Facilitators and Barriers to Implementing the International Dysphagia Diet Standardisation Initiative in Care Facilities in Upstate New York

Abstract

Introduction: Dysphagia is a swallowing disorder that can result in aspiration, asphyxiation, or other complications. One method of facilitating safer swallowing is modification of the diet and fluids of individuals living with dysphagia. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a globally standardized framework for texture modification. Its implementation has been recommended in the United States, but adoption is not yet universal. This study investigated implementation issues by surveying health care professionals in health care facilities in rural, Upstate New York. Method: A questionnaire created through the SurveyMonkey platform was distributed to health care facilities within a predetermined geographical area in Upstate New York. The survey consisted of 22 questions and utilized a mixed-methods design. Results: Forty-six participants from 10 individual professions and nine types of facilities completed the study. Twenty texture modification labels and 10 fluid modification labels were described. Analysis of qualitative data yielded three main barriers to implementation: funding, education, and communication. Within each barrier, awareness and resources were recurrent themes. Discussion: The variety of modification labels in comparison with the sample size demonstrates a lack of standardization of texture modification processes across facilities. While nearly half the respondents had not heard of IDDSI prior to the survey, 89% agreed that a standardized dysphagia diet would improve patient health and safety. This demonstrated a willingness to adopt IDDSI and indicated that staff attitudes may not be a barrier to its implementation. Participants felt that training was needed for successful implementation and expressed concern about the lack of availability of financial resources. Supplemental Material: https://doi.org/10.23641/asha.17270861