Facilitators and Barriers to Weight Loss Among Patients With Idiopathic Intracranial Hypertension.
Facilitators and Barriers to Weight Loss Among Patients With Idiopathic Intracranial Hypertension.
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特发性颅内高压患者减肥的促进因素和障碍。
DOI：
10.1097/wno.0000000000002133
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
DeLott,LindseyB
中科院分区：
文献类型：
--
作者：
Killeen,OliviaJ;Gonzalez,LizbethA;Rothberg,AmyE;Khanna,Sangeeta;Cornblath,WayneT;Deveney,Tatiana;Wong,SuiH;DeLott,LindseyB
背景：对于特发性颅内高压（IIH）患者的减肥动机和减肥障碍知之甚少。这样的信息是至关重要的发展量身定制的体重管理recommendations and novel interventions.Methods：我们进行了一项调查，IIH患者提出神经眼科诊所在密歇根大学凯洛格眼科中心（密歇根州，美国）和圣托马斯医院（伦敦，英国）。参与者对减肥的重要性和动机进行评分（1 - 10分; 10 =非常重要/动机）。促进和减肥的障碍进行了评估，使用开放式的调查问题告知动机访谈方法。开放式回答由2名团队成员独立使用修改的扎根理论方法进行编码。人口统计学数据从病历中提取。结果：在221例IIH患者（密歇根43例，伦敦178例）中，大多数为女性（密歇根40例，占93.0%;伦敦167例，占94.9%）。美国的大多数患者为白色（n = 35 [81.4%]密歇根州），英国的大多数患者为黑人（n = 67 [37.6%]伦敦]），平均（SD）BMI为38.9 kg/m 2（10.6 kg/m 2）密歇根州和37.5 kg/m 2（7.7 kg/m 2）伦敦。参与者对减肥重要性的平均（SD）水平为8.5（2.2）（密歇根州8.1 [2.3]和伦敦8.8 [2.1]），但他们减肥动机的平均（SD）水平为7.2（2.2）（密歇根州6.8 [2.4]和伦敦7.4 [2.1]）。从992个开放式编码调查中产生了9个主题，分为3个可操作的类别：自我效能，专业资源（减肥工具，饮食，身体活动水平，心理健康和身体健康）和外部因素（物理/环境条件，社会影响和时间限制）。大多数回答（55.6%; n = 551）是关于减肥的障碍。缺乏自我效能是讨论最多的单一障碍（N = 126;共22.9%，密歇根州28.9%，伦敦20.4%）和促进者（N = 77;共17.5%，密歇根州15.9%，伦敦18.7%）减肥。其他常见障碍与体力活动水平（N = 79;总计14.3%，密歇根州13.2%，伦敦14.8%）和饮食（N = 79;总计14.3%，密歇根州9.4%，伦敦16.3%）有关。常见的促进因素包括体力活动水平的改善（N = 73; 16.6%的总，18.5%密歇根州，15.1%伦敦）和饮食变化（N = 76; 17.2%的总，16.4%密歇根州，17.9%伦敦）。自我效能感是最重要的患者识别的障碍或促进者的减肥，但专业资源需求和外部因素在个人层面上有很大差异。应评估这些因素，以指导选择适合IIH患者个体的减肥干预措施。
Background:Little is known about motivation for weight loss and barriers to weight loss among patients with idiopathic intracranial hypertension (IIH). Such information is crucial for developing tailored weight management recommendations and novel interventions.Methods:We administered a survey to patients with IIH presenting to neuro-ophthalmology clinics at The University of Michigan Kellogg Eye Center (Michigan, USA) and St. Thomas' Hospital (London, England). Participants rated importance and motivation to lose weight (1–10 scale; 10= extremely important/motivated). Facilitators and barriers to weight loss were assessed using open-ended survey questions informed by motivational interviewing methodology. Open-ended responses were coded by 2 team members independently using a modified grounded theory approach. Demographic data were extracted from medical records. Descriptive statistics were used to analyze quantitative responses.Results:Of the 221 (43 Michigan and 178 London) patients with IIH (Table 1), most were female (n= 40 [93.0%] Michigan and n= 167 [94.9%] London). The majority of patients in the United States were White (n= 35 [81.4%] Michigan), and the plurality were Black in the United Kingdom (n= 67 [37.6%] London]) with a mean (SD) BMI of 38.9 kg/m 2 (10.6 kg/m 2) Michigan and 37.5 kg/m 2 (7.7 kg/m 2) London. Participants' mean (SD) level of importance to lose weight was 8.5 (2.2)(8.1 [2.3] Michigan and 8.8 [2.1] London), but their mean (SD) level of motivation to lose weight was 7.2 (2.2)(6.8 [2.4] Michigan and 7.4 [2.1] London). Nine themes emerged from the 992 open-ended coded survey responses grouped into 3 actionable categories: self-efficacy, professional resources (weight loss tools, diet, physical activity level, mental health, and physical health), and external factors (physical/environmental conditions, social influences, and time constraints). Most responses (55.6%; n= 551) were about barriers to weight loss. Lack of self-efficacy was the most discussed single barrier (N= 126; 22.9% total, 28.9% Michigan, and 20.4% London) and facilitator (N= 77; 17.5% total, 15.9% Michigan, and 18.7% London) to weight loss. Other common barriers were related to physical activity level (N= 79; 14.3% total, 13.2% Michigan, and 14.8% London) and diet (N= 79; 14.3% total, 9.4% Michigan, and 16.3% London). Commonly reported facilitators included improvements in physical activity level (N= 73; 16.6% total, 18.5% Michigan, and 15.1% London) and dietary changes (N= 76; 17.2% total, 16.4% Michigan, and 17.9% London).Conclusions:Patients with IIH believe weight loss is important. Self-efficacy was the single most mentioned important patient-identified barrier or facilitator of weight loss, but professional resource needs and external factors vary widely at the individual level. These factors should be assessed to guide selection of weight loss interventions that are tailored to individual patients with IIH.
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