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The first year after lung transplantation is a critical period during which recipients move from structured, hospital-based management to home-based rehabilitation. Although exercise rehabilitation improves exercise capacity and functional recovery, many recipients struggle to initiate and maintain home-based exercise rehabilitation after discharge. This study aimed to explore multi-stakeholder perspectives on factors influencing the initiation and maintenance of recipients’ home-based exercise rehabilitation. We conducted a descriptive qualitative study at a lung transplant centre in Zhejiang Province, China. Purposive sampling was used to recruit lung transplant recipients (within 12 months post-transplant), primary family caregivers, and healthcare professionals. Semi-structured interviews were conducted between October and December 2025, audio-recorded, transcribed verbatim, and anonymised. Data were analysed using directed content analysis guided by the Capability, Opportunity, Motivation Behaviour (COM-B) model. Twenty-seven participants were interviewed (10 recipients, 7 caregivers, and 10 healthcare professionals). Guided by the COM-B model, six themes described interacting influences on initiating and maintaining home-based exercise rehabilitation. Capability was constrained by post-transplant physical status and limited exercise-related knowledge and skills. Opportunity was shaped by home and community contexts and by social and informational support that could either help or hinder. Motivation was reinforced by goals and feedback but eroded over time by declining interest, emotional distress, uncertainty and behavioural inertia. Views differed across stakeholders. Recipients struggled to apply guidance and felt pressured by reminders, caregivers tended to limit activity for safety, and healthcare professionals emphasised monitoring and gaps in follow-up after discharge. Initiating and maintaining home-based exercise rehabilitation in the first post-transplant year are shaped by the interaction of capability, opportunity, and motivation. One-time discharge education may be insufficient to maintain engagement. Rehabilitation nursing interventions should provide ongoing, stage-specific, and context-sensitive follow-up. Not applicable.
Zhu et al. (2026) studied this question.
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