More Than a Meal: Building an Evidence-Based Framework of Mealtime-Related Quality of Life, Participation, and Inclusion for People with Swallowing Disability
- Publication Type:
- Thesis
- Issue Date:
- 2022
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Dysphagia (difficulty swallowing) affects an estimated 8% of the world’s population. Dysphagia can reduce a person’s quality of life by leading to social isolation around meals and a fear of choking. A common intervention for dysphagia, the provision of a texture-modified diet, may also impact on a person’s quality of life if the foods are unappealing and lead to reduced oral intake. 3D food printing has been proposed as a way to improve quality of life by making texture-modified foods more visually appealing.
This study involved building an evidence-based framework explaining (a) the impacts of dysphagia and dysphagia interventions on mealtime quality of life, participation, and inclusion; (b) barriers and facilitators to mealtime quality of life; (c) the impact of food design strategies on the mealtime experience; and (d) the feasibility of 3D food printing to improve the visual appeal of texture-modified foods for people with dysphagia.
A scoping review revealed widespread impacts of dysphagia on mealtime quality of life. This was followed by a narrative review of food design strategies to improve the mealtime experience for people with dysphagia. Then, nine people with dysphagia and four of their supporters engaged in in-depth interviews, a mealtime observation, and an immersive 3D food printing experience to understand their views and experiences of dysphagia, mealtime quality of life, and 3D food printing. Fifteen allied health professionals then engaged in one of four focus groups about their views on dysphagia, mealtime quality of life, and the feasibility of 3D food printing. To verify and expand upon these studies, an online survey was completed.
Dysphagia and its interventions negatively impacted on mealtime quality of life, through limited choice and control, reduced physical safety, reduced social engagement, and poor mealtime experiences. Barriers and/or facilitators to quality of life included the person with dysphagia’s ability to engage in designing their meal, ownership of swallowing difficulties, the opinions of other people, the provision of education, the person’s adaptability or resistance to change, and the provision of dysphagia interventions. Participants considered that 3D food printing could improve mealtime experiences; however, there were barriers to be overcome. Barriers included the practicality of the device, the suitability for different populations, cost of the device, and the acceptability of printed foods. A meta-synthesis across studies then integrated results to build an evidence-based framework to guide clinicians towards holistic and person-centred management of dysphagia, to sustain mealtime quality of life.
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