减重代谢术前患者肥胖相关病耻感的质性研究

doi:10.3877/cma.j.issn.2095-9605.2021.02.004

目的

深入了解减重代谢手术患者术前肥胖相关的病耻感体验，以期为提高患者手术信心和术后自我管理质量提供参考。

方法

选择北京市某三级甲等医院9名拟行减重代谢手术的患者为研究对象，采用半结构式访谈法，运用主题分析法对访谈资料进行分析、归纳及提炼主题。

结果

减重代谢手术患者的术前病耻感体验归结为4个类属。类属一：病耻感体验，即自卑感、孤独、自责和被歧视的经历；类属二：病耻感来源，一方面来自自身，另一方面来自他人，如亲友和同事、医护人员、公众；类属三：病耻感的应对，包括盲目采取各种方法，减少社会活动、逃避、持有积极减重的态度；类属四：对手术改善肥胖的态度，包括经他人推荐相信减重效果，或对手术了解较少抱着尝试心态。

结论

减重代谢手术的患者术前存在病耻感体验，医护人员应为其提供相应的心理支持，指导其采取正确的应对方式；同时应做好社会健康教育，加强公众对肥胖与代谢疾病的认识，正确认识减重代谢手术在治疗肥胖与代谢疾病中的效果。

关键词: 减重代谢手术, 肥胖, 病耻感, 质性研究

Objective

To gain an in-depth understanding of the pre-operative stigma experience in patients with bariatric and metabolic surgery for providing a reference to improve the patient's confidence in surgery and the quality of postoperative self-management.

Methods

Using qualitative research and semi-structured interviews, nine patients were selected as the research participants who were to undergo bariatric and metabolic surgery in a tertiary hospital in Beijing.

Results

The preoperative symptom experience of patients before bariatric and metabolic surgery were summarized into 4 themes. Theme 1: Disease related stigma experience, including regret and guilt, inferiority complex, discrimination experience, worry and anxiety; Theme 2: Stigma sources, including patient themselves, and other people such as, relatives and colleagues and colleagues, medical staff, and the public; Theme 3: Coping with stigma, including reducing social activities or even concealment and avoidance, and holding a positive attitude toward bariatric and metabolic surgery; Theme 4: Attitude toward the effect of surgery on weight loss, including trust the surgery effect with recommendation by other people, and attemptation yet with little knowledge about the metabolic surgery.

Conclusions

Patients with bariatric and metabolic surgery experienced stigma before surgery. Healthcare providers should provide them with corresponding psychological support and guide them to respond correctly. In the meantime, healthcare provides need to a good job in social health education and strengthen the public’s awareness of obesity and metabolic diseases. Understand and correctly understand the role of weight loss metabolic surgery in the treatment of obesity and metabolic diseases.

Key words: Bariatric and metabolic surgery, Obesity, Stigma, Qualitative research

表1 研究对象的基本资料（n=9）

编号	性别	年龄（岁）	BMI（kg/m²）	婚姻状态	籍贯
S1	女	44	39.1	已婚	北京
S2	男	20	43.0	未婚	北京
S3	男	40	45.7	离异	内蒙古
S4	男	38	37.2	已婚	天津
S5	女	33	33.8	未婚	北京
S6	男	26	40.1	未婚	北京
S7	女	31	31.1	未婚	吉林
S8	女	28	28.4	未婚	山东
S9	女	27	29.1	未婚	广东

表1 研究对象的基本资料（n=9）

编号	性别	年龄（岁）	BMI（kg/m²）	婚姻状态	籍贯
S1	女	44	39.1	已婚	北京
S2	男	20	43.0	未婚	北京
S3	男	40	45.7	离异	内蒙古
S4	男	38	37.2	已婚	天津
S5	女	33	33.8	未婚	北京
S6	男	26	40.1	未婚	北京
S7	女	31	31.1	未婚	吉林
S8	女	28	28.4	未婚	山东
S9	女	27	29.1	未婚	广东

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A Qualitative research of disease stigma in patients before bariatric and metabolic surgery.

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A Qualitative research of disease stigma in patients before bariatric and metabolic surgery.