Participants
Through convenience sampling, doctors and nurses were recruited from four primary health care institutions in Chongqing, China. The inclusion criteria were: (1) in-service personnel who had obtained professional qualification certificates for doctors and nurses; (2) had ≥ 1 year of medical work; and (3) gave informed consent. The exclusion criteria were: (1) interns, (2) medical staff from other institutions for exchange or study programs.
Procedure
From April to July 2020, investigators approached doctors and nurses in four primary health care institutions in Chongqing, China, explaining the study’s objectives and requesting them to participate. All the data were self-reported using an online questionnaire published through We-Chat. Investigators confirmed the quality of each questionnaire completed by the participants, and participants who provided incomplete or wrongly filled questionnaires were re-contacted through their We-Chat ID numbers. Participants who could not be re-contacted were not included in this study.
Thereafter, all participants were divided into three groups: Refer to specialists (Type A), perform cognitive screening (Type B), and ignore or change the subject (Type C), based on their answers to the following question in the questionnaire, “What would you do first when individuals complain of memory loss to you?” Those who would refer the individuals to specialists were grouped in Type A, those who would perform cognitive screening first were grouped in Type B, and those who would ignore it or change the subject during the conversation were grouped in Type C. The differences in the general characteristics, as well as the knowledge and self-efficacy scores for dementia prevention among the three groups, were analyzed.
Measures
General characteristic questionnaire
The participants’ general characteristics, including gender, age, education status, occupation, professional title, years of work, contact history, care history, and training history about dementia, were collected using the questionnaire.
Promotion of brain health and risks of dementia knowledge scale
Most measures in present studies only measured the general knowledge of dementia, including dementia-related symptoms, treatments, care, and so on, which do not apply to the purpose of this study. To evaluate the knowledge on brain health promotion and risks of dementia for community health workers, a specialized scale was designed based on the WHO guidelines in 2019 “Risk reduction of cognitive decline and dementia” and the risk and health promotion dimension of the dementia knowledge assessment scale.
Eighteen items were based on a Likert-5 points scale (wrong, probably wrong, unknown, probably correct, correct) for this measure. For correctly described items, participants scored 2 points for choosing “correct,” 1 point for choosing “probably correct,” and 0 points for choosing other options. Further, for misdescribed items, participants scored 2 points for choosing “wrong,” 1 point for choosing “probably wrong,” and 0 points for choosing others. The final scores of this measure ranged from 0 to 36, and higher scores indicated higher levels of related knowledge. In this study, the validity test showed that the Kaiser-Meyer-Olkin (KMO) value of the scale was 0.73, and the Cronbach’s alpha for the scale was 0.79.
Dementia prevention self-efficacy scale
A self-designed scale was used to evaluate community health workers’ self-efficacy in preventing dementia for individuals. The five items, designed through a literature review, were as follows: (1) “I am well aware of the controllable and uncontrollable risk factors for cognitive impairment,” (2) “I can help residents or patients identify if they are at risk for cognitive impairment,” (3) “I can do simple cognitive screening for residents or patients in my precinct who are at risk for cognitive impairment,” (4) “I can integrate education on risk factors of cognitive impairment and lifestyle intervention guidance into daily health education,” and (5) “I know how to help district residents or patients reduce the risk of cognitive impairment through lifestyle changes.” Likert-7 points from 1 (no confidence at all) to 7 (extreme confidence) were used in the scale, and point 4 indicated neutrality. The scale scores ranged from 5 to 35, and higher scores indicated a higher level of self-efficacy regarding the primary prevention for dementia. In this study, the validity test showed that the KMO value of the scale was 0.85, and the Cronbach’s alpha for the scale was 0.94.
Ethical considerations
This study was approved by the Medical Ethics Committee of Army Medical University. All the participants completed questionnaires voluntarily. The participants’ personal information was only used for research, and confidentiality was assured.
Data analysis
Version 21.0 of the SPSS software (IBM Corp., Armonk, NY, USA) was used in the statistical analysis. P-values ≤0.05 were taken as denoting statistical significance. Frequency and percentage were used to describe the general characteristics of participants. Participants were divided into three types: Refer to a specialist, perform cognitive screening, and ignore or change the subjects. Chi-square tests were employed to compare the numbers among the three types in each subject. A one-way ANOVA test was employed to determine the differences among the three types in knowledge and self-efficacy scores. Further, the least significance difference (LSD) test was employed for post hoc multiple comparisons. For the types with significantly different knowledge scores, a t test was used to determine the differences between two types in each item in terms of the promotion of brain health and risks of dementia knowledge scale. Finally, logistic regression was employed to explore the factors influencing whether community health workers would perform cognitive screening.