慢性肾脏病非透析患者八段锦运动康复行为促进与障碍因素的质性研究

A Qualitative Study on the Promotion and Obstruction Factors of Baduanjin Exercise Rehabilitation Behavior in Patients with Non-Dialysis Chronic Kidney Disease

摘要: 目的：基于COM-B行为改变模型，系统识别慢性肾脏病(CKD) 3~4期非透析患者练习八段锦运动康复的促进因素与障碍因素，为构建适配该人群的个性化八段锦干预方案提供实证依据。方法：采用目的抽样法，选取2025年4月~5月山西省某三甲医院肾内科12例CKD 3~4期非透析患者开展半结构化访谈，借助Nvivo 12.0软件对访谈资料进行编码，运用主题分析法提炼核心主题与子主题。结果：围绕COM-B模型的能力、机会、动机三个核心维度，提炼出促进因素、障碍因素2类核心方向及12个子主题。其中促进因素包含能力维度的强烈的动作学习意愿、生活场景化整合的认知能力；机会维度的对多元八段锦学习资源需求迫切、对社会支持体系高度依托；动机维度的有明确的症状改善预期、有正向反馈与激励的心理需求。障碍因素包含能力维度的体力储备不足限制练习时长、并发症耐受度低制约动作选择、八段锦认知缺口引发安全顾虑；机会维度的专业居家随访指导体系缺失；动机维度的病情焦虑削弱行动意愿、效果不确定性降低坚持信心。结论：CKD 3~4期非透析患者的八段锦运动康复行为受能力、机会、动机多维度因素交互影响，临床需基于COM-B模型，从弥补能力不足、完善机会支撑、激发运动动机三方面制定针对性干预策略，以此提升八段锦在该人群应用的可行性与持续性，充分发挥其运动康复价值，延缓疾病进展并改善患者身心状态。

Abstract: Objective: Based on the COM-B behavior change model, this study systematically identifies the facilitating and hindering factors for practicing Baduanjin exercise rehabilitation in non-dialysis patients with stage 3~4 Chronic Kidney Disease (CKD), providing empirical evidence for developing a personalized Baduanjin intervention program suitable for this population. Methods: Using purposive sampling, 12 non-dialysis CKD stage 3~4 patients from the nephrology department of a tertiary hospital in Shanxi Province were selected for semi-structured interviews in April-May 2025. Interview data were coded using Nvivo 12.0 software, and thematic analysis was employed to extract core themes and sub-themes. Results: Based on the three core dimensions of the COM-B model—capability, opportunity, and motivation—two main directions (facilitating factors and hindering factors) and 12 sub-themes were identified. Facilitating factors included: in the capability dimension, a strong willingness to learn movements and cognitive ability to integrate exercises into daily life; in the opportunity dimension, urgent need for diverse Baduanjin learning resources and heavy reliance on social support systems; in the motivation dimension, clear expectations of symptom improvement and psychological needs for positive feedback and incentives. Hindering factors included: in the capability dimension, insufficient physical reserves limiting practice duration, low tolerance to complications restricting movement choices, and Baduanjin knowledge gaps causing safety concerns; in the opportunity dimension, lack of professional home-based follow-up guidance systems; in the motivation dimension, disease-related anxiety weakening action intention and uncertainty of effects reducing adherence confidence. Conclusion: The Baduanjin exercise rehabilitation behavior of non-dialysis CKD stage 3~4 patients is influenced by the interaction of multiple factors across capability, opportunity, and motivation. Clinically, interventions should be developed based on the COM-B model, focusing on supplementing capability deficits, improving opportunity support, and stimulating exercise motivation, in order to enhance the feasibility and sustainability of Baduanjin application in this population, fully exert its rehabilitation value, slow disease progression, and improve patients’ physical and mental well-being.