JCPSLP
Volume 16, Number 3 2014
137
These findings contribute to our understanding of the
perspectives of key stakeholders in the adult dysphagia
context – an area that has not been previously reported in
the literature. It is important to continue to listen to family
members, support staff and individuals with dysphagia
about their experiences and preferences. This feedback
should inform practice and underpin the continuous
improvement of services. This study has provided evidence
for needed reforms in dysphagia management and gives
direction for achieving service improvements.
Limitations
There are a number of limitations of this study. The
questionnaire was customised and not based on previously
published or validated tools. Due to practical difficulties in
recruiting sufficient numbers from residential facilities, all
DSW participants were day-service employees. The
absence of a balanced perspective from residential and day
services is a limitation that could be redressed in future
research.
The response rate from family members was low and is
a source of potential bias. A number of factors may have
contributed. For example, at the time of the study, very few
adult clients in one of the organisations had active family
contact. The indirect recruitment method held a risk that
service managers might misdirect questionnaires intended
for family members of adults with dysphagia. Postal
questionnaires also typically result in lower response rates
than other methods (Bryman, 2012). Further research into
family perspectives is indicated.
This study lacked power due to the small sample size.
The extent to which findings can be generalised to the
broad population of stakeholders or to other contexts may
be limited.
Conclusion
The purpose of this study was to investigate what “good
practice” in dysphagia management means to key stake
holders and to identify the most important service elements
to include in organisational standards. Some differences in
perspective between groups were found, but also much
common ground underpinned by a shared concern to
optimise the health and well-being of adults with dysphagia.
Findings indicate strong support from stakeholders for a
range of service improvements and provide useful evidence
with which to advocate for service reform.
Acknowledgements
The authors gratefully acknowledge the Grosvenor
Foundation for funding this project.
References
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Bryman, A. (2012).
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Similarities and differences
Overall, questionnaire results revealed more similarities than
differences in reporting between groups. There was strong
endorsement of all items overall (see Table 4). An ongoing
approach to training for DSWs in dysphagia and mealtime
assistance emerged as a priority. There was also agreement
across groups that training be mandatory.
DSWs identified a multidisciplinary approach,
consultation with people with dysphagia, peer support,
collaboration and continuity of care as priorities, while family
members identified 1:1 meal assistance as particularly
important. Both groups highlighted the value of speech
pathology services.
Significant differences in the reporting of family members,
DSWs and AHPs emerged on two questions. For question
15, “making healthy food choices is encouraged and
actively promoted”, family members (mean rank = 35.56)
endorsed this more frequently than DSWs (29.76) who
in turn endorsed it more frequently than AHPs (24.08;
chi-square = 6.3, df = 2, p =.04). For the item “greater
emphasis on a multidisciplinary team approach to
dysphagia management” (Q.20) a significant difference
between groups also emerged (chi-square = 11.9, df = 2,
p = .003) with DSWs (37.32), then families (30.09), then
AHPs (22.38) rating this item of high importance. Significant
differences in group reporting were not found for other
questionnaire items.
Discussion
Responses from DSWs, family members and AHPs
indicated overwhelming support for a range of service
improvements in dysphagia management. Information and
training for DSWs emerged as a priority. Given the current
context in Victoria, where a systematic approach to the
provision of education in dysphagia and mealtime support
is lacking, this finding is not surprising. Further, results from
this study indicate that the longitudinal learning needs of
DSWs should be addressed. Although this study has
provided some insight into the training needs of DSWs, it
has not considered how organisations could deliver such
training or what would be appropriate indicators of
competence.
Continuity of care for adults with dysphagia was not
included in the questionnaire but emerged as an issue
from focus group discussions. DSWs discussed the
challenges associated with supervision, the need for
adequate handover and transfer protocols and inter-service
communication. It is recommended that attention be given
to how continuity of care can be optimised in organisational
contexts and that it be described in service procedures or
standards.
The complexity and challenges involved in supporting
adults with dysphagia need to be acknowledged,
particularly at the level of balancing safety within the context
of the person’s preferences and choices.
Given the finding of the importance of peer support,
teams and organisations may wish to consider how
to strengthen opportunities for reflective practice and
collaborative problem-solving for DSWs. Teams could also
consider how to foster and sustain effective partnerships
between all involved in supporting individuals with
dysphagia. For speech pathologists, the study draws
attention to the importance of responsive and sensitive
collaboration with adults with dysphagia, families and
service providers for the provision of quality dysphagia
support.
