JCPSLP Vol 23, Issue 1 2021

Procedure Participants with dysphagia were invited to attend the Dysphagia Afternoon Tea (DAT) group with 2–4 participants attending each group. Each session was staffed by a supervising SLP, who also acted as a clinical educator and 3–4 SLP students who provided all assessment and education. Each supervising SLP had a minimum 4 years of clinical experience and had completed additional training in clinical education and student supervision. Three SLPs facilitated the group over the 2-year period. This was a voluntary additional clinical placement opportunity for students. Prior to participating in the group, students were provided with pre-readings on relevant diagnoses and dysphagia as well as dysphagia education materials (i.e., pre-prepared PowerPoint presentation). Students were also directed to their university readings on clinical swallowing assessments in preparation for the group. The DAT group was located at Helensvale Community Health Centre with collected total of eight DAT groups run over a 2-year period. Dysphagia Afternoon Tea (DAT) format Prior to each DAT group, each client received a generic group invitation with their appointment time (as per standard health service procedures), as well as a participant information sheet explaining the research, consent form and pre group survey for completion prior to the appointment through the mail. A SLP or allied health assistant phoned each client prior to the group to introduce the research project, gain verbal consent and orientate them to the resources posted. There were 3–4 staggered arrival times for the DAT experience which ran for a maximum for 2 hours for the clients. The DATs were conducted between June 2014 to September 2017, with a maximum of four participants attending the session. The DAT was delivered over a single session; however, participants were invited to attend a repeat DAT if the supervising SP felt the participant would benefit from a subsequent review (i.e., in 12 months). As the participant’s age and swallowing ability may have changed in the 12 months since their previous attendance, each participant presenting to the DAT was treated as a unique participant for the purposes of data reporting and analyses. On the day of the group, clients with dysphagia participated in the following activities, sequentially over the 2 hours. 1. Clinical swallow assessment: All participants with dysphagia received an individual comprehensive swallowing assessment. Assessment comprised of case history, an oro-muscular examination, assessment of oral and pharyngeal phases of swallowing and trial of appropriate diet/fluid consistencies in order to establish recommendations. Assessment outcomes were documented on a routinely used dysphagia assessment form. All assessments were conducted by a pair of student SLPs under direct supervision of a qualified SLP. 2. Education: All participants with dysphagia and attending carers received a 15–20-minute education session via a PowerPoint presentation regarding dysphagia and associated signs and symptoms of aspiration, how to modify diets and general safe swallowing strategies with a focus on participants interacting, sharing information and their personal dysphagia stories. Education was provided in a group setting and led by student SLPs under the supervision of a qualified SLP. 3. Opportunity to socialise: Participants with dysphagia and their carers if present were given the opportunity

to interact with other attendees socially following assessment and group education within a 20-minute timeframe. Funding for food/fluids came from the SLP department at Gold Coast Health. Following each group, each participant’s general practitioner was sent correspondence outlining the participant’s attendance at the group, assessment results and speech-language pathology recommendations using a standardised reporting template. SLP students completed these reports under supervision as per the Gold Coast Health Speech-Language Pathology documentation guidelines. Outcome measures Participants with dysphagia Participants with dysphagia were asked to complete a 13-item pre and post questionnaire. Pre questionnaires were sent to participants via the post up to 2 weeks prior to the DAT and collected from the participant on the day of the DAT. Where the participant had not completed the pre questionnaire that was mailed to them, they were asked to complete it in person on the day of the DAT prior to the session. Post questionnaires were completed on the day, immediately following the group. The questionnaire (see attached supplementary file) employed a 5-point Likert scale rating the client’s perceptions of and satisfaction with the group-based model, as well as their level of confidence, anxiety and well-being regarding management of their swallowing issues at home. Three open-ended questions were also included to evaluate the client’s knowledge of dysphagia and when to contact their SLP, as well as provide opportunity for additional comments/suggestions regarding the model to be given. In the post group survey only, six additional satisfaction questions were asked of participants, with dysphagia with clients required to rate on a Likert scale of 1–5 their satisfaction with: the recommendations received; their understanding of education provided; the provision of a thorough assessment; the length of time of the group meeting; and whether individual needs were met by staff; and whether staff were professional and attentive. Opportunity for further comments was also provided in the post survey questionnaire. Student participants SLP students were asked to complete a 20-item pre and post group questionnaire (modified from Cardell & Hill, 2013, see Table 5) to evaluate changes in perceptions of their knowledge, skills, and confidence in dysphagia management as a result of participating in the DAT group. Pre questionnaires were completed prior to the group. Post questionnaires were completed immediately following the group. The questionnaire also employed a 5-point Likert scale whereby students rate their level of agreement to a number of statements with 1 indicating low agreement/ confidence and 5 indicating strong agreement/high confidence. Data analysis Statistical analyses were performed using the SPSS computer software program (version 23, IBM, USA). Normality of data was assessed for all questionnaire data and parametric tests (t-test for related measures) were employed for the total scores as normality was upheld for these measures. Nonparametric statistical analyses (Wilcoxon Matched Pairs Test) were used for all remaining questionnaire data. Due to multiple comparisons being

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology