Dysphagia assessment and intervention: evaluating inclusive approaches using video

Abstract

Purpose: Dysphagia experienced by adults with mental health conditions and/or intellectual disabilities (IDs) has been well-reported. However, accessible and inclusive assessment measures to identify and monitor for deterioration in dysphagia are very limited. The purpose of this paper is to explore the use of video to enhance inclusion in dysphagia assessment and intervention for an inpatient setting. Design/methodology/approach: This service evaluation involved adults with IDs and mental illness living in in-patient accommodation and their multidisciplinary team. Participants were invited to film and then reflect on videos and their comments were transcribed for qualitative analysis. Findings: In total, 42 adults gave consent to film, review and discuss mealtime video-clips. Staff feedback was invited. Thematic analysis was conducted for service-user and staff comments. A global theme of “involvement” was identified from the data analysis, with sub-themes of “enhancing participation, insight and incentive”. An additional global theme “clinical benefits” resulted from staff comments. This included sub-themes of breadth of assessment, shared working and outcome measures. Research limitations/implications: Limitations included refusal of video by people with heightened anxiety but these were a minority. Most people showed enthusiasm and enhanced engagement. Practical issues were resolved regarding governance. Practical implications: Video offers a dynamic record of muscle tone, coordination, mealtime experience and individual context benefiting both service-user and staff practice. It stimulates insightful discussion of outcomes and supports the inclusion of service-user perspectives. Further research is indicated to develop a greater understanding of dysphagia in this population. Inclusion of service-users in planning and managing safer mealtimes may be enhanced through the sensitive use of video. Social implications: This evaluation suggests opportunities for improving inclusive approaches for service-users using video to promote insight. Originality/value: Further research is indicated to explore the nature of dysphagia in people with mental health conditions using video as a dynamic and unique resource