A qualitative study on the experiences of health behavior decision-making and support needs among older adults with osteoporotic fractures

Osteoporotic fractures (OPFs) in older adults are a common geriatric condition often associated with high rates of disability, functional decline, and increased caregiving burdens. However, several urgent challenges remain in the management of health behaviors to improve patient outcomes. This study aims to explore the experiences and support needs of older adults with osteoporotic fractures when making health behavior decisions, thereby providing a basis for developing targeted intervention strategies and optimizing health management services. Guided by the social ecological model, this study employed a qualitative descriptive research design. Between March and July 2025, semi-structured and open-ended in-depth interviews were conducted with 25 older adults hospitalized for osteoporotic fractures, using purposive sampling. Data analysis was performed using thematic analysis (Braun & Clarke framework), combining inductive and deductive methods, resulting in the identification of three main themes: (1) the phased evolution of disease perception and decision triggers; (2) decision conflicts and maintenance dilemmas in health behavior management; and (3) diverse needs for health behavior decision-making. These themes reflect a dynamic and ongoing decision-making process. Participants initially tended to adopt relatively passive coping strategies but subsequently underwent cognitive adjustments and behavioral re-evaluation. During this process, they experienced a prolonged and contradictory phase characterized by uncertainty and indecision, ultimately reaching a state of temporary adaptation or compromise. Overall, older adults with OPF face multiple barriers and have complex, multidimensional needs regarding health behavior decision-making. These findings highlight the importance of patient-centered interventions that address conflicting experiences and individualized needs, thereby promoting healthier lifestyles and improving quality of life.