A total of 74 clinicians expressed interest in participating in the PedFeed ECHO network with 47 included in the study. As outlined in Fig. 2, 11 participants were excluded as they did not meet eligibility criteria, including being located outside of Queensland (n = 4), having < 6 months experience with PFD (n = 4), and not being an AHP (n = 1). Two participants did not return their enrollment forms before the commencement of the groups, and so were also excluded. Overall, 12 participants were excluded from data analysis as they attended ≤ 2 sessions. Of the participants who attended ≤ 2 PedFeed ECHO sessions, 50% (n = 6) were speech pathologists and 50% (n = 6) were dietitians, with most (n = 7, 58%) residing in non-metropolitan locations. Four of these non-attenders (33%) completed the non-attendance questionnaire and reported reason/s that they were unable to attend. Reported reason/s (some participants reported > 1) included session time/day unsuitable (n = 2), change of role (n = 2), and inability to prioritize with other work/clinical demands (n = 2). All four non-attenders who provided feedback (100%) reported accessing the resources distributed via email after each session and found these useful.

Overview of participant recruitment, allocation, and retention in PedFeed ECHO. Created in Lucidchart (www.lucidchart.com)

Participant demographics for the final set of participants (n = 47) are outlined in Table 1. The majority of participants were speech pathologists (n = 32, 68%), had been providing pediatric feeding care for < 5 years (n = 30, 63%) and provided pediatric feeding care at least once per fortnight (n = 40, 87%). There was no statistically significant difference in demographic variables between Group 1 and Group 2. Almost all of the cohort (n = 44, 94%) reported that they had previously attended pediatric feeding PD event/s (n = 3, 6% nil previous pediatric feeding PD, n = 1, 2% no response). When asked about their preferred learning methods respondents indicated preference for in-person teaching (n = 40, 83%) and webinars (n = 39, 81%) over other types of learning (online learning modules n = 35, 73%; podcast n = 26, 54%; teleconference n = 33, 69%).

Participants attended an average of 5.8 sessions within the PedFeed ECHO series (standard deviation [SD] 1.5; Group 1 average 6 sessions, SD 1.5; Group 2 average 5.7, SD 1.6). Group 1 (n = 22) had an average of 16.4 attendees per session (SD 4.4) and Group 2 (n = 25) had an average of 17 attendees (SD 3.8). There were 215 post-session satisfaction questionnaires completed by participants who attended sessions. Most participants agreed that each PedFeed ECHO session was useful for their clinical practice (n = 110, 51% strongly agree, n = 88, 41% agree, n = 17, 8% neutral, n = 0 disagree or strongly disagree). There were 63 post-session questionnaires completed by participants who did not attend a session. Reasons for non-attendance were reported to include annual leave (n = 17, 27%), clinical conflict (e.g., urgent inpatient n = 13, 21%), sick/carers leave (n = 12, 19%), scheduling conflict (n = 12, 19%), emergent leave (e.g., natural disaster n = 3, 6%), COVID-19 redeployment (n = 3, 6%), and forgot (n = 1, 2%).

Participants’ overall self-reported confidence increased over the course of the PedFeed ECHO series (pre- mean 61.3, SD 22.1; post-mean 75.9, SD 14.1; 3-month post-mean 77.1, SD 14.7). Statistical analysis identified a significant change in ratings across the three timepoints (Wilk’s Lambda = 0.49, F(2, 35) = 18.15, p < 0.01, effect size = 0.51). Post hoc analyses indicated a significant pre–post (p < 0.01)- improvement; however, no further significant change (p = 0.27) between the immediately post- and 3-month post-timepoints indicating maintenance of the post-PedFeed ECHO confidence level. When considering demographic characteristics, there was no significant difference in overall self-reported confidence according to geographical location (p = 0.89), profession (p = 0.58), employment setting (p = 0.20), frequency of service provision (p = 0.20), or proportion of PFD caseload (p = 0.50). However, there was a significant difference in post-PedFeed ECHO confidence when considering number of years’ experience working with children with PFD. Clinicians with less experience (6 months – 2 years) reported significantly greater improvement in self-reported confidence in comparison to participants with > 2 years’ experience (p = 0.002).

Average participant ratings on the self-reported confidence questionnaire are outlined in Table 2, with Friedman tests indicating significant differences in confidence across the three time points. Post hoc analysis indicated that the differences were significant between the pre- and post-PedFeed ECHO time points (i.e., pre–post and pre–3-month post; p < 0.01) but not between the two post-time points (i.e., post and 3-month post; p > 0.05) for all questions except “confidence seeking additional evidence” (p =  < 0.01 pre–post, p = 0.04 pre–3-month post). When participants were asked if they believed that the PedFeed ECHO series had contributed to their changes in confidence, most strongly agreed (n = 21, 57%) or agreed (n = 11, 28%) (neutral n = 3, 8%; no response n = 2, 5%).

Participants reported high satisfaction with the PedFeed ECHO series, with questionnaire responses detailed in Table 3. The satisfaction outcomes were positive across both groups; however, Group 2 reported significantly higher satisfaction with improvements to care and reduced feelings of professional isolation as compared to Group 1. Almost all of the cohort (n = 40/43, 93%) indicated that they wanted to continue accessing PedFeed ECHO and the majority (n = 32, 74%) reported preferring to access PedFeed ECHO over traditional lecture-style workshops in future.

Content analysis of the open-ended questions included in the overall satisfaction survey is reported in Tables 4 and 5. All participants provided responses regarding what worked well and the difference between PedFeed ECHO and other professional development opportunities, and this information is summarized across five categories in Table 4. Overall, a number of respondents reported perceiving that real and current cases were valuable, ECHO structure was good, the interactivity and opportunity for questions, discussion and participation was valuable and that the multidisciplinary format was beneficial. Suggestions for improvements for future PedFeed ECHO cohorts were analyzed separately and are outlined in Table 5. Only 23 participants provided suggestions for program improvement. From their responses, there were 7 categories identified. Due to the low response rate, most codes came from only one comment, with the exception of wanting to exchange contact information, wanting a smaller group size and wanting more time for didactic teaching.

In the 8 weeks prior to commencement of the PedFeed ECHO series, 27 requests for support were received by the specialist PFD service (n = 18, 67% via phone; n = 9, 33% via email). Overall, 25 requests were fielded by speech pathology staff (93%), and two by dietetics staff (7%). A total of 498 min (8.3 h) was spent responding to requests, with the average response taking 18.4 min (range 5–45 min). Most of these requests (n = 21, 78%) were for clinical advice/support (n = 6, 22% regarding potential referrals) and the outcome of almost all (n = 25, 93%) support was the provision of clinical advice (n = 2, 7% resulted in referral to the service). While most requests were received from professionals working within the health sector (n = 19, 70%), a small number (n = 8, 30%) were received from professionals in other sectors (e.g., private practice, disability, community health). Speech pathologists (n = 24, 89%) were the most frequent professionals contacting to request support (dietitian n = 2, 7%, nurse n = 1, 4%). Most of the requests (n = 16, 59%) were not clinically urgent.

During the 8 weeks when the PedFeed ECHO series was run, there was a 75% reduction in requests for support, with 7 requests received (n = 4, 57% via phone; n = 3, 43% via email). All requests for support were fielded by speech pathology team members (n = 7, 100%). A total of 125 min (2.1 h) was spent providing support, with the average response taking 17.9 min (range 5 – 30 min). Most of these requests (n = 5, 71%) were for clinical advice/support (n = 2, 29% regarding potential referrals) and the outcome of all requests (100%) was the provision of clinical advice. The majority of requests were received from professionals working outside the health sector (n = 4, 57%). Speech pathologists (n = 6, 86%) were the most frequent professionals contacting for support (occupational therapist n = 1, 14%). Most (n = 5, 71%) of the requests were not clinically urgent.