Healthcare Professionals’ Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study

Abstract

Background

Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified.

Purpose

The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital.

Methods

Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF).

Results

Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease.

Conclusion

This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.

Keywords:

• model of care
• theoretical domains framework
• hospitalized
• obesity

Abbreviations

TDF, Theoretical Domains Framework; BMI, body mass index; SD, standard deviation; HCP, healthcare professional; MOC, model of care, COREQ, Consolidated Criteria for Reporting Qualitative Research; IQR, interquartile range; COVID, Coronavirus Disease.

Acknowledgments

The authors thank the participants for their valuable time.

Disclosure

MR received support from an Australian Government Research Training Program Scholarship and a Dr Richard Adams Trust Memorial Scholarship (2018). CEC is supported by an NHMRC Investigator Grant Leadership Fellowship (L3 APP2009340). EM and VM report no other conflicts of interest in this work.