Barriers and Facilitators to the Symptom Self-Management in Patients With Decompensated Cirrhosis: A Qualitative Study Using Capability, Opportunity, Motivation-Behaviour Model

Abstract

Aim: To systematically investigate the barriers and facilitators of symptom self-management behaviour in patients with decompensated cirrhosis. Design: This study adopted a qualitative descriptive design, which was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. Methods: One-on-one, face-to-face, semi-structured interviews were conducted with 33 stakeholders, including nine patients, nine family caregivers and 15 healthcare professionals. Interview transcripts were analysed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model, integrating dyadic interview analysis and qualitative content analysis. Results: We identified 11 barriers to symptom self-management relating to capability (poor illness perception, limited health literacy, difficulties in information acquisition and physical dysfunction); opportunity (cultural conflicts, heavy economic burden and inadequate resource support) and motivation (diminished sense of meaning in life, insufficient internal drive, delayed perception of therapeutic benefit and low self-efficacy). Conversely, we also identified eight facilitators relating to capability (progressive cognitive restructuring and adequate health literacy); opportunity (supportive environments, family cohesion and diversified information channels); and motivation (proactive adaptation, high intrinsic motivation and sustained reinforcement of therapeutic benefit). Conclusions: This study identified key barriers and facilitators to symptom self-management in patients with decompensated cirrhosis, providing an evidence base for developing intervention strategies in the future. Patient and Public Contribution: Patients, family caregivers and healthcare professionals contributed to the study through interviews during the research process and member checks during analysis. Trial Registration: This clinical trial (registration number: ChiCTR2500097867) is registered in the Chinese Clinical Trial Registry as “Core symptoms and self-management among decompensated cirrhosis patients: a cross-sectional study”. The trial registration link is https://www.chictr.org.cn/showproj.html?proj=252931.