Barriers to Proactive Health Management Among Elderly Patients With Coronary Heart Disease in Rural Areas: A Qualitative Study

AIM: To explore the lived experiences, perceived barriers, and internal unmet needs related to proactive health management among rural elderly patients with coronary heart disease (CHD). DESIGN: Descriptive qualitative study. METHODS: Using purposive maximum variation sampling, we recruited participants from rural elderly inpatients. All subjects were diagnosed with CHD and hospitalized at Shenyang Fourth People's Hospital between May and July 2025. Seventeen eligible participants completed face-to-face interviews lasting 40-60 min each. All interviews were audio-recorded and transcribed verbatim. Inductive descriptive thematic analysis was applied for data coding and to summarize content derived from the interviews. Data collection stopped once data saturation was reached. RESULTS: Multiple challenge domains with three main themes encompassing eight subthemes were extracted. First, barriers related to individual cognition and behavioural management, including limited disease awareness and pathogenic misconceptions, poor adherence to health-promoting behaviours, and impaired psychological adaptation; Second, barriers and trust deficits in healthcare system interactions, characterized by conflicts between medical decision-making and livelihood needs, as well as insufficient trust in primary healthcare services; and Third, limited family-social care support, encompassing impaired family caregiving function, disconnection of social support networks, and limited resources for health literacy empowerment. CONCLUSION: Rural elderly patients with CHD self-reported a range of challenges hindering their proactive health management, including cognitive limitations, low trust in primary care, insufficient intergenerational care, and weak community support networks. Age-appropriate health education and county-level remote medical services are proposed as potential strategies to address these self-reported challenges, which may facilitate patients' proactive health engagement, though improvements in patients' long-term quality of life remain to be further investigated. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses caring for rural elderly patients with CHD should provide age-appropriate, simplified health education to counter disease misconceptions and unsafe self-help behaviours, alongside individualized dietary and physical activity guidance. Nurses should identify and relieve patients' fear of acute CHD-related symptom episodes and guilt over burdening their families and offer simplified home-medication-management guidance for patients and their family caregivers. IMPACT: The findings highlight patients' cognitive limitations, real-world family-care circumstances, and negative perceptions of grassroots healthcare as key considerations when delivering proactive health-management support for this population. PATIENT AND PUBLIC CONTRIBUTION: No patients or members of the public were involved in the study design, recruitment, study conduct, interpretation of findings, or manuscript preparation. REPORTING METHOD: The study report was guided by the COREQ checklist.