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Smaller Bites to Swallow Right

Written by Clare Isabel Ee | Photos provided by Alexandra Hospital



For speech-language pathologists (SLPs) working with people who have dysphagia (swallowing difficulties), texture-modified diet is no stranger. Consistencies recommended often range from regular diet (no modification necessary), to food cut up into smaller pieces, to pureed diet. The lack of texture-modified diet available in restaurants and kopitiams makes it challenging for persons with dysphagia to enjoy a meal safely outside of their home.


In 2021, SLPs from Alexandra Hospital embarked on a project to make hawker food dysphagia-friendly. The campaign, Smaller Bites to Swallow Right, led the team to collaborate with hawkers from Alexandra Village Food Centre to provide modified versions of their food to make it accessible for persons with dysphagia.


SALTS Insider had a chat with Ms Tey Jo Ching, one of the team members, to find out more.


SALTS Insider: Hi Jo Ching! Please tell us about yourself and the Smaller Bites team.

Tey Jo Ching: Hi! There are currently three STs (directly) involved in the Smaller Bites to Swallow Right campaign: Samuel Chi, Michelle Kwan, and me (Jo). We are all STs from Alexandra Hospital with different areas of interest. For me, my area of interest veers toward the geriatric population.


Ms Tey Jo Ching (fourth from left) and members of the AH Smaller Bites team with participating hawkers and Tanjong Pagar MP Mr Eric Chua (third from right).

Insider: Wow! It must be tough running such a campaign with only three people.

Jo Ching: We did not expect this campaign to go so public, honestly, and we are really thankful for all the support we received so far. We are lucky that we have our Corporate Communications department to help us with this campaign, also not forgetting our bosses and ST colleagues who give us encouragement and brainstorm with us to get the campaign going.


Insider: Team work makes the dream work indeed. What keeps the team motivated to run Smaller Bites?

Jo Ching: Hawker culture is such a big thing in Singapore. Most of the time, when we speak to patients with swallowing difficulties, one of the things that they express is not being able to enjoy food that they like anymore, and a lot of the time, it is mostly hawker food that they miss.


Some of my patients and their family have said that it is hard to have meals outside, as they have to bring their own tools to modify the food, while others said they usually prepare modified food at home and bring it out, or the person with dysphagia will have the meal at home first. So when the whole family is out for a meal, the person with dysphagia ends up sitting there, watching the others eat. This can make the person with dysphagia feel left out, or the family just loses the chance to eat out as a family as they don’t want to go through the inconvenience of bringing tools / home-prepared modified food out.


Finally, there is also the fear of embarrassing themselves when they cough or nearly-choke in public due to not being able to manage eating the food served.


Samples of texture-modified food and condiments.

Insider: What are some challenges in running Smaller Bites?

Jo Ching: It’s never easy to start something. The hawkers who joined this campaign really did it out of kindness. While modifying food is not difficult work, it is additional work on top of their usual workload.


We addressed their concerns as best as we could, but ultimately, we left it to the hawkers to decide if they are keen to be part of the programme.


Personally, I think the hardest challenge is changing the perception of how people view persons with dysphagia. I remember a lengthy conversation with one particular hawker who shared that people with dysphagia should be in nursing homes instead of being out in public places like hawker centres because they cannot eat safely. It was really tough trying to get him to understand that a person with dysphagia can still enjoy food, and that they just needed a little help to maintain quality of life. Thankfully, that was the one and only (hopefully no more) incident so far.

"Most of the time, when we speak to patients with swallowing difficulties, one of the things that they express is not being able to enjoy food that they like anymore, and a lot of the time, it is mostly hawker food that they miss."
A participating hawker prepares a texture-modified food item.

Insider: Phew, that must have been a tough conversation. How has the response to the campaign been otherwise?


Jo Ching: We are thankful that we have been receiving mostly positive feedback. Patients and caregivers are happy to hear about the campaign because it gives them more options when buying food outside, especially if they stay nearby.


The hawkers participating in the campaign are quite supportive too. We visit them every few months to check in on them and to get some feedback on how we can further improve the campaign. Those who have had customers who require modified food were happy that they are able to help, and that it does not significantly affect their workload as there aren’t that many frequent requests for modifications.


Insider: Finally, what are three things you want people to know about modified diet?

Jo Ching:

  1. Modifying the texture of food does not change the taste of the food.

  2. It is not hard to modify food.

  3. There is no shame in taking texture-modified food!


At the point of writing, the Smaller Bites campaign has published a recipe book for persons with dysphagia titled 'My Grandma's Dinner' in collaboration with ITE College West's School of Hospitality (Culinary Arts). They have recruited a total of 27 hawkers from Alexandra Village Food Centre, ABC Market, and Mei Ling Market, and the hardworking team is looking at extending recruitment to other hawkers as well, so keep your eyes peeled and tummies ready! Find out more here.




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