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"Wait for us to catch up": Aspects of family functioning after gastric bypass surgery
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. (Familjefokuserad omvårdnad)ORCID iD: 0000-0001-7118-4933
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: To investigate aspects of family functioning when a family member has undergone Gastric Bypass surgery (GBP).

Methods: Study I explored experiences of family functioning three months after GBP, based on nine family interviews, analyzed using Gadamerian hermeneutics. Using Classic grounded theory, Study II focused on how families resolve their primary concerns after GBP, through interviews with 16 families. Study III evaluated the reliability and validity of the General Functioning Scale (GFS) based on 163 self-reported questionnaires, and used psychometric analyses. Study IV explored associations between family functioning, weight loss, sex and Health Related-Quality of Life (HR-QoL), based on self-reported questionnaires from 153 participants and utilized descriptive statistics and binary logistic regression.

Results: Study I revealed a process of three intertwined changes in family functioning three months after GBP: Living in ambiguous relationship, rewriting family patterns and strengthening family cohesion. Study II showed that families shared a main concern of unexpected change after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. This resulted in attaining unity, returning to old family patterns or disconnecting. Study III suggested GFS as a promising tool for assessing family functioning in a Swedish bariatric sample, showing satisfactory reliability and validity. Study IV showed associations between family functioning and the mental dimensions of HR-QoL, two years after GBP. Percent weight loss was associated with the physical dimension. Sex showed no associations to HR-QoL.

Conclusion: Families experienced unexpected challenges after GBP affecting family functioning. Mutual remodeling of family life to incorporate changes was seen. Families underwent a social process, indicating that families may represent a resource in bariatric nursing care. A family-system nursing perspective as complement to standard care may be beneficial. As family functioning influence HR-QoL identifying available family resources and giving tailored information to support self-care strategies after GBP, may result in sustainable family functioning and individual health. Studies aimed at identify families that may benefit from family-system nursing interventions are suggested for future inquiry. 

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2017. , p. 166p. 1-72
Series
Linnaeus University Dissertations ; 272/2017
Keywords [en]
Family functioning, Family system theory, Obesity, Gastric bypass, Family Interviews, Self-reported Questionnaires
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-60684Libris ID: 20043264ISBN: 978-91-88357-53-3 (print)OAI: oai:DiVA.org:lnu-60684DiVA, id: diva2:1074541
Public defence
2017-01-20, V159, Storken, Kalmar, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-15 Created: 2017-02-15 Last updated: 2018-12-11Bibliographically approved
List of papers
1. Creating a New Sense of We-ness: Family Functioning in Relation to Gastric Bypass Surgery
Open this publication in new window or tab >>Creating a New Sense of We-ness: Family Functioning in Relation to Gastric Bypass Surgery
2013 (English)In: BARIATRIC SURGICAL PRACTICE AND PATIENT CARE, ISSN 2168-023X, Vol. 8, no 4, p. 152-160Article in journal (Refereed) Published
Abstract [en]

Background: Gastric bypass surgery (GBP) is the most common treatment for morbid obesity (body mass index 35). To date, the person with obesity has been the main focus in bariatric nursing and research, although the person coexists within their family. Aim: The aim of this study was to describe family functioning in relation to GBP. Methods: Open ended questions were used. Nine families were interviewed on two occasions within 2 weeks 3 months after surgery. The interviews were transcribed and analyzed according to a hermeneutic method. Main Findings: An ongoing process of alterations related to family functioning was identified. Before, GBP families experienced distance and disengagement. Immediately after GBP, there were changes within relationships. Families experienced a period of difficulty, in interactions, while adapting to the lifestyle changes and altered positions. After 3 months, families experienced enhanced closeness in inter-relations within the family and increased social interactions as a whole family with friends and relatives. Conclusions: To better support families and enhance family functioning, bariatric nursing care needs to shift focus from an individual to a family perspective. Further studies are needed to gain a longitudinal perspective and improve understanding of family functioning after GBP.

National Category
Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-32108 (URN)10.1089/bari.2013.0008 (DOI)000328567800008 ()2-s2.0-84890753502 (Scopus ID)
Available from: 2014-02-05 Created: 2014-02-05 Last updated: 2018-12-11Bibliographically approved
2. Stabilizing family life after gastric bypass surgery
Open this publication in new window or tab >>Stabilizing family life after gastric bypass surgery
2017 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, no 1, article id 1325674Article in journal (Refereed) Published
Abstract [en]

Weight-loss surgery requires lifelong lifestyle modifications for the maintenance of weight loss and health effects, and can affect both the individual and family. Earlier research indicates that the quality of social relationships has positive and negative influences on wellbeing and health. There is little research on family-life after a member has undergone gastric bypass (GBP) against obesity. Thus, this study aimed to develop a classic grounded theory about families with a member treated with GBP against obesity. The study design used classic grounded theory and included data from 16 interviews. Families’ shared a main concern of unexpected changes after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. The social process develops differently which entail families: attaining unity, returning to old patterns, or disconnecting to find stability, depending on the discrepancy in expectations and knowledge. This is affected by the overall life situation, life-stage and relationship quality. The theory highlights unexpected change as a potential challenge for the family, as well as how they resolve this. Hence, the theory can be applied in care strategies for families. Identification of families needing support to stabilize family life after GBP requires further research.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Grounded theory, Obesity, Remodelling family patterns, Weight loss, Weight loss surgery
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-60686 (URN)10.1080/17482631.2017.1325674 (DOI)000419643400001 ()2-s2.0-85027722370 (Scopus ID)
Note

Ingår i avhandling "Wait for us to catch up" Aspects of family functioning after gastric bypass surgery

Available from: 2017-02-14 Created: 2017-02-14 Last updated: 2019-08-29Bibliographically approved
3. Assessment of family functioning: evaluation of the General Functioning Scale in a Swedish Bariatric Sample
Open this publication in new window or tab >>Assessment of family functioning: evaluation of the General Functioning Scale in a Swedish Bariatric Sample
Show others...
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, p. 614-622Article in journal (Refereed) Published
Abstract [en]

BackgroundThe General Functioning Scale (GFS) was developed to assess self-perceived overall family functioning. The scale has satisfactory psychometric properties, is internationally recognised and has been used in different contexts. However, no validated Swedish version is available. Healthy family functioning can support patients and help them adhere to treatment regimens. Moreover, it maintains the physical and emotional health and that of the family as a unit. Yet, there is limited information regarding family functioning postgastric bypass surgery. Thus, it is important to use validated instruments to understand family functioning in bariatric contexts. AimTo evaluate aspects of reliability and validity in GFS in a Swedish bariatric sample, focusing on factor structure. MethodThe Swedish version of the GFS (S-GFS) was administered on two occasions to 163 participants who had undergone gastric bypass surgery 6-8 weeks prior to testing. Internal consistency, temporal stability and construct validity were assessed. ResultsData were positively skewed. The S-GFS showed good internal consistency (ordinal = 0.92) with a sufficient overall mean interitem correlation (0.500) and adequate temporal stability (intraclass correlation coefficient = 0.833). After modifying response alternatives, confirmatory factor analysis indicated acceptable fit for a one-factor model. ConclusionThe scale is a promising tool for assessing family functioning in bariatric settings. The S-GFS showed satisfactory reliability - consistent with prior research - and acceptable validity in the study sample. This study contributes to the limited research on the scale's validity. However, the S-GFS needs to be evaluated in different cultural and clinical contexts, focusing on various aspects of validity and responsiveness (sensitivity to detect significant change over time) in different samples.

Keywords
family functioning, family assessment device, gastric bypass, psychometric evaluation
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-57460 (URN)10.1111/scs.12269 (DOI)000383803300020 ()26555951 (PubMedID)2-s2.0-85028282792 (Scopus ID)
Available from: 2016-10-25 Created: 2016-10-19 Last updated: 2018-12-11Bibliographically approved
4. Associations between family functioning, weight loss, sex and Health-Related Quality of Life outcomes two years after gastric bypass surgery
Open this publication in new window or tab >>Associations between family functioning, weight loss, sex and Health-Related Quality of Life outcomes two years after gastric bypass surgery
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-60687 (URN)
Available from: 2017-02-14 Created: 2017-02-14 Last updated: 2018-12-11Bibliographically approved

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