Barriers and facilitators to home-based osteoporosis self-management among older lung transplant recipients: a qualitative study

Osteoporosis is common after lung transplantation and is a particular concern in older recipients. It is associated with increased risks of fracture, frailty, disability, and hospital readmission and may compromise functional recovery. After discharge, recipients need to sustain osteoporosis self-management through medication adherence, adequate calcium intake and vitamin D supplementation, and weight-bearing and resistance exercise to limit further bone loss and reduce fracture risk. However, factors influencing older recipients’ ability to maintain these behaviours remain poorly understood. This study aimed to explore barriers to and facilitators of home-based osteoporosis self-management among older lung transplant recipients. A qualitative descriptive study was conducted, with the Integrated Theory of Health Behavior Change (ITHBC) informing the interview guide and analysis. Older lung transplant recipients with confirmed osteoporosis were recruited through maximum variation purposive sampling from a tertiary hospital in Zhejiang Province, China, between November 2025 and February 2026. Semi-structured interviews were analysed using directed content analysis. Recruitment continued until code and meaning saturation were reached. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Twenty older lung transplant recipients were interviewed. Seven themes were identified across the three ITHBC domains. In the knowledge and beliefs domain, osteoporosis was difficult to recognise and was given low priority; low confidence and negative self-appraisal constrained self-management; and responsibility for preserving transplant benefits motivated self-management. In the self-regulation skills and abilities domain, task overload and limited capacity constrained self-management, whereas organising and adapting self-management in everyday life supported sustained self-management. In the social facilitation domain, multiple constraints in home-based support and resources hindered self-management, whereas multilevel support facilitated sustained self-management. Home-based osteoporosis self-management among older lung transplant recipients is shaped by recipients’ health beliefs and self-regulation abilities, and the availability and quality of multilevel support. Post-discharge support should therefore extend beyond knowledge-based education and combine coordinated, continuous, and tailored home-based guidance with family caregiver involvement and accessible professional follow-up. Management plans should be aligned with recipients’ capacities and family caregiving circumstances, with osteoporosis management integrated into established post-transplant routines.