Perspectives and Clinical Practices of Speech-Language Pathologists Regarding Cultural Food Adaptations in Dysphagia Management

Abstract

Background: Dysphagia management relies heavily on texture-modified diets and standardized frameworks such as the International Dysphagia Diet Standardization Initiative (IDDSI); however, effective implementation requires culturally responsive adaptation to traditional food practices. In Pakistan, staple foods such as roti, rice, lentils, and meat curries present unique challenges for safe texture modification, and limited evidence exists regarding clinicians’ preparedness to integrate cultural food considerations into dysphagia care. Objective: To assess the perspectives, confidence levels, clinical practices, and perceived barriers of Speech-language pathologists (SLPs) regarding cultural food adaptations in dysphagia management in Lahore, Pakistan. Methods: A cross-sectional survey was conducted among 74 practicing SLPs recruited through purposive sampling across hospitals, rehabilitation centers, and clinics. A structured 102-item questionnaire assessed demographics, dysphagia experience, confidence in modifying traditional foods, integration of cultural preferences, resource utilization, and training needs. Descriptive statistics and chi-square tests were performed using SPSS version 27 with significance set at p < 0.05. Results: Although 64.9% reported using IDDSI guidelines, 62.1% expressed low confidence in modifying traditional Pakistani foods, and 55.4% rarely or never considered cultural food preferences in therapy planning (p < 0.001). Limited knowledge (54.1%) was the most frequently reported barrier, while 64.9% expressed interest in culturally focused workshops. Utilization of local food guides was low (27.0%). Conclusion: A substantial gap exists between standardized guideline use and culturally contextualized clinical application in dysphagia management. Targeted training, interdisciplinary collaboration, and development of Pakistan-specific adaptation protocols are warranted to enhance culturally responsive practice.