Adherence to home nutritional management in patients following esophagectomy: a qualitative study based on the Health...

To identify factors influencing adherence to home-based nutritional management in post-esophagectomy patients using the Health Belief Model (HBM), thereby addressing the current gap in understanding behavioral drivers and guiding the development of theory-based transitional nutritional interventions.

Guided by the HBM, we conducted a qualitative descriptive study. Using purposive sampling, semi-structured interviews were conducted with 18 patients who had undergone radical esophagectomy at a tertiary hospital in Henan Province, China, between October and December 2025. Data were analyzed using directed content analysis. The study was approved by the hospital ethics committee [Approval No. (2025)154].

The barriers to adherence included insufficient perception of malnutrition threats (lack of awareness of long-term risks and cognitive biases), excessive perceived barriers (symptom-related eating difficulties, financial burden, negative emotions, and lack of nutrition knowledge and skills), low self-efficacy, and lack of effective cues to action. The factors facilitating adherence (termed facilitators) included a clear perception of postoperative malnutrition risk, explicit perception of the benefits of the nutritional regimen, strong self-efficacy (active learning and strategy development, positive feedback loop from experience accumulation to confidence building, and internalization of nutritional management), and positive internal and external cues to action (sensitization to physical signals and self-monitoring, and synergistic effects of multi-source support networks).

Adherence to home-based nutritional management after esophageal cancer surgery is influenced by multiple factors. Healthcare providers should pay close attention to patients' experiences, identify and mitigate barriers, and reinforce facilitators. Interventions such as risk communication, skill training, and self-efficacy enhancement can improve adherence, nutritional status, and quality of life.