# Qualitative Insights From Practicing Speech and Language Therapists on Key Textural Attributes of Transitional Foods for Dysphagia Management

## TL;DR

Speech therapists in Singapore identified key textural attributes for transitional foods used in dysphagia management, highlighting the need for better testing methods and clearer guidelines.

## Contribution

The study provides novel qualitative insights from clinicians on defining and evaluating transitional foods for dysphagia care.

## Key findings

- Rapid transition time (5–10 s), even texture change, and minimal force for breakdown are key attributes of suitable transitional foods.
- Foods like baby puff and baked meringue were widely accepted as transitional, while cheese puff and chiffon cake were less suitable.
- Current IDDSI testing protocols have limitations, such as not accounting for total mechanical effort or real-world conditions.

## Abstract

Transitional foods, as defined by the International Dysphagia Diet Standardization Initiative (IDDSI), are foods that change texture with moisture or temperature. They show promise for dysphagia management, but their clinical use is limited due to unclear guidelines and insufficient understanding of their transitional characteristics. This study aimed to identify key textural attributes of transitional foods through qualitative insights from 15 practicing speech and language therapists in Singapore. Four focus group discussions were conducted, during which participants also evaluated 10 food samples using sensory testing and supplemented by parallel IDDSI testing. Thematic analysis revealed key criteria: rapid transition time (ideally 5–10 s), even texture change, minimal force for breakdown, cohesive bolus formation, and absence of stickiness or mixed consistencies. Foods transitioning with minimal effort, such as baby puff, baby milk biscuit ball, and baked meringue samples, were considered transitional (> 90% participant agreement), while those requiring greater mechanical manipulation or showing uneven transitions, such as cheese puff and chiffon cake, were deemed less suitable (≤ 50% agreement). Discrepancies between sensory evaluations and IDDSI test outcomes, such as for tofu pudding and gelatin jelly, highlighted limitations in current testing protocols, which use a 1‐min observation period at ambient temperature and do not account for total mechanical effort. Participants also emphasized the importance of age‐appropriate appearance, localized flavors, and practical considerations for implementation. These findings support refining definitions and testing methods for transitional foods and provide foundational data to guide future product development and standardization in dysphagia care.

The desirable attributes of transitional foods include quick melting, minimal force to breakdown, even texture transitions, low stickiness, and a low degree of mixed consistencies. Instrumental testing methods for transitional foods require further development.