Analysis of barriers and facilitators to patient activation among patients with infectious keratitis from a social ecosystems theory perspective: a qualitative study in the Chinese context

BackgroundInfectious keratitis is one of the leading causes of visual impairment and blindness, placing a significant burden on global public health. Its treatment and favorable prognosis depend heavily on patients' knowledge, skills, and confidence in managing their own health. Nevertheless, qualitative investigations into patient activation among individuals with infectious keratitis within the Chinese cultural context remain scarce. Additionally, research examining this issue through the lens of social ecosystem theory is notably lacking.ObjectiveThis study aims to identify the facilitators and barriers to patient activation among patients with infectious keratitis in China using a qualitative approach to provide a theoretical basis for developing systematic, multilevel intervention strategies.MethodsThis study employed a descriptive qualitative research design. Using purposive sampling, 15 patients with infectious keratitis were recruited from a tertiary eye hospital in Zhejiang Province, China, between July and September 2025. Semi-structured interviews were conducted, and the interview data were analyzed using qualitative content analysis with NVivo 12.ResultsBased on social ecosystems theory, the analysis identified three main categories at the micro, meso, and macro levels: (1) microsystem —perceptions and behavioral adaptation challenges under disease impact; (2) mesosystem—support and tension in patient interactions with family and providers; (3) macrosystem—challenges and needs in building social networks.ConclusionsPatient activation in infectious keratitis is constrained by individual, family, healthcare, and social factors across the micro, meso, and macro levels. Future interventions need to incorporate both facilitators and barriers by strengthening patient education, family support, patient-provider communication, and coordination of social resources to enhance patient activation and improve clinical outcomes.