Relationship between Knowledge and Types of Attitudes towards People Living with Dementia

Biomedical knowledge of dementia is not enough to counteract its stigma - quantitative research among future medical and social care staff in Poland

OBJECTIVES

The aim is to assess the level of stigmatization and knowledge of dementia among university students of medical, rehabilitation and social faculties in Poland. Possible correlates of these concepts and group differences are also investigated.

METHODS

We applied quantitative methods using an online questionnaire comprising sociodemographics, the Alzheimer's Disease Knowledge Scale, a vignette of a person with dementia and the modified Family Stigma in Alzheimer's Disease Scale.

RESULTS

Students had low levels of dementia knowledge and moderate levels of stigma. Medical science students had significantly better knowledge than the other groups but did not differ in their level of stigma. Relationships between the main variables were complex. Emotional and cognitive stigmatizing attributions were negatively correlated with knowledge about communication and behaviors of people with dementia. Better knowledge on causes and characteristics, as well as on risks and health promotion of the disease also triggered fewer negative attributions toward people with dementia.

CONCLUSIONS

If health-related programs are to be effective, they should provide opportunities for the acquisition of relevant knowledge and skills that also address the stigmatization of people living with dementia. Well-established biomedical knowledge on dementia must be supplemented with a person-centered approach and proper communication skills.

The Mediating Role of Attitudes Towards Dementia on the Relationship Between Dementia Knowledge and Behaviors Towards Persons with Dementia: A Cross-Sectional Study

Purpose

To examine the mediating effect of attitudes towards dementia on the relationship between dementia knowledge and behaviors towards persons with dementia.

Participants and Methods

A cross-sectional survey was conducted with 313 adults (age ≤ 20 years). Participants were recruited using non-probability convenience sampling from medical clinics, community centers, and supermarkets located in the Wanhua District of Taipei City. Data were collected with the following self-report questionnaires: a demographic survey, validated instruments for dementia knowledge and attitudes towards dementia (assessed using the Alzheimer's Disease Knowledge Scale and the Approaches to Dementia Questionnaire, respectively), and a researcher-developed survey on unfriendly behaviors towards persons with dementia.

Results

Pearson's correlation and multiple linear regression analysis indicated that higher scores for dementia knowledge and more positive attitudes about dementia were significantly associated with lower levels of unfriendly behaviors towards persons living with dementia. Mediation analysis using a robust bootstrap test with 5000 samples indicated that attitudes toward dementia had a partial mediating effect on the relationship between dementia knowledge and unfriendly behaviors.

Conclusion

Our findings suggest that increasing public awareness and knowledge about dementia could help the general population develop better attitudes towards dementia, which could subsequently help improve behaviors towards persons living with dementia.

Public Awareness, Knowledge, and Attitude Toward Alzheimer's Disease in Makkah, Saudi Arabia

BACKGROUND

Alzheimer's disease is a neurodegenerative disease that slowly deteriorates cognitive function over time. This condition disables the geriatric population worldwide. Knowing its symptoms and presentation could help the general population seek medical attention early.

OBJECTIVE

This study aims to assess the level of awareness, knowledge, and attitude towards Alzheimer's disease among the general population in Makkah City.

METHODS

This cross-sectional study employed an online questionnaire distributed randomly in Makkah, Saudi Arabia. A sociodemographic and attitude panel is included under each section of the questionnaire, as well as a knowledge panel based on the Alzheimer's Disease Knowledge Scale (ADKS). The knowledge and awareness level regarding Alzheimer's disease was determined by adding up discrete scores for each correct knowledge item. A participant's awareness level was categorized as poor if their score was less than 60%. Participants whose scores were 60% or higher were considered to have a high level of awareness Results: A total of 545 participants were investigated; 316 (58%) were females. A range of ages was represented among the participants, from 18 to over 60. Of the study respondents, 68 (12.5%) had an overall good awareness and knowledge of Alzheimer's disease and its management while 477 (87.5%) had a poor knowledge level. Among divorced/widowed participants, 16.2% had an overall good knowledge level of the disease compared to 8.3% of married respondents with recorded statistical significance (P=.049). Also, 20.4% of those with relatives diagnosed with Alzheimer's disease had good knowledge of the disease versus 10.7% of others without (P=.009).

CONCLUSION

According to the results, there is a lack of awareness and knowledge of Alzheimer's disease. This study suggests increasing public awareness and knowledge of Alzheimer's disease through campaigns and public education so that the disease is detected earlier.

Relationship Between Dementia Knowledge and Occupational Strain Among Staff of Residential Facilities for Older Adults: A Cross-sectional Survey

Working with people living with dementia in residential facilities for older adults can be challenging, and this is exacerbated when staff have a limited understanding of dementia. However, the relationship between knowledge of dementia and strain in caring for people with dementia among residential facility staff is unclear. This cross-sectional study investigated the relationship between dementia knowledge and strain in caring for people with dementia. A questionnaire containing the Dementia Knowledge Assessment and Strain in Dementia Care Scales was administered in 2017 and 2019 to 141 staff in three southern Australian residential facilities for older adults. Bivariate and hierarchical regression analysis examined inter-scale relationships and the power of dementia strain to explain knowledge variance. It was found that staff had substantial gaps in dementia knowledge (mean score 32/50) and low strain in dementia care (mean score 4/16). A positive relationship was found between higher dementia knowledge and greater strain in dementia care (rs = 0.319, p < .001), particularly with feeling that residents are not receiving appropriate care from colleagues (Factor 1 Frustrated Empathy; rs = 0.392, p < .001). Frustrated Empathy explained a significant amount of variance in dementia knowledge beyond demographic variables. The findings suggest that more comprehensive dementia knowledge is associated with higher strain in care of people with dementia, particularly in the context of perceived lapses in the quality of care provided by colleagues. Arguably, organisational-wide dementia education to address identified gaps should be supported by facilitating staff enaction of their knowledge to improve care.

Developing a shortened version of the dementia knowledge assessment scale (DKAS-TC) with a sample in Taiwan: an item response theory approach

BACKGROUND

The 25-item Dementia Knowledge Assessment Scale (DKAS2) is a widely used tool for measuring knowledge of dementia. To increase the applicability of the Chinese-language version of the tool (DKAS-TC) for the general public, this study aimed to develop a shortened version using the item response theory (IRT) approach.

METHODS

A total of 401 participants voluntarily completed a Chinese-language version of the DKAS2 questionnaire (DKAS-TC) at the start of dementia awareness training courses in 2020 and 2021. The four Rasch family models were used to analyze the dimensionality of the shortened scale (the DKAS-s) and to confirm its accuracy in measuring dementia knowledge.

RESULTS

The results justified supported the use of a dichotomous response scale for responding to the DKAS-s and demonstrated good fit of the data to a Rasch model with the four dimensions of "Causes and Characteristics", "Communication and Engagement", "Care Needs", and "Risks and Health Promotion". Moreover, we shortened the DKAS-TC by selecting items that had both above-average discriminative ability and above-average information. The DKAS-s retained 64.13% of the information contained in the DKAS-TC, resulting in a 16-item scale which retained four items in each of the original four dimensions. The DKAS-s also correlated highly (≥0.95) with the DKAS-TC and exhibited a sizeable range of difficulty of dementia knowledge.

CONCLUSIONS

The DKAS-s is expected to be more efficient in field settings while retaining an acceptable level of psychometric properties when used as a survey instrument to measure the general public's knowledge of dementia.

Attitudes toward Alzheimer's disease and dementia caregiving and health outcomes: Racial and ethnic differences

This study aimed to explore racial/ethnic differences in the attitudes toward Alzheimer's Disease (AD) and dementia caregiving among midlife women who were family caregivers of persons living with AD (MWPLAD) in the U.S. and examine the associations of the attitudes to their health outcomes. This was a cross-sectional online survey study among 172 MWPLAD. The instruments included: the Attitude toward AD and Related Dementias Scale, the Questions on Attitudes toward AD Caregiving, the Social Readjustment Rating Scale, the EQ-5D-5L and the Midlife Women's Symptom Index. Multiple linear regression analyses were conducted. There were significant racial/ethnic differences in caregivers' attitudes toward dementia caregiving, health-related quality of life, and total severity scores of symptoms (p < .01). Controlling for covariates including race/ethnicity, caregivers' positive attitudes toward dementia caregiving were significantly associated with their health outcomes (p ≤ .05). Interventions for MWPLAD need to consider racial/ethnical differences in their attitudes toward dementia caregiving.

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.

The Attitudes of Nurses in the Hospital toward Vulnerable People

Background: Vulnerable people are at higher risk for ill health and often experience discrimination in health services. Persons with disabilities, People with Dementia (PWD), and People with HIV/AIDS (PLWHA) are some groups of people with vulnerabilities who often need hospital care. Nurses are the largest group of health personnel and frequently meet with these patients so that the attitude of nurses can have a consequence on the quality of health care. Research Objectives: To identify nurses' attitudes towards vulnerable people and factors related to their attitudes. Methods: This quantitative research used a cross-sectional design. The research subjects were 386 nurses in the main public Dr. Sardjito hospital selected using a convenience sampling technique. Data were collected in January-February 2021 with a Google Form. Researchers used a demographic data questionnaire, an attitude questionnaire (Attitude Toward Disabled Person Scale Form O, Dementia Attitude Scale, and AIDS Attitude Scale), and a knowledge questionnaire (Self-Administered Questionnaire about Knowledge), Dementia Knowledge Assessment Scale, and HIV-Knowledge Questionnaire-18). Data were analyzed using non-parametric statistical tests, specifically the Spearman rank, Mann-Whitney, and Kruskal-Wallis tests. Results: The score of nurses' attitudes towards persons with disabilities was 54.00 out of 120; the score of nurses' attitudes to PWD was 102.00 out of 140; and the score of nurses' attitudes toward PLWHA was -0.65 out of +5. Knowledge, history of interaction, and experience in caring have a significant effect on nurses' attitudes towards vulnerable people (p value <0.05). The education level only affects the attitudes of nurses towards persons with disabilities (p value = 0.042). Family history only affects nurses' attitudes to PWD (p value = 0.013). Age and special education/training only affect the attitudes of nurses on PWD and PLWHA (p value <0.05). Conclusion: Nurses tend to present positive attitudes toward PWD, but nurses are inclined to show negative attitudes against people with disabilities and PLWHA. Knowledge, caring experience, and interaction are confirmed to have an effect on nurses' attitudes with the result that programs to increase knowledge and experience of nurses towards vulnerable groups are recommended for this group. Keywords: Attitude, Dementia, Disability, HIV/AIDS, Knowledge, Nurse.

A Cross-National Study of Dementia Stigma Among the General Public in Israel and Australia

BACKGROUND

Despite the increasing amount of research on dementia stigma, there is a dearth of cross-national studies conducted on this subject. This is surprising since the experience of stigma is closely associated to socio-cultural aspects.

OBJECTIVE

The present study intended to expand knowledge about the impact of culture on dementia stigma by comparing the level and correlates of stigmatic beliefs about dementia among the general public in Israel and Australia.

METHODS

A cross-sectional study using an online survey was conducted with two age-matched samples: 447 adults in Israel and 290 adults in Australia.

RESULTS

Overall, dementia stigma was moderate in both countries. However, the level of dementia stigma was significantly higher in Australia than in Israel. Lower levels of subjective knowledge and higher levels of ageism were associated with increased levels of stigmatic beliefs in both countries. Gender was a significant correlate of dementia stigma, with male participants reporting higher levels of public stigma than women, although this gender difference was mainly driven by the Australian sample.

CONCLUSION

Our findings indicate that providing knowledge and decreasing ageist attitudes should be key considerations in dementia awareness and stigma reduction campaigns despite the cultural context. In addition, developing gender-specific messages should be considered as a way of improving the effects of such campaigns.

Nursing Staff's Knowledge and Attitudes towards Dementia in an Indian Nursing Home: A Qualitative Interview Study

Background

Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude.

Aim

To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India.

Method

An explorative and descriptive qualitative design was used. Two semi-structured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services.

Findings

The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia − a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way.

Conclusion

The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.

Laypersons' Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer's Disease Matter?

PURPOSE

The current study aimed 1) to assess laypersons' priority-setting preferences for allocating ventilators to COVID-19 patients with and without AD while differentiating between a young and an old person with the disease, and 2) to examine the factors associated with these preferences.

METHODS

A cross-sectional online survey was conducted among a sample of 309 Israeli Jewish persons aged 40 and above.

RESULTS

Overall, almost three quarters (71%) of the participants chose the 80-year-old patient with a diagnosis of AD to be the last to be provided with a ventilator. The preferences of the remaining quarter were divided between the 80-year-old person who was cognitively intact and the 55-year-old person with AD. Education and subjective knowledge about AD were significantly associated with participants' preferences.

CONCLUSION

Our results suggest that cognitive status might not be a strong discriminating factor for laypersons' preferences for allocating ventilators during the COVID-19 pandemic.

The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors

This study was to evaluate the utilization of long-term care service resources by caregivers of patients with dementia (PWD) and to determine affecting factors. In this cross-sectional study, a total of 100 dyads were enrolled and caregivers responded to the questionnaires. We found 40% of caregivers not using any care resources. Between those caregivers using and not-using care resources, we found differences (p < 0.05) in their health status and living conditions; the difference (p < 0.05) was also found in patients’ behavior and psychological symptoms of dementia (BPSD). The frequency of BPSD (OR = 1.045, p = 0.016, 95% CI = 1.001–1.083) and the living conditions (OR = 3.519, p = 0.007, 95% CI = 1.414–8.759) were related to their use of care resources. Particular BPSDs, such as anxiety or restlessness, throwaway food, aggressive behavior, tearing of clothes, and sexual harassment of patients were related to the caregivers’ use of care resources (p < 0.01). Health professionals have to evaluate the patients’ BPSD and identify the caregivers’ essential needs. Individualized medical care and BPSD-related care resources should be provided for patients and caregivers for taking off their care burden and improving patient care.