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

AIM: To explore automatic and reflective factors influencing swallowing exercise adherence in patients with head and neck cancer (HNC) using the dual-process model.

DESIGN

A descriptive qualitative study using qualitative content analysis.

METHODS

Eighteen patients with HNC who had experience of swallowing exercises were purposively recruited from a nursing rehabilitation clinic of Hubei Cancer Hospital in China between May and September 2024. Semistructured interviews were analyzed through combined deductive and inductive content analysis. Data collection continued until both code and meaning saturation were achieved. Intercoder agreement for 20% of transcripts was substantial (Cohen's kappa = 0.79).

RESULTS

Seven themes were identified. Exercise experience, habitual exercise cues and routines, and emotional support predominantly reflected system 1 processes; reflective appraisal of dysphagia, consideration of medical service resources, weighing benefits and risks, and the gap between expectations and effects predominantly reflected system 2 processes. Cross-system interactions showed that immediate bodily and emotional responses were continually reshaped by reflective appraisal, contextual resources, and perceived progress.

CONCLUSION

Swallowing exercise adherence is a dynamic product of interacting automatic and reflective processes rather than a purely rational decision. Interventions should combine habit-supportive cues and affective support with education, expectation management, accessible follow-up, and individualized goal setting.

RELEVANCE TO CLINICAL PRACTICE: Clinicians should anchor exercises to stable daily cues, involve family members as proximal habit coaches, use flexible or abbreviated protocols for working patients, and provide motivational interviewing and tele-rehabilitation support to reduce uncertainty and sustain adherence.

REPORTING METHOD: The study was reported according to the COREQ checklist; the completed checklist is submitted as a supplementary file.

PATIENT OR PUBLIC CONTRIBUTION: No patient representatives were involved in the design of the interview guide.