Implementation Strategies for the International Dysphagia Diet Standardisation Initiative

Purpose: The International Dysphagia Diet Standardisation Initiative (IDDSI) is an international standardized framework for texture-modified diets (TMDs). However, user accuracy in conducting IDDSI testing methods are unknown. The aims of this study were threefold: (a) to describe performance on two tasks (an IDDSI knowledge quiz and a TMD sample classification task), (b) to determine interrater and intrarater agreement for classification task performance, and (c) to determine predictive relationships between socioeconomic factors or prior knowledge on task performance. Method: Sixty-eight participants were recruited, including health care professionals and non-health care-related individuals. A mixed between-subjects and within-subject design was used. All participants completed a baseline knowledge quiz, 30 min of self-study using the IDDSI.org curriculum, a post self-study knowledge quiz, and a TMD classification task of 21 TMD samples with representation across all IDDSI levels. Data were collected via electronic survey. Results: There was a significant increase (p < .001) between pre and post self-study knowledge quiz scores. On the classification task, unmodified foods and drinks were most accurately classified with thickened liquids (IDDSI Levels 1, 2, 3) most inaccurately classified. At baseline, moderate interrater agreement was found with intrarater agreement ranging from fair to almost perfect among identical samples. No significant predictive relationships were found between classification task performance and socioeconomic status or prior experience. Conclusions: Thirty minutes of self-study using the online IDDSI.org curriculum improved baseline IDDSI knowledge check performance. Overall accuracy of TMD classification was low and warrants further evaluation given potential adverse health outcomes secondary to inappropriate TMD presentation. Given no predictive relationships between socioeconomic factors and prior experience on task performance, the IDDSI curriculum and classification task appear accessible to various users, including non-health care-related participants. Future studies should more closely observe testing behavior to further characterize variation in participants' use of the testing methods.