Paresh Parmar

Aim: To identify and describe the barriers and enablers to nurses routinely screening for dysphagia in hospital and map these to domains in the Theoretical Domains Framework. Design: Systematic review with meta‐ethnography. Data Base Sources: CINAHL, Embase, PubMed, Scopus, Clinical Trials and World Health Organisation trials registry (database inception to November 2024). Methods: The review protocol was registered on PROSPERO ( CRD42024608080 ). Studies set in stroke and older adult wards were included. Data were coded as barriers or enablers, mapped to the original authors' themes and then synthesised into higher‐level themes. Barrier and enabler codes were also mapped to domains in the Theoretical Domains Framework. Results: From 6750 studies identified, six were included. None of the included papers were conducted in an older adult ward setting. Four high‐level themes were developed: (i) The surrounding environment, (ii) Variation in practice, (iii) Influence of knowledge and skills, and (iv) The value of dysphagia screening. Identified barriers and enablers were predominantly mapped to ‘Environmental context and resources,’ ‘Knowledge,’ ‘Beliefs about capabilities’ and ‘Beliefs about consequences’ Theoretical Domains Framework domains. Conclusions: For successful dysphagia screening, nurses require adequate training, a standardised screening tool and sufficient environmental support. Further work is required to contextualise these findings specifically to older adult ward settings. Impact: To introduce routine nurse screening for dysphagia into different contexts, this paper provides guidance on how to set up and create a theory informed service. Mapping of barriers and enablers to the Theoretical Domains Framework can facilitate the development of a behaviour change intervention through the framework's linkage to a taxonomy of behaviour changes strategies. Reporting Method: ENhancing Transparency in REporting the synthesis of Qualitative research. Patient or Public Contribution: Patient and public involvement focused on interpretation of findings, ensuring the review identified patient‐relevant priorities. Trial Registration: PROSPERO registration number: CRD42024608080

Core Outcome Sets (COS) are used by researchers to enable synthesis and comparison of results from trials in similar patient groups and contexts. Around 50% of older adults on care of the older person wards may have Oropharyngeal Dysphagia (OD). Routine OD screening may reduce the risk of mortality and duration of hospital stay. Research is required to identify the effectiveness and cost-effectiveness of an OD screening service. Using a modified Delphi methodology, this study aimed to develop a COS for trials evaluating hospital-based OD screening services. A long list of outcomes, created from a systematic review and similar existing COS, was sent out to nurses, speech and language therapists (SLT), pharmacists, senior hospital staff, researchers, people with OD and carers who rated each outcome’s importance using a Likert scale to help refine this list. A 90-minute online consensus workshop then finalised the COS. 54 outcomes were sent to 34 stakeholders at round one. 25 outcomes were sent to 28 stakeholders at round two.13 stakeholders finalised the COS in the consensus workshop. The final COS consists of; mortality, aspiration pneumonia, choking, medication intake, patients’ experience with the intervention, swallowing-related quality of life, hospitalisation & proportion of patients referred to SLT. This study developed the first COS for evaluating OD screening services in care of the older person hospital wards. Adoption of this COS will facilitate consistency in outcome measurement, evidence synthesis and translation of OD research into clinical practice.