Home-based self-management using Traditional Chinese Medicine techniques : empowerment and risks in breast cancer survivors’ fulfillment of health-deviation self-care requisites

Abstract

Background and aim: Traditional Chinese Medicine (TCM)–based self-care is widely practiced among cancer survivors worldwide, particularly in China. For Chinese breast cancer survivors (BCSs), it embodies both an expression of ethnomedical cultural identity and a means of health self-empowerment. However, this practice often occurs without professional supervision, posing potential risks. This study aims to explore BCSs’ experiences and perspectives to elucidate the purposes and influencing factors behind their home-based TCM self-care engagement, thereby informing future optimization strategies. Methods: A focused ethnographic design was utilized, with a research framework integrating the COM-B model and Theoretical Domains Framework (TDF). Results were mapped onto constructs of a behavioral wheel derived from the COM-B/TDF matrix. Data analysis followed conventional qualitative content analysis procedures. Results: Participants viewed TCM-based self-care as a complement to rather than a substitute for standard care, primarily for relapse prevention. Facilitators of this practice included (1) strong cultural beliefs and confidence in ethnic medicine, (2) a sense of health responsibility, (3) heightened internal health locus of control, (4) prior beneficial experiences, (5) incentives from online key opinion leaders and fellow survivors, (6) support from family and peers, and (7) reduced time and financial costs. Barriers were (1) insufficient TCM knowledge and skills and (2) uncertainty about efficacy; and (3) safety concerns. Additionally, (1) the home-based treatment setting and (2) the immature internet-based TCM nurse service acted as both barriers and facilitators. Conclusions: The interrelated facilitators and barriers underscore that BCSs’ home-based TCM self-care constitutes a complex medical-sociological issue involving cultural, economic, information communication, and healthcare service delivery dimensions. Only a minority of survivors are aware of the possible adverse medical consequences. Within a patient-centered framework, healthcare providers must identify the unique health-deviation self-care requisites of BCSs in a culturally sensitive manner, and partner with them in their self-health management, such as telemonitoring their home-based TCM self-care using eHealth technologies. There is also an urgent need to develop clinical guidelines or expert consensus to support these practices. Implications for Cancer Survivors: BCSs' TCM self-care represents an intentional health autonomy strategy beyond conventional biomedical dominance, necessitating professional supervision to equilibrate health self-empowerment and iatrogenic risk.