Table 2.

Individual-level barriers to bariatric surgery (per Andersen’s Behavioral Model of Health Services Use)

Individual determinant	Individual determinant description according to Andersen’s Model	Study theme
Predisposing: Social structure	Social networks and interactions, education, occupation	1. Lack of social support
Predisposing: Health beliefs	Underlying attitudes, values, and knowledge of the healthcare system	2. Fear of surgery and its outcomes (e.g. scared of surgery, complications, excess skin, or possibility of weight regain or sub-optimal results) 3. Fear of lifestyle change (e.g., dietary, lifelong process) 4. Patient characteristics influencing provider referral (e.g., mental illness, substance abuse, perceived patient motivation)
Need: Perceived	An individual’s perceived need for healthcare based on their own health, functional state, symptoms and whether they judge the problem warrants help	5. Perception that weight had not reached its “tipping point” (i.e., not life threatening or severely impacting quality of life)
Health behaviors: Personal health practices	An individual’s practices that influence health status such as diet, stress management, and adherence to medical advice	6. Concerns about adhering to recommended dietary changes