JCPSLP Vol 20 No 3 November 2018

A key role for SLPs in health service settings may also be liaison with dietetic and food service staff regarding dysphagia and texture-modified diets and fluids, which may involve auditing of texture and/or fluid consistencies (Speech Pathology Australia, 2012; Swan, Wenke, Hopper, & Lawrie, 2017). From all angles, it is essential SLPs fully understand the process of texture and fluid modification and can support stakeholders, including patients and food services staff, to successfully implement modifications. This focuses importance on how university programs equip SLP students with this necessary skill set, particularly if the health care environment continues to seek SLP input in the food services domain as Swan et al. (2017) suggest. Therefore, the aims of this project were two-fold: 1) To support SLP student skill development in texture- modified diet recipe development and auditing; and 2) To develop a dysphagia-friendly cookbook for use by SLPs and people with dysphagia. Method Utilising the Plan, Do, Study, Act (PDSA) quality improvement cycle (Langley, Nolan, Nolan, Norman, & Provost, 1996), this project comprised of two phases of the PDSA cycle (see Figure 1). Phase 1 outlines the development of texture-modified recipes through a dysphagia kitchen learning experience, and Phase 2 outlines the development of a dysphagia-friendly cookbook. Phase 1 was completed over four years, across four consecutive cohorts annually with all students participating. Phase 2 was completed by student volunteers over three consecutive years. A quality improvement cycle was chosen as this was the first time this process had been undertaken, and the PDSA cycle would allow improvements to be made to the process itself, and outcomes from the process (Langley et al., 1996). This project was conducted with ethical approval from Griffith University’s human ethics committee (HREC 2018/038). Participants Participants were second (final) year Master of Speech Pathology (MSpPath) students enrolled at Griffith University undertaking the MSpPath program between 2014 and 2017. Information about the project was provided to all students in a lecture. Students were informed that the ultimate objective was the development of a dysphagia- friendly cookbook. A total of 121 students participated across the four years, with cohort sizes ranging from 26 to 36 students. Phase 1: The dysphagia kitchen Plan – recipe planning A curriculum-based task was developed by academic staff for students to undertake. This was in light of the lack of easily available recipes for people with dysphagia, and the need for students to understand texture modification as a central component in dysphagia intervention. Since 2014, students in the MSpPath program have been tasked with developing a series of recipes that are “dysphagia friendly” and comply with the Australian Standards for Texture Modified Foods and Fluids (Atherton, Bellis-Smith, Cichero, & Suter, 2007). An assessment piece since 2017, this task occurs early in the academic year, and coincides with the completion of learning modules related to dysphagia assessment and management. In keeping with the MSpPath program philosophy, this experience allows students to apply recent curriculum learning through real-world, practical and hands-on approaches.

PHASE 1

Student form groups Random allocation All diet textures

Students allocated diet texture

Working groups (2-3) Design Trial and error

Recipe development at home

Describe recipe Peer/Staff sampling Recipe auditing

Dysphagia kitchen experience

Receive feedback

Recipe revisions

Revise recipes Finalise recipe

Submissions for cookbook

The task was explained to students in class and expectations were made clear, which is a key element in the PDSA cycle (Varkey, Reller, & Resear, 2007). Students identified peers to work with on the task and groups of two to three students were randomly allocated a diet texture (Texture A Soft, Texture B Minced Moist or Texture C Smooth Pureed). Students then spent time thoroughly researching and understanding the specifications of the diet consistency allocated to them. Using the Australian Standards for Texture Modified Foods and Fluids (Atherton et al., 2007) and through consultation with online and print recipe sources, students formulated ideas of possible ingredients, methods of cooking, and meals that may meet the guidelines. Students were encouraged to consider the populations most likely to be attempting to make modified meals at home (e.g., older adults, families, people without expensive kitchen equipment). This helped to refine ideas, resulting in recipes being created with the intention of being easy to make, using ingredients that are easy to find, and common household utensils and appliances. Do and study – recipe development Students then came together outside of class to attempt their proposed recipe. Some students chose to attempt to modify their favourite recipes into texturally appropriate meals, while others created recipes from scratch or meshed together multiple recipes they found online or in favourite cookbooks. For many, this recipe development was a process of trial and error, attempting different cooking methods, ways PHASE 2 Compilation of recipes from 2014-2017 by academic staff. Student volunteers review recipes – identify duplicates, selection of a range of recipes (e.g., by ingredient, meal type). Select 10 recipes per diet texture for trial. Re-cook recipes and compliance auditing at home. Revision of recipe wording to improve readability. Final selection of recipes for cookbook. Graphic design consultation and preparation for publication of the cookbook.

Hollie Austin (top) and Cara Probert

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JCPSLP Volume 20, Number 3 2018

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