Abstract:

Objective To explore the connotation，formation，and maintenance mechanism of proactive health behaviors in elderly patients with chronic obstructive pulmonary disease（COPD），and to construct a proactive health behavior model for elderly COPD patients，so as to provide references for promoting their proactive health behaviors. Methods From July to September 2025，grounded theory and purpose sampling were used to select 15 elderly patients with COPD in the respiratory department of a tertiary A hospital in Jinan for semi-structured in-depth interviews. The data were analyzed via three-level coding and constant comparative analysis to extract concepts and categories，and to construct a theoretical model. Results The proactive health behaviors of elderly COPD patients mainly consisted of 3 types：treatment-related behaviors，rehabilitation exercise behaviors，and lifestyle management behaviors，with 4 core characteristics：autonomy，sustainability，adaptability，and goal-directedness. During the behavio-ral process，intrinsic driving factors such as cognitive awareness，health responsibility，self-management skills，and psychological adjustment provided impetus for the initiation of proactive health behaviors in COPD patients. External support factors including family support，medical and community support，information resources，and social support played important roles in promoting the sustainability of health behaviors. During the behavioral maintenance process，patients faced multiple barriers including physical，psychological，economic，and environmental obstacles，which they coped with through strategies of active adjustment or passive abandonment. The experiential process of proactive health behaviors could in turn influence patients’ cognition and psychological state，and further affect subsequent behavioral decisions. Conclusion The proactive health behavior model for elderly COPD patients can guide healthcare professionals from the perspective of the proactive health behavior process，help clarify its manifestations and core characteristics，systematically assess patients’ intrinsic drivers and external contexts，and thereby optimize health education and intervention strategies. It provides stratified，contextualized，and operable guidance for clinical practice.

Key words: Pulmonary Disease，Chronic Obstructive, Proactive Health Behavior, Grounded Theory, Qualita-tive Research, Geriatric Nursing

摘要：

目的 探索老年慢性阻塞性肺疾病（简称慢阻肺）患者主动健康行为的内涵、形成及维持机制，旨在构建老年慢阻肺患者主动健康行为模型，为促进其主动健康行为提供参考。方法 运用扎根理论和目的抽样法，选取于2025年7—9月在济南市某三级甲等医院呼吸科病房接受治疗的15例老年慢阻肺患者进行半结构式深入访谈。通过三级编码及不断比较法对访谈资料进行分析，提炼概念、范畴并构建理论模型。结果 共纳入了15例老年慢阻肺患者，其主动健康行为主要包括治疗相关行为、康复锻炼行为和生活方式管理3种类型，并具有自主性、持续性、适应性和目标导向性4个核心特征。在行为过程中，认知觉醒、健康责任感、自我管理技能和心理调适等内在驱动因素为主动健康行为的启动提供动力；家庭支持、医疗与社区支持、信息资源和社交支持等外部支持因素为主动健康行为的持续发挥重要促进作用。行为维持过程中，患者面临身体、心理、经济与环境等多重障碍，选择主动调整或被动放弃等应对策略。主动健康行为的体验过程可反向作用于患者的认知与心理状态，并进一步影响后续行为决策。结论 老年慢阻肺患者主动健康行为模型可引导医护人员从主动健康行为过程视角出发，明确患者主动健康行为表现形式和核心特征、系统评估患者内在驱动与外部情境，进而优化健康教育与干预策略，为临床实践提供分层、情景化和可操作的指导。

关键词: 肺疾病，慢性阻塞性, 主动健康行为, 扎根理论, 质性研究, 老年护理