Exploring Home-Based Rehabilitation Experiences After Reverse Total Shoulder Arthroplasty: A Health Belief Model–Guided Qualitative Study

Exploring Home-Based Rehabilitation Experiences After Reverse Total Shoulder Arthroplasty: A Health Belief Model–Guided Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Home-Based Rehabilitation Experiences After Reverse Total Shoulder Arthroplasty: A Health Belief Model–Guided Qualitative Study Yi Ye, Fang Tang, Xiaoxue li, Xiaoyun li, Fei Lan, Kun Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8540086/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Reverse total shoulder arthroplasty (RTSA) is increasingly performed among older adults, and postoperative functional recovery is closely associated with patients’ engagement in rehabilitation. However, participation in home-based rehabilitation varies widely, posing ongoing challenges for nurses involved in discharge education and post-discharge support. This study applied the Health Belief Model (HBM) to explore patients’ lived experiences and self-management behaviors during home-based rehabilitation. Methods A qualitative descriptive study was conducted at a tertiary hospital in southwest China. Purposive sampling with maximum variation was used to recruit patients within six months after primary unilateral RTSA. Data were collected through face-to-face semi-structured interviews and analyzed using directed content analysis guided by the HBM. Results Five themes were identified: perceived threats to recovery, anticipated benefits of rehabilitation, perceived barriers to home-based rehabilitation, cues to action, and dynamic changes in self-efficacy. Patients interpreted health threats holistically, encompassing physical, functional, and psychosocial concerns. Perceived benefits were primarily related to regaining independence and resuming valued daily activities. Barriers operated across individual, familial, and healthcare system contexts. Cues to action were embedded in ongoing interpersonal interactions. Self-efficacy evolved over time, increasing as patients accumulated successful rehabilitation experiences. Conclusion Patients’ engagement in home-based rehabilitation after RTSA is influenced by dynamic and context-specific health beliefs, and applying a HBM–informed perspective may inform the development of individualized nursing strategies to support sustained rehabilitation engagement. Reverse total shoulder arthroplasty Home-based rehabilitation Health Belief Model Qualitative research Background Reverse total shoulder arthroplasty (RTSA) has become an increasingly common surgical intervention for complex shoulder disorders[ 1 ], particularly among older adults with rotator cuff arthropathy, irreparable rotator cuff tears, and advanced glenohumeral arthritis[ 2 , 3 ]. With global population ageing, the demand for RTSA continues to rise[ 4 ], accompanied by growing emphasis on postoperative functional recovery and quality of life. Following hospital discharge, most functional recovery occurs in the home setting, where patients are expected to independently manage and perform prescribed rehabilitation exercises[ 5 , 6 ]. Effective home-based rehabilitation is therefore essential for restoring shoulder function, improving activities of daily living, and preventing postoperative complications[ 7 , 8 ]. Evidence suggests that the first six months after reverse total shoulder arthroplasty represent a critical period for functional recovery[ 9 , 10 ], placing substantial demands on patients’ engagement in home-based rehabilitation. However, participation in rehabilitation varies widely, presenting ongoing challenges for nurses involved in discharge education and post-discharge support, as patients and caregivers often experience gaps in knowledge and self-management after standard discharge education[ 11 ]. Standardized nursing instructions may be insufficient to address individual differences in beliefs, perceptions, and motivation. Furthermore, existing research has largely emphasized clinical outcomes[ 12 ], offering limited insight into patients’ lived experiences and self-management processes, highlighting the need for qualitative, nursing-focused research on home-based rehabilitation. The Health Belief Model (HBM) is a well-established theoretical framework for explaining health-related behaviors through individuals’ perceptions of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy[ 13 ]. Widely applied in nursing and rehabilitation research, the HBM offers a useful lens for interpreting patients’ engagement in self-managed and preventive health behaviors[ 14 ]. Accordingly, this study aimed to explore home-based rehabilitation experiences among patients undergoing reverse total shoulder arthroplasty and to interpret these experiences from the perspective of the Health Belief Model, thereby informing the development of theory-guided nursing interventions to support postoperative rehabilitation. Methods Study Design A qualitative descriptive study was conducted to explore patients’ experiences and needs during home-based rehabilitation after RTSA. This design is well suited to nursing research, as it facilitates a clear and in-depth understanding of patients’ health-related experiences while remaining close to the data. Participants and Sampling The study was conducted at a tertiary hospital in Chengdu, southwest China. Adult patients (≥ 18 years) who had undergone primary unilateral RTSA, were within six months of home-based rehabilitation, were able to communicate in Mandarin Chinese, and voluntarily provided written informed consent were eligible for inclusion. Patients with severe cognitive impairment or concurrent participation in other clinical studies were excluded. Purposive sampling with a maximum variation strategy was used to capture diverse rehabilitation experiences. Participants were recruited from the orthopedic department between February and June 2025, with variation sought in age, sex, and duration of home-based rehabilitation. Sample size was guided by data saturation, and recruitment ceased when no new themes emerged from three consecutive interviews. This study was approved by the Institutional Review Board (IRB) of the Ethics Committee of Basic and Clinical Research, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital (Approval No. 2025-91). Data Collection Data were collected through semi-structured interviews conducted by the first author. An interview guide was developed based on a review of relevant literature and the HBM and was refined through expert consultation with three qualitative research experts and two orthopedics specialist, as well as pilot interviews with two patients, to ensure clarity, relevance, and comprehensiveness. The final interview guide consisted of five open-ended questions (Table 1 ). Table 1 Interview Guide Based on the Health Belief Model HBM construct Interview questions 1.Perceived susceptibility and severity During your recovery process, what problems or concerns have you been worried about? 2.Home-based rehabilitation behaviors Can you describe your experiences with home-based rehabilitation exercises after surgery? 3.Perceived barriers What difficulties or challenges have you encountered while performing rehabilitation exercises at home? 4. Cues to action What factors or situations have motivated or prompted you to engage in rehabilitation exercises? 5. Perceived benefits and support needs What are your expectations for recovery, and how do you perceive the role of support from others during the rehabilitation process? Interviews were conducted face-to-face in a consultation room within the orthopedic outpatient clinic and lasted approximately 20–40 minutes. All interviews were audio-recorded with participants’ consent, and field notes were taken to document emotional responses and non-verbal behaviors. Data Analysis Audio-recorded interviews were transcribed verbatim within 24 hours by two researchers independently and managed using NVivo 11 software. Transcription discrepancies were resolved through repeated listening to the recordings. Data were analyzed using a directed content analysis approach guided by the HBM. An a priori coding framework based on the core HBM constructs was applied, while inductive coding was used to capture data that did not fit predefined categories. Coding and theme development were conducted independently by two researchers, and discrepancies were resolved through team discussion until consensus was reached. Rigour and reflexivity Rigour was ensured through purposive sampling, data saturation, and independent transcription and coding by two researchers. Data analysis was guided by an a priori HBM framework, with inductive coding used to capture emergent themes. Discrepancies were resolved through team discussion to enhance analytical credibility. Reflexivity was supported through reflexive note-taking throughout data collection and analysis. The interviewer, a nurse academic with qualitative research training, had no direct clinical relationship with participants, minimizing potential power imbalance and bias. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ)[ 15 ] (Additional file 1). Results Participant Demographics Twenty patients who had undergone RTSA were included in this study. Participants ranged in age from 62 to 87 years, with a mean age of 77 years; eight were men and twelve were women. The duration of home-based rehabilitation ranged from 1 to 6 months (mean: 4.5 months). Detailed participant characteristics are presented in Table 2 . Table 2 Participants’ Demographics and Clinical Information ID code Gender Age (year) Education level Residence Duration of home-based rehabilitation (months) Participant 1 Female 62 Primary Urban 5 Participant 2 Female 71 Tertiary Urban 5 Participant 3 Female 65 Secondary Urban 4 Participant 4 Male 87 Primary Suburban 4 Participant 5 Female 78 Primary Suburban 4 Participant 6 Male 62 Secondary Urban 4 Table 2 Participants’ Demographics and Clinical Information(continue) ID code Gender Age (year) Education level Residence Duration of home-based rehabilitation (months) Participant 7 Male 59 Secondary Urban 6 Participant 8 Female 67 Primary Urban 3 Participant 9 Male 71 Secondary Suburban 3 Participant 10 Female 73 Primary Suburban 2 Participant 11 Female 66 Tertiary Urban 3 Participant 12 Male 82 Secondary Suburban 2 Participant 13 Female 78 Primary Suburban 2 Participant 14 Female 71 Primary Suburban 2 Participant 15 Female 59 Primary Urban 2 Participant 16 Female 79 Primary Urban 2 Participant 17 Female 69 Secondary Urban 2 Participant 18 Male 65 Primary Suburban 1 Participant 19 Male 79 Secondary Suburban 1 Participant 20 Male 61 Secondary Urban 1 Theme 1. Perceived Threats to Recovery: Awareness of Vulnerability and Consequences Participants described heightened perceptions of health-related threats during home-based rehabilitation following RTSA, reflecting both perceived vulnerability and perceived severity. Concerns about wound healing and potential postoperative complications were common, particularly in the early post-discharge period, and often reduced participants’ willingness to engage fully in rehabilitation exercises. “I was always worried that the wound might not heal properly. I was afraid that doing exercises too early would make things worse.” (Participant 1) Beyond physical concerns, participants reported a perceived decline in independence in daily activities, including dressing, bathing, and household tasks, which reinforced feelings of vulnerability and dependence. Limitations in social participation further contributed to frustration and social withdrawal. Many participants also experienced psychological distress, such as fear, uncertainty, and anxiety related to their recovery process. “I used to go out and meet friends, but after the surgery, I felt limited in everything. It made me feel anxious and low.” (Participant 3) Theme 2. Anticipated Benefits of Rehabilitation: Motivations for Engagement Participants’ engagement in home-based rehabilitation was strongly shaped by their anticipated benefits of recovery. Many expressed strong expectations of regaining shoulder function, resuming daily activities, and restoring independence. These anticipated benefits acted as important motivational drivers, encouraging participants to persist with rehabilitation exercises despite discomfort or inconvenience. “I believed that if I kept exercising, my arm would gradually get better, and I could take care of myself again.” (Participant 4) In addition, participants perceived professional nursing support as beneficial in helping them understand the purpose and long-term value of rehabilitation. Clear explanations and consistent guidance from nurses strengthened participants’ confidence in the effectiveness of rehabilitation and reinforced their belief that sustained effort would lead to meaningful recovery. “When the nurse explained things clearly, I felt more confident about doing the exercises at home.” (Participant 16) Theme 3. Perceived Barriers to Home-Based Rehabilitation Although participants recognized the importance of rehabilitation, they described multiple barriers that hindered engagement in home-based exercises. Limited rehabilitation-related knowledge and uncertainty about appropriate exercise intensity were commonly reported, often leading to hesitation or avoidance. Pain and discomfort during or after exercises further discouraged participation, prompting some participants to intentionally reduce exercise frequency. “Sometimes the pain was too much. I was afraid that continuing the exercises would make it worse.” (Participant 8) Dependence on family caregivers emerged as a complex and ambivalent barrier. While family assistance was essential for daily care, excessive reliance sometimes reduced participants’ motivation to engage actively in rehabilitation. In addition, limited access to community-based rehabilitation resources, including professional guidance and nearby facilities, further constrained sustained engagement in home-based rehabilitation. “Since my family helped me with everything, I sometimes felt less motivated to push myself to exercise.” (Participant 5) Theme 4. Cues to Action: Triggers for Initiating and Maintaining Rehabilitation Participants described various external cues to action that facilitated the initiation and maintenance of rehabilitation behaviors. Peer experiences, particularly sharing recovery stories with other patients who had undergone similar surgery, provided reassurance through social comparison. Observing others’ recovery progress motivated participants to persist with rehabilitation exercises. “Hearing that others recovered well after the same surgery made me feel more hopeful.” (Participant 15) In addition, reminders and encouragement from family members and healthcare professionals served as important external cues. Regular follow-up, guidance, and reminders from nurses reinforced participants’ awareness of rehabilitation requirements and supported sustained engagement in home-based exercises. These cues functioned as practical triggers that helped participants translate intention into ongoing rehabilitation behavior. “When the nurse explained things clearly and checked on me, I felt more confident about doing the exercises at home.” (Participant 16) Theme 5. Dynamic Changes in Self-Efficacy Throughout Rehabilitation Participants’ self-efficacy regarding home-based rehabilitation was not static but evolved over time. In the early postoperative stage, many reported low confidence in their ability to perform rehabilitation exercises correctly and safely. Fear of injury, pain, and uncertainty about recovery outcomes contributed to reduced self-efficacy and cautious engagement. “At first, I didn’t believe I could do the exercises properly on my own.” (Participant 11) As rehabilitation progressed and functional improvements became more apparent, participants described increasing confidence and a stronger sense of personal control. Accumulated successful experiences and positive feedback reinforced their belief in their ability to manage rehabilitation independently, leading to more proactive and sustained engagement in exercises. “When I saw that my shoulder was getting stronger, I felt more confident and willing to exercise actively.” (Participant 8) Discussion How Do These Findings Extend or Refine the Health Belief Model? This study extends the HBM by providing a dynamic and context-specific understanding of home-based rehabilitation following RTSA. Perceived threats were interpreted holistically, encompassing not only physical complications but also psychosocial consequences such as loss of independence and social restriction. Perceived benefits focused on regaining autonomy and resuming valued daily activities rather than abstract clinical outcomes, with nursing support shaping patients’ understanding of rehabilitation value. Perceived barriers operated across individual, familial, and healthcare system levels, including caregiver dependence and limited community resources. Self-efficacy evolved over time, increasing through successful experiences and functioning as both an outcome and a driver of sustained engagement. Cues to action were embedded in ongoing interpersonal interactions with peers, family members, and healthcare professionals. Collectively, these findings suggest that applying the HBM to postoperative home-based rehabilitation requires a dynamic, relational, and context-sensitive interpretation to inform nursing interventions. Implications for Nursing Practice The findings of this study have important implications for nursing practice in the postoperative management of patients undergoing RTSA, particularly in the context of home-based rehabilitation. First, nurses should adopt a comprehensive approach to postoperative education that addresses not only physical recovery but also patients’ perceived threats related to functional limitations and psychosocial well-being. Early identification of concerns regarding wound healing, loss of independence, and restricted social participation may enable nurses to tailor education and reassurance strategies, reduce anxiety, and prevent avoidance of rehabilitation activities. Discussing expected recovery trajectories[ 16 ] during discharge planning may further alleviate uncertainty and promote engagement in home-based rehabilitation. Second, nursing interventions should explicitly emphasize rehabilitation benefits that are most meaningful to patients. Motivation theories suggest that individuals differ in intrinsic motivation, and when personal goals are aligned with rehabilitation tasks, patients may persist despite pain or discomfort[ 17 ]. Nurses can enhance motivation by linking prescribed exercises to patients’ personal goals, such as regaining independence in daily activities or resuming valued social roles. Third, the identified barriers highlight the need for individualized and context-sensitive nursing support. Postoperative pain has been widely recognized as a major barrier to rehabilitation participation, and patients often demonstrate reluctance toward analgesic use or uncertainty about appropriate pain management[ 18 ]. Nurses should assess patients’ pain experiences and rehabilitation knowledge within their home and family care contexts and provide targeted education on pain control and safe exercise performance to reduce fear-related avoidance. In addition, excessive reliance on family caregiving may inadvertently diminish patients’ motivation and autonomy in rehabilitation. Nurses should therefore tailor guidance to caregiving contexts, encouraging supportive rather than substitutive assistance to promote active patient engagement in home-based rehabilitation. Fourth, the prominent role of cues to action underscores the importance of sustained nursing involvement beyond hospital discharge. Regular follow-up through telephone calls, digital communication, or outpatient visits can serve as effective reminders that reinforce rehabilitation behaviors over time[ 19 ]. Facilitating peer support[ 20 ], such as sharing recovery experiences or connecting patients with similar postoperative backgrounds, may further enhance motivation and normalize rehabilitation challenges. These strategies highlight the nurse’s role as a continuous source of guidance and encouragement throughout the recovery process. Finally, the dynamic changes in self-efficacy observed in this study are consistent with findings reported by Xie et al[ 21 ]. among patients undergoing total hip and knee arthroplasty, indicating that self-efficacy evolves throughout the rehabilitation process. Similar patterns further emphasize self-efficacy as a modifiable construct shaped by mastery experiences and feedback[ 22 ]. These findings suggest that nursing interventions should be adapted to different phases of rehabilitation. In the early postoperative period, when self-efficacy is often low, nurses should prioritize confidence-building strategies, including demonstration, supervised practice, and positive reinforcement. As patients gain experience and confidence, nursing support can gradually shift toward fostering autonomy and self-management. Recognizing self-efficacy as an evolving construct provides nurses with a critical leverage point for promoting long-term adherence to home-based rehabilitation. Together, these implications underscore the central role of nurses in shaping patients’ beliefs, experiences, and rehabilitation behaviors during home-based recovery following RTSA. Applying a HBM–informed approach may support nurses in delivering individualized, responsive, and effective interventions tailored to patients’ evolving needs across the rehabilitation trajectory. Strengths and Limitations This study has several strengths. A theory-guided qualitative design based on the HBM was used to explore home-based rehabilitation experiences following RTSA, generating in-depth and practice-relevant insights for nursing care. By focusing on patients’ perspectives in real-world home settings, the study captured psychosocial and contextual influences that are often overlooked in quantitative research. Methodological rigor was strengthened through purposive sampling, attainment of data saturation, and adherence to the COREQ guidelines. Several limitations should be acknowledged. Participants were recruited from a limited number of clinical settings, which may limit the transferability of the findings. The data reflect self-reported experiences and may be subject to recall or social desirability bias. In addition, data were collected at a specific postoperative stage, and longitudinal qualitative data were not available. Future studies using longitudinal or mixed-methods designs are needed to further examine changes in health beliefs and rehabilitation behaviors over time. Conclusion This qualitative study explored patients’ home-based rehabilitation experiences following RTSA using the HBM as a theoretical lens. The findings illustrate how health beliefs shape patients’ engagement in rehabilitation and identify self-efficacy as a dynamic construct that evolves throughout the recovery process. These insights highlight the important role of nurses in addressing patients’ beliefs through timely education and ongoing support during home-based rehabilitation. A HBM–informed perspective may provide a theoretical basis for developing nursing strategies to support sustained rehabilitation engagement following RTSA. Abbreviations RTSA Reverse total shoulder arthroplasty HBM Health Belief Model COREQ Consolidated Criteria for Reporting Qualitative Research Declarations This study was approved by the Institutional Review Board (IRB) of the Ethics Committee of Basic and Clinical Research, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital (Approval No. 2025-91). All participants provided written informed consent. Participants retained the right to withdraw from the study at any time prior to data analysis. All participant-related data were stored confidentially and accessible only to the research team members. Clinical trial number: not applicable. The study was conducted in accordance with the ethical principles laid out in the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors have nothing to declare. Funding Not applicable. Author Contribution Y. Y. and F T conceived the study, performed the data collection, conducted the project administration and drafted the original draft and provided the methodology of the design and conducted the conceptualization. X. X. L, X. Y. L and F. L. performed the formal analysis. K.Z. reviewed and revised the idea and study design, conducted the writing-review draft. B. L. provided the project administration. All authors have read and approved the final manuscript. Acknowledgements The authors are grateful to the orthopedic team who supported and facilitated this study. Data Availability Research data will be shared with reasonable requests. References Franceschi F, Giovannetti de Sanctis E, Gupta A, Athwal GS, Di Giacomo G. Reverse shoulder arthroplasty: State-of-the-art. J isakos. 2023;8(5):306–17. Thon SG, Seidl AJ, Bravman JT, McCarty EC, Savoie FH 3rd, Frank RM. Advances and Update on Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med. 2020;13(1):11–9. Rugg CM, Coughlan MJ, Lansdown DA. Reverse Total Shoulder Arthroplasty: Biomechanics and Indications. Curr Rev Musculoskelet Med. 2019;12(4):542–53. Rupani N, Combescure C, Silman A, Lübbeke A, Rees J. International trends in shoulder replacement: a meta-analysis from 11 public joint registers. Acta Orthop. 2024;95:348–57. Schick S, Elphingstone J, Paul K, He JK, Arguello A, Catoe B, Roberson T, Momaya A, Brabston E, Ponce B. Home-based physical therapy results in similar outcomes to formal outpatient physical therapy after reverse total shoulder arthroplasty: a randomized controlled trial. J Shoulder Elb Surg. 2023;32(8):1555–61. Kennedy JS, Reinke EK, Friedman LGM, Cook C, Forsythe B, Gillespie R, Hatzidakis A, Jawa A, Johnston P, Nagda S, et al. Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. Arch Physiother. 2021;11(1):28. Bullock GS, Garrigues GE, Ledbetter L, Kennedy J. A Systematic Review of Proposed Rehabilitation Guidelines Following Anatomic and Reverse Shoulder Arthroplasty. J Orthop Sports Phys Ther. 2019;49(5):337–46. American Academy of Orthopaedic Surgeons. Shoulder surgery exercise guide [ https://www.orthoinfo.org/en/recovery/shoulder-surgery-exercise-guide/] Tiusanen H, Sarantsin P, Stenholm M, Mattie R, Saltychev M. Ranges of motion after reverse shoulder arthroplasty improve significantly the first year after surgery in patients with rheumatoid arthritis. Eur J Orthop Surg Traumatol. 2016;26(5):447–52. Matsuki K, Sugaya H, Hoshika S, Takahashi N, Kenmoku T, Banks SA. Scaption kinematics of reverse shoulder arthroplasty do not change after the sixth postoperative month. Clin Biomech (Bristol). 2018;58:1–6. Topham EW, Bristol A, Luther B, Elmore CE, Johnson E, Wallace AS. Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home. Prof Case Manag. 2022;27(4):181–93. Howard MC, Trasolini NA, Waterman BR. Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med. 2023;16(4):145–53. Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1–47. Alyafei A. Easton-Carr. R: The Health Belief Model of behavior change [ https://www.ncbi.nlm.nih.gov/books/NBK606120/] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. Rubenstein WJ, Warwick HSL, Aung MS, Zhang AL, Feeley BT, Ma CB, Lansdown DA. Defining recovery trajectories after shoulder arthroplasty: a latent class analysis of patient-reported outcomes. J Shoulder Elb Surg. 2021;30(10):2375–85. Specht K, Agerskov H, Kjaersgaard-Andersen P, Jester R, Pedersen BD. Patients' experiences during the first 12 weeks after discharge in fast-track hip and knee arthroplasty - a qualitative study. Int J Orthop Trauma Nurs. 2018;31:13–9. Specht K, Kjaersgaard-Andersen P, Pedersen BD. Patient experience in fast-track hip and knee arthroplasty–a qualitative study. J Clin Nurs. 2016;25(5–6):836–45. Sjøveian AKH, Leegaard M. Hip and knee arthroplasty - patient's experiences of pain and rehabilitation after discharge from hospital. Int J Orthop Trauma Nurs. 2017;27:28–35. Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud. 2003;40(3):321–32. Xie Y, Fu Z, Li P, Chen J, Zhang L, Liu Y, Ning N, Zhou Z. Post-traumatic growth trajectories and influencing factors in patients undergoing hip and knee arthroplasty: a prospective longitudinal study. Front Psychiatry. 2025;16:1556829. Zhou Y, Gao W, Gao S, Guo X, Liu M, Cao C. Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy. J Pain Res. 2023;16:3993–4004. Additional Declarations No competing interests reported. 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07:37:40","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79111,"visible":true,"origin":"","legend":"","description":"","filename":"4bd6b00200824e94b92669618aebbc581structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8540086/v1/9e077259f57a5e12c48c3855.xml"},{"id":99998752,"identity":"0e820044-c8c4-4d40-be5d-d23edcf4c3c8","added_by":"auto","created_at":"2026-01-12 03:44:25","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":89424,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8540086/v1/998db98b282b82a0e7bef5da.html"},{"id":100796065,"identity":"b17902b6-8b62-4ff6-ab36-5abd4acdb427","added_by":"auto","created_at":"2026-01-21 13:37:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":833678,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8540086/v1/54563039-833d-4fa1-bf76-84dcaa492136.pdf"},{"id":99998751,"identity":"d9248285-e725-4b3a-9d83-8d1bae01758f","added_by":"auto","created_at":"2026-01-12 03:44:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27106,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8540086/v1/741a4f4b5af5a3655c6811bf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Home-Based Rehabilitation Experiences After Reverse Total Shoulder Arthroplasty: A Health Belief Model–Guided Qualitative Study","fulltext":[{"header":"Background","content":"\u003cp\u003eReverse total shoulder arthroplasty (RTSA) has become an increasingly common surgical intervention for complex shoulder disorders[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], particularly among older adults with rotator cuff arthropathy, irreparable rotator cuff tears, and advanced glenohumeral arthritis[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. With global population ageing, the demand for RTSA continues to rise[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], accompanied by growing emphasis on postoperative functional recovery and quality of life. Following hospital discharge, most functional recovery occurs in the home setting, where patients are expected to independently manage and perform prescribed rehabilitation exercises[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Effective home-based rehabilitation is therefore essential for restoring shoulder function, improving activities of daily living, and preventing postoperative complications[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvidence suggests that the first six months after reverse total shoulder arthroplasty represent a critical period for functional recovery[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], placing substantial demands on patients\u0026rsquo; engagement in home-based rehabilitation. However, participation in rehabilitation varies widely, presenting ongoing challenges for nurses involved in discharge education and post-discharge support, as patients and caregivers often experience gaps in knowledge and self-management after standard discharge education[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Standardized nursing instructions may be insufficient to address individual differences in beliefs, perceptions, and motivation. Furthermore, existing research has largely emphasized clinical outcomes[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], offering limited insight into patients\u0026rsquo; lived experiences and self-management processes, highlighting the need for qualitative, nursing-focused research on home-based rehabilitation.\u003c/p\u003e \u003cp\u003eThe Health Belief Model (HBM) is a well-established theoretical framework for explaining health-related behaviors through individuals\u0026rsquo; perceptions of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Widely applied in nursing and rehabilitation research, the HBM offers a useful lens for interpreting patients\u0026rsquo; engagement in self-managed and preventive health behaviors[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Accordingly, this study aimed to explore home-based rehabilitation experiences among patients undergoing reverse total shoulder arthroplasty and to interpret these experiences from the perspective of the Health Belief Model, thereby informing the development of theory-guided nursing interventions to support postoperative rehabilitation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA qualitative descriptive study was conducted to explore patients\u0026rsquo; experiences and needs during home-based rehabilitation after RTSA. This design is well suited to nursing research, as it facilitates a clear and in-depth understanding of patients\u0026rsquo; health-related experiences while remaining close to the data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study was conducted at a tertiary hospital in Chengdu, southwest China. Adult patients (\u0026ge;\u0026thinsp;18 years) who had undergone primary unilateral RTSA, were within six months of home-based rehabilitation, were able to communicate in Mandarin Chinese, and voluntarily provided written informed consent were eligible for inclusion. Patients with severe cognitive impairment or concurrent participation in other clinical studies were excluded.\u003c/p\u003e \u003cp\u003ePurposive sampling with a maximum variation strategy was used to capture diverse rehabilitation experiences. Participants were recruited from the orthopedic department between February and June 2025, with variation sought in age, sex, and duration of home-based rehabilitation. Sample size was guided by data saturation, and recruitment ceased when no new themes emerged from three consecutive interviews. This study was approved by the Institutional Review Board (IRB) of the Ethics Committee of Basic and Clinical Research, Sichuan Academy of Medical Sciences \u0026amp; Sichuan Provincial People\u0026rsquo;s Hospital (Approval No. 2025-91).\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected through semi-structured interviews conducted by the first author. An interview guide was developed based on a review of relevant literature and the HBM and was refined through expert consultation with three qualitative research experts and two orthopedics specialist, as well as pilot interviews with two patients, to ensure clarity, relevance, and comprehensiveness. The final interview guide consisted of five open-ended questions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview Guide Based on the Health Belief Model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBM construct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterview questions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.Perceived susceptibility and severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring your recovery process, what problems or concerns have you been worried about?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.Home-based rehabilitation behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCan you describe your experiences with home-based rehabilitation exercises after surgery?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.Perceived barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat difficulties or challenges have you encountered while performing rehabilitation exercises at home?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Cues to action\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat factors or situations have motivated or prompted you to engage in rehabilitation exercises?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Perceived benefits and support needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat are your expectations for recovery, and how do you perceive the role of support from others during the rehabilitation process?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInterviews were conducted face-to-face in a consultation room within the orthopedic outpatient clinic and lasted approximately 20\u0026ndash;40 minutes. All interviews were audio-recorded with participants\u0026rsquo; consent, and field notes were taken to document emotional responses and non-verbal behaviors.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eAudio-recorded interviews were transcribed verbatim within 24 hours by two researchers independently and managed using NVivo 11 software. Transcription discrepancies were resolved through repeated listening to the recordings.\u003c/p\u003e \u003cp\u003eData were analyzed using a directed content analysis approach guided by the HBM. An a priori coding framework based on the core HBM constructs was applied, while inductive coding was used to capture data that did not fit predefined categories. Coding and theme development were conducted independently by two researchers, and discrepancies were resolved through team discussion until consensus was reached.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigour and reflexivity\u003c/h3\u003e\n\u003cp\u003eRigour was ensured through purposive sampling, data saturation, and independent transcription and coding by two researchers. Data analysis was guided by an a priori HBM framework, with inductive coding used to capture emergent themes. Discrepancies were resolved through team discussion to enhance analytical credibility. Reflexivity was supported through reflexive note-taking throughout data collection and analysis. The interviewer, a nurse academic with qualitative research training, had no direct clinical relationship with participants, minimizing potential power imbalance and bias. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] (Additional file 1).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Demographics\u003c/h2\u003e \u003cp\u003eTwenty patients who had undergone RTSA were included in this study. Participants ranged in age from 62 to 87 years, with a mean age of 77 years; eight were men and twelve were women. The duration of home-based rehabilitation ranged from 1 to 6 months (mean: 4.5 months). Detailed participant characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; Demographics and Clinical Information\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eID code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration of home-based rehabilitation (months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; Demographics and Clinical Information(continue)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eID code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration of home-based rehabilitation (months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheme 1. Perceived Threats to Recovery: Awareness of Vulnerability and Consequences\u003c/h3\u003e\n\u003cp\u003eParticipants described heightened perceptions of health-related threats during home-based rehabilitation following RTSA, reflecting both perceived vulnerability and perceived severity. Concerns about wound healing and potential postoperative complications were common, particularly in the early post-discharge period, and often reduced participants\u0026rsquo; willingness to engage fully in rehabilitation exercises.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I was always worried that the wound might not heal properly. I was afraid that doing exercises too early would make things worse.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003cp\u003eBeyond physical concerns, participants reported a perceived decline in independence in daily activities, including dressing, bathing, and household tasks, which reinforced feelings of vulnerability and dependence. Limitations in social participation further contributed to frustration and social withdrawal. Many participants also experienced psychological distress, such as fear, uncertainty, and anxiety related to their recovery process.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I used to go out and meet friends, but after the surgery, I felt limited in everything. It made me feel anxious and low.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2. Anticipated Benefits of Rehabilitation: Motivations for Engagement\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; engagement in home-based rehabilitation was strongly shaped by their anticipated benefits of recovery. Many expressed strong expectations of regaining shoulder function, resuming daily activities, and restoring independence. These anticipated benefits acted as important motivational drivers, encouraging participants to persist with rehabilitation exercises despite discomfort or inconvenience.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I believed that if I kept exercising, my arm would gradually get better, and I could take care of myself again.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003cp\u003eIn addition, participants perceived professional nursing support as beneficial in helping them understand the purpose and long-term value of rehabilitation. Clear explanations and consistent guidance from nurses strengthened participants\u0026rsquo; confidence in the effectiveness of rehabilitation and reinforced their belief that sustained effort would lead to meaningful recovery.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When the nurse explained things clearly, I felt more confident about doing the exercises at home.\u0026rdquo;\u003c/em\u003e (Participant 16)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3. Perceived Barriers to Home-Based Rehabilitation\u003c/h2\u003e \u003cp\u003eAlthough participants recognized the importance of rehabilitation, they described multiple barriers that hindered engagement in home-based exercises. Limited rehabilitation-related knowledge and uncertainty about appropriate exercise intensity were commonly reported, often leading to hesitation or avoidance. Pain and discomfort during or after exercises further discouraged participation, prompting some participants to intentionally reduce exercise frequency.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes the pain was too much. I was afraid that continuing the exercises would make it worse.\u0026rdquo;\u003c/em\u003e (Participant 8)\u003c/p\u003e \u003cp\u003e Dependence on family caregivers emerged as a complex and ambivalent barrier. While family assistance was essential for daily care, excessive reliance sometimes reduced participants\u0026rsquo; motivation to engage actively in rehabilitation. In addition, limited access to community-based rehabilitation resources, including professional guidance and nearby facilities, further constrained sustained engagement in home-based rehabilitation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Since my family helped me with everything, I sometimes felt less motivated to push myself to exercise.\u0026rdquo;\u003c/em\u003e (Participant 5)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4. Cues to Action: Triggers for Initiating and Maintaining Rehabilitation\u003c/h2\u003e \u003cp\u003e Participants described various external cues to action that facilitated the initiation and maintenance of rehabilitation behaviors. Peer experiences, particularly sharing recovery stories with other patients who had undergone similar surgery, provided reassurance through social comparison. Observing others\u0026rsquo; recovery progress motivated participants to persist with rehabilitation exercises.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Hearing that others recovered well after the same surgery made me feel more hopeful.\u0026rdquo;\u003c/em\u003e (Participant 15)\u003c/p\u003e \u003cp\u003eIn addition, reminders and encouragement from family members and healthcare professionals served as important external cues. Regular follow-up, guidance, and reminders from nurses reinforced participants\u0026rsquo; awareness of rehabilitation requirements and supported sustained engagement in home-based exercises. These cues functioned as practical triggers that helped participants translate intention into ongoing rehabilitation behavior.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When the nurse explained things clearly and checked on me, I felt more confident about doing the exercises at home.\u0026rdquo;\u003c/em\u003e (Participant 16)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5. Dynamic Changes in Self-Efficacy Throughout Rehabilitation\u003c/h2\u003e \u003cp\u003e Participants\u0026rsquo; self-efficacy regarding home-based rehabilitation was not static but evolved over time. In the early postoperative stage, many reported low confidence in their ability to perform rehabilitation exercises correctly and safely. Fear of injury, pain, and uncertainty about recovery outcomes contributed to reduced self-efficacy and cautious engagement.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;At first, I didn\u0026rsquo;t believe I could do the exercises properly on my own.\u0026rdquo;\u003c/em\u003e (Participant 11)\u003c/p\u003e \u003cp\u003eAs rehabilitation progressed and functional improvements became more apparent, participants described increasing confidence and a stronger sense of personal control. Accumulated successful experiences and positive feedback reinforced their belief in their ability to manage rehabilitation independently, leading to more proactive and sustained engagement in exercises.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I saw that my shoulder was getting stronger, I felt more confident and willing to exercise actively.\u0026rdquo;\u003c/em\u003e (Participant 8)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eHow Do These Findings Extend or Refine the Health Belief Model?\u003c/h2\u003e \u003cp\u003eThis study extends the HBM by providing a dynamic and context-specific understanding of home-based rehabilitation following RTSA. Perceived threats were interpreted holistically, encompassing not only physical complications but also psychosocial consequences such as loss of independence and social restriction. Perceived benefits focused on regaining autonomy and resuming valued daily activities rather than abstract clinical outcomes, with nursing support shaping patients\u0026rsquo; understanding of rehabilitation value. Perceived barriers operated across individual, familial, and healthcare system levels, including caregiver dependence and limited community resources. Self-efficacy evolved over time, increasing through successful experiences and functioning as both an outcome and a driver of sustained engagement. Cues to action were embedded in ongoing interpersonal interactions with peers, family members, and healthcare professionals. Collectively, these findings suggest that applying the HBM to postoperative home-based rehabilitation requires a dynamic, relational, and context-sensitive interpretation to inform nursing interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Nursing Practice\u003c/h2\u003e \u003cp\u003eThe findings of this study have important implications for nursing practice in the postoperative management of patients undergoing RTSA, particularly in the context of home-based rehabilitation.\u003c/p\u003e \u003cp\u003eFirst, nurses should adopt a comprehensive approach to postoperative education that addresses not only physical recovery but also patients\u0026rsquo; perceived threats related to functional limitations and psychosocial well-being. Early identification of concerns regarding wound healing, loss of independence, and restricted social participation may enable nurses to tailor education and reassurance strategies, reduce anxiety, and prevent avoidance of rehabilitation activities. Discussing expected recovery trajectories[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] during discharge planning may further alleviate uncertainty and promote engagement in home-based rehabilitation.\u003c/p\u003e \u003cp\u003eSecond, nursing interventions should explicitly emphasize rehabilitation benefits that are most meaningful to patients. Motivation theories suggest that individuals differ in intrinsic motivation, and when personal goals are aligned with rehabilitation tasks, patients may persist despite pain or discomfort[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Nurses can enhance motivation by linking prescribed exercises to patients\u0026rsquo; personal goals, such as regaining independence in daily activities or resuming valued social roles.\u003c/p\u003e \u003cp\u003eThird, the identified barriers highlight the need for individualized and context-sensitive nursing support. Postoperative pain has been widely recognized as a major barrier to rehabilitation participation, and patients often demonstrate reluctance toward analgesic use or uncertainty about appropriate pain management[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nurses should assess patients\u0026rsquo; pain experiences and rehabilitation knowledge within their home and family care contexts and provide targeted education on pain control and safe exercise performance to reduce fear-related avoidance. In addition, excessive reliance on family caregiving may inadvertently diminish patients\u0026rsquo; motivation and autonomy in rehabilitation. Nurses should therefore tailor guidance to caregiving contexts, encouraging supportive rather than substitutive assistance to promote active patient engagement in home-based rehabilitation.\u003c/p\u003e \u003cp\u003eFourth, the prominent role of cues to action underscores the importance of sustained nursing involvement beyond hospital discharge. Regular follow-up through telephone calls, digital communication, or outpatient visits can serve as effective reminders that reinforce rehabilitation behaviors over time[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Facilitating peer support[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], such as sharing recovery experiences or connecting patients with similar postoperative backgrounds, may further enhance motivation and normalize rehabilitation challenges. These strategies highlight the nurse\u0026rsquo;s role as a continuous source of guidance and encouragement throughout the recovery process.\u003c/p\u003e \u003cp\u003eFinally, the dynamic changes in self-efficacy observed in this study are consistent with findings reported by Xie et al[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. among patients undergoing total hip and knee arthroplasty, indicating that self-efficacy evolves throughout the rehabilitation process. Similar patterns further emphasize self-efficacy as a modifiable construct shaped by mastery experiences and feedback[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These findings suggest that nursing interventions should be adapted to different phases of rehabilitation. In the early postoperative period, when self-efficacy is often low, nurses should prioritize confidence-building strategies, including demonstration, supervised practice, and positive reinforcement. As patients gain experience and confidence, nursing support can gradually shift toward fostering autonomy and self-management. Recognizing self-efficacy as an evolving construct provides nurses with a critical leverage point for promoting long-term adherence to home-based rehabilitation.\u003c/p\u003e \u003cp\u003eTogether, these implications underscore the central role of nurses in shaping patients\u0026rsquo; beliefs, experiences, and rehabilitation behaviors during home-based recovery following RTSA. Applying a HBM\u0026ndash;informed approach may support nurses in delivering individualized, responsive, and effective interventions tailored to patients\u0026rsquo; evolving needs across the rehabilitation trajectory.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths. A theory-guided qualitative design based on the HBM was used to explore home-based rehabilitation experiences following RTSA, generating in-depth and practice-relevant insights for nursing care. By focusing on patients\u0026rsquo; perspectives in real-world home settings, the study captured psychosocial and contextual influences that are often overlooked in quantitative research. Methodological rigor was strengthened through purposive sampling, attainment of data saturation, and adherence to the COREQ guidelines.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. Participants were recruited from a limited number of clinical settings, which may limit the transferability of the findings. The data reflect self-reported experiences and may be subject to recall or social desirability bias. In addition, data were collected at a specific postoperative stage, and longitudinal qualitative data were not available. Future studies using longitudinal or mixed-methods designs are needed to further examine changes in health beliefs and rehabilitation behaviors over time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis qualitative study explored patients\u0026rsquo; home-based rehabilitation experiences following RTSA using the HBM as a theoretical lens. The findings illustrate how health beliefs shape patients\u0026rsquo; engagement in rehabilitation and identify self-efficacy as a dynamic construct that evolves throughout the recovery process. These insights highlight the important role of nurses in addressing patients\u0026rsquo; beliefs through timely education and ongoing support during home-based rehabilitation. A HBM\u0026ndash;informed perspective may provide a theoretical basis for developing nursing strategies to support sustained rehabilitation engagement following RTSA.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eRTSA Reverse total shoulder arthroplasty\u003c/p\u003e \u003cp\u003eHBM Health Belief Model\u003c/p\u003e \u003cp\u003eCOREQ Consolidated Criteria for Reporting Qualitative Research\u003c/p\u003e "},{"header":"Declarations","content":" \u003cp\u003eThis study was approved by the Institutional Review Board (IRB) of the Ethics Committee of Basic and Clinical Research, Sichuan Academy of Medical Sciences \u0026amp; Sichuan Provincial People\u0026rsquo;s Hospital (Approval No. 2025-91). All participants provided written informed consent. Participants retained the right to withdraw from the study at any time prior to data analysis. All participant-related data were stored confidentially and accessible only to the research team members. Clinical trial number: not applicable. The study was conducted in accordance with the ethical principles laid out in the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors have nothing to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY. Y. and F T conceived the study, performed the data collection, conducted the project administration and drafted the original draft and provided the methodology of the design and conducted the conceptualization. X. X. L, X. Y. L and F. L. performed the formal analysis. K.Z. reviewed and revised the idea and study design, conducted the writing-review draft. B. L. provided the project administration. All authors have read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors are grateful to the orthopedic team who supported and facilitated this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eResearch data will be shared with reasonable requests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFranceschi F, Giovannetti de Sanctis E, Gupta A, Athwal GS, Di Giacomo G. Reverse shoulder arthroplasty: State-of-the-art. J isakos. 2023;8(5):306\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThon SG, Seidl AJ, Bravman JT, McCarty EC, Savoie FH 3rd, Frank RM. Advances and Update on Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med. 2020;13(1):11\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRugg CM, Coughlan MJ, Lansdown DA. Reverse Total Shoulder Arthroplasty: Biomechanics and Indications. Curr Rev Musculoskelet Med. 2019;12(4):542\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRupani N, Combescure C, Silman A, L\u0026uuml;bbeke A, Rees J. International trends in shoulder replacement: a meta-analysis from 11 public joint registers. Acta Orthop. 2024;95:348\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchick S, Elphingstone J, Paul K, He JK, Arguello A, Catoe B, Roberson T, Momaya A, Brabston E, Ponce B. Home-based physical therapy results in similar outcomes to formal outpatient physical therapy after reverse total shoulder arthroplasty: a randomized controlled trial. J Shoulder Elb Surg. 2023;32(8):1555\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKennedy JS, Reinke EK, Friedman LGM, Cook C, Forsythe B, Gillespie R, Hatzidakis A, Jawa A, Johnston P, Nagda S, et al. Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. Arch Physiother. 2021;11(1):28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBullock GS, Garrigues GE, Ledbetter L, Kennedy J. A Systematic Review of Proposed Rehabilitation Guidelines Following Anatomic and Reverse Shoulder Arthroplasty. J Orthop Sports Phys Ther. 2019;49(5):337\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Orthopaedic Surgeons. Shoulder surgery exercise guide [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.orthoinfo.org/en/recovery/shoulder-surgery-exercise-guide/]\u003c/span\u003e\u003cspan address=\"https://www.orthoinfo.org/en/recovery/shoulder-surgery-exercise-guide/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiusanen H, Sarantsin P, Stenholm M, Mattie R, Saltychev M. Ranges of motion after reverse shoulder arthroplasty improve significantly the first year after surgery in patients with rheumatoid arthritis. Eur J Orthop Surg Traumatol. 2016;26(5):447\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuki K, Sugaya H, Hoshika S, Takahashi N, Kenmoku T, Banks SA. Scaption kinematics of reverse shoulder arthroplasty do not change after the sixth postoperative month. Clin Biomech (Bristol). 2018;58:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTopham EW, Bristol A, Luther B, Elmore CE, Johnson E, Wallace AS. Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home. Prof Case Manag. 2022;27(4):181\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoward MC, Trasolini NA, Waterman BR. Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med. 2023;16(4):145\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlyafei A. Easton-Carr. R: The Health Belief Model of behavior change [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK606120/]\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK606120/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubenstein WJ, Warwick HSL, Aung MS, Zhang AL, Feeley BT, Ma CB, Lansdown DA. Defining recovery trajectories after shoulder arthroplasty: a latent class analysis of patient-reported outcomes. J Shoulder Elb Surg. 2021;30(10):2375\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpecht K, Agerskov H, Kjaersgaard-Andersen P, Jester R, Pedersen BD. Patients' experiences during the first 12 weeks after discharge in fast-track hip and knee arthroplasty - a qualitative study. Int J Orthop Trauma Nurs. 2018;31:13\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpecht K, Kjaersgaard-Andersen P, Pedersen BD. Patient experience in fast-track hip and knee arthroplasty\u0026ndash;a qualitative study. J Clin Nurs. 2016;25(5\u0026ndash;6):836\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026oslash;veian AKH, Leegaard M. Hip and knee arthroplasty - patient's experiences of pain and rehabilitation after discharge from hospital. Int J Orthop Trauma Nurs. 2017;27:28\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud. 2003;40(3):321\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie Y, Fu Z, Li P, Chen J, Zhang L, Liu Y, Ning N, Zhou Z. Post-traumatic growth trajectories and influencing factors in patients undergoing hip and knee arthroplasty: a prospective longitudinal study. Front Psychiatry. 2025;16:1556829.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Y, Gao W, Gao S, Guo X, Liu M, Cao C. Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy. J Pain Res. 2023;16:3993\u0026ndash;4004.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Reverse total shoulder arthroplasty, Home-based rehabilitation, Health Belief Model, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-8540086/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8540086/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eReverse total shoulder arthroplasty (RTSA) is increasingly performed among older adults, and postoperative functional recovery is closely associated with patients\u0026rsquo; engagement in rehabilitation. However, participation in home-based rehabilitation varies widely, posing ongoing challenges for nurses involved in discharge education and post-discharge support. This study applied the Health Belief Model (HBM) to explore patients\u0026rsquo; lived experiences and self-management behaviors during home-based rehabilitation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative descriptive study was conducted at a tertiary hospital in southwest China. Purposive sampling with maximum variation was used to recruit patients within six months after primary unilateral RTSA. Data were collected through face-to-face semi-structured interviews and analyzed using directed content analysis guided by the HBM.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive themes were identified: perceived threats to recovery, anticipated benefits of rehabilitation, perceived barriers to home-based rehabilitation, cues to action, and dynamic changes in self-efficacy. Patients interpreted health threats holistically, encompassing physical, functional, and psychosocial concerns. Perceived benefits were primarily related to regaining independence and resuming valued daily activities. Barriers operated across individual, familial, and healthcare system contexts. Cues to action were embedded in ongoing interpersonal interactions. Self-efficacy evolved over time, increasing as patients accumulated successful rehabilitation experiences.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatients\u0026rsquo; engagement in home-based rehabilitation after RTSA is influenced by dynamic and context-specific health beliefs, and applying a HBM\u0026ndash;informed perspective may inform the development of individualized nursing strategies to support sustained rehabilitation engagement.\u003c/p\u003e","manuscriptTitle":"Exploring Home-Based Rehabilitation Experiences After Reverse Total Shoulder Arthroplasty: A Health Belief Model–Guided Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 03:44:20","doi":"10.21203/rs.3.rs-8540086/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T07:33:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T13:16:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T22:36:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T19:19:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T12:18:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178780396530626984163432273729574939389","date":"2026-02-24T09:26:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156075978475830908314595142724223415953","date":"2026-02-23T07:51:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159716557506620980633229289723582210353","date":"2026-02-20T11:27:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251987153405924531249941933919969972897","date":"2026-02-09T08:17:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122007229349630143212300616381044984055","date":"2026-01-11T18:58:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T15:22:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-08T10:38:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-07T13:13:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T13:09:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-01-07T10:15:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d78e03e-c9cb-46e7-a929-007c964c1c96","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T09:57:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 03:44:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8540086","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8540086","identity":"rs-8540086","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}