What is the experience of obese people undergoing Bariatric Surgery in the UK? BSA Medical Sociology Group 44th Annual Conference Homer, C, V., Tod, A, M. Centre for Health and Social Care Research, Sheffield Hallam University This poster presents findings from a review of literature on patients’ experiences of bariatric surgery. The findings have been used to develop a qualitative longitudinal study 'Weight Loss Surgery: Through the patients' Eyes'. The next steps: 'Weight Loss Surgery: Through the Patients' Eyes The limited findings from previous studies indicates an evidence gap. We have designed our current study to meet that gap. Three key methodological decisions were made to ensure the required in-depth evidence is generated. These are as follows: 1. Narrative Reconstruction theory (Williams 1984). The elective option of undergoing bariatric surgery is often referred to as a turning point in an obese person's life. Narrative Reconstruction theory provides a means to understanding this turning point. Narrative Reconstruction examines ways in which people normalise or make sense of acute or chronic illness in the context of their life narrative (Williams 1984). Current literature offers limited consideration of the psycho-social issues associated with obesity surgery or how people's narrative changes as a result of the procedure. Our study with patients electing for, and undergoing bariatric surgery uses the concept of Narrative Reconstruction during the interview process to allow participants to: discuss and mentally organise their thoughts and feelings regarding the origin of their obesity and weight gain; the disruption this has had on their lives; the role of surgery; and, the contribution of others in the development of, and recovery from their condition. 2. Photovoice methods can be used to explore how people reconstruct their narrative. Based on participatory action research methods, participants create and discuss photographs as a vehicle to explore issues in the context of their everyday lives. The method has been used in research to identify problems with interventions and public health programs using dialogue generated through pictures, and to inform health policy. Photovoice has been used successfully for research with various stigmatized groups. The technique enhances ‘people's ability to identify and define their own community's root-cause problems and to advocate change' Wang et al (1998). Photovoice will be used in this current study to promote participant's thinking about the root causes of their obesity, the challenges these cause, and their experience of life and changing behaviours following surgery. 3. Longitudinal methods. Previous methodologies have limited capacity to capture in-depth insight in changes to QOL and the patient experience of the complete service pathway. This study 'Weight Loss Surgery: Through the Patients' Eyes' will use a longitudinal real time approach. Participants are recruited and interviewed before surgery and post-surgery at three and nine months. Using the themes identified in previous research, Narrative Reconstruction and Photovoice methods to devise interview questions and guide the interview, will together contribute to identifying the type and levels of care and support required by patients at different stages of the bariatric surgical pathway. Background Bariatric surgery is becoming an increasingly accessed treatment of obesity. Demand for NHS funded procedures is rising at alarming rates, over 7,000 bariatric surgical procedures were carried out in 2009/10, 69% commissioned by the NHS in England and 31% were funded independently (National Bariatric Surgery Register, 2010). The increase in procedures is coupled with a wealth of published evidence (Colquitt et al 2009) positively evaluating the clinical effectiveness of surgery through weight loss and weight loss maintenance. A positive post-operative impact on health status and quality of life (QOL) when measured using standardised tools is evident in much of the research. Methodology A literature search of patient experience of bariatric surgery; support needs of patients undergoing bariatric surgery; and, improvements to the QOL in bariatric surgery patients. Electronic databases included: MEDLINE, EMBASE, CINAHL, PSYCINFO and BNI. Dates: 2000 to February Methodology: Qualitative research studies 16 abstracts were reviewed for inclusion in the literature review Results The literature review revealed little in the way of in-depth qualitative data relating to bariatric surgery. Existing research is extensively non-UK based and uses reflexive methodologies to ascertain pre and post-surgery experiences. There is a limited understanding of the patient experience, what influences their behaviour, support needs and the QOL changes following surgery. The majority of studies focused on pre-operative issues rather than post-operative long term care and behaviours. Themes that were identified in the studies include: 'last resort'; the reality and decision making related to the surgery (Wysoker 2005); patient motivation for surgery (Munoz et al 2007), support (Marcias et al 2004) and 'rebirth' of patients' lives. Conclusion The literature findings have aided the methodological design of a qualitative study. Our current study aims to generate recommendations to clinical groups and future commissioners of bariatric surgery, regarding the delivery of services to improve the intervention outcomes, and the quality of patient experience. References Colquitt, J, L., Picot, J., Loveman, E., and Clegg, J. (2009). Surgery for Obesity (Review). The Cochrane Collaboration. Publishes by John Wiley & Sons, Ltd Welbourn, R., Fiennes, A., Kinsman, R., Walton, P. (2010) National Bariatric Surgery Registry, First Registry Report to March Henley-on-Thames, Dendrite Clinical Systems. Marcias, J, A., Vaz Leal, F, J., Lopez-Ibor, J, J., Rubio, M, A., and Caballero, M, G. (2004). Marital status in morbidly obese patients after bariatric surgery. German Journal of Psychiatry. 7:3: Munoz, D, J., Lal, M., Chen, E, Y., Mansour, M., Fischer, S., Roehrig, M., Sanchez-Johnson., L., Dymek-Valentine, M., Alverdy, J., and Le-Grange,D. (2007). Why Patients Seek Bariatric Surgery: A Qualitative and Quantitative Analysis of Patient Motivation. Obesity Surgery. 17: Wang, C, C., Yi, W, K., Toa, Z, W., and Carovano, K. (1998). Photovoice as a participatory health promotion strategy. Health Promotion International. 13:1: Williams, G. (1984). The genesis of chronic illness: narrative re-construction. Sociology of Health and Illness. 6:2: Wysoker, A. (2005). The Lived Experience of Choosing Bariatric Surgery to Lose Weight. Journal of the American Psychiatric Nurses Association. 11:26 Contact Catherine Homer