Factors influencing patients' health behaviors during the transitional period after heart valve replacement: a qualitative study based on the COM-B framework.

Abstract

Objectives: To identify and map perceived barriers and facilitators to health behaviors (including medication management, exercise, nutrition, psychological adjustment, and self-care) among patients during the transitional recovery phase after heart valve replacement (HVR), using the Capability, Opportunity, Motivation - Behavior (COM-B) framework as a guiding analytical lens, and addressing the predominantly quantitative nature of existing research.

Methods: A descriptive qualitative design was employed. Fourteen patients at 1 week to 6 months post-HVR were purposively recruited between July and December 2024. Semi-structured interviews guided by the COM-B framework were analyzed using directed content analysis, integrating deductive coding derived from the model with inductive coding to capture emergent themes. Methodological rigor was established through interrater coding, member checking, and maintenance of an audit trail.

Results: Three key themes aligned with COM-B domains (capability, motivation, opportunity) and fourteen subthemes were identified. Capability barriers included insufficient disease knowledge, negative illness perceptions, and medication management challenges. Motivational factors revealed weak baseline health awareness and low self-efficacy as barriers, alongside role recovery motivation and psychological self-adjustment as facilitators. Opportunity factors included family support, health professional guidance, and peer support as resources, alongside financial burden and environmental constraints as barriers.

Conclusions: This study identified perceived barriers and facilitators to health behaviors among patients during transitional recovery following HVR, mapped across capability, opportunity, and motivation domains using the COM-B framework. From a psychological perspective, illness perceptions, self-efficacy, role-recovery motivation, and psychological self-adjustment emerged as key psychological processes associated with behavioral engagement. Further prospective and intervention research is needed to examine these exploratory patterns and evaluate whether theory-driven strategies informed by these processes can support behavior change.

Practice implications: These findings suggest the potential value of addressing psychological processes such as illness perceptions, self-efficacy, and motivational orientation alongside knowledge-based education, as a possible approach to supporting sustained engagement in health behaviors after HVR.