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

Smith, Caroline, Bhattacharya, Debi, Hansjee, Dharinee, Jeffries, Charlotte, Richards, Keisha and Scott, Sion (2024) Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions. BMJ Open, 14 (8). ISSN 2044-6055

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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.

Item Type:	Article
Additional Information:	Data availability statement: All data relevant to the study are included in the article or uploaded as supplementary information.
Uncontrolled Keywords:	aged,behavior,primary health care,systematic review,medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	23 Jan 2026 17:30
Last Modified:	25 Jan 2026 07:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101698
DOI:	10.1136/bmjopen-2024-086184

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