Knowledge, Attitude and Practices of Swallowing and Dysphagia: A Cross-Sectional Survey Among the Community Dwelling Adults of South India

Abstract

Background

Community awareness of swallowing and dysphagia plays a significant role in improving early-referral behavior. Literature reports that community awareness of swallowing and dysphagia in the Western countries to be low. Conversely, India has a diverse cultural, linguistic and healthcare-related factors which may influence the health-seeking behavior and early-referral of dysphagia. Hence, it becomes difficult to generalize the findings of existing literature.

Aim

The primary objective of this study was to analyze the knowledge, attitudes and practices (KAP) related to swallowing and dysphagia among the community dwelling adults of South India. The secondary objective was to evaluate if age, sex and education levels were associated with these factors.

Methods and Procedures

Community dwelling adults were recruited from Mangalore city, India for a cross-sectional survey using a convenience sampling design. A purposive built content validated 27-item questionnaire was distributed using Google Form and/or hard copies to the participants for data collection. Participant's responses were independently analyzed by two Speech Language Pathologists using open content analysis. The responses were summarized as percentages and categories and chi square test was administered to examine the association between age, sex and education levels and KAP enquiries at 0.05 level.

Outcomes and Results

A total of 372 participants aged 20–79 years (mean age = 46.26; SD = 15.63) participated in the study. Participants demonstrated limited knowledge of signs, causes, complications and professional management of dysphagia. Aspiration was widely recognized as unsafe, yet only one-tenth correctly identified pneumonia as a complication of dysphagia. Less than one-fifth knew the treatment options for dysphagia. Attitudes reflected fear of choking, discomfort towards nasogastric-tube feeding and moderate willingness to seek help from healthcare professionals. Practices suggested low awareness of Heimlich maneuver, inconsistent food-texture modification and reliance on water to manage dry mouth. Age, sex and education levels were significantly associated with knowledge (saliva is important for chewing, avoid eating in public space to overcome stigma, early intervention helps regain swallowing abilities, age range frequently associated with dysphagia), attitude (fear of choking, preference to non-oral feeds), practices (using internet to find solutions for dysphagia, drinking water before meals or moistening food using water, changing food consistencies, using straw over cup) at p > 0.05 level.

Conclusions and Implications

Community dwellers demonstrated insufficient knowledge, predominantly negative attitudes and unsafe self-management practices related to swallowing and dysphagia. Strengthened public education, early-referral pathways and inclusion of basic life-support skills are highly warranted to improve community awareness on swallowing and dysphagia.

WHAT THIS PAPER ADDS

What is already known on this subject

• Community awareness of dysphagia is low in Western countries. Cultural beliefs, literacy, superstition and access to healthcare influence what people know, how they respond and when they seek help. Understanding knowledge, attitude and practices (KAP) of swallowing and dysphagia in India is critical for reducing self-management risks and improving early-referral behavior.

What this study adds to existing knowledge

• The study provides the first structured KAP analysis on swallowing and dysphagia in an Indian community . Participants recognized aspiration as dangerous, yet lacked awareness of critical signs, causes, treatment options and responsible team members. Fear of choking was high, and most were uncomfortable with tube-based feeding. The public seldom employed safe compensatory strategies and very few were familiar with Heimlich maneuver or food-texture modification. Age, sex and education levels were significantly associated with multiple KAP variables.

What are the clinical implications of this work?

• There is an urgent need to conduct more public awareness programs on prevention, early identification and intervention of dysphagia by healthcare professionals involved in dysphagia care. Efforts must be scaled to provide basic life support (BLS) skills training programs, including training in Heimlich maneuver, to the public.