Barriers and Enablers to Nurses Routinely Screening for Oropharyngeal Dysphagia in Hospitalised Older Adults: An Evidence Synthesis of Qualitative Studies

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.