Implementing the International Dysphagia Diet Standardisation Initiative: Prospects and Pitfalls

For people with swallowing difficulties (dysphagia), food or liquids may often be modified to improve oral intake. The International Dysphagia Diet Standardisation Initiative (IDDSI) is the evidence-based, recommended framework to use for modifying foods/liquids. Although implementation of IDDSI has commenced, in an ad hoc manner in Sweden, evaluation of structured implementation and provision of resources is warranted to further facilitate future adoption. This mixed-methods study aimed to evaluate staff experiences of IDDSI implementation outcomes (adoption, appropriateness, usefulness, and feasibility) at two healthcare facilities. Four implementation stages were completed, guided by the IDDSI implementation guide and the Consolidated Framework for Implementation Research. Staff experiences and perceived outcomes were assessed via study-specific questionnaires and staff interviews. Triangulation of quantitative and qualitative data was conducted. Data from 125 participants showed high reported clinical use (adoption) of IDDSI at both start and post-implementation (x ~ 4, “agree”), with a moderate effect size (r = 0.49) between timepoints, though not statistically significant. Qualitative analysis revealed the theme: “Implementing IDDSI Benefits Patient Care and Streamlines Work Practices, but Challenges may Arise,” and five categories. Triangulation confirmed that quantitative and qualitative results consistently supported successful IDDSI implementation and highlighted barriers and facilitators for implementation. Healthcare staff perceived the IDDSI framework as highly adopted, relevant to their clinical setting, and beneficial for patient safety and work practices. Structured implementation and evaluation of the IDDSI framework continues to be recommended in Sweden to further improve care and management of patients with dysphagia. Standard Swedish IDDSI implementation resources are available from this project.