Determinants of Implementing the 2024 Weight Management Guidelines in Overweight Patients with Coronary Heart Disease in China: A CFIR-Based Qualitative Study of Patient and Caregiver.

BACKGROUND

The rising prevalence of overweight among patients with coronary heart disease (CHD) constitutes a critical clinical challenge. However, the multilevel determinants and patient-caregiver dynamics influencing the real-world implementation of the 2024 Weight Management Guidelines remain underexplored.

PURPOSE: To examine the facilitators and barriers influencing the clinical implementation of the 2024 Weight Management Guidelines from the perspectives of patients and their caregivers, and provide an evidence-based foundation for optimizing guideline-driven interventions in overweight patients with CHD.

MATERIAL AND

METHODS

Using a descriptive qualitative design, purposive sampling was employed to conduct semi-structured, in-depth interviews between July and December 2025 with overweight patients with CHD and their family members at a tertiary hospital in Nanjing. Data were analyzed thematically within the theoretical framework of the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Implementation determinants were synthesized into five CFIR domains. Outer

Setting

Media-driven health communication expanded patient awareness; however, implementation was constrained by the absence of community-based guidance, fragile social support, and a lack of peer support networks. Inner

Setting

Institutional trust and effective clinician-led education served as key facilitators; however, the lack of a multidisciplinary education model remained a critical barrier. Characteristics of Individuals: Patients exhibited proactive information-seeking behaviors and a "confidence cycle" driven by positive feedback. Nevertheless, deep-seated cognitive biases (e.g, the "medication-only" fallacy), entrenched dietary preferences, sedentary lifestyles, addictive behaviors, disrupted circadian rhythms, and behavioral inertia combined with skill deficits created substantial resistance. Intervention Characteristics: While caregivers are highly willing to participate, there is a clinical lack of personalized weight management programs for patients with CHD. Implementation Process: Daily familial supervision provided vital reinforcement; however, a fragmented post-discharge care chain led to the cessation of effective professional guidance and monitoring.

CONCLUSION

The implementation of the 2024 Weight Management Guidelines is governed by multilevel determinants. Clinical practice should address behavioral inertia and cognitive biases while establishing a "hospital-to-home" continuum of care. Integrating family-centered participation with precision strategies is essential to enhance adherence and facilitate the successful translation of the guidelines.