Dataset Information

Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions.

ABSTRACT:

Introduction

Oropharyngeal dysphagia (OD) is difficulty manipulating a food bolus from the mouth to the throat. Up to 70% of older adults develop OD; however, it is unmanaged in primary care, leading to avoidable hospitalisation.

Objective

This behavioural science realist review aimed to develop programme theories to describe how interventions facilitate primary care healthcare professionals (HCPs) to proactively manage OD.

Methods

We developed initial programme theories (IPTs) inductively using the expertise of stakeholders and deductively using the theoretical domains framework (TDF). Databases were searched to identify evidence regarding contexts, behavioural mechanisms and outcomes related to proactive management of OD and comparative behaviours which offer transferrable learning. IPTs were tested with the evidence to confirm, refine or refute, to produce final programme theories.

Results

36 sources of evidence were included. Five final programme theories were generated explaining how primary care HCPs can be facilitated to proactively manage OD: (1) OD education and training, (2) checklists with OD signs and symptoms, (3) incorporating OD identification into existing workflow, (4) making HCPs aware that older adults and carers expect them to manage OD and (5) raising awareness of the adverse outcomes of OD.

Conclusion

The five programme theories provide the behavioural mechanisms by which an intervention may facilitate primary care HCPs to proactively manage OD. Through the programme theories' linkage to the TDF, behaviour change techniques (BCTs) mapped to the relevant TDF domain can be selected for an intervention. Operationalisation of selected BCTs into a coherent intervention package should be undertaken using codesign methodology.

Prospero registration number

CRD42022320327.

SUBMITTER: Smith C

PROVIDER: S-EPMC11367299 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Publications

Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions.

Smith Caroline C Bhattacharya Debi D Hansjee Dharinee D Jeffries Charlotte C Richards Keisha K Scott Sion S

BMJ open 20240828 8

<h4>Introduction</h4>Oropharyngeal dysphagia (OD) is difficulty manipulating a food bolus from the mouth to the throat. Up to 70% of older adults develop OD; however, it is unmanaged in primary care, leading to avoidable hospitalisation.<h4>Objective</h4>This behavioural science realist review aimed to develop programme theories to describe how interventions facilitate primary care healthcare professionals (HCPs) to proactively manage OD.<h4>Methods</h4>We developed initial programme theories (I ...[more]

PMID: 39209492

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Project description:BackgroundOropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-admission to hospital. To date, most dysphagia interventions in acute care have been tested with acute stroke populations. While intervention studies in critical care have been emerging since 2015, they are limited and so there is much to learn about the type, the delivery and the intensity of treatments in this setting to inform future clinical trials. The aim of this systematic review is to summarise the evidence regarding the relationship between dysphagia interventions and clinically important patient outcomes in acute and critical care settings.MethodsWe will search MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL and clinical trial registries from inception to the present. We will include studies conducted with adults in acute care settings such as acute hospital wards or units or intensive care units and critical care settings. Studies will be restricted to randomised controlled trials and quasi-randomised controlled trials comparing a new dysphagia intervention with usual care or another intervention. The main outcomes that will be collected include length of time taken to return to oral intake, change in incidence of aspiration and pneumonia, nutritional status, length of hospital stay and quality of life. Key intervention components such as delivery, intensity, acceptability, fidelity and adverse events associated with such interventions will be collected to inform future clinical trials. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. A meta-analysis will be conducted as appropriate.DiscussionNo systematic review has attempted to summarise the evidence for oropharyngeal dysphagia interventions in acute and critical care. Results of the proposed systematic review will inform practice and the design of future clinical trials.Systematic review registrationPROSPERO CRD 42018116849 (http://www.crd.york.ac.uk/PROSPERO/).

Project description:BackgroundThere are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents.ObjectiveTo inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations.MethodsA realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening.ResultsWe included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the "reach" of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered.ConclusionRealist reviews can help guide the development of locally adapted primary health care interventions.

Project description:ObjectiveIdentifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care.DesignA rapid realist review.Data sourcesCochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022.Eligibility criteria for selecting studiesWe considered all types of empirical studies describing interventions targeting frailty in primary care.AnalysisWe followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation.ResultsOur primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need.ConclusionThere remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence.Prospero registration numberThe published protocol for the review is registered with PROSPERO (CRD42019161193).

Dataset Information

Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions.

Introduction

Objective

Methods

Results

Conclusion

Prospero registration number

Publications

Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions.

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