Applying the COM-B Model to Understand Adherence to Tele-Exercise Prehabilitation Among Older Patients with Lung Cancer: A Qualitative Study

Objective: To investigate the factors influencing adherence to exercise prehabilitation among elderly frail lung cancer patients under telemedicine management within the COM-B framework, and to inform the development of a targeted remote prehabilitation intervention program. Methods: This study employed purposive sampling to select 14 elderly frail lung cancer patients from a tertiary hospital in China as participants for semi-structured interviews. The data were subsequently transcribed and analyzed through qualitative inductive content analysis. Results: The following themes and subthemes were identified. Capability: (1) experience a relatively heavy symptom burden; (2) difficulty in adjusting to negative emotions; (3) digital divide among the elderly; (4) strong ability in proactive health behaviors. Opportunity: (1) remote information-assisted support; (2) incentives based on group exercise formats; (3) a sense of belonging within a multidimensional social support network; (4) excessive concerns from family caregivers; (5) facility convenience and affordability; (6) personalized exercise plans with dynamic adjustments. Motivation: (1) perceived benefits of rehabilitation outcomes and quality of life; (2) fear of exercise induces weak exercise intention. Conclusion: The adherence of elderly frail lung cancer patients to exercise prehabilitation under telemedicine management is influenced by three interrelated factors: capability, opportunity, and motivation. Healthcare professionals should establish a three-pronged intervention approach of “assessment-training-support”. They should strengthen patients’ digital technology adaptation training, design exercise programs tailored to their symptoms, and build family group support networks. In addition, psychological interventions should be emphasized to enhance patients’ willingness to participate in exercise prehabilitation. Registration Number: ChiCTR2500101145. Keywords: lung cancer, prehabilitation, frailty, telemedicine, COM-B model, qualitative study