Minority ethnic patient groups typically have the highest bariatric surgery preoperative attrition rates and lowest surgery utilisation worldwide. Eligible patients of Pacific Island ethnicity (Pacific patients) in New Zealand (NZ) follow this wider trend.
Objectives The present study explored structural barriers contributing to Pacific patients’ disproportionately high preoperative attrition rates from publicly-funded bariatric surgery in Auckland, NZ.
Setting Publicly-funded bariatric surgery programmes based in the wider Auckland area, NZ.
Design Semi-structured interviews with health sector professionals (n=21) were conducted.
Data were analysed using an inductive thematic approach.
Results Two primary themes were identified: (1) Confidence negotiating the medical system, which included Emotional safety in clinical settings and Relating to non-Pacific health professionals and (2) Appropriate support to achieve preoperative goals, which included Cultural considerations, Practical support and Relating health information. Clinical environments and an under-representation of Pacific staff were considered to be barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families. Additionally, economic deprivation and lower health literacy impacted preoperative goals.
Conclusions Health professionals’ accounts indicated that Pacific patients face substantial levels of disconnection in bariatric surgery programmes. Increasing representation of Pacific ethnicity by employing more Pacific health professionals in bariatric teams and finding novel solutions to implement preoperative programme components have the potential to reduce this disconnect. Addressing cultural competency of staff, increasing consultancy times and working in community settings may enable staff to better support Pacific patients and their families. Programme structures could be more accommodating to practical barriers of attending appointments, managing patients’ preoperative health goals and improving patients’ health literacy. Given that Pacific populations, and other patients from minority ethnic backgrounds living globally, also face high rates of obesity and barriers accessing bariatric surgery, our findings are likely to have broader applicability.
- bariatric surgery
- pacific health
- ethnic disparities
- Structural barriers
- Surgery attrition
- Preoperative bariatric surgery attrition
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Contributors Study conception and design overseen by all authors (TT, WW, OD, NT, RJS). Draft written by TT and WW. Draft critically revised by all authors (TT, WW, OD, NT, RJS). Thematic analysis by TT and NT. Theme checks by all authors. All authors agree to be accountable for all aspects of the work and agreed on the final manuscript.
Funding The research was conducted during the tenure of a Pacific Health Research Postdoctoral Fellowship of the Health Research Council of New Zealand awarded to the first author (HRC 17/472). The funders had no role in data collection, interpretation and reporting.
Competing interests The submitting author (Dr Tamasin Taylor: author 1) and the other four contributing authors (author 2: Dr Wendy Wrapson, author 3: Dr Ofa Dewes, author 4: Miss Nalei Taufa, author 5: Professor Richard John Siegert) declare they have no affiliations with or involvement in any organsation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Patient consent for publication Not required.
Ethics approval Ethics approval was granted by the Health and Disability Ethics Committee and by Auckland University of Technology Ethics Committee. Research locality approval from all participating DHBs was obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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