Strategies for enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease: a qualitative study

Cardiac rehabilitation encompasses a comprehensive approach to ensure that patients with heart disease achieve optimal physical, mental, and social functioning, enabling them to restore normalcy in their lives through personal effort [1, 2]. Compared to traditional in-hospital rehabilitation, home-based cardiac rehabilitation offers a more flexible recovery method, particularly for patients who face geographic, time, or economic barriers to regular hospital visits [3]. Home-based cardiac rehabilitation not only enhances patient engagement and adherence but also significantly improves cardiovascular health metrics, reduces readmission and mortality rates, and boosts quality of life [4‐6]. However, these benefits rely on the active participation and optimal self-management of heart disease patients.

In the context of home-based cardiac rehabilitation, self-management is considered a key determinant of rehabilitation success. Self-management involves the proactive management of exercise, nutrition, psychological well-being, medication, and risk factors, directly influencing patient recovery progress [7, 8]. Optimal self-management can help patients better monitor their cardiac condition, adopt healthy lifestyles, adhere to treatment plans, cope with psychological stress, and acquire relevant education and information [9‐11]. Nonetheless, many patients with coronary heart disease face self-management challenges during home-based rehabilitation, including limited health literacy [12], inadequate health monitoring skills, and difficulties in sustaining lifestyle changes, leading to suboptimal recovery outcomes and increased risks of complications and readmission.

In this process, clinical nurses play an indispensable role in enhancing home-based cardiac rehabilitation self-management capabilities. Nurses can facilitate better understanding and execution of self-management strategies through health education, behavioral interventions, and personalized guidance. Studies show that nurse-led interventions can significantly improve patients’ health literacy, adherence, and self-management abilities, thereby enhancing rehabilitation outcomes [13‐16]. Although numerous nurse-led intervention strategies exist to enhance patients’ self-management capabilities, discrepancies persist regarding clinical nurses’ perceptions and practical experiences with these strategies to a certain extent [17, 18]. These discrepancies include differing interpretations of patient needs, inconsistent use of evidence-based practices, and difficulties in tailoring interventions to accommodate the diverse profiles and challenges of patients [19, 20]. A thorough understanding of these differences and diverse strategies is essential for designing more effective intervention programs.

Currently, there is a lack of comprehensive exploration of how nurses perceive and implement evidence-based interventions that address the diverse and complex needs of these patients. To bridge this important research gap, this study aims to explore clinical nurses’ experiences and strategies for improving self-management of patients with coronary heart disease during home-based cardiac rehabilitation, thereby providing valuable insights for optimizing interventions. These findings will not only provide theoretical support for improving self-management methods, but also help effectively promote and apply tailored strategies in clinical practice, and ultimately improve the treatment outcomes of patients with home-based cardiac rehabilitation.

The primary findings of this study indicate that clinical nurses employ several strategies to enhance self-management among patients with coronary heart disease during home-based cardiac rehabilitation. These strategies include precise and visual aided educational approaches, diverse nudging techniques, and collaborative support strategies. The significance of these findings underscores the crucial role of nurses in the home rehabilitation process, which not only helps patients improve their self-management capabilities but also promotes better health outcomes. Therefore, further developing nurses’ professional skills and enhancing their understanding of self-management strategies will contribute to improving overall rehabilitation effectiveness.

In terms of precision education, the study reveals that nurses tailor health education to meet individual patient needs, effectively enhancing their understanding of the importance of self-management. Personalized education enables patients to grasp their health status and management requirements, increasing their sense of involvement and confidence, thus motivating them to actively engage in rehabilitation [23, 24]. This approach aligns with the knowledge factor in the self- and family management framework [25‐27], emphasizing the importance of equipping patients with actionable health information and practical skills. Additionally, the application of visual aided education, through tools such as charts and videos, simplifies complex health information, making it easier for patients to process and apply what they learn in their self-management [28]. By improving comprehension and application health information and self-management strategies, visual aided education enhance patients’ ability to implement behavioral changes, a core aspect of self-management models [29]. This intuitive approach effectively addresses the information transfer inadequacies often seen in traditional educational methods.

Nudging refers to a strategy that influences individual behavior by subtly changing the decision-making environment or choice architecture, without the need for coercion or explicit information provision [30]. The core of nudging lies in making small adjustments to the environment to guide individuals toward choices that align with their best interests, often without their conscious awareness [31]. Unlike educational strategies, nudge strategies reject the assumption that patients can make the best decisions given the right information [31].

The application of information framing assists patients in identifying priority health issues, facilitating more informed health decisions. Nurses utilize the principle of loss aversion, transforming complex medical terminology into content that patients can readily understand. Loss aversion refers to the phenomenon where individuals are more sensitive to losses than to equivalent gains [32]. When nurses emphasize the potential health losses associated with poor self-management, patients are more likely to feel a sense of urgency, prompting them to take action to avoid these losses [33]. Such motivational strategies are crucial in addressing the psychological and emotional dimensions of self-management, fostering stronger commitment and proactive engagement [25]. By clearly delineating the potential consequences of negative behaviors, nurses can motivate patients to prioritize self-management and instigate positive changes. Similarly, the social norms strategy proves effective; by introducing successful rehabilitation cases and organizing patient interactions, nurses can enhance patients’ sense of belonging and engagement [34, 35]. Interaction in a supportive environment can encourage patients to actively participate in their self-management, thereby improving their capabilities. The core of this mechanism lies in social support, which increases patients’ sense of accountability and self-efficacy, making them feel less isolated in facing rehabilitation challenges [36, 37]. These findings highlight the importance of embedding interpersonal and community-based elements within self-management frameworks to sustain patient motivation and adherence. Verbal reminders utilize emphatic sentences to encourage patients to take self-management seriously, as it heightens their health vigilance and sense of responsibility. Research indicates that such reminders can not only facilitate patients’ understanding of the importance of self-management but also motivate them to make proactive changes in their daily lives [38, 39]. By employing clear and impactful words, nurses can help patients recognize the potential risks of harmful behaviors, thereby stimulating more active participation in their rehabilitation plans.

Finally, regular follow-ups and collaborative management strategies provide patients with ongoing support and feedback. Continuous tracking and assessment allow nurses to stay updated on patients’ rehabilitation progress and offer necessary adjustment recommendations. This sustained care and support have been shown to enhance patient compliance and foster a sense of belonging and engagement with their rehabilitation plans [40, 41]. Collaborative management emphasizes cooperation among the healthcare team, patients, and their families, reinforcing patients’ confidence and ensuring comprehensive support throughout their self-management process. The underlying mechanism here is the formation of a strong support system through collective efforts, helping patients overcome difficulties encountered during rehabilitation [42, 43].

Importantly, collaborative management strategies reveal limitations in current self-management theories when applied to complex healthcare environments [44]. Collaborative management emphasizes the joint efforts of patients, families, and healthcare teams, extending beyond the individual behavior focus of existing frameworks [45]. These strategies strengthen support networks and empower patients to play an active role in rehabilitation by incorporating dynamic feedback within social and emotional support systems [46]. However, such system- and relationship-centered approaches remain underrepresented in current self-management models [44].

By highlighting the multidimensional role of collaboration, continuous feedback mechanisms, a sense of belonging through social interactions, and synergy between families and healthcare teams, collaborative strategies address diverse patient needs and demonstrate practical value [45, 47, 48]. Integrating these strategies into existing theories could fill theoretical gaps, making self-management models more applicable to the complexities of home-based rehabilitation. This refinement offers a promising direction for enhancing patient outcomes in challenging healthcare settings.

This study delves into the crucial role of clinical nurses in enhancing the self-management capabilities of patients with coronary heart disease during home-based cardiac rehabilitation. By exploring various effective educational, nudging, and support strategies, the research demonstrates that nursing interventions can significantly improve patients’ self-management skills and rehabilitation outcomes. These findings underscore the importance of personalized education, straightforward nudging strategies, and ongoing support in nursing practice, providing a theoretical foundation for optimizing home rehabilitation for patients with coronary heart disease.