Knowledge, Attitude, Belief, And Practice(KABP/KAP) About Alzheimer Disease Among Suspectable Individuals With Mild Cognitive Impairment

This study aims to provide supportive information for future community health policies related to dementia and Alzheimer disease (AD) by systematically examining the current situation of Knowledge, Attitude, Belief and Practice (KABP/KAP) about AD among the elderly and those suspectable individuals with mild cognitive impairment (MCI).The interviewees for face to face semi-structured interview were family members of elderly with mild cognitive impairment (MCI) who were living in Wuhan and diagnosed as MCI by the memory clinic in Zhongnan hospital, Wuhan. Inclusion criteria for interviewees were:1) family members of elderly who were diagnosed as MCI by the memory clinic in Zhongnan hospital, Wuhan, in the last quarter of2009;2)18years or above;3) living with and taking responsibility to care individuals with MCI;4) willing and able to describe the experience before and after their family member was diagnosed as MCI.The objects for KAP investigation were elders living in Honggangcheng and Shouyi road, Wuhan. Inclusion criteria were:1) living in the community for six months or longer;2) aged between65and84. Exclusion criteria were:1) those who didn't live in the community during the investigation;2) those with psychiatric history or congenital mental retardation;3) those with serious dysphrenia, dysthymia disorders, and previous diagnosis of AD/dementia;4) those who were diagnosed as alcohol dependence or drug dependence in the last half year;5) those who didn't want to participate in the KAP investigation.Multiple methods were used in this study.1) Literature review:we systematically searched and reviewed related literatures about cognitive impairment.2) Expert consultation:we formulated a face to face semi-structured interview outline by consulting experts.3) Face to face semi-structured interview:we recruited participants from an epidemiological study on dementia titled "Cognitive Impairment Survey in Chinese Hospitals". The physicians in the memory clinics at Zhongnan Hospital at Wuhan University in Wuhan, China, referred the individuals with MCI and their family members to the study team immediately after the individuals were diagnosed as MCI.4) Knowledge, Attitude, Belief and Practice (KABP/KAP) scale: based on the results of semi-structured interview and expert consultation, we formulated the item pool of Knowledge, Attitude, Belief and Practice (KABP/KAP) scale.5) Item selection and reliability and validity assessment for KAP scale: dispersion degree, correlation coefficient, discriminability analysis, and Cronbach's alpha were used to select items. The KAP scale reliability was assessed by retest reliability and internal consistency, and the scale validity was assessed by content validity, discrimination validity, and construct validity.6) Rapid screening of MCI:we screened the elderly in communities by MoCA (Montreal cognitive assessment, MoCA). The screening sample was estimated by the formula for ratio survey.7) Household survey:household survey was conducted by focusing on the places where the elderly gather frequently in the community, complemented by hut-to-hut check. The questionnaire focused on the participants'demographic characteristics, and KAP scale.8) Data management and analysis:the qualitative data was analysed by coding analysis and theme analysis based on the Grounded Theory; the quantitative data was double input in the computer and the database was established by Epidata3.02. SPSS18.0was used for data analysis, and some statistical processes were completed by SAS9.2with advanced programs.The main study results were as follows which can be divided into five parts.The first part was study result for semi-structured interview.1) There were13family members of individuals with mild cognitive impairment (MCI) participated in the face to face semi-structured interview. The majority of participants were females (53.8%), spouses (76.9%), married (92.3%), retired (84.6%), with a mean age of68.5(±12.3) years (range from41to86), and a high school graduate or lower level of education (46.2%). Data analysis revealed three themes, that is, initial recognition of cognitive decline, attitude towards diagnosis of MCI, and perception of cognitive decline as a normal part of ageing.The second part was about the development and evaluation of Knowledge, Attitude, Belief and Practice (KABP/KAP) scale. The items of KAP scale were screened by two rounds of pilot study and expert consultation. Data suggested that the internal consistency of KAP scale was good (Cronbach's Alpha=0.645), with good content validity, and discrimination validity. Factor analysis was used to assess construct validity of KAP scale. Common factors were abstracted by methods of principal component analysis and variance orthogonal rotation. We chose the first three factors (eigenvalue>1), and the accumulative contributions of these factors to the variance reached58.09%. The abstracted factors responded to knowledge, attitude, and practice respectively.The third part was about rapid screening in communities. There were867elders in Honggangcheng and635in Shouyi road who were investigated in2009, Sep. Totally,1198(79.8%) elders were screened, and304(20.2%) were not screened due to personal matters. The screening results showed that the prevalence rate of MCI among elderly was21.9%. Binary logistic regression analysis showed that female (OR=1.879,95%CI:1.34-2.637), advanced age (75years old and above)(OR=3.042,95%CI:2.216-4.177), and school education year≤12(OR=2.515,95%CI:1.109-5.702) were risk factors for positive screening result.The fourth part was about KAP investigation in communities. Totally, we released1502KAP scales and all of them were resumed effectively. The total score of KAP scale was26.89±5.30, with knowledge dimension2.72±2.032, attitude dimension14.81±2.54, and practice dimension9.36±3.48. Multivariate regression analysis showed that advanced age (75years old and above) negatively influenced KAP total score, and school education year>12, regularly participating in the activities in community, regularly doing physical exercises, and having one and more hobbies positively influenced KAP total score. Knowledge dimension:the awareness rates for AD symptoms (memory loss, intelligence decline, emotion or behavior change, language performance ability decline, and prognosis of AD) were63.6%,58.9%, 45.5%,50.2%,54.2%, respectively. Multivariate regression analysis showed that female, advanced age (75years old and above) negatively influenced knowledge dimension score, and school education year>12, regularly participating in the activities in community, and regularly doing physical exercises positively influenced knowledge dimension score. Attitude dimension:those who disagreed/strongly disagreed the opinion that "it is not necessary to take my family member to seek healthcare when he/she shows some sign or symptom of AD" accounted for58.6%; those who disagreed/strongly disagreed the opinion that "it is not necessary to take my family member for medical treatment when he/she has been diagnosed as AD" accounted for57.3%; those who disagreed/strongly disagreed the opinion that "it is shame to be diagnosed as AD" accounted for82.1%; those who disagreed/strongly disagreed the opinion that "it is shame to have a family member with AD" accounted for82.6%. Multivariate regression analysis showed that advanced age (75years old and above) negatively influenced attitude dimension score, and regularly doing physical exercises and having one and more hobbies positively influenced attitude dimension score. Practice dimension:those who "never","occasionally","regularly","always" paid attention to nutrition balance of diet accounted for26.7%,9.1%,30.4%and21.0%respectively. Those who "never","occasionally","regularly","always" paid attention to daily dosage of salt accounted for24.6%,8.0%,35.2%and23.6%respectively. Those who "never","occasionally","regularly","always" paid attention to daily dosage of sugar accounted for32.1%,9.6%,27.5%and23.6%respectively. Multivariate regression analysis showed that female, school education year>12, regularly participating in the activities in community, regularly doing physical exercises, and having one and more hobbies positively influenced practice dimension score.The fifth part was about the KAP score difference between two screening result groups.By comparing KAP scores between individuals with and without MCI, this study found that individuals with MCI had significantly lower scores of KAP and three dimensions than those without MCI. Knowledge dimension:the awareness rates for AD symptoms for individuals with and without MCI are reported respectively in the following:memory loss (57.3%vs.72.2%), intelligence decline (51.1%vs.67.9%), emotion or behavior change (38.5%vs.52.8%), language performance ability decline (40.8%vs.59.4%), and prognosis of AD (43.1%vs.63.9%). Attitude dimension:compared with those without MCI, individuals with MCI had more negative attitude to timely diagnosis of AD and had stronger feeling of stigma with AD. Practice dimension:the row mean scores of items about health behavior among individuals with MCI were significantly lower than those without MCI.The study conclusions were as follows:1) Family members of individuals with mild cognitive impairment expected preventive information of cognitive impairment, and they were worried about future caregiving for individuals with mild cognitive impairment.2) Most family members of individuals with mild cognitive impairment disliked the Chinese term "laonian chidai" which may lead to discrimination to individuals with cognitive impairment.3) It was proved that KAP scale was useful to study the situation of Knowledge, Attitude, Belief and Practice (KABP/KAP) about AD among the elderly and those suspectable individuals with mild cognitive impairment (MCI).4) The awareness rate of memory loss of AD among the elders was high (63.6%), with low awareness rate (45.5%) for emotion or behavior change of AD. More than a half of participants showed positive attitude to timely diagnosis of AD, felt mild stigma with AD, and paid attention to daily health diet.5) Those who were female, with advanced age (75years old and above) and low education level were high risk population for MCI. Among them, the awareness rates of AD were low, with negative attitude to timely diagnosis of AD, stronger feeling of stigma with AD, and unhealthy behaviors. Particularly, those with low education level may be main body for discrimination to individuals with cognitive impairment.