Bariatric Times - January 2009 - (Page 15)

Bariatric Times • January 2009 Psychological Perspective 15 disclosure or limited disclosure that these participants reported as it relates to their decision to undergo WLS. Data were collected and analyzed over a five-month period in 2008. Data collection and preliminary analysis was done concurrently, allowing identification of coding, validation of the emerging codes with participants, and gathering of additional information for verification, relevance, and saturation. Data was considered saturated by the creation of dense, logical categories, with no new data emerging. These criteria were achieved after 11 participants shared their experiences. No new data emerged in the last three interviews; therefore, data gathering was terminated. The research assistant/ interviewer was a registered nurse currently enrolled in a doctoral program. The research assistant has no experience with bariatric structure. Then the team came together to share and discuss the individual analysis, to identify common findings, and to verify the meaning of the data. This process enhanced the trustworthiness and reproducibility of the findings and verified that the themes identified reflected the participants’ experiences and captured the meanings. An audit trail was established through the field notes maintained by the interviewer during the interviews and by notations of all the researchers during the transcription, coding, and organizing of the data in the analysis process. weight, but had been consistently unsuccessful. These participants also shared negative encounters with family members, coworkers, and others related to their weight and their struggles to lose weight. The three following themes were identified that illuminated the common attribute of secrecy surrounding the participants’ decisions to pursue WLS: “the lonely decision,” “looking for approval,” and “not telling.” THE LONELY DECISION For the participants, the initial introduction to a bariatric surgical program was through an acquaintance, a complete stranger, or a marketing item, such as an advertisement or brochure. These participants did not independently initiate the search for a bariatric procedure, nor was the idea of surgery introduced by their primary healthcare providers. However, once introduced to the possibility of After having attended the information sessions, meeting the surgeon, and doing their own research, all participants expressed a level of comfort having been informed about surgical interventions to achieve weight loss. One participant shared, “I did my homework and knew what I wanted to do and I didn’t want people who were uneducated to try and scare me.” Another participant echoed the need to make her own decision: “I wanted the surgery and I did not want to be talked out of it.” LOOKING FOR APPROVAL If the participant chose to share his or her exploration of bariatric surgery, it was usually with an individual who had previously undergone WLS. This individual served as an encouraging role model and advocate for the procedure, one who could offer authentic information regarding his or her own WLS experience. Participants RESULTS The sample included individuals who had undergone WLS and volunteered to participate. Snowball sampling was used to identify potential subjects who would consent to being interviewed for this study. The sample consisted of As a result of the stigma associated with obesity, obese persons report they have experienced discriminatory behaviors in multiple aspects of their personal and professional lives that have negatively affected their attitudes and beliefs in themselves. patients; therefore, the potential introduction of bias in the data collection process was minimized. The interviewer’s use of field notes during the interview enhanced the reproducibility of the data. The audiotaped interviews were converted to text transcripts by a paid transcriptionist. As each transcript was ready, the researchers read the transcript and compared it to the audio file for accuracy and to minimize transcription errors. The transcripts were analyzed for common themes as appropriate for phenomenological inquiry.7 Words, statements, and paragraphs were extracted to communicate the participants’ sharing of the decision to seek WLS. Themes were exemplified by quotes that provide a rich description of the meaning. Initially, each member of the research team analyzed the data using a common organizing 14 females, all of whom had completed high school and had taken college level course work or had graduated from college with a baccalaureate degree or higher. Nine of the participants (64%) described themselves as healthcare professionals. Subjects ranged in age from 28 to 63 years. The highest reported weight prior to surgery was 412 pounds, and the lowest was 247 pounds. Amount of weight lost ranged from a high of 167 pounds to a low of 72 pounds. As the data collection evolved, the phenomena of secrecy emerged as a constant and commonly shared experience. The decision to not disclose or to limit disclosure regarding the decision to pursue WLS was a consistent theme heard across the interviews. Each of the participants had a long history of weight management issues and had used a variety of diet programs in the past in an attempt to lose WLS, all of the participants engaged in the process of learning about it. The participants described visiting the surgeon, attending presurgical information sessions, and doing research on the internet, while also exploring personal financial options related to covering the costs associated with the procedure. Frequently participants reported that the entire fact-finding mission leading to the decision to undergo WLS was completed in secrecy or under limited disclosure to others. This self-imposed isolation was partially the result of comments made by family and friends regarding weight loss surgery. Participants recalled statements such as the following: “My family didn’t want me to do it (the surgery);” “People said I was taking the easy way out;” and “Someone told me it was unfair, like I was not taking real responsibility for how or why I was overweight.” acknowledged the impact of these individuals with statements such as the following: “A night nurse (work colleague) came to me very privately and said, ‘I had it done, my husband and I had it done, and it was just a great experience;” and “I learned about the surgery from a patient. He said it was the best thing he ever did. After we talked, he gave me the name of his surgeon, and that was the beginning of my decision.” One participant reported going to a presentation about bariatric surgery offered by a physician. Although she found his presentation helpful, she reports that her ultimate decision was based on the physician’s personal disclosure of having had bariatric surgery himself. She stated, “At the end of his presentation, he showed a picture of himself as an obese man. So he could talk to us from a doctor’s perspective as well as a

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Bariatric Times - January 2009

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