Abstract:

Background: Evidence-based interventions (EBIs) are frequently adapted or modified during the implementation process to meet the needs of the target context, public health professionals, or health practitioners. However, little is known about how the EBIs of the same clinical problem at a different time (sustainability) and a different setting (scalability) should be adapted to facilitate implementation. To address this gap, this research aims to analyze the adaptations process of EBIs by taking post-stroke dysphagia screening as an example based on a series of empirical studies.

Methods: We reviewed three best practice implementation projects of post-stroke dysphagia identification and management in mainland China, and conducted a comparative analysis of three projects of dysphagia screening practical decision-making according to core elements of evidence-based nursing (EBN).

Results: We identified the core elements of EBN that influence decision-making in each best practice implementation project. The decision-making of screening time and tool for dysphagia in the three projects varied. Project 1: Post-stroke dysphagia was screened using Water Swallow Test (WST) before the first intake of liquid or food. Project 2: A sustainability study based on project 1, post-stroke dysphagia was screened using Standardized Swallowing Assessment (SSA) before the first intake of liquid or food, within 24 hours of admission. Project 3: A community scalability study based on project 2, post-stroke dysphagia was screened using Water Swallow Test (WST) before the first intake of liquid or food, within 24 hours after referral.

Conclusions: Adaption of EBIs needs to fully consider the best available external evidence from systematic research, clinical expertise, patient preferences, as well as context.

Key words: Adaptation, Evidence-based nursing, Stroke, Dysphagia, Screen, Implementation