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Determinants of Dietary Adherence Among Chinese Patients After Bariatric Surgery Based on the Attitude-Social Influence-Efficacy Model

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Abstract

Purpose

To explore main determinants of dietary adherence among Chinese patients after bariatric surgery based on the Attitude-Social influence-Efficacy (ASE) model.

Methods

A cross-sectional survey was conducted by using convenience sampling method to select 288 participants in a tertiary hospital in Jiangsu, China. General information and disease-related information were collected as well as applying the Dietary Adherence Scale after Bariatric Surgery (DASBS) and Attitude-Social influence-Efficacy Questionnaire after Bariatric Surgery (ASEQBS). Univariate analysis, correlation analysis, and multivariate analysis were used to identify determinants of dietary adherence among patients after bariatric surgery.

Results

A total of 288 questionnaires were effectively collected. The mean DASBS score was 54.90 ± 10.08 among post-bariatric patients. Univariate analysis results showed that education level, time since surgery, smoking, exercise, participation in peer support groups, and participation in nutrition counseling had significant effects on postoperative diet adherence level of patients (P < 0.05). The correlation analysis results showed that the total score of dietary adherence was positively correlated with the total score of intention, attitude, social influence, and self-efficacy, and the correlation coefficients were 0.511, 0.550, 0.460, and 0.484, respectively (P < 0.05). The results of multiple linear regression analysis showed that time since surgery, attitude, intention, social influence, exercise, and self-efficacy entered the regression equation (P < 0.05). The standardized regression coefficients of attitude and intention are 0.237 and 0.196, respectively. The regression model could explain 44.0% of the total variation.

Conclusion

The dietary adherence of Chinese post-bariatric patients is at an upper-middle level, which needs to be further improved. Time since surgery, exercise, intention, attitude, social influence, and self-efficacy had significant effects on patients’ dietary adherence. Attitude had the greatest effect on dietary adherence, followed by intention. The results shed light on that these factors should be emphasized to take personalized intervention strategy in designing dietary intervention program, in order to improve the patient’s dietary adherence and surgical outcomes.

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Acknowledgements

We thank Donglian Xu (Department of Clinical Nutrition, The First Affiliated Hospital of Nanjing Medical University) for nutrition guidance.

Funding

This research was funded by the project “The exploration of trajectories and intervention program of frailty for gastric cancer survivors based on the health ecology theory (82073407)” (supported by NSFC); Project of “Nursing Science” Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (2018, No.87); and Project “Early warning and intervention of childhood and adolescent obesity in the context of big data: Development and demonstrative application of iNATURE intelligent platform based on hospital, community, and family linkage” supported by the Social Development Fund of Jiangsu Province (No: BE2021722).

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Authors and Affiliations

  1. School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China

    Hanfei Zhu, Kang Zhao, Lingyu Ding, Xiaoman Jiang, Shuqin Zhu & Qin Xu

  2. School of Nursing, Fudan University, Shanghai, 200032, China

    Ziqi Ren

  3. Department of Bariatric and Metabolic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Hongxia Hua, Ningli Yang & Hui Liang

  4. Department of Nursing, Jiangsu College of Nursing, Huai’an, 223000, Jiangsu, China

    Tianzi Zhang

Authors
  1. Hanfei Zhu
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  2. Kang Zhao
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Contributions

Hanfei Zhu contributed to conception, design, data acquisition, analysis, and interpretation; and drafted and critically revised the manuscript. Kang Zhao contributed to data acquisition, analysis, and interpretation. Ziqi Ren, Hongxia Hua, Tianzi Zhang, Lingyu Ding, and Xiaoman Jiang were responsible for the design, data analysis, interpretation, and manuscript revision. Ningli Yang, Hui Liang, and Shuqin Zhu were responsible for data interpretation, and manuscript revision. Qin Xu was responsible for the conception, study design, manuscript drafting, and study supervision.

Corresponding author

Correspondence to Qin Xu.

Ethics declarations

Ethics Approval

This study was approved by the ethics committee of the Nanjing Medical University (ethical approval number: 2020-SR-247). All procedures performed in studies involving human participants followed the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key Points

• The dietary adherence of Chinese post-bariatric patients needs to be improved.

• Time since surgery and exercise are important factors that influence patients’ dietary adherence.

• ASE factors (intention, attitude, social influence, and self-efficacy) have significant effects on patients’ dietary adherence.

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Zhu, H., Zhao, K., Ren, Z. et al. Determinants of Dietary Adherence Among Chinese Patients After Bariatric Surgery Based on the Attitude-Social Influence-Efficacy Model. OBES SURG 32, 3064–3073 (2022). https://doi.org/10.1007/s11695-022-06208-4

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  • DOI: https://doi.org/10.1007/s11695-022-06208-4

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