Patient perspectives on adherence to a virtual multimodal (P)REHABILITATION program in gastrointestinal cancer: a theory-driven qualitative behavioural analysis

PURPOSE: This qualitative study explored barriers and facilitators to adherence among participants of a virtual multimodal (p)rehabilitation program for gastrointestinal cancer surgery and investigated how these aligned with constructs from Temporal Self-Regulation Theory (TST), a theoretical behaviour change framework. MATERIALS AND METHODS: Semi-structured interviews were conducted with participants of the PRIORITY-CONNECT 2 Pilot Trial, a virtual multimodal (p)rehabilitation program for patients undergoing major gastrointestinal cancer surgery. TST informed the development of the semi-structured interview questions to explore participants' experiences of barriers and facilitators to uptake of the program recommendations. Reflexive thematic analysis was conducted to identify patterns within participants' experiences and perceptions of the (p)rehabilitation program. RESULTS: 13 interviews were conducted. Six themes were identified: (1) Trust in Healthcare Professionals; (2) Overall Program Perceptions; (3) Socioenvironmental Impacts; (4) Personal Characteristics and Motivation; (5) Prior Health Habits; (6) Symptoms Impacting Physical Capacity. These themes mapped to the constructs of TST, identifying how beliefs about program value, contextual barriers, and self-regulatory capacity shape adherence behaviour. CONCLUSIONS: Adherence to virtual (p)rehabilitation was influenced by trust, perceived benefit, and flexible, supervised delivery, but limited by competing demands and treatment-related fatigue. Integrating behaviour-change principles from TST may enhance adherence in future multimodal (p)rehabilitation programs.