Translation to English, cross-cultural adaptation, and pilot testing of the self-report questionnaire on swallowing difficulties with medication intake and coping strategies (SWAMECO) for adults with polypharmacy

Abstract

ObjectivesTo translate the SWAMECO from German into English; to complete content and face validity with healthcare professionals (HCPs) and with patients from the target population that is, community-dwelling adult patients taking three or more medicines for three or more months.DesignThe process followed guidance from Sousa et al and included translation and cross-cultural adaptation, and cognitive testing among selected HCPs and patients. As the SWAMECO questionnaire is a screening instrument, pilot testing was performed in the target population.SettingThree community pharmacies in and around Cork (Ireland) recruited patients for interviews and pilot testing.ParticipantsCommunity-dwelling patients with ≥3 oral medications for ≥3 months, aged ≥18 years.Outcome measuresAnswers to the SWAMECO questionnaire; clarity of each question, each instruction and each response format.ResultsIssues related to cultural and conceptual differences were resolved by rewording some items. Ten HCPs and 11 patients completed the questionnaire and gave their feedback and opinions on criteria according to Fitzpatrick et al. Revisions included rewording; deleting of two questions; using of colour to signpost that is, where to skip questions that were not applicable to the participants; and replacement of the A-14 medication adherence scale with three validated items. Of the 66 patients enrolled for pilot testing, eight (12.1%) indicated swallowing difficulties. Difficulties with ingesting foods or liquids correlated with swallowing difficulties (p=0.001). All patients perceived discomfort (mean 6.9 on a Visual Analogue Scale from 0 to 10). Patients with swallowing difficulties were significantly more likely to report modifying their medicines (p=0.004) and having poorer medication adherence (p=0.028) than those who had no swallowing difficulties.ConclusionsThe version of the SWAMECO questionnaire in English contains 28 items and is ready for use in adults with polypharmacy.

Identifying and addressing pill aversion in adults without physiological‐related dysphagia: A narrative review

“…size, shape, texture, taste and smell, were widely referred to as influential factors for ease of swallowability. 1,15,18,20,22,26,29,31 White colour was most preferred and purple/ brown least in Overgaard et al 28 Capsules are considered preferable to tablets 18,23,28 with Ibrahim et al demonstrating an association with gender (females) and age (<45 years). 18 Size matters and is demonstrated in Figures 2 and 3: larger capsules, e.g.…”

“…17,19 The overall mean prevalence of pill aversion was 23 specified painkillers, hyoscine butyl bromide, esomeprazole and antibiotics as associated with poor swallowability. 26 Fields et al…”

“…25 The SWAMECO questionnaire also captures this, asking participants to describe how SODF localisation feels. 26 professional prior to modifying their medicines. 21,26 Uloza et al…”

“…Seedat et al describes medicines taken by participants including vitamins, medicines for long‐term conditions such as cardiovascular disease, and antibiotics, but does not identify those causing swallowing difficulties 23 . Respondents to Arnet et al specified painkillers, hyoscine butyl bromide, esomeprazole and antibiotics as associated with poor swallowability 26 . Fields et al used a range of SODFs as models to determine perceived ease of swallow; these included “small SODFs”: e.g., thiazide diuretics and thyroid treatments, antibiotics to represent “very large” capsules, and calcium and potassium supplements to represent “jumbo” tablets 27 …”

“…Liu et al (Sydney Swallow and Medicines Acceptabilityquestionnaires),1 Marquis et al determined participant perception of their state of health using a question from the General Health SF-36 questionnaire,21 Souza et al (EAT-10),22 Nativ-Zeltzer et al (PILL-5)25 and Arnet et al (SWAMECO questionnaire) 26. Dorman et al's two studies explored difficulties swallowing SODFs from a different angle, posing open questions to explore the psychological aspects of medicine-taking.…”