Motivational Trajectories in Cardiac Rehabilitation: A Qualitative Study of Coronary Heart Disease Patients

Guided by Self-Determination Theory (SDT), this qualitative study explored motivational archetypes among coronary heart disease (CHD) patients during cardiac rehabilitation (CR). From May to July 2024, we interviewed 20 purposively sampled coronary heart disease patients at two Class A tertiary hospitals in Heilongjiang Province, China. Data were analyzed using directed content analysis, adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The findings identified three motivational archetypes: (1) amotivation, (2) controlled motivation, and (3) autonomous motivation. The study revealed that the majority of participants exhibited controlled motivation, such as following medical advice or coping with the guilt of disappointing a loved one. Autonomous motivation manifests as a gradual process involving accurate perceptions of recovery, healthy lifestyle choices, and enhanced self-efficacy. Patients internalizing cardiac rehabilitation behaviors demonstrated sustained adherence despite challenges. On the other hand, some participants felt uncomfortable and frustrated when their behaviors changed quickly. These results show the importance of using personalized interventions that take into account different types of motivation in clinical practice, educational programs, and policymaking to improve CR adherence.