{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:07:17Z","timestamp":1791209237178,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,16]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to explore perceived factors shaping preoperative self-preparation among older patients undergoing total knee arthroplasty (TKA), drawing on the Capability, Opportunity and Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework, with a view to informing the design of targeted preoperative health education interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This study employed a descriptive qualitative research design. Purposive sampling was used, guided by the principle of maximum variation, taking into account factors such as age, gender, educational background and disease severity. A total of 16 participants were enrolled. Data were collected through semi-structured in-depth interviews conducted 1\u2009day before surgery. This study employed a strategy of concurrent data collection and analysis. During data collection, the study was guided by Information Power. The data were analysed using reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted in a tertiary hospital in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes with nine subthemes were generated: (1) limited preoperative self-preparation capability in older patients with TKA (difficulty coping due to multimorbidity, insufficient cognitive understanding); (2) insufficient opportunity and support for preoperative self-preparation in older patients with TKA (disparities in external support, limited access to medical and nursing care, unmet prehabilitation needs, difficulties in obtaining and identifying information); and (3) varied motivation for preoperative self-preparation in older patients with TKA (perceived benefits of preoperative self-preparation, desire to resume social participation as a driver, intertwined positive and negative emotions).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preoperative self-preparation in older patients with TKA is not determined by a single factor. Healthcare providers should attend to patients\u2019 preoperative physiological status to strengthen the foundational capacity for self-preparation; integrate and optimise diverse external support systems to enhance the external impetus for self-preparation; and address patients\u2019 emotional concerns to stimulate the internal motivation for self-preparation, thereby facilitating comprehensive preoperative self-preparation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-122819","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:34Z","timestamp":1791207334000},"page":"e122819","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Perceived factors shaping preoperative self-preparation among older patients undergoing total knee arthroplasty: a qualitative study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3678-8864","authenticated-orcid":false,"given":"Jiawen","family":"Sun","sequence":"first","affiliation":[{"name":"School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongle","family":"Pei","sequence":"additional","affiliation":[{"name":"School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuhua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Operating Room, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"},{"name":"Health Care Research Center for Xinjiang Regional population, Urumqi, Xinjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100506351941000_16.10.e122819.1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ocl.2019.11.003","article-title":"Global Perspectives on Arthroplasty of Hip and Knee Joints","volume":"51","author":"Abdelaal","year":"2020","journal-title":"Orthop Clin North Am"},{"key":"2026100506351941000_16.10.e122819.2","first-page":"594","article-title":"Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty","volume":"38","author":"DeFrance","year":"2023","journal-title":"A Systematic Review of the Literature [J] J Arthroplasty"},{"key":"2026100506351941000_16.10.e122819.3","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-48291-2","article-title":"Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty","volume":"13","author":"Var\u0131\u015f","year":"2023","journal-title":"Sci Rep"},{"key":"2026100506351941000_16.10.e122819.4","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2022.916554","article-title":"Psychometric properties of the Chinese version of the preoperative assessment of readiness tool among surgical patients","volume":"13","author":"Bao","year":"2022","journal-title":"Front Psychol"},{"key":"2026100506351941000_16.10.e122819.5","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1093\/ehjqcco\/qcad042","article-title":"Preparation for cardiac procedures: a cross-sectional study identifying gaps between outpatients\u2019 views and experiences of patient-centred care","volume":"10","author":"Fakes","year":"2024","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026100506351941000_16.10.e122819.6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/aorn.13425","article-title":"Systematic Review of Preoperative Patient Readiness","volume":"114","author":"Torres","year":"2021","journal-title":"AORN J"},{"key":"2026100506351941000_16.10.e122819.7","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1002\/acr.24562","article-title":"Relationship Between Patient-Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One-Year Follow-Up","volume":"74","author":"Hawker","year":"2022","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026100506351941000_16.10.e122819.8","doi-asserted-by":"crossref","first-page":"3156","DOI":"10.1007\/s00167-019-05804-9","article-title":"Patient satisfaction and perception of success after total knee arthroplasty are more strongly associated with patient factors and complications than surgical or anaesthetic factors","volume":"28","author":"Khatib","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2026100506351941000_16.10.e122819.9","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1002\/msc.1825","article-title":"A mixed methods approach to investigating physical activity in people with obesity participating in a chronic care programme awaiting total knee or hip arthroplasty","volume":"21","author":"Pavlovic","year":"2023","journal-title":"Musculoskeletal Care"},{"key":"2026100506351941000_16.10.e122819.10","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"key":"2026100506351941000_16.10.e122819.11","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-37"},{"key":"2026100506351941000_16.10.e122819.12","doi-asserted-by":"publisher","DOI":"10.1080\/2159676x.2019.1704846"},{"key":"2026100506351941000_16.10.e122819.13","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"2026100506351941000_16.10.e122819.14","doi-asserted-by":"publisher","DOI":"10.1111\/jan.13031"},{"key":"2026100506351941000_16.10.e122819.15","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2018.1497149"},{"key":"2026100506351941000_16.10.e122819.16","doi-asserted-by":"crossref","DOI":"10.1002\/msc.70001","article-title":"A Phenomenological Qualitative Study Protocol and Semi-Structured Interview Guide Development to Identify Perceptions, Experiences, Facilitators and Inhibitors in Patients With Knee Osteoarthritis Undergoing Rehabilitation in a Low- and Middle-Income Country","volume":"22","author":"Bathran","year":"2024","journal-title":"Musculoskeletal Care"},{"key":"2026100506351941000_16.10.e122819.17","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2026100506351941000_16.10.e122819.18","doi-asserted-by":"publisher","DOI":"10.1080\/2159676x.2019.1628806"},{"key":"2026100506351941000_16.10.e122819.19","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241234800"},{"key":"2026100506351941000_16.10.e122819.20","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2026100506351941000_16.10.e122819.21","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16324"},{"key":"2026100506351941000_16.10.e122819.22","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2106"},{"key":"2026100506351941000_16.10.e122819.23","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-022-05955-w","article-title":"Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement","volume":"23","author":"Kappenschneider","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"2026100506351941000_16.10.e122819.24","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-017-0879-4"},{"key":"2026100506351941000_16.10.e122819.25","first-page":"1153","article-title":"A qualitative study on the perception of preoperative self-preparedness in women with stress urinary incontinence","volume":"29","author":"Su","year":"2023","journal-title":"Chinese Journal of Modern Nursing"},{"key":"2026100506351941000_16.10.e122819.26","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/jorc.12462","article-title":"Effectiveness of teach\u2010back for chronic kidney disease patient education: A systematic review","volume":"50","author":"M. H. Jagodage","year":"2024","journal-title":"J Ren Care"},{"key":"2026100506351941000_16.10.e122819.27","first-page":"387","article-title":"Decision Support for Joint Replacement: Implications for Decisional Conflict and Willingness to Undergo Surgery","volume":"73","author":"Riffin","year":"2018","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"2026100506351941000_16.10.e122819.28","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.jopan.2016.07.010","article-title":"Scale Development and Psychometric Evaluation of the Preoperative Assessment of Readiness Tool","volume":"33","author":"Torres","year":"2018","journal-title":"Journal of PeriAnesthesia Nursing"},{"key":"2026100506351941000_16.10.e122819.29","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajog.2017.04.017","article-title":"Evaluation of patient preparedness for surgery: a randomized controlled trial","volume":"217","author":"Greene","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"2026100506351941000_16.10.e122819.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2025-104740","article-title":"Experience of patients with total knee arthroplasty for knee osteoarthritis in China: a patient journey map based on qualitative research","volume":"16","author":"Zhan","year":"2026","journal-title":"BMJ Open"},{"key":"2026100506351941000_16.10.e122819.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-025-08637-5","article-title":"Pre-operative education and prehabilitation provision for patients undergoing hip and knee replacement: a national survey of current NHS practice","volume":"26","author":"Omar","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"2026100506351941000_16.10.e122819.32","doi-asserted-by":"crossref","first-page":"677","DOI":"10.2340\/17453674.2024.42304","article-title":"Digital health literacy in Norwegian patients with hip and knee arthroplasty: normative data from a cross-sectional study","volume":"95","author":"Rognsv\u00e5g","year":"2024","journal-title":"Acta Orthop"},{"key":"2026100506351941000_16.10.e122819.33","first-page":"881","article-title":"Research progress on the application of mobile health in the management of patients undergoing total knee arthroplasty","volume":"24","author":"Li","year":"2024","journal-title":"Chinese Nursing Management"},{"key":"2026100506351941000_16.10.e122819.34","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1302\/0301-620X.105B5.BJJ-2022-1123.R1","article-title":"Depression and anxiety are associated with an increased risk of infection, revision, and reoperation following total hip or knee arthroplasty","volume":"105-B","author":"Harmer","year":"2023","journal-title":"Bone Joint J"},{"key":"2026100506351941000_16.10.e122819.35","doi-asserted-by":"crossref","first-page":"4373","DOI":"10.1111\/jocn.14557","article-title":"Triggers and decision\u2010making patterns for receiving total knee arthroplasty among older adults with knee osteoarthritis: A qualitative descriptive study","volume":"27","author":"Hsu","year":"2018","journal-title":"J Clin Nurs"},{"key":"2026100506351941000_16.10.e122819.36","first-page":"2677","article-title":"Research progress on episodic future imagery in health behaviour decision-making among patients with chronic diseases","volume":"58","author":"Ru","year":"2023","journal-title":"Chinese Journal of Nursing"},{"key":"2026100506351941000_16.10.e122819.37","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.arth.2024.03.007","article-title":"The Impact of Mental Health on Patient Outcomes After Total Knee and Hip Arthroplasty","volume":"39","author":"Scuderi","year":"2024","journal-title":"J Arthroplasty"},{"key":"2026100506351941000_16.10.e122819.38","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1111\/jan.14339","article-title":"The mediating role of pre\u2010operative patient readiness on surgical outcomes: A structural equation model analysis","volume":"76","author":"Torres","year":"2020","journal-title":"J Adv Nurs"},{"key":"2026100506351941000_16.10.e122819.39","first-page":"41","article-title":"Current status and influencing factors of preoperative self-preparedness in patients with glioma","volume":"39","author":"Zhang","year":"2024","journal-title":"Journal of Nursing Science"},{"key":"2026100506351941000_16.10.e122819.40","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.pmn.2024.04.002","article-title":"A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences","volume":"25","author":"Reynolds","year":"2024","journal-title":"Pain Manag Nurs"},{"key":"2026100506351941000_16.10.e122819.41","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000022213","article-title":"The efficacy of nursing intervention to reduce preoperative anxiety in patients with total knee arthroplasty","volume":"99","author":"Fu","year":"2020","journal-title":"Medicine (Baltimore)"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-122819","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:39Z","timestamp":1791207339000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-122819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bmjopen-2026-122819"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-122819","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}