feaSibility and SatiSfaction

objective The aim of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. methods Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program ‘In Tune without Cords’ (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and post intervention T1) on TLPs’ uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. results HCPs of 6 out of 9 centers (67% uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73% uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69% usage rate). Most (66%) TLPs were satisfied (i.e., score ≥7 (scale 1-10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P=.004, P=.038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life. Conclusion The online self-care education program ITwC supporting early rehabilitation is feasible in clinical practice. In general, TLPs are satisfied with the program. 6 107 AN ONLINE SELF-CARE EDUCATION PROGRAM introduction Laryngeal cancer is the second most common cancer of the upper aerodigestive tract [1]. Worldwide, it accounts for 130,000 new cases per year in men and 21,000 in women, with significant differences in incidence across countries [2]. In The Netherlands, ±700 persons are diagnosed with laryngeal carcinoma annually [3]. Each year, about 150 Dutch patients undergo total laryngectomy (TL) [4]. A TL is performed in patients with advanced laryngeal cancer or in patients with recurrent disease after treatment with (chemo)radiation. Patients who underwent TL (TLPs) face various physical and emotional challenges while returning home after surgery [5]. Changes in airway management, nasal function, swallowing and taste, loss of voice, neck and shoulder mobility problems, and impaired social functioning have a considerable impact on the quality of life of TLPs [6-9]. The provision of self-care education might be an effective strategy to adjust to these functional changes and to improve quality of life [10]. By providing access to clinician-generated selfcare education via the Internet, patients can participate more effectively in their care and are supported in their information seeking [11-13]. The development and evaluation of tailored self-care education in a variety of forms, such as Internet and DVD, are urgently needed for patients who have undergone surgery for head and neck cancer (HNC) [14,15]. To bridge the transition from hospital to home and to support self-management during rehabilitation after TL, an online program ‘In Tune without Cords’ (ITwC) was developed, featuring a self-care education program and an exercise program. Both programs are provided with illustrated, tailored information and video demonstrations. To ensure that ITwC would adequately meet the needs of the end-users, a participatory design approach was followed, with stakeholders’ involvement in the development process [16,17]. To guarantee the best utilization of the eHealth intervention, it is essential to be attentive to the usability, keeping in mind its intended users (e.g., clinicians, patients), task (e.g., medication management, selfmanagement), and the environment (e.g., the outpatient clinic, at home) [18]. In a previous study on the usability of ITwC [19], TLPs and health care professionals (HCPs) evaluated content, completeness, and ease of use of a prototype of ITwC. Some technical revisions were made based on usability test results. However, usability of technology is determined not only by its user-computer interactions, but also by the degree to which it can be successfully integrated in the intended work environment [18]. Therefore, the aim of the present study was to investigate the feasibility of the self-care education program of ITwC in clinical practice by assessing uptake and usage rate and user satisfaction of ITwC supplementary to regular care. Secondary aim of this study was to investigate which sociodemographic and clinical factors are associated with user satisfaction.