Swallowing exercise adherence in patients with head and neck cancer based on the dual-process model: a qualitative study

Abstract Aim: This study aims to explore the factors influencing swallowing exercise adherence in patients with head and neck cancer (HNC), based on dual-process theory, with a particular focus on cognitive and emotional determinants. Design: A descriptive qualitative study was conducted, utilizing content analysis to examine the factors influencing adherence to swallowing exercises in HNC patients. Methods: This study was carried out in Hubei Cancer Hospital. Purposive sampling was used to recruit 18 HNC patients who had either undergone swallowing exercises or received related training at the nursing rehabilitation clinic between May and September 2024. Data were gathered through semi-structured interviews and analyzed using content analysis techniques. Results: Seven key themes were identified that influence adherence to swallowing exercises in HNC patients. These themes were categorized according to the dual-process theory: three themes (exercise experience, exercise habits, and emotional support) were identified as part of System 1, while System 2 included themes such as (1) patient cognition of dysphagia, (2) consider medical service resources, (3) weigh benefits and risks, and (4) the gap between expectations and effects. The study also found significant interactions between the components of System 1 and System 2. Conclusion: The findings highlight multiple factors influencing adherence to swallowing exercises among HNC patients, offering valuable insights into the dynamics of adherence. Relevance to clinical practice: The results of this study provide critical insights into the determinants of swallowing exercise adherence in HNC patients. This evidence can inform the development of targeted, theory-based interventions aimed at improving adherence and facilitating the recovery of swallowing function. Reporting Method: The COREQ checklist. Patient or Public Contribution: Patient representatives of five HNC patients were involved in the design of the interview guide.