Influencing Factors of Dietary Guidance Compliance in Patients with Esophageal Cancer During Preoperative Neoadjuvant Therapy: A Qualitative Study.

Purpose: To explore the factors influencing dietary guidance adherence in esophageal cancer patients receiving neoadjuvant therapy and to understand their decision-making process through the theoretical lens of the health belief model (HBM). Methods: A descriptive qualitative study was conducted via in depth, semistructured interviews. A purposive sample of 15 esophageal cancer patients receiving preoperative neoadjuvant therapy was recruited until data saturation was achieved. The data were analyzed via directed content analysis, guided by the core constructs of the HBM. Results: Six categories and fifteen subcategories were identified: perceived susceptibility (intuitive perception of body signals, risk awareness via medical information); perceived severity (insufficient threat recognition, awareness of malnutrition-related harm); perceived benefits (improving physical condition, promoting disease recovery); perceived barriers (treatment-related side effects, economic burden, psychological distress, conflicts in dietary habits); self-efficacy (empowerment strategies of highly efficacious individuals, the helplessness of those with low efficacy); and cues to action (professional nutritional education, family supervision and support, peer support). Conclusion: This study suggests that clinical medical workers should fully recognize the impact of personal health beliefs on dietary behavior compliance. This study provides a robust, theory-driven evidence base for developing targeted, multicomponent nutritional interventions that are fundamentally patient-centered, with the ultimate goal of improving treatment tolerance, surgical outcomes, and overall survival.