| Objectives:With the intensification of aging problem,the number of dementia patients is increasing and the copying strategies would be more difficult.The World Alzheimer Report called attention to the issues of dementia early detection,risk reduction and advocated stigma reduce,and pointed out that community will be the main battlefield of dementia prevention and intervention.Community nurses play a crucial role in early detection,timely diagnosis of dementia and dementia care,but most of them are usually not prepared for the role through formal education.Studies showed that they have difficulties in helping doctors of dementia early detection among dementia high-risk people and high-quality caregiver support of dementia care.Facing the situation that the system of geriatric nursing course is not complete in China,which is needed to be improved urgently in western areas.The study designed a dementia-specific care training program to improve community nurses' dementia knowledge,attitudes,and intentions to make changes to achieve early detection and timely diagnosis of dementia in local primary care settings.Methods:Four community health service centers(CHSCs)in Chongqing were randomly selected from 23 communities.The CHSCs were then randomly divided into intervention and control groups and received the training program.The intervention group received dementia-specific care training program,and control group received other nursing-care knowledge.Nurses were assessed at baseline(T1),immediately post-training(T2)and 3-month follow-up(T3).Alzheimer's Disease Knowledge Scale(ADKS),Dementia Attitudes Scale(DAS)and Dementia Knowledge Assessment Tool Version 2(DKAT2)were used to measure dementia knowledge and attitudes of community nurses.Intentions to make changes to achieve early detection and timely diagnosis of dementia were measured by one self-developed,closed-ended question.Program acceptance was assessed at immediately post-training and 3-month follow-up using a self-developed,training satisfaction questionnaire and written feedback.Nurses in intervention group provided feedback at 2-week post-training and 3-month follow-up.Data was analysed using SPSS 19.0.Demographic characteristics were compared using t-test for normally distributed continuous variables,the Mann-Whitney U test for continuous variables with skewed distributions,and the ?2 test for categorical variables.A non-parametric test was used if the normality was violated.A repeated measures ANOVA was used to assess differences of dementia knowledge and attitudes.The p-value was set at 0.05 for statistical significance.Results:The enrolled nurses were 115,excluding 14 nurses,the final effective nurses were 101,and the responses rate was 87.8%.The control group was 52 nurses and the intervention group was 49 nurses.1.The level of nurses' knowledge,attitudes towards dementia and intentions to make changes to achieve early detection and timely diagnosis of dementiaBaseline results showed that ADKS score was 19.36±2.40,the lowest three mean scores of the ADKS domains: symptoms,care giving and risk factors were 2.16±1.00,2.77±0.94,3.57±1.10.The baseline score of DKAT2 was 15.17±2.57.The baseline score of DAS was 88.78±12.75,and the scores of two domains of DAS: social comfort,dementia knowledge were 37.52±8.11,51.26±10.76.Intentions to make changes to achieve early detection and timely diagnosis of dementia were low,with only 33.7% preferred to ‘suggest to see specialists',27.7% and 13.9% preferred to ‘give advice of cognitive screening' and ‘perform cognitive screening for clients',24.8% chose the ‘comfort clients' or ‘ignore the topic'.There were no significant differences between groups of dementia knowledge,attitudes and intentions to make changes to achieve early detection and timely diagnosis of dementia(P>0.05).2.The effect of the specific on-the-job training program for nurses(1)There was a significant group × time interaction(F = 48.95,p < 0.001)on ADKS,and significant main effects of groups and time were also observed(F = 96.10,p < 0.001;F = 81.61,p < 0.001).There was no significant difference of basic score of ADKS between groups(P?0.05),t-tests indicated that compared to the CG,IG showed higher scores at T2(t=11.80,p < 0.001)and T3(t=10.09,p < 0.001).There was a significant group × time interaction(F = 16.52,p < 0.001)on DKAT2,and significant main effects of groups and time were also observed(F = 47.10,p < 0.001;F = 19.87,p < 0.001).There was no significant difference of basic score of DKAT2 between groups(P?0.05),t-tests indicated that compared to the CG,the IG showed higher scores at T2(t=7.79,p < 0.001)and T3(t=6.77,p < 0.001).(2)There was a significant group × time interaction(F = 26.05,p < 0.001)on DAS,and significant main effects of groups and time were also observed(F = 52.40,p < 0.001;F = 25.07,p < 0.001).There was no significant difference of basic score of DAS between groups(P?0.05),t-tests indicated that compared to the CG,the IG showed higher scores at T2(t=7.90,p < 0.001)and T3(t=7.91,p < 0.001).(3)There was no significant differences of intentions to make changes to achieve dementia early detection and timely diagnosis before the training program.There were significant differences between intervention and control groups of ‘give advice of cognitive screening'(p =0.044)and ‘perform cognitive screening for clients'(p=0.004)at 3-month follow-up.(4)The intervention group had a high satisfaction of this training program.At T2,more than 91.8% of the participants showed ‘agreed' or ‘strongly agreed' with each program acceptance statement;and the ratio of ‘agreed' or ‘strongly agreed' with each program acceptance statement was more than 89.8% at T3.Conclusion:This training program showed feasibility and improved nurses' dementia knowledge,attitudes and intention to make changes to achieve early detection and timely diagnosis of dementia,and well-received by nurses as well. |
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