Weight management experiences and perspectives of people with overweight/obesity and atrial fibrillation: a qualitative study

Bates, Rachel (2022). Weight management experiences and perspectives of people with overweight/obesity and atrial fibrillation: a qualitative study. University of Birmingham. M.Res.

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Abstract

Background: Overweight/obesity is a risk factor for the development of atrial fibrillation (AF) and associated comorbidities. While results from interventional quantitative studies have shown that weight loss can improve AF symptoms and slow disease progression, many participants in these studies did not manage to significantly reduce their bodyweight. Achieving and sustaining weight reduction can be challenging in most populations, but symptoms and comorbidities may pose additional obstacles for people with AF. Better understanding of the barriers to weight management in this population is needed to improve service design and delivery.

Objectives: To investigate barriers and facilitators of healthy weight management in people with AF and overweight/obesity.

Methodology and Methods: This thesis is presented in three parts: a literature review and thematic synthesis (Part 1); the research study (Part 2); and a reflexive report on the study process (Part 3).The Capability, Opportunity and Motivation model of behaviour change (COM-B) was used as the theoretical framework for the literature review of the weight management experiences of people with cardiac disease, and a realist approach (what works for whom, when, under what circumstances) was used to interrogate the data (Part 1). COM-B provided the framework for the qualitative research study of interviews exploring the weight management experiences of 12 participants with AF (Part 2). The Peshkin Approach was used to structure a reflexive account of the research process, examining
the role of the values, priorities and assumptions of the researcher in shaping the enquiry and its findings (Part 3).

Findings: A systematic literature search (Part 1) identified no existing research into the weight management experiences and perspectives of people with AF. Five studies exploring the weight management experiences of people with cardiovascular disease were identified. A qualitative synthesis identified four themes: Wanting to Change, which relates to the Motivation component of COM-B; Building Capacity, which relates to Capability; Having Support and Having Control, which relate to Opportunity. The qualitative study (Part 2) investigated the previously unexplored weight management experiences of people with overweight/obesity and AF. Three major themes were identified. Being Out of Rhythm related to the physical and psychological impact of AF and linked to Motivation in the COM-B model. Doing the Right Thing explored participants’ frustration when weight loss efforts were unsuccessful or went unrecognised, linking to Capability, Opportunity and Motivation. Broaching the Subject reflected participants’ lack of awareness of the link between AF and overweight/obesity
and their experiences of discussing weight management with health care professionals, linking to Opportunity and Motivation. The examination of subjectivity in the reflexive report (Part 3) uncovered Ambivalent I, considering the clinical and ethical complexity of weight management. Apprehensions
felt whilst undertaking a research study for the first time are explored in Novice Researcher I. The tension between Healthcare professional I and the role of researcher are examined. Political I explores the emotions engendered by health inequalities, perceived medical paternalism, and obesity stigma.

Conclusion: The barriers to weight management faced by patients with AF have to date been largely underexplored. Patients in the present study did not associate overweight/obesity with the development and progression of AF. Improved communication is needed between health care professionals and patients with AF on the subject of weight management.

Type of Work:

Thesis (Masters by Research > M.Res.)

Award Type:

Masters by Research > M.Res.

Supervisor(s):