Barriers and facilitators to return to work in young and middle-aged patients after PCI: a qualitative study based on the COM-B model

Abstract

Abstract The issue of younger onset coronary heart disease (CHD) is becoming increasingly prominent. Percutaneous coronary intervention (PCI) has proven to be an effective treatment for CHD, significantly reducing mortality risk. Young and middle-aged patients with CHD typically need to return to work (RTW) following PCI; however, the proportion of those who achieve a timely return remains low. Further research is needed to identify factors influencing RTW decisions post-PCI. This study adopted a qualitative research design to investigate the barriers and facilitators influencing the RTW among young and middle-aged patients with CHD following PCI. 19 patients had undergone PCI were purposively selected from a tertiary hospital in Xi’an, China, and semi-structured interviews were conducted with them. The data were analyzed using an inductive thematic approach. Thirteen themes were identified and directly mapped onto the COM-B model (Capability, Opportunity, Motivation-Behavior). The constructs of the COM-B model revealed three primary barriers: physical limitations, insufficient knowledge, and lack of employment opportunities. Key facilitators for RTW included health-oriented behavioral modifications, manageable workloads, strong social support networks, family and professional responsibilities, optimism regarding RTW prospects, belief in the positive outcomes associated with RTW, the objective of securing economic income, and habitual behaviors influenced by professional identity. Additionally, two factors served dual roles as both facilitators and barriers: descriptive norms and emotional responses. This study identified key barriers and facilitators influencing RTW among young and middle-aged patients after PCI. The findings indicate that RTW behavior in this population is shaped by the interplay of capability, opportunity, and motivation. Healthcare providers should focus on enhancing patients’ cardiac function, delivering relevant work-related knowledge and health education, and strengthening social support systems to improve both their capability and opportunity for returning to work. Furthermore, promoting positive beliefs and attitudes regarding RTW while alleviating negative emotions can further bolster their motivation to re-enter the workforce.