B. Henchcliffe1, J. L. Holihan1, J. R. Flores1, T. O. Mitchell1, T. C. Ko1, L. S. Kao1, M. K. Liang1 1University Of Texas Health Science Center At Houston,Surgery,Houston, TX, USA
Introduction:
Patients presenting with a ventral hernia often have modifiable risk factors. Preoperative risk reduction programs have been shown to be efficacious in behavior modification; however, generalizability of these outcomes to underserved patients may be hindered by unrecognized barriers. The aim of this study is to identify patient-reported barriers to successful implementation of a preoperative risk reduction program at a safety-net hospital.
Methods:
This was a prospective exploratory qualitative study. The study was initiated concurrently with a new preoperative risk reduction program. One-on-one semi-structured interviews were conducted. Latent content analysis applying inductive coding methods was used to code and condense raw qualitative data.
Results:
The study population (n=43) was largely unemployed (77.1%) and uninsured (81.4%), minorities (88.3%). Patients self-identified as being overweight (76.7%), a smoker (18.6%), and diabetic (20.9%). Over half (51.2%) of respondents reported a barrier to participation in the preoperative program including lack of transportation (20.9%), lack of time (9.3%), distance from the program site (7.0%), and scheduling conflicts (7.0%). Administration of the survey correlated with an improved enrollment rate in the preoperative program (20.8% vs 66.7%, p=0.006).
Conclusion:
Patients at a safety-net hospital report numerous barriers to participation in a preoperative risk reduction program despite significant potential benefits. Integrating patients as key stakeholders in the development of clinical programs and initiating interactions with open ended questions may stimulate self-reflection, patient interest, and adaptive changes that can improve enrollment and effectiveness.