Zeng Qiuxuan, Chen Wenli, Xu Siyi, Yang Xu, Xue Dandan, Peng Yuhang, Lin Xiaohong, Yu Yingwen, Huang Huixin, Huang Ping, Dong Min, Li Jiaying
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou, China.
School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Public Health. 2025 May 20;13:1553744. doi: 10.3389/fpubh.2025.1553744. eCollection 2025.
Home-based pulmonary rehabilitation (PR) is a key non-pharmacological intervention for chronic obstructive pulmonary disease (COPD), but poor adherence limits its effectiveness. The factors influencing adherence, particularly from the patients' perspective, are not well understood. This study aims to identify the factors that promote or hinder adherence to home-based rehabilitation in COPD patients, to inform more effective and personalized strategies.
This study guided by Health Belief Model (HBM), and data were collected through semi-structured in-depth interviews with eligible COPD patients during May and July 2024. Deductive thematic analysis approach was used to analyze the data.
Eighteen patients were recruited through purposive sampling. Two main themes emerged-facilitating health beliefs and challenges- along with five subthemes under the HBM framework: perceived threats, perceived benefits, cues to action, self-efficacy, and perceived barriers. In total, 28 categories were identified (21 facilitators, 7 barriers), including 11 newly discovered facilitators and one new barrier. Newly identified facilitators included physical limitations and fatigue, emotional distress, perceived ineffectiveness, time constraints, caregiving responsibilities, lack of support, cost, poor exercise conditions, reduced medical dependence, self-awareness of functional decline, attention-seeking behaviors, environmental cues, mental resilience, and religious beliefs. The new barrier related to environmental limitations and poor exercise conditions.
This study underscores facilitators and barriers influencing home-based PR adherence within the HBM framework. Facilitators include broad factors related to perceived benefits, cues to action, self-efficacy, and perceived threats, while barriers encompass physical limitations, time constraints, and insufficient support. Flexible, personalized programs and greater family involvement can enhance adherence, improve long-term outcomes, and mitigate the rising burden of chronic diseases in aging societies.
居家肺康复（PR）是慢性阻塞性肺疾病（COPD）的一项关键非药物干预措施，但依从性差限制了其有效性。影响依从性的因素，尤其是从患者角度来看的因素，目前尚不清楚。本研究旨在确定促进或阻碍COPD患者居家康复依从性的因素，以制定更有效和个性化的策略。
本研究以健康信念模型（HBM）为指导，于2024年5月至7月期间通过对符合条件的COPD患者进行半结构化深度访谈收集数据。采用演绎主题分析法对数据进行分析。
通过目的抽样招募了18名患者。出现了两个主要主题——促进健康信念和挑战——以及HBM框架下的五个子主题：感知威胁、感知益处、行动线索、自我效能感和感知障碍。总共确定了28个类别（21个促进因素，7个障碍），包括11个新发现的促进因素和1个新障碍。新发现的促进因素包括身体限制和疲劳、情绪困扰、感知无效、时间限制、照顾责任、缺乏支持、成本、运动条件差、医疗依赖减少、功能下降的自我意识、寻求关注行为、环境线索、心理韧性和宗教信仰。新障碍与环境限制和运动条件差有关。
本研究强调了HBM框架内影响居家PR依从性的促进因素和障碍。促进因素包括与感知益处、行动线索、自我效能感和感知威胁相关的广泛因素，而障碍包括身体限制、时间限制和支持不足。灵活、个性化的方案以及更多的家庭参与可以提高依从性，改善长期结果，并减轻老龄化社会中慢性病不断上升的负担。
