Carer knowledge of dysphagia management strategies

Dysphagia can have many negative health consequences for people with learning disabilities, including dehydration, aspiration and asphyxiation. Few studies have investigated dysphagia management among adults with learning disabilities. This study aims to contribute to the existing knowledge by investigating carer knowledge of speech and language therapists' (SLTs) recommendations regarding dysphagia management, and by comparing carer knowledge with their behavioural adherence to SLT recommendations. An exploratory study was undertaken investigating carer knowledge of dysphagia management strategies, along with a within-participants' study comparing carer knowledge and adherence. Structured interviews were conducted with carers supporting adults with learning disabilities and dysphagia to explore and ascertain their knowledge of dysphagia management. These data were then compared with observational data gathered in naturalistic contexts, assessing the behavioural adherence of these same carers. Recommendations pertaining to altering consistency and using specialized equipment and utensils were recalled significantly more readily than those concerning support and prompting for the dysphagic persons. Moreover, carers adhered to management strategies to a significantly greater degree than they could recall the details of the written guidelines containing the dysphagia management strategies. The findings suggest that tangible and routinely used management strategies, e.g. food and drink consistency, and use of specialized utensils, are easier for carers to adhere to and remember than support-based strategies such as verbal prompting and pacing. The discrepancy between compliance and knowledge can be explained by calling upon cognitive theories of memory and skill acquisition. This has implications for the selection of relevant outcomes of dysphagia training of direct care staff. Knowledge does not necessarily predict actual behavioural adherence and, though desirable, does not appear to be an adequate outcome indicator if the goal is behavioural adherence. Practice implications for SLTs training carers in dysphagia management strategies include combating fossilization of incorrect knowledge; encouraging carers to refamiliarize themselves with management strategies and their rationales periodically following initial training; and providing more specific contingency information for support and prompting in the guideline documentation.