Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

Figures & data

Figure 1 Summary of the calculation of the Delphi results.

Figure 2 Participants of each subcategory and the reasons for attrition.

Table 1 Median and Interquartile Calculation of the Relevance of the Objectives of Round One

Themes	Objectives	Delphi Round 1
		Relevance
		Mdn	IQR
1. Normal swallowing vs difficulty in swallowing	Explain the normal mechanism for swallowing.	7	1
	Understand the role of coordination between breathing and swallowing.	7	1
	Identify possible impairment locations during the passage of food between the mouth and the stomach.	7	1
2. Symptoms of oropharyngeal dysphagia	Identify the different signs and symptoms of oropharyngeal dysphagia	7	1
3. Consequences of oropharyngeal dysphagia	List the consequences of oropharyngeal dysphagia.	7	1
4. Aspiration	Recognize and differentiate the different types of aspiration.	7	1
	Distinguish and recognize myths related to aspiration.	7	1
	Apply appropriate behavior to deal with aspiration.	7	0
5. Oral hygiene	Choose the right tool to achieve good oral and dental hygiene.	6	1
6. Specific rehabilitation	Apply specific rehabilitation exercises to improve dysphagia.	7	1
7. Compensatory Strategies	Identify and correct environmental elements and surrounding behavior for a safe meal.	7	1
	Know how to prepare food textures and menus efficiently.	7	1
8. Tracheotomy cannula	Explain the potential benefits of tracheostomy.	6	2*
	Describe the care process of a tracheotomy cannula.	7	1
	Carry out the technical gestures related to tracheotomized patients during meals.	7	2*
9. Enteral feeding	Identify complications of enteral feeding.	6.5	1
	Know how to apply tips to better manage enteral feeding.	7	1
10. Communication of health needs	Communicate health needs with your health care professional.	7	1
11. Help and support	Identify and ask for people who support dysphagia patients and their caregivers.	7	1
	Identify and use the resources of the healthcare system by the dysphagia patient and his/her caregiver.	7	1
12. Managing Stress	Mastering tools to help manage the stress that accompanies dysphagia.	7	1

Note: Scores with *Symbol indicate that themes did not reach a consensus.

Table 2 Stability of the Responses Between Round 1 and Round 2 Using Wilcoxon Sign-Rank Test and Calculation of Median and Interquartile of the Relevance of the Stable Objectives of Round 2

Themes	Objectives	Stability Between R1 and R2		Delphi Round 2
				Relevance
		Z	p	Mdn	IQR
1. Normal swallowing vs difficulty in swallowing	Explain the normal mechanism for swallowing.	−0.373	(0.709) > 0.05	7	1
	Identify possible places of disturbance during the passage of food between the mouth and the stomach.	−1.906	(0.57) > 0.05	7	1
3. Symptoms of oropharyngeal dysphagia	Describe and locate the different signs and symptoms of oropharyngeal dysphagia.	−0.138	(0.891) > 0.05	7	1
4. Consequences of oropharyngeal dysphagia	List the consequences of oropharyngeal dysphagia.	−0.798	(0.425) > 0.05	7	1
6. Specific rehabilitation	Apply specific rehabilitation exercises to improve swallowing.	−0.802	(0.423) > 0.05	7	0
7. Compensatory Strategies	Identify and correct environmental adaptations and the behavior of the surrounding for a safe meal.	−1.683	(0.092) > 0.05	7	0
10. Communication of health needs	Communicate health needs with your healthcare professional.	−2.182	(0.029) < 0.05*
11. Help and support	Identify and solicit the people who support the patient with dysphagia and their caregiver.	−1.331	(0.183) > 0.05	7	1
	Identify and use the resources of the healthcare system by the patient with dysphagia and his/her caregiver.	−1.099	(0.272) > 0.05	7	1
12. Managing Stress	Mastering strategies to help manage the stress that accompanies dysphagia.	−0.575	(0.565) > 0.05	7	1

Note: Scores with *Symbol indicate that p ˃.05.

Table 3 Stability of the Responses Between Round 2 and Round 3 Using Wilcoxon Sign-Rank Test and Calculation of Median and Interquartile of the Relevance of the Stable Objectives of Round 3

Themes	Objectives	Stability Between R2 and R3		Delphi Round 3
				Relevance
		Z	p	Mdn	IQR
1. Normal swallowing vs difficulty in swallowing	Explain the role of coordination between breathing and swallowing and recognize the impact of the underlying cause of dysphagia on the breathing mechanism.	−0.151	(0.880) > 0.05	7	1
2. Aspiration	Recognize the different types of aspiration.	−2.396	(0.017) < 0.05*
	Apply suitable actions to deal with aspiration.	−1.486	(0.137) > 0.05	7	0
	Distinguish and recognize wrong attitudes to deal with aspiration.	−0.721	(0.471) > 0.05	7	0
5. Oral hygiene	Explain the link between good oral/dental hygiene and swallowing disorder.	−0.882	(0.378) > 0.05	7	1
	Choose the appropriate tool and apply the gestures effectively to achieve good oral and dental hygiene.	−0.15	(0.988) > 0.05	7	1
7. Compensatory Strategies	Know how to prepare food textures efficiently and make the right choice according to the patient’s needs.	−1.126	(0.260) > 0.05	7	0
	Choose foods and drinks to get the recommended calorie and water intake.	−0.732	(0.464) > 0.05	7	1
8. Tracheostomy cannula	Explain the potential benefits of tracheostomy.	−0.627	(0.530) > 0.05	7	1
	Demonstrate the care process of a tracheostomy cannula.	−1.713	(0.087) > 0.05	7	1
	Carry out the technical gestures related to tracheotomized patients during meals.	−1.445	(0.149) > 0.05	7	0
9. Enteral feeding	Identify complications of enteral feeding.	−0.311	(0.755) > 0.05	7	1
	Understand how to apply tips to better manage enteral feeding.	−0.095	(0.924) > 0.05	7	1
10. Communication of health needs	Communicate health needs with your healthcare professional.	−1.127	(0.260) > 0.05	7	0
13. Appropriation of dysphagia	Describe your story experience from the onset of dysphagia and plan your life project.	−0.632	(0.527) > 0.05	7	1

Note: Scores with *Symbol indicate that p ˃.05.

Figure 3 Priority ranking of the themes.