Identifying theoretical frameworks and “active ingredients” in health education for breast cancer-related lymphedema: A scoping review and social network analysis

Objectives This scoping review aimed to map the theoretical frameworks used in health education strategies for breast cancer-related lymphedema (BCRL), identify their “active ingredients”, namely behavior change techniques (BCTs), and explore the structural relationships among these elements using social network analysis (SNA). Methods A systematic electronic search was conducted in the Cochrane Library, CINAHL, Embase, PubMed, Web of Science, CNKI, Wanfang, CBM, and VIP databases from inception to May 2024. Intervention components were extracted and coded according to the Michie Behavior Change Technique Taxonomy (v1). SNA was used to calculate descriptive metrics, including degree centrality and network density, to identify core techniques and their patterns of co-occurrence. Results A total of 18 studies were included. Regarding theoretical frameworks, eight studies explicitly applied formal frameworks, including the Health Belief Model, Empowerment Theory, Knowledge-Attitude-Practice Theory, the Stress and Coping Model, Problem-Based Learning, and Solution-Focused Nursing. The remaining studies mainly adopted clinical nursing models or structured health education programs. Regarding behavior change techniques, 42 distinct BCTs were identified, with an average of 15.39 BCTs per study. The most commonly used BCT categories were “goals and planning,” “repetition and substitution,” “feedback and monitoring,” and “shaping knowledge.” SNA identified “instruction on how to perform the behavior,” “action planning,” and “demonstration of the behavior” as the techniques with the highest degree centrality, constituting the core structure of the intervention network. Three functional communities were identified: “skill acquisition & execution,” “self-regulation & monitoring,” and “social support & knowledge.”Overall, existing interventions generally showed positive trends in subjective outcomes, including quality of life, disease-related knowledge, and self-care ability. In contrast, findings for some objective physiological outcomes, such as lymphedema incidence, remained inconsistent. Conclusions Current health education for BCRL primarily relies on a set of techniques focused on skill development and action planning, yet generally lacks rigorous theoretical integration. Future research should prioritize developing precision, theory-driven interventions aligned with patients’ survivorship trajectories and integrating these core BCTs with digital technologies to promote long-term patient adherence.