The Lived Experiences of People with Severe Obesity Who Use Community Health and Social Care Services: A Qualitative Interview Study

IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Kath Williamson, Michael E. J. Lean, David N. Blane
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Abstract

Evidence indicates growing demand on community health and social care services by people with severe obesity (BMI ≥40 kg/m2), often due to functional limitations. The experiences of this population are largely unexplored. As part of a larger mixed-methods study, this qualitative study explored the lived experience of people with severe obesity using community health and social care services. Participants were recruited via community professionals and visited at home. They consented to individual, audio-recorded, semistructured interviews, which were transcribed and analysed using thematic analysis. Nine women and three men (n = 12) participated, aged 40–76 (mean 60) years, BMI ranged from 45 to 74 (mean 59) kg/m2, and eight were housebound. Three overarching themes were identified. Firstly, the hidden struggles of living with a larger body affected all participants, including functional limitations affecting mobility and personal care. These contributed to a sense of being stuck physically, socially, and biographically. Secondly, most participants reported implicit weight bias by a system structurally unprepared to care for people with larger bodies. The majority of participants showed strong internalised weight bias, linked to shame and self-blame for their poor function and larger bodies. Thirdly, a day-to-day coping theme highlighted strategies regularly used by participants: resigned acceptance, avoidance and denial, exercising choice, and support from informal carers. These findings demonstrate that participants experienced unmet physical and psychological care needs associated with living with a larger body, leading to poor quality of care and life. Given rising prevalence, changes to care services are needed. Specific recommendations include staff training about the needs of people with severe obesity, ensuring that the physical infrastructure of care services can safely accommodate people with severe obesity, and improving access to effective, person-centred weight management treatments.

使用社区卫生和社会护理服务的严重肥胖症患者的生活经历:定性访谈研究
有证据表明,重度肥胖(体重指数≥40 kg/m2)患者对社区卫生和社会护理服务的需求日益增长,这通常是由于他们的功能受到限制。而这一人群的经历在很大程度上尚未被探索。作为一项大型混合方法研究的一部分,本定性研究探讨了严重肥胖症患者使用社区卫生和社会护理服务的生活经历。研究人员通过社区专业人员招募参与者,并对他们进行家访。他们同意接受单独的半结构式录音访谈,访谈内容经誊写后采用主题分析法进行分析。九名女性和三名男性(n = 12)参加了访谈,他们的年龄在 40-76 岁(平均 60 岁)之间,体重指数在 45-74 公斤/平方米(平均 59 公斤/平方米)之间,其中八人居家。会议确定了三个重要主题。首先,所有参与者都面临着因身体肥胖而带来的不便,包括影响行动和个人护理的功能限制。这些都造成了一种身体、社交和生理上的困顿感。其次,大多数参与者都报告说,他们的体重受到了隐性体重偏见的影响,而这个系统在结构上并没有为照顾体型较大的人做好准备。大多数参与者表现出强烈的内化体重偏见,这与他们功能不佳和体型较大的羞耻感和自责有关。第三,日常应对主题强调了参与者经常使用的策略:逆来顺受、回避和否认、行使选择权以及非正式照顾者的支持。这些研究结果表明,参与者因身体肥胖而产生的生理和心理护理需求得不到满足,导致护理和生活质量低下。鉴于患病率不断上升,护理服务需要做出改变。具体建议包括对员工进行有关重度肥胖症患者需求的培训,确保护理服务的物质基础设施能够安全地容纳重度肥胖症患者,以及改善获得有效的、以人为本的体重管理治疗的途径。
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来源期刊
CiteScore
4.50
自引率
8.30%
发文量
423
期刊介绍: Health and Social Care in the community is an essential journal for anyone involved in nursing, social work, physiotherapy, occupational therapy, general practice, health psychology, health economy, primary health care and the promotion of health. It is an international peer-reviewed journal supporting interdisciplinary collaboration on policy and practice within health and social care in the community. The journal publishes: - Original research papers in all areas of health and social care - Topical health and social care review articles - Policy and practice evaluations - Book reviews - Special issues
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