Table 1

Themes from stakeholder workshop activities

Activity 1: defining the specific practitioner behaviour
Theme	Statements
Target population	Who do we mean by general older population?
	Frailty and vulnerability of adults not a universal experience once at a certain age. Some people may experience the effects of ageing earlier than others.
	Ambulatory patients living independently in primary care.
	Care homes a key population, but different approach required.
Awareness	More awareness needed of the condition itself.
Awareness	Education a priority to incite action.
Incentive	Cost prioritised over time in the health system.
	Introduce annual targets for swallow screening.
	HCPs need to be prompted by targets, pro formas and financial rewards to include screening for dysphagia in their health checks.
Practitioner role	Introduce dysphagia as a specialism in certain practitioner groups as seen in other health conditions, for example, Parkinson’s nurses.
	To effectively pick up undiagnosed dysphagia, all HCPs must be able to recognise the symptoms of OD and conduct a simple swallow screen.
	Primary care role is about initial diagnosis and referral with secondary care and specialists providing management and treatment.
Acceptability to patient	Patients are happier to travel to their GP than outpatients at hospital.
	Including a swallow screen during other health check-ups/appointments.
	Patients welcome extra screening, initial diagnosis and appropriate, early advice before seeking specialist management and treatment.
	By incorporating screening into existing health check-ups/screens, it would be less intimidating and more practical.

Activity 2: defining the scope of comparative interventions
Theme	Statements
Dementia and cancer patient groups	These patient groups cover a large diverse range of the population.
	Screening for dementia and cancer is prevalent in primary care.
	Targets and rewards incentivise early screening and diagnosis of these conditions.
	Large body of research to gather evidence.
Incentive	When screening activities are linked to targets, audits, Care Quality Commission, these act as an incentive and a trigger to increase screening and diagnosis.
Overwhelming the system	Long clerking pro forma to check for health conditions/concerns leads to HCPs feeling overwhelmed and elements missed.
	Need to make sure there is equity in who is screened—too costly to screen everyone and not enough resources to refer everyone who may potentially have OD.
	Target those at highest risk, but not currently covered groups for maximum effect and to establish trial sample size.
Self-administered screening	Patients receive screening tool by GP receptionist to fill in and handover to practitioner.
	Cognitive tests are an example of self-administered screening in the waiting room.
	Self-administered screening may exclude people who do not have English as their first language.
	Patients are more honest when talking directly to an HCP.

Activity 3: refining the research questions
Theme	Statements
Recognising OD	Increasing awareness and education of OD in primary care HCPs.
Screening and initial diagnosis	Screening and making an initial diagnosis felt to be the key goal for primary care HCPs.
	Management and care may be more the remit of specialists and secondary care.
	Only the initial diagnosis to be given in primary care. A formal diagnosis will be given by the dysphagia specialists.
Basic advice and adjustments	Providing basic advice and adjustments, for example, changing a medicine formulation, in primary care.
	May make the practitioner feel more empowered to carry out a screening test if basic advice can be provided afterwards.
	Any advice or adjustments given must be acceptable to the patient and within the remit of the HCPs’ practice.
(Q3) Service provider	‘Service provider’ to replace ‘organisations’. ‘Organisations’ did not relate to healthcare and the healthcare system.

GP, general practitioner; HCPs, healthcare practitioners; OD, oropharyngeal dysphagia.