A Qualitative Study of Preventive Behaviors Among Patients Considered at High Risk of Lower Limb Lymphedema After Gynecological Cancer Surgery Using the Theoretical Domains Framework

Purpose: To explore experiences, barriers, and facilitators related to preventive behaviors among patients considered at high risk of lower limb lymphedema (LLL) after gynecological cancer surgery, using the Theoretical Domains Framework (TDF). Methods: Eighteen patients considered at high risk of LLL and assessed as having no clinically apparent LLL at enrollment were purposively recruited. Semi-structured interviews were conducted between March and July 2026. The 14-domain TDF informed the interview guide and initial deductive coding. Directed content analysis was used to develop subthemes and overarching themes. Reporting followed the Standards for Reporting Qualitative Research (SRQR). Results: Three overarching themes and nine subthemes were identified: (1) everyday activities and practical constraints: access to and understanding of preventive practices, role-driven activity, and changes in activity after role disruption; (2) emotional responses in the context of daily activity and preventive practices: anxiety alongside differing levels of engagement, fear and limited enactment of preventive intentions, distress around illness-related events, and acceptance, optimism, and everyday activity; and (3) following advice and remembering preventive practices: willingness to follow advice and remembering practices through everyday cues. Conclusion: Participants described practical constraints, family roles, emotional responses, and reliance on advice or everyday cues in relation to daily activity and preventive practices. The findings may inform context-sensitive nursing support before clinically apparent LLL develops. However, any resulting intervention requires prospective evaluation of its acceptability, feasibility, and effects. Keywords: gynecological cancer, lower limb lymphedema, preventive behaviors, theoretical domains framework, qualitative study