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Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study


Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study

Gabriela Constantinescu et al. JMIR Rehabil Assist Technol.


Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions.

Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app.

Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs.

Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use.

Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development.

Keywords: app design; dysphagia; games for health; gamification; head and neck cancer; mHealth; mobile health; patient adherence; patient engagement.


Figure 1
Figure 1
Screenshots of design concepts for visual biofeedback, distinguished across 2 features: the type of visuals (simple, complex, abstract), and the presence or absence of a character. An example for each of the swallow exercises was created for all 6 categories and explained to patients in a video.
Figure 2
Figure 2
Fragment of notes taken during the analysis of convergent interviews. The following codes were used: (✓) participant agreed with issue; (✗) participant disagreed with issue; (-) participant did not raise this issue, or issue was not probed by clinician; (A) issue actively probed for by interviewer in subsequent set and participant agreed; (D) issue actively probed for by interviewer in subsequent set and participant disagreed; (U) issue actively probed for by interviewer in subsequent set and participant undecided or gave contradicting statements throughout the interview; (.) not a converging theme from previous set and not specifically probed for by interviewer. Highlighted issues were deemed convergent.

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    1. Arrese LC, Lazarus CL. Special groups: head and neck cancer. Otolaryngol Clin North Am. 2013 Dec;46(6):1123–36. doi: 10.1016/j.otc.2013.08.009. - DOI - PubMed
    1. Dysphagia Section‚ Oral Care Study Group‚ Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM, Gibson RJ, Eilers JG, Waltimo T, Bots CP, Michelet M, Sollecito TP, Rouleau TS, Sewnaik A, Bensadoun R, Fliedner MC, Silverman S, Spijkervet FK. Swallowing dysfunction in cancer patients. Support Care Cancer. 2012 Mar;20(3):433–43. doi: 10.1007/s00520-011-1342-2. - DOI - PMC - PubMed
    1. Langerman A, Maccracken E, Kasza K, Haraf DJ, Vokes EE, Stenson KM. Aspiration in chemoradiated patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1289–95. doi: 10.1001/archotol.133.12.1289. - DOI - PubMed
    1. Szczesniak MM, Maclean J, Zhang T, Graham PH, Cook IJ. Persistent dysphagia after head and neck radiotherapy: a common and under-reported complication with significant effect on non-cancer-related mortality. Clin Oncol (R Coll Radiol) 2014 Nov;26(11):697–703. doi: 10.1016/j.clon.2014.08.009. - DOI - PubMed
    1. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007 Jul;22(3):251–65. doi: 10.1007/s00455-006-9074-z. - DOI - PubMed

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