A qualitative study exploring patient suggestions for the design, functionality and implementation of digital health technologies before and after bariatric surgery
Authors: Robinson A , Husband A K , Slight R D , Slight S P 
Published: March 2021

Abstract

Introduction
Health behaviour changes made during the pre-operative period can positively impact on post-operative outcomes and the success of bariatric surgery.(1) Digital technologies present an opportunity to support patients with this. Currently, little is known about the optimal design or delivery of digital technologies for this patient cohort. In order to develop useful and effective digital strategies for this unique patient cohort, it is important to first understand how bariatric surgery patients want to be supported.(2)

Aim
To understand how digital technologies could be designed and delivered to better support patients with surgical health behaviour changes, specifically: 1) what do patients want from technologies, 2) how do they want to use them, and 3) when should they be implemented?

Methods
According to the EQUATOR guidelines, the consolidated criteria for reporting qualitative research (COREQ) checklist was followed. Pre- and post-operative patients attending bariatric surgery clinics within one large teaching hospital in the North of England were invited to take part. Purposive sampling was employed to recruit a representative sample of patients. Participants received an information sheet detailing the study purpose and aims. Written informed consent was obtained before conducting semi-structured interviews. Semi-structured interviews took place between February-March 2020 and were audio-recorded and transcribed verbatim. Interviews included questions on participant surgical experience, health behaviour change and perspectives on digital technologies. A reflexive thematic analysis approach enabled the development of themes from the data. NVivo 12 software assisted data organisation.

Results
Eighteen patients were recruited and interviewed. The average age of participants was 46-years. 55% (n=10) of participants had or were undergoing a gastric bypass procedure. The data analysis enabled the development of four themes which highlighted specific participant desires relating to the design, functionality and implementation of optimal digital technologies to best support them during the pre- and post-operative periods. Specifically, the themes related to an intervention’s ability to: 1) provide structured content and support, 2) facilitate self-monitoring and goal-setting, 3) deliver information in an accessible, trusted and usable manner, and 4) meet patient information-seeking and engagement needs (Figure 1). “In the first couple of weeks (following surgery), we need to be told what to do by the technology” Participant 9.

Conclusion
This patient-informed research highlighted how interventions could be designed, what functionality would be most useful and when they should be implemented within the NHS pathway for bariatric surgical patients. This study is one of the first in this patient cohort to involve pre- and post-operative participants and provides key insights to fill knowledge gaps relating to the design and optimisation of person-centred digital interventions. We acknowledge some limitations with our work. Whilst we did not sample participants by socioeconomic status, it is possible that different socioeconomic classes may have varied experiences with technologies. Our focus was solely bariatric surgery and thus findings may not be generalisable to other elective surgical procedures. These findings have the potential to shape and influence future work on the co-design and optimisation of person-centred digital health technologies in modern healthcare settings.

References
1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology. 2009;28(6):690.
2. Donetto S, Pierri P, Tsianakas V, Robert G. Experience-based Co-design and Healthcare Improvement: Realizing Participatory Design in the Public Sector. The Design Journal. 2015;18(2):227–48.