Abstract
Purpose: Adherence to swallowing exercises prescribed to improve swallow function after head and neck cancer has been reported to be suboptimal or poor in several studies. In this study, we identify the barriers and facilitators to performing exercises, and determine the likely strategies to reduce the barriers and enhance the facilitators. Method(s): Semi-structured face to face in-depth interviews were conducted on 13 patients post treatment for head and neck cancer. A comprehensive framework (Theoretical Domains Framework) was used to probe reasons for patients' adherent and non-adherent exercise behaviour. Findings were analysed using Content Analysis. The emergent categories were mapped onto a theory-based model of behaviour change. This facilitated the process of selecting strategies that are most likely to improve patient adherence based on insights from psychological theory and behavioural science. Result(s): Key barriers included inadequate knowledge of the impact of treatment on own swallow function, forgetting to do exercises, overwhelmed by information at a difficult time, pain and fatigue. Key facilitators included social support, knowing how to do the exercises, desire to prevent negative consequences and having a trigger to do exercises. Conclusions (Including Clinical Relevance): This study has used a behavioural science lens to examine head and neck patients adherence to swallowing exercises. The strategies likely to improve adherence will be included in the design of a new swallowing intervention package. The methodology employed in this study could have wider application for other patient groups. Relevant Financial Relationships: Roganie Govender: Has affiliations to disclose; National Institute of Health Research: Grant: Other Activities; Caroline Wood: Nothing to Disclose; Stuart Taylor: Nothing to Disclose; Benjamin Gardner: Nothing to Disclose; Christina Smith: Nothing to Disclose. Relevant Non-Financial Relationships: Roganie Govender: Nothing to Disclose; Caroline Wood: Nothing to Disclose; Stuart Taylor: Nothing to Disclose; Benjamin Gardner: Nothing to Disclose; Christina Smith: Nothing to Disclose.