Computer Literacy and Health Locus of Control as Determinants for Readiness and Acceptability of Telepractice in a Head and Neck Cancer Population

Bena Cartmill, Laurelie R. Wall, Elizabeth C. Ward, Anne J. Hill, Sandro V. Porceddu


Understanding end-user populations is required in designing telepractice applications. This study explored computer literacy and health locus of control in head/neck cancer (HNC) patients to inform suitability for telerehabilitation. Sixty individuals with oropharygneal cancer were recruited. Computer literacy was examined using a 10-question survey. The Multidimensional Health Locus of Control Scale Form C (MHLC-C) examined perceptions of health “control”.  Participants were mostly middle-aged males, from high socioeconomic backgrounds. Only 10% were non-computer users. Of the computers users, 91% reported daily use, 66% used multiple devices and over 75% rated themselves as “confident” users. More than half were open to using technology for health-related activities. High internal scores (MHLC-C) signified a belief that own behaviour influenced health status.  HNC patients have high computer literacy and an internal health locus of control, both are positive factors to support telepractice models of care. This may include asynchronous models requiring heightened capacity for self-management.


Andersson, M., Janson, C., & Emtner, M. (2014). Accuracy of three activity monitors in patients with chronic obstructive pulmonary disease: A comparison with video recordings. COPD: Journal of Chronic Obstructive Pulmonary Disease, 11, 560-567.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.

Brooks, D., Krip, B., Mangovski-Alzamora, S., & Goldstein, R. S. (2002). The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. European Respiratory Journal, 20, 20-29.

Burtin, C., Langer, D., van Remoortel, H., Demeyer, H., Gosselink, R., Decramer, M., . . . Troosters, T. (2015). Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial. PloS One, 10(12), e0144989. doi:10.1371/journal.pone.0144989

Byrom, B., & Rowe, D. A. (2016). Measuring free-living physical activity in COPD patients: deriving methodology standards for clinical trials through a review of research studies. Contemporary Clinical Trials, 47, 172-184.

Cavalheri, V., Donária, L., Ferreira, T., Finatti, M., Camillo, C. A., Ramos, E. M. C., & Pitta, F. (2011). Energy expenditure during daily activities as measured by two motion sensors in patients with COPD. Respiratory Medicine, 105, 922-929.

Demeyer, H., Burtin, C., Hornikx, M., Camillo, C. A., Van Remoortel, H., Langer, D., . . . Troosters, T. (2016). The minimal important difference in physical activity in patients with COPD. PloS One, 11(4), e0154587.

Demeyer, H., Burtin, C., Van Remoortel, H., Hornikx, M., Langer, D., Decramer, M., . . . Troosters, T. (2014). Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program. Chest, 146, 318-327. doi:10.1378/chest.13-1968

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., . . . Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43, 1334-1359.

Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Antó, J. M. (2006). Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax, 61, 772-778.

García-Polo, C., Alcázar-Navarrete, B., Ruiz-Iturriaga, L. A., Herrejón, A., Ros-Lucas, J. A., García-Sidro, P., . . . Miravitlles, M. (2012). Factors associated with high healthcare resource utilisation among COPD patients. Respiratory Medicine, 106, 1734-1742. doi:

Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2016). Global strategy for the diagnosis, management and prevention of COPD. Retrieved from

Hellem, E., Bruusgaard, K. A., & Bergland, A. (2012). Exercise maintenance: COPD patients' perception and perspectives on elements of success in sustaining long-term exercise. Physiother Theory Pract, 28, 206-220.

Hoaas, H., Andreassen, H., Lien, L., Hjalmarsen, A., & Zanaboni, P. (2016). Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study. BMC Medical Informatics and Decision Making, 16, 26.

Hurst, H., & Bolton, J. (2004). Assessing the clinical significance of change scores recorded on subjective outcome measures. Journal of Manipulative and Physiological Therapeutics, 27(1), 26-35. doi:10.1016/j.jmpt.2003.11.003

Kon, S. S. C., Canavan, J. L., Jones, S. E., Nolan, C. M., Clark, A. L., Dickson, M. J., . . . Man, W. D. C. (2014). Minimum clinically important difference for the COPD Assessment Test: a prospective analysis. The Lancet Respiratory Medicine, 2, 195-203. doi:10.1016/S2213-2600(14)70001-3

Lundell, S., Holmner, Å., Rehn, B., Nyberg, A., & Wadell, K. (2015). Telehealthcare in COPD: A systematic review and meta-analysis on physical outcomes and dyspnea. Respiratory Medicine, 109, 11-26.

Marquis, N., Larivée, P., Dubois, M.-F., & Tousignant, M. (2014). Are improvements maintained after in-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease? International Journal of Telerehabilitation, 6(2), 21-30.

Norton, K., Norton, L., & Sadgrove, D. (2010). Position statement on physical activity and exercise intensity terminology. Journal of Science and Medicine in Sport, 13, 496-502. doi:10.1016/j.jsams.2009.09.008

Patel, S. A., Benzo, R. P., Slivka, W. A., & Sciurba, F. C. (2007). Activity monitoring and energy expenditure in COPD patients: A validation study. COPD: Journal of Chronic Obstructive Pulmonary Disease, 4, 107-112.

Ries, A. L., Kaplan, R. M., Myers, R., & Prewitt, L. M. (2003). Maintenance after pulmonary rehabilitation in chronic lung disease: A randomized trial. American Journal of Respiratory and Critical Care Medicine, 167, 880-888.

Spruit, M. A., Singh, S., Garvey, C., Zuwallack, R., Nici, L., Rochester, C., . . . Wouters, E. F. M. (2013). An official American Thoracic Society/European Respiratory Society Statement: Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13-e64.

Spruit, M. A., & Singh, S. J. (2013). Maintenance programs after pulmonary rehabilitation: How may we advance this field? Chest, 144, 1091-1093.

Suissa, S., Dell'Aniello, S., & Ernst, P. (2012). Long-term natural history of chronic obstructive pulmonary disease: Severe exacerbations and mortality. Thorax, 67, 957-963.

Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R. A., Vogiatzis, I., Weisman, I., & Kulich, K. (2013). Improving physical activity in COPD: Towards a new paradigm. Respiratory Research, 14, 115.

Tudor-Locke, C., Craig, C. L., Brown, W. J., Clemes, S. A., De Cocker, K., Giles-Corti, B., . . . Blair, S. N. (2011). How many steps/day are enough? for adults. International Journal of Behavioral Nutrition and Physical Activity, 8(1), 1-17. doi:10.1186/1479-5868-8-79

Tudor-Locke, C., Washington, T. L., & Hart, T. L. (2009). Expected values for steps/day in special populations. Preventive Medicine, 49(1), 3-11. doi:

Van Remoortel, H., Hornikx, M., Demeyer, H., Langer, D., Burtin, C., Decramer, M., . . . Troosters, T. (2013). Daily physical activity in subjects with newly diagnosed COPD. Thorax, 68, 962-963.

Vassilev, I., Rowsell, A., Pope, C., Kennedy, A., O’Cathain, A., Salisbury, C., & Rogers, A. (2015). Assessing the implementability of telehealth interventions for self-management support: a realist review. Implementation Science, 10(1), 59. doi: 10.1186/s13012-015-0238-9

Waschki, B., Kirsten, A., Holz, O., Müller, K.-C., Meyer, T., Watz, H., & Magnussen, H. (2011). Physical activity is the strongest predictor of all-cause mortality in patients with COPD: A prospective cohort study. CHEST Journal, 140, 331-342.

Watz, H., Pitta, F., Rochester, C. L., Garcia-Aymerich, J., ZuWallack, R., Troosters, T., . . . Polkey, M. I. (2014). An official European Respiratory Society statement on physical activity in COPD. European Respiratory Journal, 44, 1521-1537.

Zanaboni, P., Hoaas, H., Lien, L. A., Hjalmarsen, A., & Wootton, R. (2016). Long-term exercise maintenance in COPD via telerehabilitation: A two-year pilot study. Journal of Telemedicine and Telecare, 0(0), 1-9.

Zanaboni, P., Lien, L. A., Hjalmarsen, A., & Wootton, R. (2013). Long-term telerehabilitation of COPD patients in their homes: Interim results from a pilot study in Northern Norway. Journal of Telemedicine and Telecare, 19, 425-429.




  • There are currently no refbacks.

Copyright (c) 2016 Bena Cartmill, Laurelie Rae Wall, Elizabeth Celeste Ward, Sandro Porceddu

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.