Introduction
Purpose
Methods
Design
Participants and recruitment
Data collection
Data analysis
Results
Participant ID | Genger | Ages (years) | BMI (kg/m2) | Highest level of education | Employment | Annual household income | Medical insurance | Transplant time (months) | Complications | Current state |
---|---|---|---|---|---|---|---|---|---|---|
1 | Male | 24 | 17.48 | Elementary school | Unemployed | Middle-income | Resident medical insurance | 0.3 | – | In hospital |
2 | Female | 56 | 23.32 | High school | Retired | High-income | Employee medical insurance | 0.5 | Hypertension | At home |
3 | Male | 69 | 24.80 | High school | Unemployed | Middle-income | NRCMS | 23 | Hypertension, diabetes | At home |
4 | Male | 33 | 23.65 | Junior school | Employed | High-income | NRCMS | 3 | – | In hospital |
5 | Male | 55 | 23.30 | Junior school | Unemployed | High-income | NRCMS | 15 | – | At home |
6 | Male | 56 | 14.86 | High school | Retired | High-income | Employee medical insurance | 6 | Diabetes | In hospital |
7 | Male | 68 | 27.76 | High school | Unemployed | Middle-income | Resident medical insurance | 0.1 | – | In hospital |
8 | Female | 51 | 23.14 | Elementary school | Unemployed | Low-income | NRCMS | 0.5 | Hypertension | At home |
9 | Male | 59 | 22.41 | High school | Retired | Middle-income | Employee medical insurance | 43 | – | At home |
10 | Male | 75 | 24.16 | Elementary school | Unemployed | Middle-income | Resident medical insurance | 2 | Hypertension | In hospital |
11 | Male | 45 | 25.21 | High school | Unemployed | Middle-income | NRCMS | 13 | – | In hospital |
12 | Male | 50 | 21.34 | College/university | Employment | High-income | Employee medical insurance | 14 | – | In hospital |
13 | Female | 49 | 25.30 | High school | Employment | Middle-income | Employee medical insurance | 31 | – | At home |
14 | Male | 57 | 27.31 | Junior school | Unemployed | Low-income | NRCMS | 0.5 | – | In hospital |
15 | Male | 61 | 24.45 | College/university | Unemployed | Middle-income | Commercial insurance | 2 | Coronary heart disease | In hospital |
COM-B | TDF | Barriers | Facilitators |
---|---|---|---|
Physical capability | Physical skills | • Physical limitations • Insufficient exercise endurance | • Physical condition improved after transplantation • Reduce discomfort symptoms |
Psychological capability | Knowledge Emotion and behavioural regulation | • Lack of exercise-related knowledge • Healthcare providers’ conflicting or vague advice • Negative life events after transplantation | • Actively learn basic exercise knowledge • Actively seek professional guidance • Positive improvement of exercise behavior |
Physical opportunity | Environmental context and resources | • Bad weather • The limitation of external environment • Heavy financial burden | • Accessibility and convenience of exercise |
Social opportunity | Social influence | • Lack of social support • Insufficient support from healthcare providers • Negative social effect | • Peer support • Professional support from healthcare providers |
Automatic motivation | Emotion Reinforcement | • Ambivalence in decision-making • Anxiety about impaired health • Worries about the outcomes of LTx • Discomfort experience brought by exercise | • Perceive the significance of exercise rehabilitation • Optimistic exercise attitude • Adapting to LTx and reinventing oneself |
Reflective motivation | Beliefs about capabilities Goals Intention | • Excessive self-expectation • Lack of exercise confidence • Not be included in the priority target • Lack of motivation | • High self-efficacy • Priority of moving target • Enhanced motivation of exercise rehabilitation |
Physical capability
Barriers
“I feel particularly painful after the operation. The wound is so big that I can’t sleep, let alone exercise.” (P1, 24 years).
“I have just finished surgery, I am afraid of touching the thoracic drainage tube and urinary catheter when I exercise in bed.” (P7, 68 years).
“In the last week, my blood concentration of tacrolimus was not well controlled (...). I have diarrhea for two days and I can’t exercise. I plan to go to the hospital.” (P10, 75 years).
“I have hypertension and diabetes, and my physical condition is relatively poor. After exercising for a while, I will break out in a cold sweat and feel dizzy.” (P3, 69 years).
“I still feel weak after LTx. I used to move things and do housework effortlessly, but now I feel a little chest tightness when walking, let alone other exercise.” (P2, 56 years).
Facilitators
“I persevered with cycle ergometer training for a week, and I noticed a significant increase in the strength of my lower limbs.” (P15, 61 years).
“When I initially began exercising, I felt a lack of strength in my body. But after a year of persistence, my limbs were slowly gaining strength. Now there is no problem in my daily life. I still insist on exercising every day and look forward to returning to my former state.” (P11, 45 years).
“After exercising for a while, I found that my physical condition was getting better and better. Now I have been insisting for more than a year. I really think that exercise is very important.” (P5, 55 years).
“After the operation, I still feel chest tightness. Under the guidance of healthcare providers, I insisted on exercising. Now I feel that my breathing is smooth and my limbs are strong.” (P8, 51 years).
Psychological capability
Barriers
“I know I’m going to start exercising. During my stay in the hospital, both doctors and nurses instructed me to exercise, but after I stayed at home, I was a little at a loss and couldn’t master the degree of exercise well.” (P8, 51 years).
“I can understand the precautions explained by healthcare providers, but I always feel wrong when I actually do it. I still have difficulties in exercising myself, and I want the healthcare providers to guide me.” (P14, 57 years).
“I dare not move casually after the operation. I am worried that I will suddenly feel chest tightness and asthma after exercise. The feeling is particularly uncomfortable, and I still have a lingering fear.” (P7, 68 years).
Facilitators
“After I learned how to exercise before the operation, I became more active after the operation.” (P4, 33 years).
“Doctors and nurses gave me exercise rehabilitation instruction manuals, which I thought were particularly useful. The contents were very clear, so I just followed them.” (P15, 61 years).
“My family has specially equipped me with sports equipment. After a month of exercise, I have climbed four flights of stairs now, and I have no symptoms of chest tightness or asthma. I think I have made great progress.” (P6, 56 years).
Physical opportunity
Barriers
“It is too cold or too hot for me to go out for exercise.” (P9, 59 years).
“There are no exercise facilities around my home. I need to go to other places for exercise by car. This is very difficult for me, and it is far away and expensive. I am also afraid of any accidents when I exercise.” (P6, 56 years).
“I used to have a job, but now I can’t work after the operation. The cost of the whole operation and postoperative treatment is relatively high. I am under great pressure and don’t want to exercise.” (P13, 49 years).
Facilitators
“There is a square in our community, and we have a square dance every night. I think it is very useful for my health.” (P8, 51 years).
Social opportunity
Barriers
“My family and friends think that exercise is not effective and do not support me to continue to exercise (...).” (P4, 33 years).
“Doctors don’t communicate with me much; I especially want to know more about LTx disease counseling, home care, follow-up contact(...).” (P14, 57 years).
“I seldom go out to exercise (...). In our countryside, when it comes to “transplantation“, everyone thinks that this disease may be contagious. I am afraid that others will forsake me.” (P8, 51 years).
Facilitators
“I joined a WeChat group consisting of LTx patients. We made an appointment to exercise and connected the dragon every day. I feel very good.” (P11, 45 years).
“I am especially willing to participate in activities with fellow patients because we share a common topic. We also set up a WeChat group to often talk about how to exercise after transplantation.” (P5, 55 years).
“The healthcare providers regularly contacted me after my discharge, providing guidance for home-based exercise and boosting my confidence to continue exercising.” (P15, 61 years).
Automatic motivation
Barriers
“Now I don’t know what to do about many things. For example, I want to take an exercise after the operation, but my family thinks I should rest, and I’m afraid I won’t get good results after I insist. I don’t know whether I should insist on exercising or not, and my mind is very chaotic.” (P14, 57 years).
“Affected by the COVID-19 epidemic, many friends wanted to visit me, but I didn’t let them come. My immunity was low after the operation, and I was afraid it would affect me.” (P1, 24 years).
“I am particularly worried about infection when I exercise. I don’t know how to avoid infection. I only know cleaning and taking anti-infective drugs on time”. (P5, 55 years).
“If other problems damage pulmonary function and eventually lead to graft loss, I will collapse. So I dare not exercise, for fear that being too tired will affect pulmonary function.” (P12, 50 years).
“I didn’t pay attention to breathing and blood oxygen saturation before exercise (...). As a result, I had asthma and decreased blood oxygen saturation after exercise.” (P13, 49 years).
Facilitators
“After this major operation, I realized that people should learn to be grateful and satisfied. I must exercise diligently and make the most of my second chance at life.” (P8, 51 years).
“I feel my breathing suddenly becoming unobstructed. This feeling is really wonderful. I want to exercise well, improve my physique and live a happy life.” (P11, 45 years).
“After LTx, my heart suddenly calmed down and I felt suddenly enlightened. I believe this is the best arrangement for me now.” (P15, 61 years).
Reflective motivation
Barriers
“I have been exercising for three months. I thought my physical fitness would be improved obviously, but in fact I am still weak and can’t lift heavy objects.” (P4, 33 years).
“Although I have finished the operation, I still feel very sick, and I don’t have the strength to exercise. I’m also afraid that there will be other problems in case (...). I’m not sure.” (P2, 56 years).
“I think the most important thing after transplantation is to actively cooperate with postoperative treatment, such as taking immunosuppressive drugs, so exercise can be postponed.” (P7, 68 years).
“My friend called me to participate in group exercise, (...). I don’t think it makes any sense, and I don’t like it. I don’t have great expectations for postoperative life.” (P4, 33 years).
Facilitators
“After the operation, I felt very tired when I started to exercise. But I think I have finished the transplant operation, so what else can I not overcome?” (P1, 24 years).
“I used to think that work was of utmost important, but now exercise to keep healthy is the first priority. I adhere to my exercise plan every day, gradually increasing it from 2 days a week, 30 minutes a day, to 5 days a week. I believe exercise has become an integral part of my life, and I aspire to return to normal life as soon as possible.” (P8, 51 years).
“I felt uncomfortable at the beginning of exercise, but I found that my body is becoming healthier and I feel full of energy every day.” (P15, 61 years).