Table 2.

Key barriers to swallowing exercises

Key barriers	COM-B	Examples
Inadequate knowledge of how treatment will affect own swallowing.	Psychological capability	The doctor scribbled down a few symptoms that I would suffer after the radiotherapy, one of which was sore throat and one of which was maybe problems with the swallowing, or something along these lines (P12) They told me I will need a feeding tube, I will have a feeding tube. Even if I don’t use it they are going to give me a feeding tube, because, I don’t know, for example, nine out of ten patients, at some point during treatment, won’t be able to take food. So I will definitely need one (P13)
Inadequate understanding of why exercises given pre-treatment	Psychological capability	I understand someone sitting there explaining to me that you will need to do these exercises to help you swallow, but I don’t think the emphasis was how important they were, for me. I don’t think I actually took that on board (P3) I was given some leaflets on swallowing exercises and told that I would probably get a dry mouth and that would cause problems with swallowing (P11)
Forgetting to do exercises, no system of keeping track	Psychological capability	It was a bit random; I would just do it when I remembered, some of the time (P1) I think what I’m remembering and what I’m saying is because there wasn’t a discipline around it, sometimes they slipped a bit (P9)
Overwhelmed by information at a difficult time (emotion)	Automatic motivation	Loads and loads of stuff was happening that was unfamiliar and a bit scary, and so, you know, I, sort of, felt a bit bombarded with stuff (P1) There was a lot to take in during that period. This is something else to take in as well, necessary but not life… This isn’t going to save your life; this is going to make it better afterwards. Very important. But as a patient, when you are faced with a life-threatening situation, I think that wouldn’t be a priority and you’d want to push that away for now (P5)
Pain and fatigue	Physical capability	I tried to do some of the exercises some of the days. And some of the exercises I just couldn’t do because of the pain I was actually experiencing that particular day (P3) When I got tired from the chemotherapy and so forth, I think I let it all, kind of, go a bit (P2)