Table 2.

Summary of facilitators and barriers to adherence identified in each theme.

Theme	Factor	Sample quote
Theme 1: Perceptions on outcomes and progress
Facilitators	Perceived regression in function or fear of poor outcomes	“I need to work harder at it. And, because, I’ve already been pretty sick, I don’t want to get sick again.”
	Perceived benefit as a result of the exercise	“I did stick with it because I went, ‘Wow, I’d do this.’ Any improvement in swallowing, being able to maybe eat a little faster cuz it’s going down quicker, I want. I really want it.”
Barriers	No swallowing problem or restored function	“I told myself, oh I’m in the clear!”
	Perceived little or no progress	“I don’t see any more progress, I’m not doing this anymore.”
	Unrealistic postcancer treatment outcome expectations	“(...) you realize okay well this is gonna take time.”
	Pessimistic adjustment in outcome expectations	“I just resigned myself to the fact that I don’t think my situation is really gonna change.”
Theme 2: Role of clinical appointments
Facilitators	Education	“Now, now I see where you-, what you’re getting at, when you invent these exercises.”
	Building confidence	“I was always second-guessing really my technique. So I found the technique a little bit difficult to actually maintain. Um, especially after (...) I would leave the in-house session and try to do them at home.”
	Tailored prescriptions	“But she said if it’s too difficult and you find an issue then just at least continue on with the other ones. Just don’t stop”
	Accountability	“(...) you slide into bad habits pretty fast. If you’re not constantly monitored.”
Barrier	Access	“So so if I was doing something wrong, I didn’t have the feedback to tell me try this or try that. I had to wait till my next appointment.”
Theme 3: Cancer treatment
Barriers	Memory and focus	“I’d get home and you’d hand it to me, like do this, this and this, and I’d go, ‘Well that’s so simple’ Good God. And I’d get home and go (face palm) ‘What, what (...) oh man, I don’t remember, I don’t know what this means, and I’m not gonna phone because this is grade 3 instructions’ know what I mean?”
	Sense of overwhelm with information and recommendations	“(...) this type of cancer is very complex in its requirements for support and therapy, yeah, some days, it’s just like whoa, it’s a lot to keep on track, I can’t keep it all up.”
	Low energy and fatigue	“So sometimes all I had time for or energy in the day was a 1 hour visit with somebody. Maybe half an hour only. And then exercises, even eating sometimes would fall off because I wanted to go nap and sleep.”
	Other side effects	“You’re tired. You’re tired of choking. You’re miserable. You’re isolated. You can’t communicate as it is except by writing a lot of places. Like for months. After the radiation burns your throat and that, it makes it harder to swallow, your throat’s raw. For so many reasons that make it easy not to, to swallow. And to take the food, there’s just an endless list of reasons why you can say, ‘Well, it’s too hard!’”
Theme 4: Rehabilitation program
Facilitators	General: tracking progress, providing reminders, routine, setting goals	“So then I was tracking my swallow exercises at home, which, yeah, helped, I think. Helped to motivate me, to remind me that those were really critical. And helped me to also track how was how well I was doing.”
	Patient-specific: adjusting the practice environment, customizing the exercise schedule	“At first, I’d get up in the morning and do them, kind of when I did my meds and stuff and try and get rid of all that at the same time.”
	Exercise-specific: novel, interesting, easy, tackle multiple goals at once	“(...) but some of the ones were very unique, so there (were) more complex ones where you held (...) your breath. I thought, ‘Oh, actually this is kind of cool’ So it was kind of intriguing for a while.”
Barriers	General: no structure, distractions, length of time in rehabilitation program	“(...) But it’s not official, it’s not regimented, it’s not programmed (...)”
	Exercise-specific: too complex or difficult, feeling self-conscious, misinterpreting other activities as exercise	“(...) but after a while the complex ones fell off rather quickly” “So there is an embarrassment factor that you have to get over. But I just go down into in my room in the basement and sortta, I guess isolate myself a lot to do certain exercises.”
Theme 5: Personal factors
Facilitators	Positive and grateful	“But then after I started feeling better again, then I thought, ‘Well, the rest of me is getting better, this part might as well come along too’ so, I kind of got back into doing them a little more.”
	Coping, through self-talk and self-compassion	“I would think, ‘Just stop, stop whining, get get up and get better’”. “I would forgive myself that day. And then I would (unintelligible) tomorrow.”
	Sense of personal obligation to health care workers involved in extended treatment	“The thing is to (...) keep it in your mind that the surgeons and the therapists and the nurses and the whoever are the ones that are the reason why you’re here. And you owe it to them and to yourself to, (unintelligible) and to be strong (...).”
	Wish to become a role model or helper	“I think more like, I want to be a role model for my friends. Yeah. I want to show them that if you put your mind to it, you can do it.”
Theme 6: Connection
(Potential indirect) facilitator	Patient perceives his or her function to be better than that of peers	“It’s not fair, but then there’s others where, like there’s for example the guy that can only eat cream of wheat, I’m going ‘Wow, I’m miles ahead of him!’”
(Potential indirect) barrier	Patient perceives his or her function to be worse than that of peers	“(...) and it got really depressing, because all these people they would be put on the peg, taken off the peg, off they go. New norm! (...) and they would come in and, ‘Today I ate half a hamburger!’ Well, I ate my first half of hamburger the other day. And this was within 3 months of their treatment (...).”