A TTM-Based Qualitative Study on Factors Influencing Respiratory Training for Balance Recovery in Older Stroke Patients in County-Level Rural China

Background :Respiratory training has been shown to improve core stability and postural control, which are closely associated with balance function in elderly stroke survivors. However, the uptake and sustained practice of respiratory training remain limited, especially in rural county-level settings in China, where health resources are constrained and patient awareness is low. This study aims to explore the real-life experiences and influencing factors of elderly ischemic stroke patients engaging in respiratory training for balance improvement, guided by the Transtheoretical Model of Change (TTM). Methods :A descriptive qualitative design was adopted based on the TTM framework. Eleven elderly ischemic stroke patients with lower-limb dysfunction were recruited from the neurology department of Sinan County People’s Hospital between October and November 2024 through purposive sampling. Semi-structured, face-to-face interviews were conducted and audio-recorded. Data were analyzed using Colaizzi’s seven-step method, and NVivo 12 software was employed for coding and thematic organization. Results :Three main themes and ten subthemes were identified: (1) Intrinsic factors: low health and digital health literacy, and a dynamic decline in self-efficacy; (2) Motivational factors: financial and emotional burdens, safety concerns, and a perceived lack of training efficacy; (3) Support system factors: limited access to medical services, shortage of professional rehabilitation staff, insufficient guidance from healthcare providers, urban–rural disparity in resources, and weakening social support networks. Conclusion :Multiple internal and external factors hinder respiratory training engagement among elderly stroke patients in county-level rural areas. To improve training adherence and balance outcomes, it is essential to implement tailored health education, strengthen community-based rehabilitation capacity, reinforce family support, and apply behavior change strategies aligned with the stages of the Transtheoretical Model (TTM).