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Paul P, Mahfoud ZR, Malik RA, Kaul R, Muffuh Navti P, Al-Sheikhly D, Chaari A. Knowledge, Awareness, and Attitude of Healthcare Stakeholders on Alzheimer's Disease and Dementia in Qatar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4535. [PMID: 36901551 PMCID: PMC10002196 DOI: 10.3390/ijerph20054535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Dementia is characterized by progressive cognitive decline, memory impairment, and disability. Alzheimer's disease (AD) accounts for 60-70% of cases, followed by vascular and mixed dementia. Qatar and the Middle East are at increased risk owing to aging populations and high prevalence of vascular risk factors. Appropriate levels of knowledge, attitudes, and awareness amongst health care professionals (HCPs) are the need of the hour, but literature indicates that these proficiencies may be inadequate, outdated, or markedly heterogenous. In addition to a review of published quantitative surveys investigating similar questions in the Middle East, a pilot cross-sectional online needs-assessment survey was undertaken to gauge these parameters of dementia and AD among healthcare stakeholders in Qatar between 19 April and 16 May 2022. Overall, 229 responses were recorded between physicians (21%), nurses (21%), and medical students (25%), with two-thirds from Qatar. Over half the respondents reported that >10% of their patients were elderly (>60 years). Over 25% reported having contact with >50 patients with dementia or neurodegenerative disease annually. Over 70% had not undertake related education/training in the last 2 years. The knowledge of HCPs regarding dementia and AD was moderate (mean score of 5.3 ± 1.5 out of 7) and their awareness of recent advances in basic disease pathophysiology was lacking. Differences existed across professions and location of respondents. Our findings lay the groundwork for a call-to-action for healthcare institutions to improve dementia care within Qatar and the Middle East region.
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Affiliation(s)
| | - Ziyad Riyad Mahfoud
- Division of Medical Education, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, NY 10065, New York, USA
| | - Rayaz A. Malik
- Division of Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9NT, UK
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK
| | | | - Phyllis Muffuh Navti
- Division of Continuing Professional Development, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
| | - Deema Al-Sheikhly
- Division of Medical Education, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
- Division of Continuing Professional Development, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
| | - Ali Chaari
- Premedical Division, Weill Cornell Medicine-Qatar, Doha 24144, Qatar
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Lu Y, Liu C, Fawkes S, Wang Z, Yu D. Perceived extrinsic barriers hinder community detection and management of mild cognitive impairment: a cross-sectional study of general practitioners in Shanghai, China. BMC Geriatr 2022; 22:497. [PMID: 35681136 PMCID: PMC9185915 DOI: 10.1186/s12877-022-03175-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by intrinsic and extrinsic factors. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes, and intended practice of GPs in community detection and management of MCI. Methods A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effect of training on the association between MCI knowledge and practice scores, as well as the moderation effect of past experience on the association between MCI knowledge and extrinsic barriers, were tested through structural equation modelling (SEM) with a partial least square (PLS) approach. Results The study participants reported an average barrier score of 65.23 (SD = 13.98), 58.34 (SD = 16.95), and 60.37 (SD = 16.99) for patient engagement, working environment, and system context, respectively. Although knowledge had both direct and indirect (through attitudes) effects on intended practice, perceived extrinsic barriers negatively mediated (β = − 0.012, p = 0.025) the association between knowledge and practice. Training moderated the effect of knowledge on practice (β = − 0.066, p = 0.014). Conclusions Perceived extrinsic barriers have a detrimental effect on the translation of knowledge into practice for community detection and management of MCI. The effect of training on practice declines when knowledge scores become higher. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03175-4.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.,Tongji University School of Medicine, Shanghai, 200092, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Sally Fawkes
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China. .,Tongji University School of Medicine, Shanghai, 200092, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.
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Lu Y, Liu C, Fawkes S, Wang Z, Yu D. Knowledge, attitudes, and practice of general practitioners toward community detection and management of mild cognitive impairment: a cross-sectional study in Shanghai, China. BMC PRIMARY CARE 2022; 23:114. [PMID: 35545764 PMCID: PMC9092880 DOI: 10.1186/s12875-022-01716-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/21/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China. METHODS An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and practice was tested using the PROCESS model 4 macro with 5000 bootstrap samples through linear regression modelling. RESULTS A total of 1253 GPs completed the questionnaire, with an average score of 54.51 ± 18.18, 57.31 ± 7.43, and 50.05 ± 19.80 for knowledge, attitudes, and practice, respectively. More than 12% of respondents scored zero in knowledge, 28.4% tended not to consider MCI as a disease, and 19.1% completely rejected MCI screening. Higher levels of knowledge were associated with more favourable attitudes toward community management of MCI (AOR = 1.974, p < 0.001). Higher compliance with practice guidelines was associated with both higher levels of knowledge (AOR = 1.426, p < 0.01) and more favourable attitudes (AOR = 2.095, p < 0.001). The association between knowledge and practice was partially mediated by attitudes (p < 0.001). Training was associated with higher levels of knowledge (AOR = 1.553, p < 0.01), while past experience in MCI management was associated with more favourable attitudes (AOR = 1.582, p < 0.05) and higher compliance with practice guidelines (AOR = 3.034, p < 0.001). MCI screening qualification was associated with higher compliance with practice guidelines (AOR = 2.162, p < 0.05), but less favourable attitudes (AOR = 0.452, p < 0.05). CONCLUSION The MCI knowledge of GPs in Shanghai is low, and is associated with less favourable attitudes toward MCI management and low compliance with practice guidelines. Attitudes mediate the association between knowledge and practice. Training is a significant predictor of knowledge. Further studies are needed to better understand how the attitudes of GPs in Shanghai are shaped by the environments in which they live and work.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Tongji University School of Medicine, Shanghai, 200092, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Sally Fawkes
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.
- Tongji University School of Medicine, Shanghai, 200092, China.
- Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.
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Hallam B, Rees J, Petersen I, Cooper C, Avgerinou C, Walters K. How are people with mild cognitive impairment or subjective memory complaints managed in primary care? A systematic review. Fam Pract 2021; 38:669-683. [PMID: 33907811 PMCID: PMC8604277 DOI: 10.1093/fampra/cmab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary care is typically the first point of contact in the health care system for people raising concerns about their memory. However, there is still a lack of high-quality evidence and understanding about how primary care professionals (PCPs) currently manage people at higher risk of developing dementia. OBJECTIVES To systematically review management strategies provided by PCPs to reduce cognitive decline in people with mild cognitive impairment and subjective memory complaints. METHOD A systematic search for studies was conducted in December 2019 across five databases (EMBASE, Medline, PsycInfo, CINAHL and Web of Science). Methodological quality of included studies was independently assessed by two authors using the Mixed Methods Appraisal Tool. RESULTS An initial 11 719 were found, 7250 were screened and 9 studies were included in the review. Most studies were self-reported behaviour surveys. For non-pharmacological strategies, the most frequent advice PCPs provided was to increase physical activity, cognitive stimulation, diet and social stimulation. For pharmacological strategies, PCPs would most frequently not prescribe any treatment. If PCPs did prescribe, the most frequent prescriptions targeted vascular risk factors to reduce the risk of further cognitive decline. CONCLUSION PCPs reported that they are much more likely to provide non-pharmacological strategies than pharmacological strategies in line with guidelines on preventing the onset of dementia. However, the quality of evidence within the included studies is low and relies on subjective self-reported behaviours. Observational research is needed to provide an accurate reflection of how people with memory problems are managed in primary care.
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Affiliation(s)
- Brendan Hallam
- UCL Research Department of Primary Care and Population Health, London, UK
| | - Jessica Rees
- Division of Psychiatry, University College London, London, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | | | - Kate Walters
- UCL Research Department of Primary Care and Population Health, London, UK
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Godbee K, Gunn J, Lautenschlager NT, Curran E, Palmer VJ. Implementing dementia risk reduction in primary care: a preliminary conceptual model based on a scoping review of practitioners' views. Prim Health Care Res Dev 2019; 20:e140. [PMID: 31640836 PMCID: PMC6842648 DOI: 10.1017/s1463423619000744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Primary care practitioners (PCPs) do not routinely promote dementia risk reduction. The purpose of this study was to map the published literature on the views of PCPs about dementia risk reduction, in order to identify implementation constructs and strategies crucial to the development of an implementation intervention to support dementia risk reduction in primary care. We undertook a scoping review of the PCPs' views about promoting brain health for reducing dementia risk. We searched MEDLINE, PsycINFO, CINAHL, and Embase for English-language articles published between 1995 and December 2017. We then applied the Consolidated Framework for Implementation Research (CFIR) and matched Expert Recommendations for Implementing Change to the scoping review findings in order to develop a preliminary implementation model. Eight articles reported views of PCPs about dementia prevention. Study findings were mapped to 5 of the 39 CFIR constructs: (i) knowledge and beliefs about dementia risk reduction, (ii) evidence strength and quality, (iii) relative priority, (iv) available resources, and (v) external policy and incentives. The findings suggest implementation strategies to consider in our preliminary model include (i) educational meetings, (ii) identifying and preparing champions, (iii) conducting local consensus discussions, (iv) altering incentive structures, and (v) capturing and sharing local knowledge. There have been few studies about the views of PCPs about dementia risk reduction. Implementation in the primary care setting is fundamental to early identification of risk and supporting preventive practices, but it needs to focus on more than just education for PCPs. We need more up-to-date and in-depth data on the views of PCPs about dementia risk reduction and context-specific analyses of implementation needs. Further research into effective primary care interventions to reduce dementia risk is expected to support implementation efforts.
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Affiliation(s)
- Kali Godbee
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Jane Gunn
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Victoria J Palmer
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia
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Cohen-Mansfield J. Who is informed and who uninformed? Addressing the legal barriers to progress in dementia research and care. Isr J Health Policy Res 2019; 8:17. [PMID: 30782212 PMCID: PMC6381665 DOI: 10.1186/s13584-018-0279-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/20/2018] [Indexed: 02/01/2023] Open
Abstract
Conduct of research is an essential tool for the evaluation and improvement of health services. In Israel, research on persons with dementia is very limited, with the largest portion of such research involving a few surveys and examining risk factors for dementia. Very few studies describe clinical research, and those that do either include participants at early stages of dementia, or rely completely on caregivers' perceptions and experiences, often without reference to any individual with dementia. This dearth of research is due, to a substantial extent, to Ministry of Health regulations which do not permit family proxy consent for research involving persons with dementia. Alternative models for regulation of consent for research exist in other countries, including the U.S., and these allow for proxy consent under certain conditions. This paper presents such a model and its underlying ethical principles. It contends that the current state of affairs, which stands in the way of clinical research concerning persons with advanced dementia, is contrary to the interests of such persons, their caregivers, and Israeli society. Therefore, this paper calls for a change in the present regulations and/or law in the cause of advancing knowledge and improving care for persons with dementia.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, P.O.B. 39040, Ramat Aviv Tel-Aviv, Tel-Aviv, Israel.
- Minerva Center for the Interdisciplinary Study of End of Life, Tel Aviv University, P.O.B. 39040, Ramat Aviv Tel-Aviv, Tel-Aviv, Israel.
- The Herczeg Institute on Aging, Tel-Aviv University, P.O.B. 39040, Ramat Aviv Tel-Aviv, Tel-Aviv, Israel.
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Amano T, Yamanaka K, Carpenter BD. Reliability and validity of the Japanese version of the Alzheimer’s Disease Knowledge Scale. DEMENTIA 2016; 18:599-612. [DOI: 10.1177/1471301216685943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Werner P, Goldstein D, Karpas DS, Chan L, Lai C. Help-seeking for dementia: a systematic review of the literature. Alzheimer Dis Assoc Disord 2015; 28:299-310. [PMID: 25321607 DOI: 10.1097/wad.0000000000000065] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Help-seeking (HS) for dementia presents a great challenge, especially because a timely and appropriate HS process might be associated with better outcomes for the person with dementia, their caregivers, and society. A clear understanding of the HS concept and its measurement in the area of dementia might improve the effectiveness of the process. AIMS The aims of our systematic review were: (1) to systematically obtain and evaluate the relevant literature on HS and dementia; and (2) to summarize current research findings and draw conclusions for future research and clinical care in this area. METHOD A systematic review of the literature on HS and dementia was conducted up till June 2013. RESULTS From the 478 retrieved articles, 48 were included in the review. Conceptually, the studies examined professional and nonprofessional sources of help; showed preference for seeking help from close relatives followed by primary health caregivers; and identified inadequate knowledge and stigmatic beliefs as the main barriers to HS. The majority of the studies did not rely on a theoretical framework. CONCLUSIONS Although the body of literature in the area of HS and dementia is growing, several conceptual and methodological limitations still have to be resolved to advance knowledge in the area.
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Affiliation(s)
- Perla Werner
- *Department of Community Mental Health †Center for Research and Study of Aging, University of Haifa, Haifa, Israel ‡Ho Cheung Shuk Yuen Charitable Foundation, Hong Kong §Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Werner P, Heinik J, Giveon S, Segel-Karpas D, Kitai E. Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public. Clin Interv Aging 2014; 9:613-9. [PMID: 24748779 PMCID: PMC3986294 DOI: 10.2147/cia.s60248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer’s disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management. Objectives To compare help-seeking preferences of family physicians and the lay public in the area of MCI. Methods A structured questionnaire was used to collect data from 197 family physicians (self-administered) and 517 persons aged 45 and over from the lay public (face to face). Information regarding familiarity with MCI and help-seeking preferences was assessed. Results The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help. Discussion There were both similarities and differences between family physicians and the lay public in their preferences regarding help-seeking for a person with MCI. Most prominent is the physicians’ greater tendency to recommend professional sources of help-seeking. Conclusion Understanding of help-seeking preferences of both physicians and lay persons might help overcome barriers for establishing diagnosis, receiving care, and improving communication between doctors and patients.
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Affiliation(s)
- Perla Werner
- Center for the Research and Study of Aging, University of Haifa, Haifa, Israel
| | - Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Dikla Segel-Karpas
- Center for the Research and Study of Aging, University of Haifa, Haifa, Israel
| | - Eliezer Kitai
- Department of Family Medicine, Leumit Health Services, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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