• Swallowing Disorder Impact Survey

    This information will provide insight into the real-world impact of swallowing disorders and strengthen our advocacy for increased federal recognition, coordination, and research support. The information you provide will be used to support dysphagia advocacy, education, and awareness initiatives.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Name and email are optional

    Providing your contact information allows us to follow up with you regarding advocacy efforts or your survey responses. It also assists when seeking congressional support.
  • Residency

  • For U.S. residents, your address helps us identify your congressional representatives so we can advocate for dysphagia research and policy improvements at the Federal level.

  • Gender of person filling out the survey
  • What best describes you?*
  • Age of person filling out the survey

  • Patient/Caregiver questions

  • Impacts of Dysphagia

    The following questions ask about the physical, emotional, social, and financial impacts of living with dysphagia. Your responses will help inform others on the full impact and burden of swallowing disorders.
  • What is the underlying cause of your or your loved one's dysphagia?*
  • Impact of Dysphagia - How much has dysphagia affected each of the following areas of your or your loved one's life?
    Rows
  • Which best describes your or your loved one's current eating and drinking?

  • Impact Scope

    The following questions are open ended. They cover:

    • physical health
    • financial wellbeing
    • emotional impact
    • social impact
    • occupational/educational impact
    • quality of life
    • other

    Taking into consideration how you answered the above impact matrix, please choose the top few impact areas that have the greatest impact and provide an open ended answer to each. Fill out as many as you would like, but please feel free to skip the ones that do not fit or ones with a low impact.

  • Provider questions

  • Dysphagia impact on those under your care

    The following questions ask about the physical, emotional, social, and financial impacts of those under your care who are living with dysphagia. Your responses will help inform others on the full impact and burden of swallowing disorders.
  • Approximately how many patients with dysphagia do you personally see or manage in a typical year?
  • Approximately how many years have you worked with patients with dysphagia?
  • Based on your experience, how much does dysphagia typically affect each of the following areas for the patients you see?
    Rows

  • Impact Scope

    The following questions are open ended. They cover:

    • physical health
    • financial wellbeing
    • emotional impact
    • social impact
    • occupational/educational impact
    • quality of life
    • other

    Taking into consideration how you answered the above impact matrix, please choose the top few impact areas that have the greatest impact on your patient population and provide an open ended answer to each. Fill out as many as you would like, but please feel free to skip the ones that do not fit or ones with a low impact.

  • Professors/researchers/students

  • What is your primary area of work, research, or study?
  • How would you characterize the current state of scientific knowledge about dysphagia?
  • How adequately do you believe current research addresses the following areas of dysphagia?
    Rows
  • What do you believe are the greatest barriers to advancing dysphagia research and improving outcomes? (Select up to three.)
  • Where should additional dysphagia research funding have the greatest priority? (Select up to three)
  • Should be Empty: