Determinants of Implementing the 2024 Weight Management Guidelines in Overweight Patients with Coronary Heart Disease in China: A CFIR-Based Qualitative Study of Patient and Caregiver.

BACKGROUND: The rising prevalence of overweight among patients with coronary heart disease (CHD) constitutes a critical clinical challenge. However, the multilevel determinants and patient-caregiver dynamics influencing the real-world implementation of the 2024 Weight Management Guidelines remain underexplored. PURPOSE: To examine the facilitators and barriers influencing the clinical implementation of the 2024 Weight Management Guidelines from the perspectives of patients and their caregivers, and provide an evidence-based foundation for optimizing guideline-driven interventions in overweight patients with CHD. MATERIAL AND METHODS: Using a descriptive qualitative design, purposive sampling was employed to conduct semi-structured, in-depth interviews between July and December 2025 with overweight patients with CHD and their family members at a tertiary hospital in Nanjing. Data were analyzed thematically within the theoretical framework of the Consolidated Framework for Implementation Research (CFIR). RESULTS: Implementation determinants were synthesized into five CFIR domains. Outer Setting: Media-driven health communication expanded patient awareness; however, implementation was constrained by the absence of community-based guidance, fragile social support, and a lack of peer support networks. Inner Setting: Institutional trust and effective clinician-led education served as key facilitators; however, the lack of a multidisciplinary education model remained a critical barrier. Characteristics of Individuals: Patients exhibited proactive information-seeking behaviors and a "confidence cycle" driven by positive feedback. Nevertheless, deep-seated cognitive biases (e.g, the "medication-only" fallacy), entrenched dietary preferences, sedentary lifestyles, addictive behaviors, disrupted circadian rhythms, and behavioral inertia combined with skill deficits created substantial resistance. Intervention Characteristics: While caregivers are highly willing to participate, there is a clinical lack of personalized weight management programs for patients with CHD. Implementation Process: Daily familial supervision provided vital reinforcement; however, a fragmented post-discharge care chain led to the cessation of effective professional guidance and monitoring. CONCLUSION: The implementation of the 2024 Weight Management Guidelines is governed by multilevel determinants. Clinical practice should address behavioral inertia and cognitive biases while establishing a "hospital-to-home" continuum of care. Integrating family-centered participation with precision strategies is essential to enhance adherence and facilitate the successful translation of the guidelines.