Author: Yao Wang
Wang, Yao, 2015 The development and evaluation of a dementia education program for health professionals in primary care in China, Flinders University, School of Nursing & Midwifery
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INTRODUCTION It is estimated that approximately 46 million people are living with dementia worldwide in 2015 and this number will triple by 2050 as the word population ages. Health professionals in primary care play a crucial role in achieving timely diagnosis and early interventions to enable people with dementia to function at the highest level of their capacity as long as possible and relieve caregiver burden. However, a body of evidence revealed unmet care needs for both people with dementia and their caregivers in community care settings especially in countries with undeveloped dementia cares services. Although numerous factors contributing to the undesirable situation, the lack of education opportunities for health professionals in primary care to learn and translate dementia care knowledge into their practice was viewed as one of key factors. AIMS The aims of this study were: (1) to select, translate and evaluate instruments used in a dementia education program for health professional; and (2) to develop, implement and evaluate a dementia education program for health professionals in China. METHODS This study was conducted in two phases. In phase one a cross-sectional design was used to address aim one. Dementia care competence for health professionals was used as a framework in the selection of the Alzheimer’s Disease Knowledge Scale and the Dementia Care Attitudes Scale. These two scales were translated into Chinese using a forward and backward translation method. Content validity, test-retest reliability, construct validity and known-group validity were used to assess the reliability and validity of these scales. A person-centred care scale was utilised as a gold standard to establish concurrent validity of these two scales. In phase two, Graham’s Knowledge Translation was used as a conceptual framework in the program design and implementation. Kirkpatrick’s four-level model was used in program evaluation. A cluster randomized controlled trial (RCT) and focus groups were conducted. A multi-level mixed effect linear regression model was applied to examine whether there was a significant difference between the intervention group and control group at the three time points using STATA version 13.0. In addition, on the completion of the program, focus gruops were conducted to elicit program participants’ perceptions of the program and changes in practice they observed using open-ended questions. Content analysis was used to identify categories of the focus group data. RESULTS In phase one, a total of 442 health professionals participated in the study. The results demonstrated acceptable content validity, internal consistency, test-rest reliability and concurrent validity of the Chinese Alzheimer’s Disease Knowledge Scale and the Chinese Dementia Care Attitudes Scale. These two Chinese scales also demonstrated known-group validity evidenced by significantly higher scores identified from the sub-group with a longer work experience compared to those in the sub-group with less work experience. In phase two, a total of 170 health professionals from 14 primary care centres participated in the study. The program comprised a total of 20 hours of dementia education sessions delivered by trainers in a 12-week period in the intervention sites and a 3-month follow-up. Following the education program, participants in the intervention group showed a statistically significant improvement of knowledge about dementia, attitudes towards dementia care and the use of person-centred care approach compared with control group (P<0.001). Participants in the intervention group were satisfied with the educational program. Five focus groups were conducted that included 30 participants from intervention group. Participants perceived that the dementia education program had met their leaning needs and they had made changes in dementia care. However, they also suggested that they needed to engage in regular dementia education programs that should incorporate components of clinical observations and peer review to update their knowledge in dementia care. Participants also anticipated government’s further commitments to dementia care services in China through policy, workforce and resource development. CONCLUSION The Chinese Alzheimer’s Disease Knowledge Scale and Chinese Dementia Care Attitudes Scale are reliable and valid instruments for health professionals. A dementia education program that targets health professionals’ learning needs and facilitates knowledge translation contributes to changes in practice in dementia care.
Keywords: dementia, care edcuation, care competency, health professionals, primary care, knowledge, attitudes, care approach
Subject: Nursing thesis
Thesis type: Doctor of Philosophy
School: School of Nursing & Midwifery
Supervisor: Lily Dongxia Xiao