Barriers and Facilitating Factors for Preoperative Non-Invasive Positive Pressure Ventilation Compliance in Chinese Patients with Obesity Hypoventilation Syndrome: A Qualitative Study.

AIM: To explore factors influencing compliance with Non-invasive Positive Pressure Ventilation therapy in patients with obesity hypoventilation syndrome (OHS) prior to bariatric surgery, and to identify enabling factors and barriers using the capability, opportunity, and motivation-behavior model (COM-B model).

DESIGN

A qualitative descriptive design.

METHODS

Using purposive sampling, 13 patients with OHS who underwent bariatric metabolic surgery in the general surgery department of a tertiary hospital in Taiyuan from March to September 2025 were selected. Face-to-face semi-structured in-depth interviews were conducted, and the interview data underwent content analysis to extract themes.

RESULTS

This study summarizes from three main factors: capability, opportunity, and motivation, and extracts the three major facilitating factors and barrier factors for patients with OHS to use Non-invasive Positive Pressure Ventilation (NIPPV) before weight loss surgery. Among them, facilitating factors include: Capability factors (positive perceptions and internalization of health awareness for positive pressure ventilation), Opportunity factors (family support, motivational effects of and peer support, assistance and supervision from professionals), and Motivation factors (urgency of ensuring surgical safety, strong motivation for rehabilitation, fear of severe health consequences, positive feedback from symptom improvement). Barrier factors include: Capability factors (the physiological burden of obese patients, lack of self-efficacy in changing past habits, insufficient cognitive ability), Opportunity factors (insufficient professional support, unfavorable rehabilitation environment), Motivation factors (uncomfortable wearing experience, fatigue while wearing, anxious mind and sense of shame).

CONCLUSION

The use of NIPPV before weight loss surgery in patients with OHS is influenced by their capability, opportunity, and motivation. Patients with OHS are highly reliant on authoritative information. Clinical medical staff can leverage "peer support", focus on the spontaneous motivational role of positive pressure ventilation in patients with OHS, and use positive feedback incentive mechanisms to improve the enthusiasm and compliance with positive pressure ventilation, thereby helping patients with OHS achieve better ventilation outcomes.

PRACTICE IMPLICATIONS: Clinical interventions should target the above multidimensional factors, focusing on strengthening patient cognitive education and self-efficacy, optimizing family and social support systems, improving wearing comfort, and alleviating psychological burden, thereby effectively enhancing preoperative adherence to NIPPV.