Using Backward Design in Dysphagia Management: A Paradigm Shift Toward More Culturally Responsive Care

Abstract

Purpose: Marginalized communities have an increased predisposition to disease where dysphagia is often associated. While commonly used as paradigms in health care and dysphagia management, the biomedical model and forward design do not adequately support equitable, inclusive, and quality care for individuals of culturally and linguistically diverse (CLD) backgrounds. A more-narrow focus on curative and impairment-based management may actually be detrimental to patients' personal and cultural identities. Therefore, it is crucial to broaden the focus of service delivery to provide culturally responsive, patient-centered care. This tutorial describes the application of backward design to dysphagia management, with practical strategies and tools offered to increase the quality of care for persons of CLD backgrounds. Conclusion: Clinicians need to prioritize the individual cultural dynamics of each patient. Personalized ethnocentric care requires clinicians to become aware of their own worldviews and biases while understanding better their patients' identities. Clinicians should consider adopting a more holistic lens and beginning the dysphagia management process with the patient's end goal in mind. Through this critical first step, clinicians will be better equipped to inform appropriate assessment and intervention selections that leverage all aspects of the biopsychosocial framework, helping to reduce health disparities in CLD populations.