Barriers and facilitators to self-management in postoperative survivors of glioma in early-to-middle adulthood: A qualitative study using the COM-B model.

OBJECTIVE

To systematically identify barriers and facilitators to self-management in postoperative patients with glioma in early-to-middle adulthood, utilising the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

METHODS

Employing purposive sampling, 14 postoperative patients with glioma were recruited from a tertiary hospital in Beijing. Guided by the principle of maximum variation, participants were selected to cover core dimensions, including age and histological grade. Data were collected via semi-structured interviews. Colaizzi's phenomenological analysis method was used to extract themes, with theoretical saturation achieved at the 12th participant.

RESULTS

For the capability dimension, 80% of patients reported postoperative symptom burden (headache, cognitive decline), directly impeding self-management execution. Prevalent knowledge gaps (uncertainty regarding medication management, rehabilitation standards) and barriers to information access (limited channels, information overload) were identified. In the opportunity dimension, financial strain (35%-50% income reduction due to workforce disruption) and difficulties accessing non-local healthcare (challenges in appointment scheduling, bed shortages) constituted primary barriers. Family support (collaborative care) and peer support (informational and emotional support) emerged as key facilitators, although cultural beliefs led some patients to conceal their condition. For the motivation dimension, fear of recurrence ('fear of asymptomatic recurrence') and disease-related stigma ('perceived self as a family burden') inhibited self-management behaviours. Treatment beliefs ('strict adherence to medical advice'), social role identity ('persisting with rehabilitation to care for grandchildren') and self-efficacy ('adopting a pragmatic attitude towards daily life') significantly enhanced management adherence.

CONCLUSION

Self-management in this population represents a dynamic balancing process constrained by capability limitations, opportunity deficits and motivational conflicts.