[[alternative]]The Biopsychosocial Life Modification and Health effects among Post- Bariatric Surgery Patients

[[abstract]]背景: 減重手術(Bariatric surgery)是治療肥胖(body mass index:BMI≧35 kg/m2)，嘗試各種減重方法後效果仍不彰，所採取的治療方式。然而手術的生活修正及適應是另一個挑戰研究目的: (一)建立減重手術一年後個案生活經驗的描述性理論；(二)建構減重手術後個案身心生活修正量表。研究方法: 研究分為二階段：(一)紮根理論質性研究法；(二)參考第一階段質性研究結果類屬，研擬、建構「減重手術後病人身心生活修正量表」初稿，及橫斷性調查。 研究內容及結果: 於某醫學中心減重中心收案，第一階段共17人深度訪談，手術後時間平均21.8個月、平均減重47.1公斤、術前平均BMI 41.8、術後為24.5kg/m2；以持續比較法分析；其經驗之故事線如下描述: 「與我的小胃共存」是生活經驗的核心類，手術後改造的‟小胃”雖帶來的快速減重，病人也會自覺有「非預期性的身體改變」--噁心、嘔吐、心灼熱感、無法控制的食慾等；有兩種不同的行為類屬出現在過程中，部分病人會因小胃而進入生活修正的五個互動類屬歷程，另有5位個案則因身體出現症狀，而開始經歷折磨過程(suffering) 的五個互動類屬歷程，最後這些個案持續生活修正以珍惜目前的身體改變。第二階段共收集100位行減重手術後半年以上者，平均減重32.3公斤、術後BMI平均28.1kg/m2；進行「減重手術後病人身心生活修正量表」建構信效度檢定。效度方面：專家效度CVI值為0.96；驗證性因素分析以31題五因素之模式為良好適配，五個因素分別命名為「飲食修正」、「運動建立」、「認知修正」、「自我照顧」及「尋求支持」；同時效度則以健康促進生活量表(health promoting lifestyle profile)、抑鬱感量表(CES-D)進行相關係數檢定，結果分別為.688、-.244均達顯著相關(P<.005)；預測效度方面，「減重手術後身心生活修正量表」及五個次量表對於手術後健康行為執行的預測率估計，五個因素可聯合預測變異數為67.6%。信度檢定方面，總量表Cronbach'sα係數為.911，五個次量表分別為飲食修正(.726)、運動建立(.774)、認知修正(.834)、自我照顧(.760)、尋求支持(.694)，顯示「減重手術後病人身心生活修正量表」有良好的信、效度。而減重手術後病人健康行為的執行與胃腸問題、求醫次數、生活困擾及對手術滿意度等相關性的探討，顯示手術後健康行為執行與胃腸問題、求醫次數、生活困擾等為負相關，與手術的滿意度呈現正相關。 建議：減重手術後個案的體重遽減，更需提醒按時門診追蹤的必要性，均衡營養與監測更是不可忽視；而本研究所發展的「減重手術後病人身心生活修正量表」，具良好的信效度，可了解術後個案居家生活健康行為執行程度，未來亦可發展相關介入措施暨評量工具，以提供臨床實務使用。[[abstract]]Background: Bariatric surgery is a therapeutic option for obesity (body mass index: BMI≧35 kg/m2) with poor result after all weight-loss methods. However, correction and adaptation of life after surgery should be another challenge.Purpose: (1) To develop a descriptive theory of living experiences of severely obese post-bariatric surgery patients within one year after discharge.; (2) Establishment of Scale for Biopsychosocial Life Modification of Post- Bariatric Surgery Patients.Methods: This study is established as 2 stages: (1) qualitative research method of grounded theory; (2) refer to the generic result of the first stage qualitative research method, develop and construct the first draft of the “scale for Biopsychosocial Life Modification of Post- Bariatric Surgery Patients” and cross-sectional survey.Contents and results: We collected cases in one medical center. In the first stage, we had deep interviews with 17 cases, whose mean post-operative time is 21.8 months, mean weigh loss is 47.1 kg, mean pre-operative BMI is 41.8, and post-operative BMI is 24.5 kg/m2. Analysis was done by constant comparison method. The storyline is described as below: “Living with my small stomach.” was the core category of the patients’ postoperative life. In addition to the rapid weight loss due to the “small stomach” resulting from surgery, the patients perceived “unexpected physical changes,” such as nausea, vomiting, heartburn and uncontrolled appetite etc. During the initial occurrence of physical discomfort, the patients demonstrated two different types of behavior. Some patients adjusted their life in five areas due to having a small stomach. Other patients experienced suffering in three categories due to the physical symptoms that they encountered. Eventually, the patients began to engage in the five categories of life adjustment and appreciate the changes in their bodies, learning to live with their small stomach.In the second stage, the samples were 100 patients more than half year after bariatric surgery, whose mean weight loss is 32.3 kg and mean post-operative BMI is 28.1 kg/m2. We perform the “Scale for Biopsychosocial Life Modification of Post- Bariatric Surgery Patients” to construct the reliability and validity. The Content Validity Index, CVI = 0.96; confirmatory factor analysis takes 31 questionnaires of 5 factors modes as good adaptation, which are named as “diet correction”, “exercise establishment”, “cognition correction”, “self-care” and “seeking for support”. Concurrent Validity: concurrent with health promoting lifestyle profile and center of epidemiological study depression (CES-D) the scale are.688, -0.244 respectively, (p<.005); Predictive Validity, the “Scale for Biopsychosocial Life Modification of Post- Bariatric Surgery Patients” predict post-operative health behavior is 67.6%; In the validity, the total scales Cronbach's α = .911. subscale of diet correction=.726, exercise establishment=.774, cognition correction=.834, self-care=.760 and seeking for support=.694. It indicates that the “Scale for Biopsychosocial Life Modification of Post- Bariatric Surgery Patients” has good reliability and validity. Explore the relationship between the implementation of patient health behavior after weight loss surgery and gastrointestinal problems, the number of seeking medical treatment, life disturbances, and satisfaction with surgery. Post-bariatric surgery patients health behaviors and gastrointestinal problems, the number of seeking medical treatment, and life disturbances were statistically significant negative correlation, with satisfaction showed significant positive correlation.Suggestion: Weight loss is rapid after bariatric surgery, medical follow-up and nutrition monitoring are very important. “Scale for Biopsychosocial Life Modification of Post- Bariatric Surgery Patients” has good reliability and validity, which can understand the degree of implementation of health behaviors at home after surgery. In the future, relevant intervention measures and assessment instrument can also be developed to provide clinical practice and use of Weight loss is rapid after bariatric surgery