BMJ open · 2026
Perceived factors shaping preoperative self-preparation among older patients undergoing total knee arthroplasty: a qualitative study.
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Sun Jiawen, Pei Yongle, Zhang Xiuhua
Аннотация
OBJECTIVES: This study aimed to explore perceived factors shaping preoperative self-preparation among older patients undergoing total knee arthroplasty (TKA), drawing on the Capability, Opportunity and Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework, with a view to informing the design of targeted preoperative health education interventions.
DESIGN: This study employed a descriptive qualitative research design. Purposive sampling was used, guided by the principle of maximum variation, taking into account factors such as age, gender, educational background and disease severity. A total of 16 participants were enrolled. Data were collected through semi-structured in-depth interviews conducted 1 day before surgery. This study employed a strategy of concurrent data collection and analysis. During data collection, the study was guided by Information Power. The data were analysed using reflexive thematic analysis.
SETTING: The study was conducted in a tertiary hospital in China.
RESULTS: Three themes with nine subthemes were generated: (1) limited preoperative self-preparation capability in older patients with TKA (difficulty coping due to multimorbidity, insufficient cognitive understanding); (2) insufficient opportunity and support for preoperative self-preparation in older patients with TKA (disparities in external support, limited access to medical and nursing care, unmet prehabilitation needs, difficulties in obtaining and identifying information); and (3) varied motivation for preoperative self-preparation in older patients with TKA (perceived benefits of preoperative self-preparation, desire to resume social participation as a driver, intertwined positive and negative emotions).
CONCLUSIONS: Preoperative self-preparation in older patients with TKA is not determined by a single factor. Healthcare providers should attend to patients' preoperative physiological status to strengthen the foundational capacity for self-preparation; integrate and optimise diverse external support systems to enhance the external impetus for self-preparation; and address patients' emotional concerns to stimulate the internal motivation for self-preparation, thereby facilitating comprehensive preoperative self-preparation.
DESIGN: This study employed a descriptive qualitative research design. Purposive sampling was used, guided by the principle of maximum variation, taking into account factors such as age, gender, educational background and disease severity. A total of 16 participants were enrolled. Data were collected through semi-structured in-depth interviews conducted 1 day before surgery. This study employed a strategy of concurrent data collection and analysis. During data collection, the study was guided by Information Power. The data were analysed using reflexive thematic analysis.
SETTING: The study was conducted in a tertiary hospital in China.
RESULTS: Three themes with nine subthemes were generated: (1) limited preoperative self-preparation capability in older patients with TKA (difficulty coping due to multimorbidity, insufficient cognitive understanding); (2) insufficient opportunity and support for preoperative self-preparation in older patients with TKA (disparities in external support, limited access to medical and nursing care, unmet prehabilitation needs, difficulties in obtaining and identifying information); and (3) varied motivation for preoperative self-preparation in older patients with TKA (perceived benefits of preoperative self-preparation, desire to resume social participation as a driver, intertwined positive and negative emotions).
CONCLUSIONS: Preoperative self-preparation in older patients with TKA is not determined by a single factor. Healthcare providers should attend to patients' preoperative physiological status to strengthen the foundational capacity for self-preparation; integrate and optimise diverse external support systems to enhance the external impetus for self-preparation; and address patients' emotional concerns to stimulate the internal motivation for self-preparation, thereby facilitating comprehensive preoperative self-preparation.