Barriers and facilitators to healthy lifestyle behaviours for people living with post pulmonary embolism syndrome. A qualitative study exploring participants lived experiences

• Key barriers identified were in knowledge, beliefs, consequences and emotion. • Individual, economic and environmental factors shape healthy lifestyle engagement. • Dyspnoea, fatigue and pain constrained physical capability post-PE. • Anxiety and fear of recurrence reduced engagement in activity. • Access to informed support enhanced behavioural capability. Key barriers identified were in knowledge, beliefs, consequences and emotion. Individual, economic and environmental factors shape healthy lifestyle engagement. Dyspnoea, fatigue and pain constrained physical capability post-PE. Anxiety and fear of recurrence reduced engagement in activity. Access to informed support enhanced behavioural capability. People living with post-pulmonary embolism syndrome (PPES) commonly experience persistent dyspnoea, fatigue, reduced exercise tolerance, anxiety, and fear of recurrence. When symptoms continue beyond three months after effective anticoagulation, quality of life can be substantially impaired. Although healthy lifestyle behaviours may improve PPES symptoms, little is known about the barriers and facilitators influencing behaviour change from the perspective of those affected. To explore patients' perceived barriers and facilitators to adopting healthy lifestyle behaviours following PE, in order to inform the future development of rehabilitation interventions for people with PPES. A purposive sample of adults with PPES took part in semi-structured interviews informed by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation–Behaviour (COMB) model. Interviews were transcribed and analysed using a framework approach with inductive and deductive coding. Codes were grouped into categories and mapped to the 14 TDF domains and six COM-B constructs to identify behavioural influences and key barriers and facilitators. Thirty-one participants (18 women, 13 men; aged 25–67 years) were interviewed. Ninety-eight codes were identified and organised into 35 categories, which were mapped to TDF and COM-B domains. The most frequently represented domains were Knowledge, Beliefs about Capabilities, Beliefs about Consequences, and Emotion. Key barriers and facilitators included pain, dyspnoea, healthcare professional knowledge and training, financial resources, and access to education and rehabilitation services. Engagement in healthy lifestyle behaviours after PE is shaped by interacting physical, emotional, socioeconomic, and environmental factors. These findings highlight the need for comprehensive, theory-informed rehabilitation strategies that address both individual and contextual influences on behaviour change in people with PPES.