, which was for the HB to be an addition to the already well-standardized and proven face-to-face consultations by a dietician. A combination of face-to-face appointments and digital access to information between the appointments might be a good solution for providing better support to patients with obesity [64]. The questionnaire showed highly esteemed benefits from the HB, as the items "The HB can/should be recommended to people who are in a similar situation as I am" and "The HB is certainly a good addition to my regular nutrition counseling care" achieved high scores.…”

A mixed‐method study to inform the development and implementation of eHealth in a bariatric surgery service in an Australian public hospital

“…37 Participants were accepting of a range of eHealth modalities with email and text messaging approaches favoured. Concurring with Robinson et al, 13 the provision of a eHealth 'package' is recommended. This package could include text messages and emails in addition to usual care, which may be face-to-face or via telecommunications.…”

A non-randomised feasibility study of a mHealth follow-up program in bariatric surgery

“…mHealth is the use of mobile wireless technologies for public health and includes text messaging programs, mobile applications, and wearable devices [ 14 ]. A benefit of mHealth is that it can enable the provision of a ‘package of care’ to offer additional lifestyle support [ 15 ]. Although various digital strategies can be delivered via mHealth currently, evidence for the effective use of digital technologies in bariatric surgery is mostly focused on text messaging approaches.…”