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The Bariatric Surgery Motivation Questionnaire: A Validated Tool for Preoperative Assessment in Persian Population
Hastimansooreh Ansar1, Razieh Salehian2, Mohammad Eslami3,4
1Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Introduction:
Bariatric surgery represents a highly effective intervention for individuals with severe obesity, yet the preoperative motivational factors influencing adherence and long-term outcomes remain insufficiently explored, particularly in the context of mental health. This study aimed to develop and validate a culturally tailored questionnaire to assess preoperative motivations among bariatric surgery candidates, thereby enhancing personalized care.
Methods:
A mixed-methods study conducted from 2017 to 2019 at Rasool-e-Akram Hospital, Tehran, Iran, enrolled 448 adults with severe obesity (BMI ≥40 kg/m2 or ≥35 kg/m2 with at least one comorbidity). Semi-structured interviews (n = 200) generated an initial 158-item pool, which was refined into a 94-item pilot questionnaire (n = 100) and subsequently a final 30-item version (n = 148). The validation process encompassed evaluations of content validity (via content validity Ratio [CVR] and Content Validity Index [CVI]), construct validity (through Exploratory Factor Analysis [EFA]), reliability (using Cronbach's alpha), and convergent/divergent validity (employing the Treatment Self-Regulation Questionnaire [TSRQ] and Patient Health Questionnaire-9 [PHQ-9]).
Results:
The 30-item Bariatric Surgery Motivation Questionnaire encompasses four domains: Health (8 items), Physical Discomfort (4 items), Psychosocial Factors (12 items), and Attitudes Toward Surgery (6 items). EFA confirmed the factorial structure, accounting for 63.4% of variance (KMO = 0.739, p < 0.001). Content validity was strong (S-CVI/Ave = 0.87; CVR >0.49). Overall reliability was satisfactory (α = 0.813), with domain-specific alphas ranging from 0.312 to 0.807. Convergent validity with TSRQ (r = 0.78, p < 0.001) and divergent validity with PHQ-9 (r = -0.02, p = 0.032) were supported.
Conclusion:
The Bariatric Surgery Motivation Questionnaire is a potentially valid and reliable instrument for evaluating preoperative motivations among bariatric surgery candidates. It provides clinicians with a practical means to identify motivational factors that may affect surgical outcomes. Further refinement of domains with lower reliability and validation in larger multicenter samples could enhance its clinical utility.
