Situational Factors Associated with Dietary Behavior in Stroke Patients During Rehabilitation: A Qualitative Study Based on the COM-B Model.

Objective: This study investigated situational factors associated with dietary behavior in stroke patients during rehabilitation using the Capability, Opportunity, Motivation - Behavior (COM-B) model, which explains behavior via three components: capability, opportunity, and motivation. Methods: This study employed a qualitative and descriptive design. Using purposive sampling, 17 stroke patients during rehabilitation were recruited from a tertiary hospital in Jiangsu Province, China, between July and September 2024. Semi-structured interviews were conducted, and data were analyzed using directed content analysis. Results: The following themes and (sub)themes were identified. Capability: (1) a lack of knowledge relating to dietary management; (2) difficulty managing negative emotions; (3) reduced self-regulatory ability; (4) distress caused by symptoms of functional impairment. Opportunity: (1) support from the physical environment; (2) using and adjusting assistive feeding devices; (3) influence of the social environment; (4) accessibility and quality of external help services. Motivation: (1) clarification of eating intentions; (2) lack of focus during eating; (3) differences in food assessment. Conclusion: The situational factors associated with dietary behavior in stroke patients during rehabilitation are influenced by a complex interplay of factors within the personal, social, and environmental domains. The application of the COM-B model in this research is a significant contribution. It not only helps to clearly categorize and understand the various situational factors but also provides a structured framework for developing targeted interventions. Interventions that promote healthy dietary behaviors for stroke patients during rehabilitation should incorporate strategies to enhance capability, optimize opportunity, and strengthen motivation.