Using the Consolidated Framework for Implementation Research (CFIR) to Evaluate the Implementation of the International Dysphagia Diet Standardisation Initiative (IDDSI) and Provision of Texture Modified Diets (TMDs) in age-care Facilities: Barriers and Enablers to Implementation

BackgroundTexture modified diets (TMDs) are a common intervention for older adults with swallowing difficulties as they improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed methods study used the Consolidated Framework for Implementation Research (CFIR) to evaluate the effectiveness of IDDSI adoption in aged-care facilities (ACFs) and identify barriers and enablers to facilitate future implementation.MethodsFive New Zealand ACFs who had adopted IDDSI >12 months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from i) mealtime observations; ii) manager interviews and iii) staff (nursing, carers and kitchen) self-administrated surveys. ResultsAll facility and kitchen managers were IDDSI-aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5-79% and <50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project lead and no speech pathologist onsite were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. ConclusionACF staff were aware of IDDSI but staff knowledge was low. Using the CFIR, site-specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.