, Volume 34, Issue 1, pp 105–111 | Cite as

Dysphagia Management in Iran: Knowledge, Attitude and Practice of Healthcare Providers

  • Sima Farpour
  • Hamid Reza FarpourEmail author
  • David Smithard
  • Bahareh Kardeh
  • Fatemeh Ghazaei
  • Mohsen Zafarghasempour
Original Article


Despite the remarkable burden of dysphagia, appropriate multidisciplinary management is lacking in Iran and patients are often deprived of effective treatments. Obtaining a full understanding of knowledge, attitude and practice (KAP) of healthcare providers is necessary to determine the gaps in improvement of the quality of care for dysphagic patients. A questionnaire was designed covering demographic information and the parameters of KAP. Face and content validity were determined. Test–retest reliability confirmed that the questionnaire scores are stable over time (r = 0.77, p value < 0.01). Participants were healthcare providers employed in university-affiliated hospitals in three major cities of Iran; Tehran, Shiraz and Mashhad. In total, 312 healthcare professionals completed our survey. The majority (96.8%) were familiar with the term “dysphagia or swallowing disorders”. Most of the participants believed their profession (88.5%), as well as other disciplines (92.3%) can play an important role in the management of dysphagia; and this problem should be recognized in a multidisciplinary manner (96.2%). Also, 60.9% had encountered a patient with dysphagia. 52.2% had used at least one assessment method, while 49.9% had applied at least one treatment method. However, very few participants were familiar with a standard test for screening and assessment of dysphagia (11.9%). 74.7% were willing to participate in a workshop on dysphagia. As the main pitfalls of care lie in diagnosis and treatment expertise, the policy of hospitals should prioritize educating and updating the skills of healthcare professionals, encourage multidisciplinary teamwork, establishing clear guidelines and facilitate access to advanced tools.


Deglutition Deglutition disorders Health personnel Knowledge Quality of health care 



This study was funded by Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (Grant No. 13502).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Cho SY, Choung RS, Saito YA, Schleck CD, Zinsmeister AR, Locke G, et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212–9. Scholar
  2. 2.
    Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49. Scholar
  3. 3.
    Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259–70. Scholar
  4. 4.
    Kidambi T, Toto E, Ho N, Taft T, Hirano I. Temporal trends in the relative prevalence of dysphagia etiologies from 1999-2009. World J Gastroenterol. 2012;18(32):4335. Scholar
  5. 5.
    White GN, O’Rourke F, Ong BS, Cordato DJ, Chan DK. Dysphagia: causes, assessment, treatment, and management. Geriatrics. 2008;63(5):15–20.Google Scholar
  6. 6.
    Schindler A, Ginocchio D, Ruoppolo G. What we don’t know about dysphagia complications? Rev Laryngol Otol Rhinol. 2008;129(2):75–8.Google Scholar
  7. 7.
    Rofes L, Arreola V, Almirall J, Cabré M, Campins L, García-Peris P, et al. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Prac. 2011. Scholar
  8. 8.
    Chen P-H, Golub JS, Hapner ER, Johns MM. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24(1):1–6. Scholar
  9. 9.
    Eslick GD, Talley N. Dysphagia: epidemiology, risk factors and impact on quality of life–a population based study. Aliment Pharmacol Ther. 2008;27(10):971–9. Scholar
  10. 10.
    Barikroo A, Hosseini Z, Ansari Z. The prevalence of oropharyngeal dysphagia among nursing home residents in Isfahan. J Res Rehabilit Sci. 2012;7(2):155–61.Google Scholar
  11. 11.
    Poorjavad M, Derakhshandeh F, Etemadifar M, Soleymani B, Minagar A, Maghzi A-H. Oropharyngeal dysphagia in multiple sclerosis. Mult Scler J. 2010;16(3):362–5. Scholar
  12. 12.
    Guan X-L, Wang H, Huang H-S, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671–81. Scholar
  13. 13.
    Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, Tafakhori A, Logemann J, Faghihzadeh S, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol. 2015;14(3):119.Google Scholar
  14. 14.
    Farpour S, Farpour HR. Acute phase of stroke and dysphagia: A cross-sectional study in Shiraz, Iran. An International Peer Reviewed Open Access Journal For Rapid Publication. 2017:328.Google Scholar
  15. 15.
    Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia. 2010;25(1):40–65. Scholar
  16. 16.
    Association AS-L-H. Scope of practice in speech-language pathology. Rockville: Association AS-L-H; 2016.Google Scholar
  17. 17.
    Do Canada. Defining the role of the dietitian in dysphagia assessment and management. Can J Diet Pract Res. 2015;76(2):100. Scholar
  18. 18.
    Macleod M, O’Shea S. The dietitian’s role in diagnosis and treatment of dysphagia. Med Radiol Diagn Imaging. 2017. Scholar
  19. 19.
    Ortega O, Sakwinska O, Combremont S, Berger B, Sauser J, Parra C, et al. High prevalence of colonization of oral cavity by respiratory pathogens in frail older patients with oropharyngeal dysphagia. Neurogastroenterol Motil. 2015;27(12):1804–16. Scholar
  20. 20.
    Pace CC, McCullough GH. The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia. 2010;25(4):307–22. Scholar
  21. 21.
    Poisson P, Laffond T, Campos S, Dupuis V, Bourdel-Marchasson I. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology. 2016;33(2):161–8. Scholar
  22. 22.
    Ortega O, Parra C, Zarcero S, Nart J, Sakwinska O, Clavé P. Oral health in older patients with oropharyngeal dysphagia. Age Ageing. 2014;43(1):132–7. Scholar
  23. 23.
    Speyer R. Oropharyngeal dysphagia. Otolaryngol Clin N Am. 2013;46(6):989–1008. Scholar
  24. 24.
    Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806–15. Scholar
  25. 25.
    Kamal RM, Ward E, Cornwell P. Dysphagia training for speech-language pathologists: implications for clinical practice. Int J Speech Lang Pathol. 2012;14(6):569–76. Scholar
  26. 26.
    Dolce MC, Haber J, Shelley D. Oral health nursing education and practice program. Nurs Res Pract. 2012;2012:149673. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sima Farpour
    • 1
  • Hamid Reza Farpour
    • 2
    Email author
  • David Smithard
    • 3
  • Bahareh Kardeh
    • 4
  • Fatemeh Ghazaei
    • 5
  • Mohsen Zafarghasempour
    • 6
  1. 1.Shiraz Geriatric Research CenterShiraz University of Medical SciencesShirazIran
  2. 2.Department of Physical Medicine and Rehabilitation, Bone and Joint Diseases Research CenterShiraz University of Medical SciencesShirazIran
  3. 3.Queen Elizabeth Hospital, Lewisham and Greenwich NHS TrustLondonUK
  4. 4.Bone and Joint Diseases Research Center, Clinical Neurology Research CenterShiraz University of Medical SciencesShirazIran
  5. 5.Neuromusculoskeletal Research CenterIran University of Medical SciencesTehranIran
  6. 6.Department of Physical Medicine and RehabilitationMashhad University of Medical SciencesMashhadIran

Personalised recommendations