Implementation of the International Dysphagia Diet Standardisation Initiative in neurological hospitals in the German-speaking D-A-CH region: structural and organizational associations from a cross-sectional survey
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a common terminology and testing framework for texture-modified foods and liquids in dysphagia care. Despite increasing global adoption of IDDSI, evidence remains limited which structural and organisational conditions are associated with successful implementation in routine clinical practice. Methods This cross-sectional first-wave hospital survey examined IDDSI knowledge, planning and implementation status for Germany, Austria and German-speaking Switzerland (D-A-CH), using the Monitor-Aware-Prepare-Adopt implementation model to classify implementation as a staged organisational process. One knowledgeable professional per site was invited to complete an electronic questionnaire. Institutional characteristics and IDDSI-related variables were analysed. Differences were examined using non-parametric and categorical tests. Ordinal logistic regression was used to explore structural and organisational characteristics associated with implementation status. Results Of 332 invited institutions, 132 were included in the analysis. The overall response rate was 39.8%, with country-specific rates of 25.9% in Germany, 55.1% in Austria and 51.9% in German-speaking Switzerland. Most respondents were speech and language therapists or related professionals (87.1%). Awareness was high, with 97.7% reporting familiarity with IDDSI, and 76.5% indicating active institutional engagement with implementation. Implementation status differed significantly between countries (p = .006), with lower levels in Germany than in Austria and German-speaking Switzerland. The final regression model was significant (p = .044). No individual predictor reached significance. Discussion IDDSI awareness was high among institutions, but implementation remained heterogeneous. Implementation is embedded in broader organisational conditions and accessible across settings rather than explained by a single institutional factor. Longitudinal follow-up is planned to examine implementation trajectories and institutional predictors of change.
Source: Research Square
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204199849