Barriers and facilitators to health promotion behaviours in women with polycystic ovary syndrome and infertility who are actively trying to conceive: a qualitative study using the COM-B model and the Theoretical Domains Framework

Abstract Background The 2023 International Evidence-based Guideline on polycystic ovary syndrome assessment and management recommends healthcare providers promote healthy lifestyles for all women with polycystic ovary syndrome, particularly emphasizing lifestyle modification for those with infertility during preconception care. Health promotion behaviours (HPBs) refer to proactive, multidimensional actions individuals adopt to improve health outcomes. Recommended HPBs encompass five domains: health responsibility, nutrition, physical activity, social support, and emotional regulation. However, limited evidence exists regarding barriers and facilitators to health promotion behaviours among Chinese women with polycystic ovary syndrome and infertility who are actively trying to conceive. Methods Between July and October 2024, we conducted face-to-face semi-structured interviews with 13 women with polycystic ovary syndrome and infertility who were actively seeking pregnancy at a tertiary hospital in Hangzhou, China, using purposive sampling with maximum variation. Data were analyzed via inductive thematic analysis using NVivo 14.0, with findings mapped to the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to identify behavioural determinants. Results Fifteen themes mapped to the COM-B model and nine TDF domains. Capacity: physical limitations, insufficient exercise endurance, lack of knowledge and inherent preferences. Opportunity: mismatch between recommended interventions and daily life context, limitations of objective conditions (e.g., widespread availability of unhealthy foods, lack of exercise facilities), impact of work, the need to accompany children, social support and impact of cultural factors. Motivation: impact of personal first-hand experience, lack of power to act, desire for a good figure, desire to be pregnant and emotional management during preparation for pregnancy. Conclusion This study systematically identified barriers and facilitators to health promotion behaviours in women with polycystic ovary syndrome and infertility who were actively trying to conceive using the COM-B model and the TDF, providing a foundation for designing interventions via the Behaviour Change Wheel and the Behaviour Change Techniques Taxonomy v1 to improve health behaviours in this population.