Implementation of a Self-Help Swallowing Exercise Program in Head and Neck Cancer

Introduction Swallowing problems frequently occur during and after (chemo)radiotherapy among patients with head and neck cancer (HNC). Head Matters (HM) is a guided self-help exercise program developed to prevent or reduce swallowing problems and support self-management. This study evaluated the adoption and implementation of HM across HNC centres in the Netherlands and explored healthcare professionals' perceived barriers and facilitators for sustainable use. Methods This mixed-methods study included all 14 Dutch HNC centres. Quantitative data were collected using the Measurement Instrument for Determinants of Innovations (MIDI) before and after implementation. Qualitative data were obtained through semi-structured interviews with healthcare professionals from different disciplines to explore experiences with and contextual factors influencing implementation. Results Thirteen centres adopted HM (93%), and eleven centres implemented the program (85% of adopters). Determinants for implementation were generally evaluated as neutral to positive. Speech-language pathologists rated procedural clarity, completeness, and compatibility more positively than other professionals. Perceptions of coordination, completeness, and professional support improved over time. Interviews confirmed that the intuitive design and accessibility of HM facilitated implementation, whereas limited digital literacy, login procedures, and limited organizational visibility were perceived barriers. Conclusion HM was widely adopted and implemented across Dutch HNC centres. Allowing local adaptation and appointing clear coordinators facilitated uptake. Sustainable implementation of swallowing exercise programs requires continued attention to training, organizational embedding, and institutional visibility.