Date of Award
2025
Degree Type
Dissertation
Degree Name
Doctor of Philosophy in Psychology
Department
Psychology
First Advisor
Ceren Gunsoy
Second Advisor
Kathleen Melanson
Abstract
Obesity disproportionately affects Hispanic-Latino adults in the United States, yet rates of metabolic and bariatric surgery (MBS) remain lower in this population compared with non-Hispanic White adults. This dissertation comprises three interconnected phases aimed to (I) explore perceptions of obesity, obesity treatment, and patient-provider communication, (II) inform the development of a culturally responsive bilingual educational material about obesity and MBS, and (III) evaluate its acceptability among Hispanic-Latinos adults with obesity.
Phase I involved a qualitative exploration using semi-structured interviews with Hispanic-Latino adults (n=26) recruited from a community and a clinical MBS setting. These interviews explored participants’ perceptions of obesity and obesity care, as well as their experiences with treatment, including beliefs, perceived barriers, and opportunities, and how these factors influenced their decision-making regarding obesity care. Participants frequently associated obesity with emotional distress, maladaptive eating behaviors, and negative self-perception, while attributing positive characteristics, such as health and wellbeing to individuals without obesity.
Despite recognizing obesity as a multifactorial condition, many participants did not perceive it as a chronic disease but rather as a condition curable through personal effort (e.g., self-care, diet, and physical activity), medication, or surgery. When discussing available treatments, participants expressed concerns about obesity medications and MBS, including issues related to insurance coverage, potential side effects, the possibility of weight recurrence, and perceived surgical risks. Participants who selected surgery reported learning about MBS through family and friends and relied on them and their physicians for guidance during decision-making. In contrast, those who did not consider MBS reported having less in-depth discussions with their physicians about obesity treatment and described hearing negative accounts of MBS outcomes, expressing fear of surgical risks, and noting limited knowledge about the procedure.
These findings underscore the importance of framing obesity as a chronic disease and developing culturally tailored educational materials that enhance patient–provider communication, reduce stigma and misinformation, and support informed decision-making. Overall, participants frequently viewed obesity as controllable through personal effort, while stigma, misinformation, and fear of surgery continued to limit engagement in care. These insights informed the development of the culturally responsive educational materials described in Phase II.
Phase II involved the thematic analysis of the qualitative data to inform the development of a bilingual, culturally responsive educational handout grounded in the Transtheoretical Model (TTM) and Narrative Theory. The handout integrated patient narratives, reflective prompts, and family-centered messaging to promote self-reflection and facilitate dialogue between patients and healthcare providers regarding obesity and MBS. Phase III evaluated the handout through a pilot study (n = 20), assessing its clarity, relevance, and actionability, while open-ended feedback offered additional insights into its cultural resonance and perceived usefulness.
Collectively, these studies demonstrate that integrating behavioral and narrative frameworks into culturally and linguistically tailored resources may empower patients, reduce stigma, and improve access to obesity treatment and MBS among Hispanic-Latino adults. Future research should include a broader sample of Hispanic-Latino individuals representing diverse countries of origin, gender identities, and classes of obesity to ensure the generalizability and cultural relevance of findings across subgroups. Additionally, future research should examine the implementation and clinical impact of this educational handout within healthcare settings to assess its effectiveness in enhancing patient engagement and informed decision-making.
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Recommended Citation
Fornasaro-Donahue, Viviane, ""UNDERSTANDING OBESITY EXPERIENCES AND TREATMENT DECISION-MAKING IN HISPANIC-LATINO COMMUNITIES”" (2025). Open Access Dissertations. Paper 4529.
https://digitalcommons.uri.edu/oa_diss/4529