Dynamic trade-off evaluation framework for bariatric surgery outcomes: a qualitative Straussian Grounded Theory study

Objective Guided by Straussian Grounded Theory, this study aimed to explore patients' dynamic trade-off processes in evaluating bariatric surgery outcomes and to construct a patient-centred theoretical framework to inform clinical assessment and intervention. Design Qualitative study using Straussian Grounded Theory, semi-structured, in-depth interviews were conducted.

Data were analysed using open, axial and selective coding. Reporting followed the Standards for Reporting Qualitative Research guidelines.

Setting This study was conducted at a tertiary hospital in China between June 2023 and August 2023. Participants A total of 11 patients who had undergone bariatric surgery were enrolled, aged 21 - 54 years, with postoperative follow-up durations ranging from 1 to 10 years.

Results A core category - Dynamic Trade-off Evaluation of Bariatric Surgery Outcomes - was identified, characterised by dynamism, trade-off and subjectivity. The framework comprises four inter-related components: trade-off basis, trade-off moderation, trade-off process and comprehensive evaluation.

Outcome evaluation emerged as a non-linear process progressing through four stages: burden-dominant, contradiction-coexistence, contradiction-persistence and meaning-reconstruction stages. Individual goal orientation and psychological resilience served as key moderating factors shaping evaluative trajectories.

Conclusion This study proposes a novel theoretical framework elucidating how patients dynamically evaluate bariatric surgery outcomes. By revealing stage-specific mechanisms and moderating factors, the framework provides a theoretical basis for improving preoperative expectation management and postoperative support.