Demographics of medical and nursing students
Of the 1200 questionnaires distributed, 85% (n=1020) were returned. Data from participants with more than 10% missing responses were excluded (n=27); the remaining 993 completed questionnaires yielded a response rate of 82.3%. The mean age of the sample was 19.9±1.8 years (range: 16-25 years). Most were female (74.4%), without informal caregiving experience for people with dementia (82.1%) and had interest in learning more about dementia (85.5%). A higher proportion of nursing students had geriatric clinical practice experience and dementia education or training than medical students (p<0.05). The demographics of medical and nursing students are summarized in Table 1.
Knowledge
The overall mean knowledge score was 19.49±2.82 (ranging from 10 to 30 out of 30) and equivalent to 65% of answers correct. Medical students demonstrated higher mean scores in the ‘symptoms’ and ‘life impact’ content domains than nursing students (p<0.05). The lowest overall scores were achieved on the ‘symptoms’ content domain (53%). From analyzing the four items of ‘symptoms’, a majority of students (72.3% n=718) mistakenly believed that ‘tremor or shaking of the hands or arms was a common symptom in people with Alzheimer’s disease’. In addition, only 27.8% (n=276) of students responded correctly to the item that ‘in rare cases, people have recovered from Alzheimer’s disease’ and 31% (n=308) gave the correct answer to the item that ‘if trouble with memory and confused thinking appears suddenly, it is likely due to Alzheimer’s disease’. Higher correct rates were obtained in the content domains of ‘treatment and management’ (72%) and ‘life impact’ (74%). Most students knew that ‘people whose Alzheimer’s disease was not yet severe could benefit from psychotherapy for depression and anxiety’. In the ‘life impact’ domain, most students knew the statement ‘it was safe for people with Alzheimer’s disease to drive, as long as they had a companion in the car at all times’ was wrong. Moreover, in the ‘course of disease’ domain, most students knew that ‘a person with Alzheimer’s disease became increasing likely to fall down as the disease got worse’ (Table 2).
Informal caregiving experience for people with dementia was not found to be significantly related to knowledge scores (p>0.05). Knowledge scores were significantly different when related to gender, academic year, clinical practicum experience in geriatrics, dementia education or training, and interest in learning more about dementia (p<0.05). In particular, students in year three had the highest knowledge scores.
Attitudes
Table 3 shows the total mean attitude score (mean=29.92, SD=3.35) and the mean scores of two factors (‘heartfelt’ and ‘heartsink’). There were statistically significant differences in the total mean attitudes score (F=18.235, p<0.01) and mean score of the ‘heartfelt’ factor (F=7.409, p<0.01) between nursing and medical students. In the ‘heartfelt’ factor, most students agreed that that ‘much could be done to improve the quality of life of people with dementia (mean=4.33, SD=0.63) and caregivers of people with dementia’ (mean=4.20, SD=0.72). In the ‘heartsink’ factor, most students disagreed that ‘patients with dementia could be a drain on resources with little positive outcome’. However, lowest scores were achieved in the items ‘the primary care team had a limited role to play in the care of people with dementia’ (mean=2.34, SD=0.87) and ‘managing dementia was more often frustrating than rewarding’ (mean=3.52, SD=0.99).
In addition, students who were female, had dementia education or training, and showed interest in learning more about dementia showed statistically significant higher attitudes scores (p<0.05). There were statistically significant decreases in attitudes scores between students in year 1 and other academic years (p<0.05).
Care approach
The total mean score of care approach was 5.42±2.20, indicating most students would not apply a person-centered approach in dementia care. Over 85% (n=848) of students realized that people with dementia should be allowed to freely express themselves even in seemingly meaningless behavior. However, more than 88% of students thought that when people with dementia participated in group activities they should be told what to do and that the aim of communicating should be to help them to better handle their life situation. Moreover, in all content domains a student’s major was not related to their dementia care approach (Table 4). There were no statistically significant differences in care approach scores between student groups.
Predictors of knowledge, attitudes and care approach
The results revealed that gender, major, clinical practicum experience in geriatrics, dementia education or training, and interest in learning more about dementia were predictors of dementia knowledge (F=6.614, P=0.000), explaining 5% of the variance in knowledge. The multiple regression model using attitudes as the dependent variable was statistically significant and three factors were identified to be associated with attitudes (F=10.956, P=0.000), explaining 7% of the variance. These factors were gender, dementia education or training, and interest in learning more. Moreover, only gender and interest in learning more about dementia were predictors of the care approach (F=2.234, P=0.023), accounting for 1% of the total variance (Table 5).
Table 1 Demographics of medical and nursing students and relationship the ADKS, DCAS and ADCQ
Variables
|
The total=993
|
Medical students=526
(53.0%)
|
Nursing students=467
(47.0%)
|
ADKS
Mean(SD)
|
p-value
|
DCAS
Mean(SD)
|
p-value
|
ADCQ
Mean(SD)
|
p-value
|
Age: Mean(SD)
|
19.9(1.8)
|
20.21(1.98)
|
19.55(1.50)
|
——
|
0.939c
|
——
|
0.000*c
|
——
|
0.765c
|
Gender: n(%)
|
|
|
|
|
0.034*d
|
|
0.000*d
|
|
0.018*d
|
Female
|
739(74.4)
|
310(58.9)
|
429(91.9)
|
19.6(2.8)
|
|
30.3(3.2)
|
|
5.3(2.2)
|
|
Male
|
254(25.6)
|
216(41.1)
|
38(8.1)
|
19.2(2.9)
|
|
29.0(3.6)
|
|
5.7(2.3)
|
|
Academic year: n(%)
|
|
|
|
|
0.009*e
|
|
0.002*e
|
|
0.232e
|
Year 1
|
250(25.2)
|
123(23.4)
|
127(27.2)
|
19.2(2.7)
|
|
30.4(3.1)
|
|
5.5(2.4)
|
|
Year 2
|
234(23.6)
|
112(21.3)
|
122(26.1)
|
19.4(2.5)
|
|
30.1(3.4)
|
|
5.4(2.1)
|
|
Year 3
|
223(22.5)
|
107(20.3)
|
116(24.8)
|
20.1(2.9)
|
|
29.9(3.2)
|
|
5.1(2.2)
|
|
Year 4
|
195(19.6)
|
93(17.7)
|
102(21.8)
|
19.2(3.2)
|
|
29.4(3.8)
|
|
5.6(1.9)
|
|
Year 5
|
91(9.2)
|
91(17.3)
|
|
19.5(2.8)
|
|
29.2(3.0)
|
|
5.4(2.5)
|
|
Informal caregiving experience for people with dementia: n(%)
|
|
|
|
|
0.209d
|
|
0.273d
|
|
0.064d
|
Yes
|
178(17.9)
|
88(16.7)
|
90(19.3)
|
19.3(3.0)
|
|
29.7(3.4)
|
|
5.7(2.2)
|
|
No
|
815(82.1)
|
438(83.3)
|
377(80.7)
|
19.6(2.8)
|
|
30.0(3.3)
|
|
5.4(2.2)
|
|
Clinical practicum experience in geriatrics: n(%)
|
|
|
|
|
0.010*d
|
|
0.342d
|
|
0.205d
|
Yes
|
101(10.2)
|
44(8.4)a
|
57(12.2)a
|
19.6(2.8)
|
|
29.6(3.5)
|
|
5.7(2.0)
|
|
No
|
892(89.8)
|
482(91.6)
|
410(87.8)
|
18.8(3.3)
|
|
30.0(3.3)
|
|
5.4(2.2)
|
|
Dementia education or training experience: n(%)
|
|
|
|
|
0.004*d
|
|
0.004*d
|
|
0.456d
|
Yes
|
206(20.7)
|
91(17.3)b
|
114(24.4)b
|
20.0(3.0)
|
|
30.6(3.5)
|
|
5.4(2.2)
|
|
No
|
787(79.3)
|
435(82.7)
|
353(75.6)
|
19.4(2.8)
|
|
29.8(3.3)
|
|
5.4(2.2)
|
|
Interest in learning more about dementia: n(%)
|
|
|
|
|
0.000*d
|
|
0.000*d
|
|
0.013*d
|
Yes
|
849(85.5)
|
457(86.9)
|
392(83.9)
|
19.6(2.8)
|
|
30.1(3.2)
|
|
5.4(2.2)
|
|
No
|
144(14.5)
|
69(13.1)
|
75(16.1)
|
18.7(3.1)
|
|
28.8(3.9)
|
|
5.8(2.2)
|
|
SD, standard deviation
a A higher proportion of nursing students had clinical practicum experience in geriatrics than the medical students (t=-2.000; p=0.046).
b A higher proportion of nursing students had dementia education or training than the medical students(t=-2.772; p=0.006).
c Statistic was based on independent-samples t test.
d Statistic was based on Pearson correlation analysis.
e Statistic was based on ANOVA.
*p<0.05.
Table 2 Scores of content domains of ADKS and student groups
|
|
|
|
Student groups
|
|
Variables
|
|
|
|
Medical
(n=526)
|
Nursing (n=467)
|
|
|
#items
|
Mean±SD
|
%Correct
|
Mean±SD
|
Mean±SD
|
F value
|
p-value
|
ADKS
|
30
|
19.49±2.82
|
65%
|
19.71±2.86
|
19.25±2.76
|
6.574
|
0.010*
|
Risk Factor
|
6
|
4.09±1.08
|
68%
|
4.09±1.06
|
4.09±1.10
|
0.002
|
0.968
|
Symptoms
|
4
|
2.11±0.97
|
53%
|
2.20±1.00
|
2.00±0.93
|
9.933
|
0.002*
|
Disease progression
|
4
|
2.46±0.93
|
61%
|
2.48±0.95
|
2.43±0.90
|
0.724
|
0.395
|
Assessment and Diagnosis
|
4
|
2.64±0.81
|
66%
|
2.67±0.80
|
2.60±0.83
|
1.923
|
0.166
|
Treatment and Management
|
4
|
2.89±0.80
|
72%
|
2.89±0.80
|
2.88±0.81
|
6.574
|
0.793
|
Life Impact
|
3
|
2.23±0.72
|
74%
|
2.30±0.72
|
2.15±0.71
|
10.604
|
0.001*
|
Care Giving
|
5
|
3.08±1.09
|
62%
|
3.08±1.08
|
3.09±1.10
|
0.054
|
0.817
|
The total score range was 0-30 with higher scores indicating better knowledge.
p-value was based on Multivariate analysis of variance(MANOVA).
Bonferroni correction for multiple comparisons was applied. With 8 group comparisons conducted, a corrected p-value of 0.0062 was required.
*Significant after Bonferroni correction (p-value <0.0062).
Table 3 Scores of subscales of DCAS and student groups
|
|
|
Student groups
|
|
Variables
|
|
|
Medical
(n=526)
|
Nursing
(n=467)
|
|
|
#items
|
Mean±SD
|
Mean±SD
|
Mean±SD
|
F value
|
p-value
|
DCAS
|
8
|
29.92±3.35
|
29.50±3.34
|
30.40±3.29
|
18.235
|
0.000*
|
Heartfelt
|
4
|
16.23±2.01
|
16.07±2.07
|
16.41±1.93
|
7.409
|
0.007*
|
Heartsink
|
4
|
13.44±2.49
|
13.42±2.42
|
13.47±2.56
|
0.103
|
0.749
|
Items of the DCAS were rated on a 5-point Likert scale with higher scores indicating better attitudes.
p-value was based on Multivariate analysis of variance(MANOVA).
Bonferroni correction for multiple comparisons was applied. With 3 group comparisons conducted, a corrected p-value of 0.0167 was required.
*Significant after Bonferroni correction (p-value <0.0167).
Table 4 Scores of content domains of ADCQ and student groups
|
|
|
Major
|
|
Variables
|
|
|
Medical
(n=526)
|
Nursing
(n=467)
|
|
|
#items
|
Mean±SD
|
Mean±SD
|
Mean±SD
|
F value
|
p-value
|
ADCQ
|
13
|
5.42±2.20
|
5.43±2.35
|
5.41±2.04
|
0.012
|
0.912
|
Orientation of time, place and situation
|
3
|
1.03±0.81
|
1.04±0.84
|
1.02±0.76
|
0.270
|
0.604
|
Correction of behavior
|
3
|
1.46±0.75
|
1.47±0.80
|
1.46±0.69
|
0.017
|
0.895
|
Emphasis on the past or the present
|
3
|
1.33±1.01
|
1.31±1.02
|
1.35±1.01
|
0.479
|
0.489
|
Aim of the nurses’ communication
|
3
|
0.82±0.73
|
0.84±0.77
|
0.79±0.69
|
1.551
|
0.213
|
Whether confusion had any meaning for the patient
|
1
|
0.78±0.41
|
0.77±0.42
|
0.80±0.40
|
1.372
|
0.242
|
The person-centred approach answer earned a score of 1 point, whereas the reality-oriented answer earned no points. The total score range was 0-13.
p-value was based on Multivariate analysis of variance(MANOVA).
Bonferroni correction for multiple comparisons was applied. With 6 group comparisons conducted, a corrected p-value of 0.0083 was required.
Table 5 Factors associated with the ADKS, DCAS and ADCQ identified in three multiple regression models
Variables
|
ADKS
|
DCAS
|
ADCQ
|
B(SE)
|
95%CI
|
p-value
|
|
B(SE)
|
95%CI
|
p-value
|
|
B(SE)
|
95%CI
|
p-value
|
Age(years)
|
-0.14(0.11)
|
-0.351-0.07
|
0.198
|
|
-0.15(0.13)
|
-0.395-0.101
|
0.252
|
|
-0.04(0.09)
|
-0.204-0.134
|
0.682
|
Gender(male=1)
|
0.67(0.22)
|
0.233-1.099
|
0.003*
|
|
0.99(0.26)
|
0.491-1.493
|
0.000*
|
|
-0.42(0.18)
|
-0.768--0.077
|
0.017*
|
Major(nursing=1)
|
0.67(0.20)
|
0.294-1.058
|
0.001*
|
|
-0.39(0.23)
|
-0.838-0.055
|
0.090
|
|
-0.09(0.16)
|
-0.392-0.217
|
0.567
|
Year of education (year1=1)
|
0.21(0.15)
|
-0.090-0.509
|
0.170
|
|
-0.16(0.18)
|
-0.508-0.193
|
0.361
|
|
0.01(0.12)
|
-0.227-0.252
|
0.906
|
Informal caregiving experience for people with dementia (yes=1)
|
0.18(0.23)
|
-0.275-0.635
|
0.443
|
|
0.28(0.27)
|
-0.257-0.808
|
0.309
|
|
-0.29(0.19)
|
-0.656-0.070
|
0.113
|
Clinical practicum experience in geriatrics (yes=1)
|
1.08(0.33)
|
0.444-1.727
|
0.001*
|
|
0.33(0.38)
|
-0.433-1.066
|
0.390
|
|
-0.36(0.26)
|
-0.862-0.160
|
0.171
|
Dementia education or training (yes=1)
|
-0.91(0.24)
|
-1.403--0.469
|
0.000*
|
|
-1.10(0.28)
|
-1.606--0.513
|
0.000*
|
|
0.22(0.19)
|
-0.168-0.577
|
0.246
|
Interest in learning more about dementia (yes=1)
|
0.84(0.26)
|
0.343-1.342
|
0.001*
|
|
1.24(0.30)
|
0.656-1.824
|
0.000*
|
|
-0.43(0.20)
|
-0.831--0.035
|
0.033*
|
Adjusted R2, p-value
|
0.047, p<0.001
|
0.074, p<0.001
|
0.010, p<0.05
|
B, unstandardized coefficients
SE, Std. error of B
β, standardized coefficients
*p<0.05