Background
Dementia care training is a pressing global issue [
1]. Compromised cognitive functioning deprives people with dementia the ability to express their thoughts or apprehend the information surrounding them, thus leading to various challenging behaviors. Studies show that health care providers perceive themselves as lacking confidence or skills in dementia care [
2,
3]. Their inappropriate attitudes toward dementia negatively impact care quality, job satisfaction, relationships with clients and their family members [
2,
4]. Hence, training is needed to enhance the knowledge, attitudes, skills, and confidence of staff in meeting the care needs of people with dementia [
5‐
8].
Nearly 50 million people worldwide currently suffer from dementia. The incidence rate of newly diagnosed is expected to surge at about 10 million new cases per year [
9]. With the rising service demand, the care for people with dementia is expanding beyond mental health specialist services or long-term care settings to general hospital and community care settings. Moreover, patients’ complex care needs require diverse support from staff of different levels, disciplines and expertise [
10,
11]. However, existing evidence of dementia care training is predominant only in health professionals, nursing homes and Western countries and is limited by small sample size [
7,
8,
12].
The current project aims to examine the effects of the Best Practice in Dementia Care Learning Program [
13], a structured dementia training program in community care services in Hong Kong. Although this program is widely adopted in various care settings in European countries, only one paper report its effects [
13] The findings suggested that participants gained additional knowledge about dementia and that the care practices improved after the training, but the outcomes were only measured by using a self-developed questionnaire among 100 participants.
The current project is built on the previous work to specifically [
1] examine the effects of the program on staff knowledge, attitude, sense of competence related to dementia care and job satisfaction using validated instruments and [
2] explore how the dementia care practices has been influenced by the training. Previous studies concluded that knowledge may not necessary translate into practices [
7,
14]. Hence, the project evaluation included several staff outcomes. In this project, two sets of training kits were translated to Chinese and tailored according to the local sociocultural context in residential and community care services. To ensure holistic care, the program curriculum comprised the following domains: (i) dementia and persons with dementia; (ii) person-centered care and building meaningful relationship; (iii) communication and behaviors; (iv) support for people with dementia, family, and carers; (v) health and wellbeing; and (vi) legal aspects and issues related to dementia. The program adopted the train-the-trainer model. Seventeen local health and social care experts in aged care services received training at the Dementia Services Development Centre of the University of Stirling in Scotland. The trained personnel then delivered a series of three-day facilitator training workshops to experienced staff members in the local care settings. These staff members will serve as facilitators for the situated training for their colleagues. Each facilitator provided 12 two-hour training sessions for a group of around six staff members (i.e. learners) in their workplace for 6 months. This training program emphasized skilled facilitation and situated reflective learning within the workplace [
13]. Therefore, the training sessions encompassed various interactive activities, such as case sharing, group discussion, and reflective exercises to encourage active learning. After completing 12 training sessions, all participants were required to write a reflective essay describing how they managed the challenging situations related to dementia. Reflective writing, which highlights the critical consideration of one’s experience, is an effective learning strategy in medical education because the deliberation process fosters the integration of new learning and existing knowledge [
15].
Results
Participants’ characteristics
A total of 1264 participants, including 195 facilitators and 1069 learners, completed the baseline and 12-month follow-up assessments, resulting in a response rate of 93.8%. Table
1 presents the characteristics of the participants from a range of care settings, types of occupations and experiences in dementia care. The participants had an average of approximately 7 years of experience in aged care services. The majority (82.5%) of the participants were involved in direct services for people with dementia in their daily work. Many clerical staff (52.9%) and supporting staff (23.8%) considered that their duties were not directly related to dementia care. More than two-thirds of the participants received dementia care training in various formats, such as talks, seminars, or workshops before joining the program. Of which, most of the managerial staff (81.0%), professional staff (68.8%) and care assistants (69.5%) had received prior training whereas less than half of supporting staff (45.4%) and clerical staff (32.8%) had such preparation.
Table 1Participants’ characteristics (N = 1264)
Gender |
Male | 200 | 15.8 |
Female | 1039 | 82.2 |
Age (years) |
≤ 24 | 71 | 5.6 |
24–34 | 353 | 27.9 |
35–44 | 250 | 19.8 |
45–54 | 397 | 31.4 |
55–64 | 161 | 12.7 |
≥ 65 | 14 | 1.1 |
Types of care settings |
Community centers | 255 | 20.2 |
Day care centers | 275 | 21.8 |
Residential care homes | 486 | 38.4 |
Others | 246 | 19.5 |
Types of staff |
Care assistants | 613 | 48.5 |
Supporting staffs | 23 | 1.8 |
Clerical staffs | 75 | 5.9 |
Professional staffs | 486 | 38.4 |
Management staffs | 29 | 2.3 |
Types of professional staffs (n = 486) |
Social work | 202 | 15.9 |
Nursing | 194 | 15.3 |
Allied health | 38 | 3.0 |
Others | 68 | 13.4 |
Year(s) of experience working in aged care service, M (SD) | Facilitators: 6.96 (6.25) |
| Learners: 7.27 (6.42) |
Provision of direct services to people with dementia in daily job duties |
Yes | 1043 | 82.5 |
No | 187 | 14.8 |
Ever received dementia training before this study |
Yes, more than once | 435 | 34.4 |
Yes, once only | 388 | 30.7 |
No | 381 | 30.1 |
The mean total DKAS and the four subscale scores of the learners significantly improved after training (
Ps ≤ .001) (Table
2). An increase in the total DKAS score was observed in 71.9% of the learners. The reflective essays revealed that certain participants knew little about dementia before receiving training. They failed to recognize the challenging behaviors exhibited by the clients were related to dementia and often found them uncooperative. For example, scolding others or suspecting their things had been stolen. The participants used to argue with the clients in an attempt to correct them but they remained defensive. One participant who worked in a care home shared that,
“There was once when we were playing building blocks, an old lady put one piece into her mouth. We immediately tried to open her mouth to get it back when we noticed that. She was resistant and ran back to her room. This lady had the experience of picking the food from other resident’s dishes. At that time, I tapped on her shoulder to remind her wrongdoing, but she vituperated. Her reaction was totally intolerable.”
Table 2Knowledge, Attitudes, Sense of Competence and Job Satisfaction toward Dementia Care at baseline and 12-month follow up (N = 1264)
DKAS - Total scoreb | 0–50 | 27.7 (8.6) | 32.7 (7.6) | + 5.0 (8.0) | 20.4*** | 0.619 |
DKAS – Causes and characteristicsb | 0–14 | 7.7 (3.0) | 9.0 (2.7) | + 1.3 (3.0) | 14.1*** | 0.438 |
DKAS – Communication and behaviorb | 0–12 | 5.7 (2.8) | 7.2 (2.8) | + 1.5 (3.0) | 16.0*** | 0.495 |
DKAS – Care considerationsb | 0–12 | 8.3 (2.9) | 9.2 (2.6) | + 0.8 (3.1) | 8.5*** | 0.288 |
DKAS – Risk factors and health promotionb | 0–12 | 6.8 (2.7) | 7.3 (2.6) | + 0.6 (3.2) | 5.9*** | 0.157 |
DAS – Total scorea | 20–140 | 108.2 (12.1) | 117.3 (10.6) | + 8.9 (9.2) | 13.4*** | 0.983 |
DAS – Total scoreb | | 102.2 (12.0) | 112.0 (11.2) | + 9.7 (11.9) | 26.6*** | 0.819 |
DAS – Dementia knowledgea | 10–70 | 57.3 (5.8) | 60.9 (4.9) | + 3.6 (4.7) | 10.7*** | 0.782 |
DAS – Dementia knowledgeb | | 48.4 (7.9) | 54.3 (7.0) | + 6.0 (7.5) | 25.9*** | 0.785 |
DAS – Social comforta | 10–70 | 50.7 (8.4) | 56.3 (6.9) | + 5.6 (6.6) | 11.8*** | 0.871 |
DAS – Social comfortb | | 53.9 (6.1) | 57.7 (5.5) | + 3.7 (6.4) | 19.2*** | 0.599 |
SCIDS – Total scoreb | 17–68 | 43.2 (8.9) | 48.3 (7.6) | + 5.1 (8.2) | 21.4*** | 0.619 |
SCIDS – Professionalismb | 5–20 | 13.9 (3.2) | 15.2 (2.8) | + 1.3 (3.0) | 13.6*** | 0.425 |
SCIDS – Building relationshipb | 4–12 | 9.3 (2.2) | 10.6 (2.0) | + 1.3 (2.4) | 19.2*** | 0.545 |
SCIDS – Care challengesb | 4–12 | 9.3 (2.4) | 10.6 (2.1) | + 1.3 (2.4) | 17.9*** | 0.555 |
SCIDS – Sustaining personhoodb | 4–12 | 10.7 (2.4) | 11.9 (2.0) | + 1.2 (2.4) | 17.4*** | 0.501 |
SNCW– Total scorea | 32–160 | 117.4 (13.3) | 121.5 (14.0) | + 4.1 (12.1) | 4.8*** | 0.337 |
SNCW– Total scoreb | | 119.7 (13.7) | 125.3 (14.6) | + 5.6 (12.2) | 14.6*** | 0.458 |
Upon receiving the training, the participants were interested in exploring the reasons behind the behaviors or emotions exhibited by their clients.
Attitudes toward dementia
The mean total DAS and the two subscale scores amongst facilitators and learners significantly improved (
Ps ≤ .001) (Table
2). An increase in the total DAS scores was noted in 80.5% of the participants. In their reflective essays, the participants shared that they started to appreciate the abilities of people with dementia after their training rather than merely focusing on their weaknesses and recognized the time needed for trust building. For example, some participants often kept their clients in armchairs or held their arms whenever they walked because they were worried that their clients may fall due to lower limbs weakness or visual impairment. However, their actions were not appreciated by these clients and in turn triggered unsafe or aggressive reactions, such as fleeing or pushing others. A participant shared that,
“Mr Wong had left the center for several times himself and could not recognize the route back over the past year. Fortunately, every time he was brought back by some neighbors. We sometimes mocked him for his absent-mindedness and then he became short tempered. Once he asked me if he was being put under surveillance due to his misbehaviors.”
The participants realized that people with dementia also have psychosocial needs. A participant highlighted in the essay the importance of being empathetic and paying attention to their psychosocial needs.
She recalled an incident that an old lady had wet her pants when she was walking away during a group activity. Her colleague noticed and shouted, “Ms. Lee, you have wet your pant. Please don’t move around and I will go to get another pair of trousers for you to change.” When she assisted Ms Lee back to the seat, she further said, “You have already wet your pants once this morning.” At that moment, everyone turned silent and looked at Ms. Lee who denied that she had done so. She replied irritably, “Don’t call my daughter. I haven’t wet my pants. I was just walking to the toilet...Get off from me! I don’t need your help!” Ms Lee shook her colleague off and walked away. They helped her to change the trousers eventually. However, she remained unhappy throughout the day, even though she cannot recall what evoked the negative emotion.
After the training, the participant reflected that people with dementia may also have the feeling of embarrassment. Hence, she discussed strategies for preserving their dignity in the essay. Another participant also shared her experience wherein she was once rejected by an old man for accompanying him to the toilet, as he was concerned about the gender difference.
Sense of competence in dementia care
The mean total SCIDS and the four subscale scores of the learners significantly improved after training (
Ps ≤ .001) (Table
2). An increase in the total SCIDS scores was observed among 73.4% of the learners. Many participants shared in the reflective essays that they were greatly confident in interacting with people with dementia. Many examples on how the participants attempted to design different kinds of activities in relation to previous work experiences or the specific hobbies of the people with dementia were gathered. One participant shared her experience in managing the challenging behaviors of her client.
Mr. Chan was restless in the community center and kept on shouting that he wanted to leave and went to the restaurant that he owned. Initially, the staff members attempted to orient him the purpose of attending the center, but he became unhappy as he perceived himself useless. His family members were frustrated because his behaviors persisted at home and can hardly be settled.
Following the training, the participant attempted to learn more about his life story and then design activities that matched his experience. She stated that,
Instead of calling him “Uncle Chan,” she called him “Boss Chan.” I tried to invite him to write menu. He was very delighted to do so and became very concentrated in the planning and writing process.
The participant underscored knowing the person is an effective way to understand the reasons behind the challenging behaviors exhibited by people with dementia. Likewise, another participant also shared her positive experience on how to engage an old man who was used to yelling out profanities in the center.
“We have tried to think about the solution for months. We invited him to read aloud the newspapers at least this can prevent him from using swear words. Recently, we tried to change the text to Tang poems (a kind of Chinese classical literature). We can’t imagine that he can even tell us the meaning of the ancient words, apart from reading it out. He became courteous and patience. This is the first time I found that we can communicate with him.”
Other participants also noted that they engaged their clients according to their interests.
Job satisfaction
The mean SNCW score of the facilitators and learners significantly improved after the training (
p ≤ .001) (Table
2). Around two-thirds of the participants (66.5%) reported a higher level of job satisfaction than the baseline after training. In the reflective essays, some of the learners valued an open atmosphere for active sharing in the training sessions, and an improvement in collegial relationship and team collaboration was observed. Here is a quote from their essays,
“The group sessions held regularly in our workplace provided us an opportunity to share our observations of different clients and discuss strategies for addressing the need of each individual.”
Comparison of outcomes based on learners’ characteristics
Tables
3 and
4 compares the study outcomes at baseline and the within-group changes in these outcomes on the basis of learners’ characteristics. At baseline, there were significant differences in the DKAS scores amongst different age group (
p = .002), with the highest in those aged between 55 and 64, and followed by those aged between 25 and 44. The differences in the SNCW scores and the SCIDS scores across age groups were also statistically significant (
Ps ≤ .001), with the middle aged group (aged between 35 and 64) had relatively higher scores. Significant group differences were found in all outcomes amongst different occupations (
Ps ≤ 0.001). The scores of the clerical staff and supporting staff were generally lower than the other groups, suggesting poorer knowledge and more negative attitudes toward dementia. Staff members who were not involved in direct care for people with dementia and had not received any training before this project obtained significantly lower scores in all outcomes (
Ps ranged from ≤ .001 to 0.012).
Table 3Comparison of outcome variables based on learners’ characteristics at baseline (N = 1069)
Gender |
Male | 28.4 (8.6) | .847 | .397† | 100.6 (12.9) | −1.84 | .066† | 117.5 (14.4) | −1.98 | .051† | 42.3 (6.8) | −1.90 | .058† |
Female | 27.7 (8.3) | | | 102.6 (11.7) | | | 120.0 (13.6) | | | 43.7 (8.3) | | |
Age groups | | 3.89 | .002‡ | | 0.59 | .707‡ | | 9.94 | < .001‡ | | 6.41 | < .001‡ |
≤ 24 | 26.0 (8.4) | | | 101.5 (8.9) | | | 116.7 (13.0) | | | 42.4 (6.9) | | |
25–34 | 28.6 (8.0) | | | 101.6 (13.3) | | | 115.4 (13.0) | | | 41.5 (7.1) | | |
35–44 | 28.8 (9.2) | | | 102.9 (11.8) | | | 120.6 (13.4) | | | 43.6 (7.4) | | |
45–54 | 26.6 (8.1) | | | 102.5 (11.4) | | | 122.4 (14.0) | | | 44.9 (8.3) | | |
55–64 | 29.1 (8.0) | | | 103.3 (11.6) | | | 121.7 (13.3) | | | 44.5 (8.1) | | |
≥ 65 | 27.6 (8.2) | | | 101.8 (15.1) | | | 116.4 (18.2) | | | 44.0 (14.7) | | |
Types of staff | | 21.36 | < .001‡ | | 6.16 | < .001‡ | | 10.48 | < .001‡ | | 29.14 | < .001‡ |
Care assistants | 26.9 (7.8) | | | 103.0 (11.7) | | | 122.1 (12.8) | | | 45.0 (7.6) | | |
Supporting staff | 20.0 (7.7) | | | 98.9 (12.2) | | | 120.4 (17.1) | | | 41.4 (8.0) | | |
Clerical staff | 24.4 (9.1) | | | 96.2 (11.6) | | | 112.7 (12.4) | | | 35.7 (9.5) | | |
Professional staff | 31.2 (8.0) | | | 103.0 (11.9) | | | 117.1 (13.9) | | | 42.7 (7.1) | | |
Managerial staff | 28.5 (10.0) | | | 102.6 (12.8) | | | 117.7 (14.5) | | | 43.7 (7.7) | | |
Provision of direct services to people with dementia in daily job duties | | 2.53 | .012 | | 4.91 | < .001† | | 4.85 | < .001† | | 7.12 | < .001† |
Yes | 28.2 (8.3) | | | 103.1 (11.6) | | | 120.5 (13.5) | | | 44.3 (7.6) | | |
No | 26.3 (8.5) | | | 97.9 (12.7) | | | 114.5 (14.3) | | | 39.3 (8.6) | | |
Ever received dementia care training before this study | | 41.69 | < .001‡ | | 47.53 | < .001‡ | | 18.32 | < .001‡ | | 30.61 | < .001‡ |
Yes, more than once | 30.8 (8.2) | | | 106.2 (11.8) | | | 122.3 (13.0) | | | 45.4 (7.8) | | |
Yes, once only | 28.1 (7.7) | | | 103.5 (10.4) | | | 120.8 (13.7) | | | 44.8 (7.7) | | |
No | 25.1 (8.2) | | | 97.8 (11.9) | | | 116.2 (14.0) | | | 41.0 (7.9) | | |
Table 4Comparison of changes in outcomes based on learners’ characteristics (N = 1069)
Gender | | 0.13 | .900† | | 1.95 | .140 † | | −0.79 | .429 † | | −0.78 | .490† |
Male | 5.0 (7.3) | | | 11.1 (12.2) | | | 4.8 (12.0) | | | 4.4 (6.7) | | |
Female | 4.9 (7.9) | | | 9.6 (11.2) | | | 5.6 (12.3) | | | 4.8 (6.9) | | |
Age groups | | 2.29 | .044‡ | | 3.73 | .019 ‡ | | 1.41 | .274‡ | | 4.27 | < .001‡ |
≤ 24 | 4.5 (7.3) | | | 8.7 (10.2) | | | 5.0 (10.3) | | | 4.3 (6.7) | | |
25–34 | 5.4 (7.6) | | | 11.9 (12.0) | | | 6.8 (12.1) | | | 6.4 (6.8) | | |
35–44 | 4.9 (7.9) | | | 9.8 (10.4) | | | 4.3 (9.5) | | | 5.0 (7.3) | | |
45–54 | 5.3 (8.2) | | | 8.9 (10.7) | | | 5.1 (12.6) | | | 4.0 (7.0) | | |
55–64 | 3.4 (7.5) | | | 8.4 (11.3) | | | 6.5 (12.3) | | | 3.7 (6.3) | | |
≥ 65 | 0.9 (7.0) | | | 6.9 (15.8) | | | 4.1 (10.2) | | | 3.0 (3.3) | | |
Types of staff | | 3.22 | .007‡ | | 4.20 | < .001‡ | | 4.53 | .011‡ | | 18.15 | < .001‡ |
Care assistants | 4.9 (8.0) | | | 8.9 (11.2) | | | 5.2 (12.0) | | | 4.0 (6.9) | | |
Supporting staff | 6.3 (7.2) | | | 5.1 (10.4) | | | 2.5 (7.3) | | | 3.6 (7.9) | | |
Clerical staff | 6.3 (8.5) | | | 12.0 (11.5) | | | 2.2 (9.8) | | | 7.3 (6.4) | | |
Professional staff | 4.7 (7.1) | | | 11.7 (11.0) | | | 7.2 (11.7) | | | 6.1 (6.7) | | |
Managerial staff | 1.0 (7.3) | | | 5.7 (8.4) | | | 0.8 (9.0) | | | 2.5 (7.2) | | |
Provision of direct services to people with dementia in daily job duties | | −3.75 | < .001† | | −4.03 | < .001 † | | −1.16 | .248 † | | −3.60 | < .001† |
Yes | 4.4 (7.7) | | | 9.2 (11.0) | | | 5.3 (12.2) | | | 4.4 (6.9) | | |
No | 7.1 (8.1) | | | 13.6 (12.4) | | | 6.6 (11.7) | | | 6.6 (6.6) | | |
Ever received dementia care training before this study | | 16.64 | < .001‡ | | 12.31 | < .001‡ | | 1.81 | .319‡ | | 8.06 | < .001‡ |
Yes, more than once | 3.8 (7.4) | | | 8.4 (9.8) | | . | 5.8 (11.4) | | | 3.9 (6.7) | | |
Yes, once only | 3.9 (7.7) | | | 8.7 (10.3) | | | 4.8 (11.8) | | | 4.1 (6.8) | | |
No | 6.8 (8.1) | | | 12.5 (12.8) | | | 6.2 (11.6) | | | 6.1 (7.2) | | |
The changes in the outcomes were not associated with the gender of the learners. Except for the SNCW score, significant differences were noted amongst different age groups in the changes in the DKAS score (p = .044), the DAS score (p = .019) and the SCID score (p ≤ .001). Smaller changes were observed among those aged 55 years or above in these three study outcomes when compared with their younger counterparts. Significant differences were noted amongst staff members with different occupations in the DKAS score (p = .007), the DAS score (p ≤ .001), the SCID score (p ≤ .001) and SNCW total scores (p = .011). The managerial staff demonstrated the least improvement in all outcomes, whereas changes were high among the clerical staff in the DAS score and the SCIDS score, indicating improvement in attitude and sense of competence. Improvement in the DKAS scores were higher in clerical staff and supporting staff members in comparison with other groups. Although the DKAS score did not apparently increase amongst the professional staff, improvement in the DAS score, SNCW score and SCIDS score were generally high. Except for the SNCW score, the learners who have not been involved in dementia care and never received dementia training demonstrated significantly greater improvements across all outcomes (Ps ≤ .001) than those who have received certain kinds of training or involved in direct care for people with dementia.
Discussion
This study is the largest reported in the field of building dementia care workforce across different community care settings. Significant improvements were observed in all outcomes concerning staff knowledge, attitudes and sense of competence in dementia care, and job satisfaction at the 12-month follow-up assessment. The findings of the current study provide a relatively detailed examination of the training effects on different outcomes and staff members than the previous study [
13]. The analysis on the changes in outcomes further showed that the effects of the training program significantly varied across different groups of learners in terms of age, occupations, work, and training experience. The findings contribute new knowledge to the field in terms of different training needs amongst staff members of various roles or qualifications.
The remarkable improvements of clerical and supporting staff on various outcomes, including knowledge, attitude, and sense of competence, suggested the training needs of non-care related staff to enhance their awareness toward dementia. The results are consistent with those of Adler et al.’s (2015) that supporting staff had lower levels of dementia knowledge and skills than the health care professionals [
3]. The results also showed the knowledge gaps in staff members who had not been involved in dementia care or received prior relevant training. The training needs about dementia care of staff members who are not involved in direct care services but working within care settings are ignored. Previous studies on dementia care training mainly focused on health professionals, direct care workers, and healthcare students [
2,
5,
6,
8,
14,
24]. Given that people with dementia interact with different staff members in the care environment, their reactions and responses would also be influential to care recipients’ wellbeing and thus care quality. Therefore, an inclusive approach to enhance the training impacts on care culture is warranted [
10,
25]. The success of the present training program may be partly because it follows several key recommendations of teamwork education drawn from a meta-synthesis, including participation of all members, understanding on how the team function, opportunities for practice as well as reflection and debriefing [
26]. Given that this project offered on-site training delivered by staff members trained as facilitators, the training focus could be tailored according to the context of their workplace and the learners could also directly apply the newly learned knowledge and skills in their real-world practice.
The substantial improvements in attitudes, sense of competence and job satisfaction of professional staff and care assistants were also noteworthy, given that their scores were amongst the top of all learners at baseline. These findings are in line with the literature that training is effective in increasing staff sense of competence in dementia care by improving their understanding about the challenging behaviors of people with dementia [
7]. However, the findings disprove the conclusion of a systematic review that staff training has limited impact on care providers’ attitudes or job satisfaction [
7]. The promising results of this study may be partly explicable in terms of the program design with continual sessions. Surr’s (2017) suggested that the consolidated time for training over a longer term is needed for attitudinal change [
8]. The notable positive change in attitude can also be attributed to reflective learning, which invoked a careful consideration and questioning of one’s own beliefs, attitudes and values with respect to the existing care practices, thereby promoting self-awareness [
15].
Third, the least improvements were observed generally in the managerial staff and those who were over 55 years old. The scores of the managerial staff were comparable with the professional staff at baseline. This can largely be explained by the fact that they generally possessed health and social care professional qualification. The subtle within-group changes could suggest that their training needs might be different from those working at frontline. Such observation was not noted in previous studies because the staff members of the managerial grades were not analysed separately [
8,
25]. Given that organisational and managerial support is often regarded an a contributing factor to the implementation of dementia training [
7,
25,
27], the findings seem to suggest the need for devising a specific program to address the training needs of this staff group. On the other hand, the insignificant changes of the older counterparts would need further investigations. The results may possibly relate to their job nature rather than age itself because their baseline scores were at both ends.
We acknowledged several study limitations. First, self-report measures and reflective essays were used to detect and explain changes. Second, the sustained effects of the training programs could not be ascertained yet because the follow-up assessment was conducted after 12 months, which is approximately 6 months after the training. Moreover, there was no control group for comparison, and the outcomes for the people with dementia and care quality were not collected. To enhance the credibility of the results, validated instruments were used in this study. In addition, the reflective essays were not graded, and the database was only accessible to the researchers who were external to the participants’ workplaces to prevent biased responses. We are collecting the third wave of data as the 24-month follow-up to examine the program effects using latent variable evaluation approach. Given the difficulty of adopting conventional research designs, future research can focus on the implementation sciences or comparison of the different modes of training on practice change and thus the influence on the care service for people with dementia and the satisfaction of their family members with regard to the service.
Conclusions
Building the capacity of health and social care workforce for dementia care is at the top of the policy agenda worldwide [
1]. This project provided a foundation for enhancing knowledge, attitudes, sense of competence in dementia care, and job satisfaction through an in-service dementia training program amongst different staff groups across community care and care home settings.
The promising results can be attributed to several crucial elements in the design of the training program, which aimed to create a supportive environment for in-service learning. First, the train-the-trainer model increased the extensiveness and cost-effectiveness of the training to a wider society and cultivated an atmosphere for workplace learning. The trained facilitators were the key to supporting on-going situated learning. Second, an inclusive approach was employed so that all staff members, including non-care related staff who were often neglected in relevant training, were involved to support and enhance the sustainability of practice and cultural changes, notwithstanding high staff turnover. The program also highlighted the importance of reflective learning. Rather than didactic teaching, regular face-to-face training sessions were filled with interactive activities and group discussions that encouraged learners to reflect upon the current dementia care practices in their workplace and appreciate how their newly learnt knowledge can inform practices. The reflective learning approach enabled the learners to actively develop practical knowledge in bridging the gap between theoretical knowledge and the reality in care settings. Instead of teaching one-size-fits-all management strategies, the learners had to exercise their own judgment in deciding which strategies would well address individual concerns on the basis of the principles of person-centered care.
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