Exploring home-based rehabilitation experiences after reverse total shoulder arthroplasty: a health belief model–guided qualitative study

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.