Effects of a Perma-h Model Mobile-based Rehabilitation Support Program on Hope, Self-efficacy, Perceived Social Support and Rehabilitation Outcomes in Post- Tracheostomy Oral Cancer Patients

Hope

The Herth Hope Index is widely used in clinical research to assess hope levels among adult patients. The instrument shows good reliability, with a Cronbach's α of 0.85. Developed by Herth (1992) as a shortened version of the original 30-item Hope Scale, it was translated and culturally adapted for China by Zhao (1997), resulting in a three-dimensional structure: positive attitude toward reality and the future (4 items), taking positive actions (4 items), and maintaining close relationships with others (4 items). Each item is rated on a 4-point Likert scale, ranging from 1 ("strongly disagree") to 4 ("strongly agree"), with Items 3 and 6 reverse-scored. The total score ranges from 12 to 48, with higher scores reflecting greater levels of hope. Specifically, scores of 12-23 indicate low hope, 24-35 indicate moderate hope, and 36-48 indicate high hope.

perceived social support

The Perceived Social Support Scale measures individuals' subjective perception of social support. Widely used in psychology, medicine, and sociology, it demonstrates strong reliability and validity. Developed by Zimet et al. (1990) and revised by Jiang (2001) for cultural adaptation, the Chinese version replaced the "other support" dimension with "support from leaders, relatives, and colleagues," yielding a Cronbach's α of 0.92. The scale includes three dimensions-family support, friend support, and support from leaders, relatives, and colleagues-each comprising four items. Responses are rated on a 7-point Likert scale (1 = "strongly disagree" to 7 = "strongly agree"), yielding a total score of 12-84. Scores of 12-36, 37-60, and 61-84 indicate low, moderate, and high PSS, respectively.

self-efficacy

The General Self-Efficacy Scale, developed by Schwarzer and Jerusalem (1995), originally comprised 20 items and was later refined to 10. It has been translated into more than 20 languages for global use. The Chinese version, translated and validated by Wang et al. (2001), measures individuals' confidence in managing challenges. Reported Cronbach's α coefficients for this version range from 0.87 to 0.96, indicating strong reliability and validity. Each item is rated on a 4-point Likert scale ("not at all true," "somewhat true," "mostly true," "completely true"), with scores ranging from 1 to 4. The total score ranges from 10 to 40, with higher scores reflecting stronger perceived self-efficacy. Based on the total score, self-efficacy can be categorized into three levels: scores below 20 indicate low self-efficacy, scores between 20 and 30 indicate moderate self-efficacy, and scores above 30 indicate high self-efficacy.

rehabilitation willingness

The Rehabilitation Willingness Questionnaire, developed by Liu et al. (2011) based on the TPB, assesses stroke patients' willingness to engage in rehabilitation. The instrument shows good reliability, with Cronbach's α = 0.79. It comprises three dimensions: behavioral attitude (3 items), subjective norms (4 items), and perceived behavioral control (5 items). Each item is rated on a 5-point Likert scale, producing total scores of 12-60, where higher scores indicate stronger rehabilitation willingness. Scores are categorized as low (12-27), moderate (28-43), and high (44-60).

Swallowing function assessment

Swallowing function was assessed using the water swallowing test proposed by Toshio Kubota, which provides clear grading criteria and is simple to administer. During the assessment, patients are seated and instructed to drink 30 mL of warm water, while swallowing frequency and the presence of coughing are observed. Swallowing performance is graded as follows: 1 point-swallowing the water in a single attempt; 2 points-swallowing the water in two or more attempts without coughing; 3 points-swallowing the water in a single attempt with coughing; 4 points-swallowing the water in two or more attempts with coughing; and 5 points-unable to swallow all the water with frequent coughing. Scores of 1-2 indicate normal swallowing function, whereas scores of 3-5 indicate dysphagia.