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. 2025 Apr;19(2):642-658.
doi: 10.1007/s11764-023-01497-9. Epub 2023 Nov 16.

Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study

Aomei Shen  1   2 , Peipei Wu  3 , Wanmin Qiang  1 , Fei Zhu  4 , Zijuan Zhang  2 , Ying Wang  5 , Qian Lu  6
Affiliations

Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study

Aomei Shen et al. J Cancer Surviv. 2025 Apr.

Abstract

Purpose: Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors.

Methods: In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis.

Results: A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers.

Conclusions: Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors.

Implications for cancer survivors: Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.

Keywords: Barriers; Breast cancer-related lymphedema; Content analysis; Facilitators; Qualitative study; Self-management.

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Conflict of interest statement

Declarations. Ethics approval: This study was approved by the Biomedical Ethics Committee of Peking University (Approval number: IRB 00001052–21123) prior to the commencement. Consent to participate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

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