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Facilitators and Barriers to Voice Prosthesis Rehabilitation After Total Laryngectomy: A Qualitative Study Using the
Meiqin Shi1, Huili Le1, Ling Chen2
1Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Objective:
This study aimed to explore the facilitators and barriers influencing patients' decisions to adopt and persist with voice prosthesis rehabilitation after total laryngectomy from the patient's perspective, using the Capability-Opportunity-Motivation-Behavior (COM-B) model as a theoretical framework.
Method:
A qualitative phenomenological approach was employed. Purposive sampling was used to recruit 12 patients who had undergone secondary Provox voice prosthesis implantation at a tertiary hospital in China between August 2024 and March 2025. Face-to-face, semi-structured, in-depth interviews were conducted based on the COM-B model. Data were analyzed using Braun and Clarke's six-phase thematic analysis.
Result:
Two major themes emerged from the interviews based on the COM-B model. Facilitators included capability factors (good physical fitness and positive mindset), opportunity factors (re--ation by medical staff, family support, volunteer encouragement, superior voice quality, and failure of esophageal speech), and motivation factors (perception of extreme suffering, desire for social integration, need to be understood, restricted independent activities, and unfair treatment). Barriers comprised opportunity factors (unfavorable rehabilitation environment, burdensome daily maintenance, heavy economic burden, and troublesome complications) and motivation factors (uncomfortable replacement experience and frustration from unresolved complications).
Conclusions:
This study provides a theory-driven understanding of the multidimensional factors shaping voice prosthesis rehabilitation adherence. The findings highlight the importance of enhancing patient capability, optimizing external opportunities, and addressing motivational drivers. Future interventions should focus on improving rehabilitation environments, reducing economic burden, simplifying maintenance procedures, and providing psychological support to improve long-term adherence and quality of life.
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