Recognizing new perspectives in eating difficulties following stroke: A concept analysis

Purpose: To describe and identify various perspectives on eating difficulties following stroke to enable theory development and facilitate advancement of interventions. Methods: Concept analysis in line with Morse's principles of exploring pragmatic utility was used throughout the data collection and analysis. Peer-reviewed research on eating difficulties was systematically and critically appraised. Literature included the bibliographic databases, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and PsycInfo, published up until November 2011. A total of 33 key articles were included in the final analysis. Results: A conceptual model of eating difficulties is presented showing the multiple affecting factors, namely meaning-related, functional and contextual factors and the consequences of non-intervention, feeling of loss, social isolation, negative sensations and depression-all of which potentially increase the impact of disease severity, functional outcome and quality of life. Based upon the dimensions identified, the definition of eating difficulties was synthesized as "any activity and emotional requirement and relations, which alone or in combination interfere with the process of preparing food, transferring food into the mouth, chewing and swallowing". Conclusion: Eating difficulties have profound effects on people. The conceptual model serves to guide health care professionals to assess and help stroke patients in facing a life with eating difficulties. Implication for rehabilitation Eating difficulties is a complex concept that touches essential areas of life following stroke. Attending to eating difficulties in a structured way that encompasses meaning, functional and contextual issues might facilitate successful rehabilitation. The conceptual framework suggests a focus for developing effective, holistic interventions with initial screening and following assessment, so that appropriate interventions can commence and adverse consequences prevented. Items to consider in the assessment of eating difficulties are offered.