Facilitating primary care healthcare professionals to proactively manage oropharyngeal dysphagia in older adults: Co-design of a theory and evidence-based behaviour change intervention

30% of older adults living in their own homes experience swallowing difficulties known as oropharyngeal dysphagia (OD), but this is largely undiagnosed until they are hospitalised. This PhD aimed to co-design a behaviour change intervention to support primary care healthcare professionals to proactively manage OD in older adults living in their own homes.

Methods

Underpinned by behaviour change theory and a co-design approach, the PhD comprised three empirical studies: 1) a realist review of current OD interventions, 2) focus groups with primary care healthcare professionals to identify and explore the barriers and enablers to proactively managing OD and 3) workshops with key stakeholders to co-design the intervention.

Results

Primary care healthcare professionals may be facilitated to proactively manage OD through: (1) OD education and training, (2) decision making support, (3) incorporating OD identification into existing workflow, (4) increasing awareness of older adults and carers expectations to manage OD, (5) raising awareness of OD’s adverse outcomes, (6) changing perceptions that OD is a red flag for cancer, (7) practical support from a colleague and (8) incentives.

Workshop participants co-designed the intervention to comprise; an e-learning training module, video case studies, a resource on OD versus oesophageal dysphagia, OD questions integrated into clinical systems, a directory of OD specialists’ contacts, an OD advice leaflet, a pop-up in the clinical system and a national OD dashboard. These components were grouped into three phases; 1) Before the consultation- education and training, 2) During the consultation- clinical decision support and, 3) After the consultation- feedback on practice.

Conclusion

The PhD co-designed a behaviour change intervention to facilitate primary care healthcare professionals to undertake proactive OD management. The next step would be to co-produce and test the intervention to determine its feasibility and, subsequently, its efficacy to change healthcare professionals’ behaviour.