The Impact of E-Learning Platforms on Dementia Knowledge Acquisition Among General Public: A Systematic Review.

Testing the sensitivity of two dementia knowledge instruments in dementia workforce education

BackgroundResearch on Alzheimer’s disease (AD) and related dementias is increasingly focused on prevention and identification of risk factors. In order to effectively disseminate knowledge about dementia risk, there is need to understand gaps in dementia knowledge (Carpenter et al., 2011, Cations et al., 2018). For example, education level, among other factors, may be associated with reduced knowledge about AD, which could impact engagement in early prevention strategies (Ayalon & Arean, 2004). We explored dementia knowledge and demographic variables in a community‐based registry sample to inform approaches to psychoeducation and intervention.MethodWe administered surveys via REDCap to participants enrolled in an online registry. Surveys included measures of dementia knowledge (subset of 13 questions from the Dementia Knowledge Assessment Scale (DKAS)), personality (Ten‐Item Personality Inventory), and demographic variables. Response rate was 42%. Participants were 292 clinically normal adults (mean age=67.4 (range: 50‐87); 65% women; 98% non‐Hispanic or Latino; 94% Caucasian; 81% with a bachelor’s degree or higher).ResultMost participants (77%) reported knowing “some” to “a good amount” about dementia, learned primarily via family/friends (27%), doctors (21%), and the internet (22%). Mean dementia knowledge on the DKAS was 14.4 (range=1‐26, out of 26 possible points). Dementia knowledge was weakly associated with age (r=‐.12, p=.045), with younger individuals showing higher knowledge. Controlling for age, self‐reported dementia knowledge correlated with objective dementia knowledge on the DKAS (r=.46, p<.01). Also controlling for age, dementia knowledge was higher among individuals with more education (F(1, 287)=8.6, p=.004) and among women (F(1, 285)=5.9, p=.016). Dementia knowledge was not associated with aspects of personality (ps>.08).ConclusionDementia knowledge was higher among younger individuals, as well as those with more education and among women, but did not relate to personality. Self‐reported dementia knowledge correlated with objective dementia knowledge, suggesting that participants accurately judged their own knowledge. Future work should examine these questions within a more diverse registry sample. Findings underscore the value of registries to examine dementia knowledge and inform dissemination and intervention strategies. By increasing psychoeducation about dementia among adults with lower baseline knowledge, we may facilitate early engagement in preventative strategies to reduce dementia risk.

BackgroundDementia is a life-limiting condition that is increasing in global prevalence in line with population ageing. In this context, it is necessary to accurately measure dementia knowledge across a spectrum of health professional and lay populations with the aim of informing targeted educational interventions and improving literacy, care, and support.Building on prior exploratory analysis, which informed the development of the preliminarily valid and reliable version of the Dementia Knowledge Assessment Scale (DKAS), a Confirmatory Factor Analysis (CFA) was performed to affirm construct validity and proposed subscales to further increase the measure’s utility for academics and educators.MethodsA large, de novo sample of 3649 volunteer respondents to a dementia-related online course was recruited to evaluate the performance of the DKAS and its proposed subscales. Respondents represented diverse cohorts, including health professionals, students, and members of the general public. Analyses included CFA (using structural equation modelling), measures of internal consistency (α), and non-parametric tests of subscale correlation (Spearman Correlation) and score differences between cohorts (Kruskal-Wallis one-way analysis of variance).ResultsFindings of the CFA supported a 25-item, four-factor model for the DKAS with two items removed due to poor performance and one item moved between factors. The resultant model exhibited good reliability (α = .85; ωh = .87; overall scale), with acceptable subscale internal consistency (α ≥ .65; subscales). Subscales showed acceptable correlation without any indication of redundancy. Finally, total and DKAS subscale scores showed good discrimination between cohorts of respondents who would be anticipated to hold different levels of knowledge on the basis of education or experience related to dementia.ConclusionThe DKAS has been confirmed as a reliable and valid measure of dementia knowledge for diverse populations that is capable of elucidating knowledge characteristics across four coherent domains: 1) Causes and Characteristics, 2) Communication and Behaviour, 3) Care Considerations, and 4) Risks and Health Promotion. Importantly, the four confirmed subscales clearly distinguish between groups who might be expected to hold differing levels of knowledge about dementia, allowing for a fine-grained level of detail to be established when evaluating baseline understanding or knowledge change associated with educational intervention.

BackgroundDementia is a life limiting disease following a progressive trajectory. As carers often become key decision makers, their knowledge of dementia will have health implications for the person living with dementia as well as carer’s psychological wellbeing.AimTo explore how sociodemographic factors, health literacy and dementia experience influence family carers knowledge about dementia.MethodIn this cross-sectional, mixed methods study, we interviewed 150 family carers and assessed their dementia knowledge using the Dementia Knowledge Assessment Scale (DKAS). Linear regression analyses were used to examine whether health literacy, previous experiences of dementia, support group attendance and sociodemographic characteristics predicted knowledge. Sixteen carers also completed qualitative interviews which explored unmet information needs. Transcripts and field notes were thematically analysed.ResultsMost participants were partners (47%) or adult children (48%) and cared for someone with severe (32%) or moderate (43%) dementia. Mean DKAS scores were 34.8/50 (SD = 7.0, range = 17–48) reflecting 8/25 incorrect answers. Backwards elimination regression found greater dementia knowledge was associated with greater health literacy for appraising information (coef 3.48, 95% CI (1.38, 5.58); p = 0.001) and more years of education (coef 0.39, 95% CI (0.12, 0.65); p = 0.004). Although not significant, knowledge was slightly lower in those who attended a support group, and a trend was found between ability to understand health information and knowledge. Only 39% accurately identified dementia as life shortening, indicating notable gaps in knowledge. Four qualitative themes were identified; arm yourself with information, ability to steer through information, other experience of dementia can be helpful and the importance of relationships with health care professionals.ConclusionsIn an information age, vast amounts of information are available, but this can bring difficulties. Carers with more years of education and higher health literacy knew more about dementia. Professionals should consider how carers with lower health literacy can be supported through provision of timely, relevant information.

BackgroundThe elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is compounded by the lack of assessment of preparedness of future healthcare workers to manage complications related to ageing i.e., dementia. Studies in countries with NDS demonstrated lack of dementia knowledge among medical undergraduates. Hence, this study aimed to assess the knowledge on dementia among final year medical undergraduates in Malaysia and its associated factors, using the Dementia Knowledge Assessment Scale (DKAS).MethodsThis cross-sectional study, employed multistage sampling method to recruit final year medical undergraduates from eleven selected public and private medical institutions across Malaysia. Online self-administered measures were delivered to final year medical undergraduates through representatives of medical students’ society after approval from Deanery and institutional ethics board of participating universities. The measure collected demographic information, previous dementia exposure (i.e., formal or informal) and the 25-item Likert scale DKAS. Bivariate analysis and linear regression were conducted to confirm factors influencing dementia knowledge components.ResultsA total of 464 respondents from 7 universities participated in this study. Overall dementia knowledge among respondents with and without exposure, was low, with average score of 29.60 ± 6.97 and 28.22 ± 6.98, respectively. DKAS subscales analysis revealed respondents scored highest in care consideration subscale (9.49 ± 2.37) and lowest in communication and behaviour subscale (4.38 ± 2.39). However, only causes and characteristic subscale recorded significantly higher knowledge score among respondents with previous exposure (7.88 ± 2.58) (p =0.015). Higher knowledge of dementia was associated with previous formal dementia education (p=0.037) and informal occupational/working experience in caring for dementia patients (p = 0.001). Informal occupational/working experience (B = 4.141, 95% CI 1.748–6.535, p = 0.001) had greater effect than formal education (i.e. lectures/workshops) (B = 1.393, 95% CI 0.086–2.700, p = 0.037) to influence respondents’ knowledge on dementia.ConclusionDementia knowledge among final year medical undergraduates is low. To improve dementia knowledge, Malaysian medical curriculum should be reviewed to incorporate formal education and informal occupational/working experience, as early as in undergraduate training to help prepare future healthcare providers to recognise dementia among ageing Malaysians.

BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

Purpose Community health physicians and nurses are pivotal in the prevention, detection, and management of dementia, particularly as its prevalence continues to rise globally. This study aims to assess community health physicians’ and nurses’ dementia knowledge and attitudes, as well as the associated factors. Design A cross-sectional study. Methods A survey was conducted with 146 participants, including 103 nurses and 43 physicians, . The research tools were the demographic characteristics form, dementia knowledge assessment scale (DKAS), and dementia attitudes scale (DAS). The data were analyzed using descriptive statistics and multiple regression analysis. Findings Mean score on the DKAS was 16.53 ± 6.24 (min: 0 point, max: 30 points) out of 34 and DAS was 96.23 ± 15.72 (min: 12 points, max: 120 points) out of 140. The total score of DKAS was positively predicted by being a physician, having prior education about dementia, and having experience with caring for people with dementia (PwD). These variables accounted for 35.4% of the total variance of DKAS (F: 8.292, R2 : 0.354, p < 0.001). Age and total scores of DKAS predicted the total scores of DAS. These variables accounted for 25.2% of the total variance of DAS (F: 4.553, R2 : 0.252, p < 0.001). Conclusions While community health physicians and nurses lack comprehensive knowledge about dementia, their positive attitudes present an opportunity for improvement. Clinical evidence It is crucial to foster community health professionals’ dementia knowledge, as well as more positive attitudes toward PwD, in order to enhance the quality of care provided in primary care settings.

Background:Assessing dementia knowledge is critical for developing and improving effective interventions. There are many different tools to assess dementia knowledge, but only one has been validated in German so far.Objective:To validate two tools for assessing dementia knowledge – the Dementia Knowledge Assessment Scale (DKAS-D) and the Knowledge in Dementia Scale (KIDE-D) for the German general population – and compare their psychometric properties with the Dementia Knowledge Assessment Tool 2 (DKAT2-D).Methods:A convenience sample of 272 participants completed online surveys. Analyses included internal consistency, structural validity, construct validity through the known-groups method, retest-reliability with a subgroup of n = 88, and floor and ceiling effects. This study used the STROBE checklist.Results:Internal consistency was acceptable for DKAT2-D (α= 0.780), very good for DKAS-D (α= 0.873), and poor for KIDE-D (α= 0.506). Construct validity was confirmed for all questionnaires. Retest-reliability was good for DKAT2-D (0.886; 0.825–0.926) and KIDE-D (0.813; 0.714–0.878), while it was great for DKAS-D (0.928; 0.891–0.953). Trends toward ceiling effects were observed for DKAT2-D and KIDE-D but not for DKAS-D. The principal component analysis did not reveal a coherent structure for DKAT2-D or KIDE-D, while the confirmatory factor analysis proposed the removal of 5 items for DKAS-D, resulting in the shortened DKAS20-D, which had nearly identical properties.Conclusion:Both DKAS-D and its shortened version, DKAS20-D, are reliable instruments for evaluating programs intended for the general population, as they were found to be convincing in all aspects.

Alzheimer's disease and other dementias threatens the health and well-being of older Latino adults and their caregivers. Latinos are affected at one and one-half times the rate of White Caucasians. Two-thirds of all dementia family caregivers are women. Dementia caregivers have higher-than-average rates of anxiety and depression. For this reason, educational workshops were developed to promote brain health among Latinas and to teach family caregivers stress-reducing activities, including journaling and doodling. This study aimed to determine baseline dementia and brain health knowledge among Latinas and dementia caregivers, to assess the perceived stress levels of caregivers, and to evaluate if Latinos perceived educational comics as a useful health literacy tool. A series of bilingual one-hour journaling and doodling workshops for family caregivers and one-hour brain health workshops for Latinas were conducted throughout El Paso County, Texas. Educational comic booklets illustrating brain health strategies and caregiver self-care activities were presented. In this mixed-methods pilot study, mean scores were obtained on the Dementia Knowledge Assessment Scale and Perceived Stress Scale among participants. A thematic analysis was conducted on data gathered through focus groups. Dementia knowledge among Latina women and Latino dementia caregivers, and stress levels among the Latino dementia caregivers (Cohort 1-Latino caregivers, n=43; Cohort 2-Latina women, n=114) were assessed. Baseline Dementia Knowledge Assessment Survey (DKAS) scores revealed knowledge gaps in both cohorts (Cohort 1: 25.05 ± 7.66; Cohort 2: 18.39 ± 9.57/50 points), while Perceived Stress Scale (PSS-10) scores in Cohort 1 indicated moderate stress (18.48 ± 5.37). Qualitative analysis revealed themes of enhanced relatability to comic storylines and characters and perceived enhanced understanding of brain health and dementia caregiving concepts. Educational comics can be efficacious as a health literacy tool for this population. This study supports further investigation into using educational comics to educate Latinos about improving brain health and expanding knowledge about Alzheimer's disease and other dementias to minimize the risk of disease development. This knowledge will support brain health practices and help those who live with Alzheimer's disease and other dementias develop stress-management strategies that enhance quality of life as the disease progresses.

Background As the global population ages, the prevalence of dementia increases, and the need for healthcare services increases. Healthcare workers should possess necessary knowledge and appropriate attitudes to care for dementia patients. Objectives There is a lack of studies of dementia knowledge and attitudes of healthcare workers in post-acute and intermediate care settings. Our study aims to address this gap and evaluate factors associated with dementia knowledge and attitudes in community hospitals. Methods Eligible healthcare workers from three community hospitals in Singapore were invited to fill in anonymous, self-administered questionnaires consisting of sociodemographic, work or training-related, assessment of self-competence factors together with Dementia Knowledge Assessment Scale (DKAS) and Approaches to Dementia Questionnaire (ADQ). Univariate analysis followed by multiple linear regression was conducted to determine the association between covariates with DKAS and ADQ scores. Results A total of 500 responses were obtained, giving a response rate of 60.2%. Mean DKAS and ADQ scores were 27.8 and 68.4 respectively. Multiple linear regression revealed better dementia knowledge was associated with occupation, highest education level, having attended a dementia training course, experience in caring for dementia patients and self-assessment of dementia knowledge. More positive attitudes towards dementia care were associated with occupation, time spent providing dementia care and self-assessment of attitude towards dementia care. Conclusion Healthcare workers in community hospitals exhibit positive attitudes towards providing dementia care but have a lower level of dementia knowledge compared to other study populations. Modifiable factors can be targeted to improve dementia knowledge and attitudes amongst healthcare workers.

Most massive open online courses (MOOCs) are offered in English, including those offered by non-English speaking universities. The study investigated an identified English language dementia MOOC’s accessibility and effectiveness in improving the dementia knowledge of non-native English speaker participants. A total of 6,389 enrolees (age range 18–82 years; 88.4% female) from 67 countries was included in analyses. Dementia knowledge was measured by the Dementia Knowledge Assessment Scale (DKAS) before and after the MOOC completion. Rates of completion were also compared. Native English speakers (n = 5,320) were older, more likely to be female, less likely to be employed, and had lower educational attainment than non-native English speakers (n = 1025). Native English speakers were also more likely to care for or have cared for a family member or friend living with dementia than were non-native English speakers. Native English speakers had a significantly higher DKAS score both pre- (M = 33.0, SD = 9.3) and post-MOOC (M = 44.2, SD = 5.5) than did non-native English speakers (M = 31.7, SD = 9.1; and M = 40.7, SD = 7.7 for pre- and post-MOOC, respectively). Non-native English speakers with low pre-MOOC dementia knowledge scores gained significantly less dementia knowledge following course completion than did native English speakers (p &lt;.001, adjusted for age and education). There was no significant difference between the two groups in their likelihood of completing the MOOC. Our findings suggest that non-native English speakers are motivated and able to complete the MOOC at similar rates to native English speakers, but the MOOC is a more effective educational intervention for native English speakers with low dementia knowledge.

Are tomorrow’s doctors prepared to prevent dementia? A cross-sectional study of Tasmanian medical students’ knowledge of dementia risk factors

Background:Measuring dementia knowledge can be a valuable tool for assessing the effectiveness of dementia awareness activities, identifying the potential benefits of dementia training programs, and breaking down common myths and stereotypes about dementia.Objective:To compare the psychometric properties of three widely used dementia knowledge tools, the Dementia Knowledge Assessment Tool 2 (DKAT2-G), the Dementia Knowledge Assessment Scale (DKAS-G), and the Knowledge in Dementia Scale (KIDE-G) in the Greek adult population.Methods:A convenience sample of 252 participants from the general population completed the survey online. Statistical analyses included Cronbach’s internal reliability, retest reliability, factor analysis, concurrent and construct validity, and floor and ceiling effects.Results:The DKAS-G had the most appropriate reliability levels (Cronbach’s alpha = 0.845; retest reliability = 0.921), whereas the DKAT2-G had satisfactory indexes (Cronbach’s α= 0.760; retest reliability = 0.630). The KIDE-G showed unsatisfactory reliability (Cronbach’s α= 0.419; retest reliability = 0.619). Construct validity was confirmed for all questionnaires, showing that all of them detected participants with pre-existing knowledge of dementia. Confirmatory factor analysis revealed a four-factor model for the DKAS-G and proposed the removal of 5 items. Floor and ceiling effects were found for the DKAT2-G and the KIDE-G, mainly among those who had previously participated in dementia training.Conclusions:The DKAS-G was found to have the highest levels of reliability and validity. The results prove that the DKAS-G meets the requirements for measuring dementia knowledge and evaluating dementia training programs in health professionals, caregivers, and the general population.

Objectives: The Dementia Knowledge Assessment Scale (DKAS) is a validated assessment tool to measure dementia knowledge. However, the factor structure of the DKAS has yet to be validated in Singapore. This study aims to investigate the DKAS factor structure amongst a sample of informal dementia caregivers in Singapore, as well as their sociodemographic correlates.Methods: A total of 282 participants were evaluated on their knowledge of dementia by an interviewer administering the DKAS. Confirmatory factor analysis (CFA) of factor models proposed by previous study yielded poor fit for our sample. Thus, an exploratory factor analysis (EFA) was conducted. Multiple linear regression was then performed to examine the sociodemographic correlates of DKAS factors.Results: EFA revealed a 23-item 3-factor model – ‘misconceptions about dementia’ (MD), ‘caregiving considerations towards dementia’ (CD) and ‘dementia symptoms’ (DS). Being a male caregiver and having lower educational levels were associated with poorer scores on MD and CD.Conclusion: A 3-factor model of the DKAS was found to be more appropriate with the sample in this study. Findings from this study suggests the need for more dementia literacy intervention for caregivers of dementia patients in Singapore, especially for male caregivers and those of lower education levels.

BackgroundPeople living with dementia increasingly prefer to live in their own home as their care needs progress. Home care workers (HCWs) are essential for supporting independent living, and need training and support on how to deliver evidence‐based and best‐practice dementia care. The home care workforce is diverse, and in Australia, the number of workers who identify as culturally and linguistically diverse (CALD) in 2020 represented 21% of the total direct‐care workforce.The Promoting Independence Through quality Care at Home (PITCH) project aims to improve outcomes for people living with dementia and their paid and family carers by co‐designing and testing an evidence‐based specialist training program for dementia care. A pragmatic stepped‐wedge cluster RCT is being conducted to evaluate the program. To date, 227 HCWs from seven home care providers across Australia have completed baseline measures.MethodHCWs completed the Strain in Dementia Care Scale (SDCS), Sense of Competence In Dementia Care – Staff (SCIDS), Dementia Attitudes Scale (DAS) and Dementia Knowledge Assessment Scale (DKAS). Associations between these measures was assessed using Pearson correlations. HCWs were grouped into CALD/non‐CALD groups based on self‐reported cultural background. ANOVAs examined group differences by CALD status.ResultFor the whole sample, SCIDS was correlated with DAS (r = 0.599, p&lt;0.005) and DKAS (r = 0.257, p&lt;0.005). DAS and DKAS were moderately correlated (r = 0.334, p&lt;0.005). Nearly 30% of HCWs in our sample identified as CALD. The CALD group showed lower DAS, DKAS and SCIDS compared to the non‐CALD group (p’s&lt;0.001). No differences were observed on SDCS (p = 0.58).ConclusionHCWs who were more knowledgeable about dementia had more positive attitudes toward dementia and a higher sense of competence in dementia care. HCWs who did not identify as CALD showed greater dementia knowledge, more positive dementia attitudes, and higher sense of competence in dementia care. Findings suggest that better dementia literacy supports more positive attitudes to dementia and sense of competence, and highlights that more targeted and specialized support may be beneficial for staff from CALD backgrounds (who comprise a high proportion of the Australian aged care workforce). Findings have implications for clinicians, researchers, policy‐makers, educators, and providers of dementia services.