Compliance and Patients' Perspectives Towards Nutritional Supplementation Following Bariatric Surgery

Background Nutritional supplementation is recommended as a prophylactic strategy for nutritional deficiencies after bariatric surgery. Little is known regarding compliance and patients' perspectives. The purpose of the study was to explore supplement intake, compliance, and patients' perspectives (including barriers, facilitators, and beliefs) and to examine whether compliance to nutritional supplementation can be predicted after bariatric surgery. Material and Methods A questionnaire was developed to explore supplement intake and patients' perspectives. The Probabilistic Medication Compliance Scale (ProMAS) was included and modified to measure behaviors related to supplementation compliance. Content validity was assessed with an expert and patient panel. Consequently, a cross-sectional survey was conducted among patients that underwent bariatric surgery, who were invited using social media. Descriptive statistics and Spearman correlations were applied. Multiple linear regression analysis was performed to predict compliance. Results A 58-item questionnaire was developed and content validated, resulting in a scale-content validity index of 0.93. The questionnaire was completed by 402 subjects. Sixty-nine subjects reported not consuming any nutritional supplement (n = 69; 17.2%). For the supplement users (n= 333; 82.8%), a median ProMAS sum score of 11.0 (7.0-15.0) was observed. Increasing age and medicine intake were positive predictors of compliance (age: B = 0.058, p= 0 .01; medicine intake: B = 0.39, p < 0.001), while experiencing barriers was identified as a negative predictor of compliance (B = - 4 .637, p < 0.001). Top three barriers for supplement use were forgetfulness (n= 118; 29.4%), too expensive (n= 91; 22.6%), and experiencing side effects (n= 61; 15.2%). Conclusion Lifelong nutritional supplementation is essential after bariatric surgery, but compliance can be affected by the presence of barriers.