Perceived factors shaping preoperative self-preparation among older patients undergoing total knee arthroplasty: a qualitative study

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.