A comprehensive approach to psychometric assessment of instruments used in dementia educational interventions for health professionals: A cross-sectional study

Knowledge of Alzheimer's disease and associated factors among adults in Zhuhai, China: a cross-sectional analysis

BACKGROUND

This study aimed to assess the public knowledge regarding Alzheimer's Disease (AD) in Zhuhai, China, focusing on identifying knowledge gaps and the influence of demographic and health factors.

METHODS

A cross-sectional study was conducted in Zhuhai, China, from October to November 2022. A total of 1986 residents from 18 communities were selected employing stratified multi-stage equi-proportional sampling. Questionnaires covering general information and the Alzheimer's Disease Knowledge Scale (ADKS) were investigated face-to-face. Ordinal multiclass logistic regression was applied to assess the relationship between AD awareness and demographic and health characteristics.

RESULTS

The average ADKS score was 18.5 (SD = 3.36) in Zhuhai. The lowest awareness rates were observed in the "Symptoms" and "Caregiving" subdomains of ADKS, with rates of 51.01% and 43.78%, respectively. The correct rates for the 30 ADKS questions ranged from 16.62 to 92.6%, showing a bimodal pattern with clusters around 80% and 20%. Women (OR = 1.203, 95% CI: 1.009-1.435), individuals aged 60 years or older (OR = 2.073, 95% CI: 1.467-2.932), those living in urban areas (OR = 1.361, 95% CI: 1.117-1.662), higher average monthly household income per capita (OR = 1.641, 95% CI: 1.297-2.082), and without any neurological or mental disorders (OR = 1.810, 95% CI: 1.323-2.478) were more likely to have higher levels of awareness about Alzheimer's disease.

CONCLUSIONS

Adults in Zhuhai show a limited knowledge of AD, particularly in the 'Symptoms' and 'Caregiving' subdomains. Upcoming health campaigns must focus on bridging the knowledge gaps in different subdomains of AD, especially among subgroups with lower awareness, as identified in our study.

A study of knowledge on Alzheimer's disease and attitudes of Chinese social residents toward Alzheimer's disease: A cross-sectional survey in China

OBJECTIVE

Social residents become increasingly concerned about Alzheimer's dementia (AD) as a global public health crisis. China's AD population is the largest and growing fastest. However, no study has examined Chinese social residents' knowledge and attitudes concerning Alzheimer's illness. This study examined Chinese social residents' AD knowledge and attitudes using the Alzheimer's Disease Knowledge Scale (ADKS) and dementia attitudes scale (DAS).

DESIGN

Cross-sectional survey.

SAMPLE

338 social residents over 18 years old from various Chinese regions were recruited using convenient sampling.

MEASUREMENTS

The ADKS (Chinese) and the Dementia Attitude Scale (Chinese) were used to assess their knowledge and attitude regarding AD.

RESULTS

A total of 328 respondents (97.04%) completed the survey. ADKS = 19.44 ± 3.33; DAS = 86.98 ± 12.7. Age and education levels can have a substantial impact on ADKS scores, and education levels can have a substantial impact on DAS scores.

CONCLUSIONS

Low levels of awareness and acceptance of AD exist among Chinese residents. The results indicate that China must immediately implement comprehensive AD education for its social residents.

An analysis of nursing and medical students' attitudes towards and knowledge of Alzheimer's Disease (AD)

OBJECTIVES

Little is known about how Jordanian undergraduate medical and nursing students perceive Alzheimer's disease (AD) care. This study aimed to investigate nursing and medical students' AD knowledge, attitudes, and associated factors with their knowledge to inform reforms to multidisciplinary AD education undergraduate programs in Jordan.

METHODS

Cross-sectional research was carried out using a self-administered questionnaire. Students' knowledge was measured using the Alzheimer's Disease Knowledge Scale (ADKS) and attitudes were measured using the Dementia Care Attitude Scale (DCAS). The survey was completed by 423 nursing and medical students.

RESULTS

The overall mean score on the ADKS for students' AD knowledge was 17.50 (SD=3.08) out of 30 and the DCAS for students' attitudes toward AD was 26.76 (SD=6.19) out of 40.

CONCLUSIONS

Medical students had a higher level of AD knowledge and a lower level of positive attitude than nursing students (p<0.05).

Psychometric properties of the dementia knowledge assessment scale-traditional Chinese among home care workers in Taiwan

BACKGROUND

The Dementia Knowledge Assessment Scale (DKAS) is a reliable and valid measurement of dementia knowledge for diverse allied health professionals but its traditional Chinese version has not been formally validated yet. The purpose of this study was to translate the DKAS from English to traditional Chinese and evaluate its psychometric properties among home care workers in Taiwan.

METHODS

The DKAS scale was translated into traditional Chinese through a forward translation and back translation process following the cross-cultural translation guideline. A total of 285 home care workers in eastern Taiwan were recruited using convenience sample. A total of 252 participants completed the questionnaires, giving a response rate of 88.4%. We tested the construct validity by confirmatory factor analysis (CFA) and evaluated the reliability by internal consistency.

RESULTS

The results of the CFA supported the 25-item, four-factor model for the DKAS-TC. The DKAS-TC achieved a good overall Cronbach's alpha of .93 and McDonald's omega of 0.94 with acceptable subscales McDonald's omega ranged from .77 to .82.

CONCLUSIONS

The DKAS-TC has adequate construct validity and reliability and can serve as an assessment tool to evaluate the knowledge level of home care workers in a dementia training program in Taiwan. The dementia knowledge level among home care workers in Taiwan was inadequate. There is a need for developing suitable dementia care training tailored to their learning needs and educational levels, and to improve their quality of care for those with dementia.

Dementia knowledge and associated factors among older Chinese adults: a cross-national comparison between Melbourne and Beijing

OBJECTIVES

This study compared dementia knowledge between older Chinese adults in Melbourne, Australia, and Beijing, China, and explored factors associated with dementia knowledge between these two groups. Ultimately, this study aimed to inform the development of tailored dementia education programs for older Chinese adults.

DESIGN

A cross-sectional design was employed in this study.

SETTING

Participants were recruited from 5 Chinese community senior groups in Melbourne and 10 community health centers in Beijing from March to May 2019.

PARTICIPANTS

A total of 379 older Chinese adults aged 50 and over completed the questionnaire, including 153 from Melbourne and 226 from Beijing.

MEASUREMENTS

Dementia knowledge was assessed using the Alzheimer's Disease Knowledge Scale (ADKS). Demographic characteristics, dementia-related experience, and the mental health status of participants were collected. Stepwise linear regression was used to analyze the factors associated with dementia knowledge.

RESULTS

In general, older Chinese adults in Melbourne and Beijing reported similar levels of dementia knowledge for both the overall ADKS scale (mean ± SD: 17.2 ± 2.9 in Melbourne vs. 17.5 ± 2.9 in Beijing, p > 0.05) and the seven subdomains. Of the subdomains, the highest correct response rates were observed in the life impact of the dementia subdomain, and the lowest rates were observed in the caregiving subdomain. Stepwise linear regression analysis revealed that younger age and self-reported dementia worry were significantly associated with higher levels of dementia knowledge in the Melbourne group, whereas a positive family history of dementia was significantly associated with higher levels of dementia knowledge in the Beijing group.

CONCLUSIONS

Older Chinese adults living in Melbourne and Beijing share similar levels of dementia knowledge, but factors associated with their knowledge are different. These findings will inform the development of culturally and socially appropriate dementia education programs for older Chinese populations in different countries.

The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO

People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.

A comparative study of dementia knowledge, attitudes and care approach among Chinese nursing and medical students

BACKGROUND

Dementia care requires inter-disciplinary collaboration starting from formal health professional education. Yet, little is known about how undergraduate medical and nursing students perceive dementia care in China. The aim of this study was to investigate undergraduate medical and nursing students' dementia knowledge, attitudes and care approach in China.

METHODS

A cross-sectional survey was conducted. Students enrolled in a 5-year Bachelor of Medicine Program and a 4-year Bachelor of Nursing Program from four universities with campuses across Eastern, Western, Southern and Northern China were recruited into the study. Three validated instruments, Alzheimer's Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and Approach to Advanced Dementia Care Questionnaire (ADCQ), were used to examine students' dementia knowledge, attitudes and perceived care approach. Data were collected using a self-administered survey.

RESULTS

The number of medical and nursing students completing the survey was 526 and 467 respectively. Students' overall knowledge about dementia was poor, but attitudes were generally positive. The overall mean score of students' dementia knowledge examined by the ADKS was 19.49 (SD = 2.82) out of 30, students' attitudes to dementia was 29.92(SD = 3.35) out of 40, and students' person-centred care approach of dementia was 5.42 (SD = 2.20) out of 13. Medical students demonstrated higher dementia knowledge scores and showed less positive attitude scores than nursing students (p < 0.05). Students would not apply a person-centred care approach. There were no statistically significant differences in the mean scores of ADCQ between nursing students and medical students.

CONCLUSIONS

Study results highlight the urgent need to implement an inter-disciplinary approach to increasing dementia education among Chinese medical and nursing students, and ensuring that students have adequate knowledge, attitudes and experience in the care of people with dementia.

Validation of a Chinese version of the dementia knowledge assessment scale in healthcare providers in China

AIMS

To translate 25-item Dementia Knowledge Assessment Scale into Chinese and evaluate its psychometric properties amongst Chinese healthcare providers.

BACKGROUND

The prevalence of dementia is increasing in China, but development of relevant training for healthcare providers is still in its infancy stage. A comprehensive, valid and reliable Chinese knowledge-of-dementia measure is needed to identify training needs and evaluate the effect of educational interventions.

DESIGN

A cross-sectional survey.

METHODS

The Dementia Knowledge Assessment Scale was translated into Chinese following the modified Brislin's translation model. Content and face validity were established by an expert panel in dementia care and healthcare providers. A convenience sample of 290 healthcare providers in care homes and hospitals was recruited. Construct validity was evaluated through confirmatory factor analysis, concurrent validity and known groups' comparisons method. Reliability was evaluated through internal consistency reliability and 2-week test-retest reliability. This study used the STROBE checklist for reporting.

RESULTS

The content validity index was 0.98. The confirmatory factor analysis model revealed that the four-factor model was partly supported in the present study. The moderate correlation between Chinese version of Dementia Knowledge Assessment Scale and Alzheimer's Disease Knowledge Scale indicated acceptable concurrent validity. The mean score of the scale and subscale scores showed significant differences between health professionals and care assistants, except for the subscale of "Care Considerations." The reliability was demonstrated with Cronbach's alpha of .77 and intra-class correlation coefficients of each subscale between .74 and .92 among 56 respondents.

CONCLUSIONS

The Chinese version of Dementia Knowledge Assessment Scale demonstrated acceptable concurrent validity but marginal factorial validity and satisfactory reliability amongst Chinese healthcare providers. Therefore, applying the four-factor structure of Chinese version scale should be considered.

RELEVANCE TO CLINICAL PRACTICE

Chinese version of Dementia Knowledge Assessment Scale can be used to understand the training needs of healthcare providers in dementia.

Knowledge evaluation instruments for dementia caregiver education programs: A scoping review

With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non-RCTs = 6, one-group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi-country (n = 1). Only two studies focused on minority populations. While author-developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397-413.

Caregivers' Dementia Knowledge and Care Approach in Residential Aged Care Facilities in China

OBJECTIVE

To investigate the dementia knowledge and care approach used by caregivers in residential aged care facilities (RACFs) in China.

METHOD

A cross-sectional survey of 785 caregivers from a random sample of 34 RACFs in China. Caregivers' knowledge and care approach were assessed using the Chinese version of the Dementia Knowledge Assessment Tool 2 and Advanced Dementia Care Questionnaire.

RESULTS

The majority of caregivers showed limited knowledge of dementia and tended not to adopt a person-centered approach to care. Educational level, dementia care training, and years of work experience were positively associated with dementia knowledge. Educational level and years of work experience were also associated with a person-centered approach to care.

CONCLUSIONS

This study provides insight into the care available to people with dementia in RACFs in China. The results suggest dementia care education programs as well as person-centered care training are urgently needed for caregivers in China.

Community health professionals' dementia knowledge, attitudes and care approach: a cross-sectional survey in Changsha, China

BACKGROUND

Community health professionals play a significant role in dementia care. However, little is known about community health professionals' capacity in dementia care, especially in low and middle-income countries. The aim of the present study was to assess community health professionals' dementia knowledge, attitudes and care approach in China, a country with the largest population of people with dementia in the world and where community based dementia care services are much needed.

METHODS

A cross-sectional survey was conducted. 450 health professionals were recruited into the study using random sampling from community health service centres in Changsha, China. Their knowledge, attitudes and care approach were assessed utilising the Chinese version of the Alzheimer's Disease Knowledge Scale, Dementia Care Attitude Scale and Approach to Advanced Dementia Care Questionnaire respectively.

RESULTS

A total of 390 participants returned the questionnaire (response rate 87%). Age, education, professional group and care experience were associated with knowledge scores, and overall dementia knowledge was poor. Attitudes were generally positive and influenced by age, professional group, gender and care experience. The experience of caring for people with dementia was positively associated with a person-centred care approach, although the participants tended not to use a person-centred care approach. A statistically significant association was found between knowledge and attitudes (r = 0.379, P < 0.001), and between attitudes and care approach (r = 0.143, P < 0.001). However, dementia knowledge has no relationship with a person-centred approach.

CONCLUSIONS

Community health professionals showed generally positive attitudes towards people with dementia. However, they demonstrated poor dementia knowledge and tended not to use a person-centred care approach. The results suggest that a multifaceted approach consisting of educational interventions for community health professionals, and policy and resource development to meet the demand for community dementia care services, is urgently needed in China.

Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial

BACKGROUND

The lack of dementia education programmes for health professionals in primary care is one of the major factors contributing to the unmet demand for dementia care services.

AIMS

To determine the effectiveness of a nurse-led dementia education and knowledge translation programme for health professionals in primary care; participants' satisfaction with the programme; and to understand participants' perceptions of and experiences in the programme.

DESIGN

A cluster randomized controlled trial was used as the main methodology to evaluate health professionals' knowledge, attitudes and care approach. Focus groups were used at the end of the project to understand health professionals' perceptions of and experiences in the programme.

PARTICIPANTS AND SETTINGS

Fourteen community health service centres in a province in China participated in the study. Seven centres were randomly assigned to the intervention or control group respectively and 85 health professionals in each group completed the programme.

METHODS

A train-the-trainer model was used to implement a dementia education and knowledge translation programme. Outcome variables were measured at baseline, on the completion of the programme and at 3-month follow-up. A mixed effect linear regression model was applied to compare the significant differences of outcome measures over time between the two groups. Focus groups were guided by four semi-structured questions and analysed using content analysis.

RESULTS

Findings revealed significant effects of the education and knowledge translation programme on participants' knowledge, attitudes and a person-centred care approach. Focus groups confirmed that the programme had a positive impact on dementia care practice.

CONCLUSIONS

A dementia education and knowledge translation programme for health professionals in primary care has positive effects on their knowledge, attitudes, care approach and care practice.