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Original Research (Original Article) 


Ahmed Basheer Alazmi et al, 2020;4(2):389–394.

International Journal of Medicine in Developing Countries

A survey-based study of knowledge of Alzheimer’s disease among health care staff

Ahmed Basheer Alazmi1*, Ali Basheer Alazmi2

Correspondence to: Ahmed Basheer Alazmi

*Family Medicina Registrar, Qurayyat Health Affairs, Ministry of Health, Qurayyat, Saudi Arabia.

Email: dr.aazmi [at] yahoo.com

Full list of author information is available at the end of the article.

Received: 09 December 2019 | Accepted: 26 December 2019


ABSTRACT

Background:

Dementia is a public health concern as the prevalence is increasing worldwide with the significant increase being in low-middle income countries. However, these countries appear to be less prepared in handling this rise in terms of diagnosis and management. Proper knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population.


Methodology:

This cross-sectional study was conducted in Gurayyat General Hospital, Saudi Arabia. Knowledge levels were inspected by using the validated Alzheimer’s disease Knowledge Scale (ADKS) 30-item. All health service district staffs were invited to participate in an online survey with e-mail access. Knowledge levels were compared across some aspects, such as demographic categories, professional groups, and by the professionalism of the respondent or personal experience caring for patients with dementia. The impact of dementia-specific training or education on knowledge level was also evaluated.


Results:

Overall knowledge about Alzheimer’s disease was of a moderate level. Knowledge level was lower for some of the ADKS, particularly those who were more medically-oriented. Knowledge was higher for those who had attended a series of relevant workshops.


Conclusion:

Professionals with direct patient contact (medical, nursing) were found to have better knowledge regarding dementia than those in a supportive role (administrative, housekeeping, security, and transport staff), according to ADKS. The staff concerned in direct patient care should need a comprehensive extended education program, with information about degrees of severity of dementia, which provide participants with specific skill sets to enable the delivery of high-quality care to these patients in an acute setting.


Keywords:

Alzheimer’s disease, dementia, knowledge, health care staff.


Introduction

It is a growing challenge to provide effective and appropriate care for individuals with dementia [1]. Prevalence of dementia is growing globally with significant rising in low-middle income nations [2]. The functional status and the quality of life of dementia patients are affected by the quality of care they receive [1]. The risk of developing cognitive impairment is increasing with an increase in longevity [3]. In Saudi Population, the age is shifting toward elderly, in 2016, it was estimated that there were 1.3 million (6.5%) individuals having age over 60-year old and it is expected that the number will exceed 10 million by 2050 [3]. The level of knowledge regarding dementia among healthcare providers was found to affect the critical issues in care, including quality of care environments, the timing of diagnosis, and implementation of interventions [46]. All these factors will affect the patient outcome, and improving them will improve the outcome of patients [5,7,8]. Care of patients with dementia is a growing global challenge; health care staffs are responsible for caring, diagnosis, and planning treatment of patients. Late diagnosis results in late initiation of treatment course and this, in turn, leads to the poor outcome of patients and bad quality of life. Healthcare staff should have adequate knowledge about dementia to diagnose it early and provide the appropriate treatment for the patients. There was no previous Saudi study conducted on these subjects. Moreover, few studies were reported from other countries about this subject. Hence, the purpose of this study to investigate the level of knowledge about Alzheimer among Saudi healthcare staff, to investigate the factors associated with good and bad knowledge, and to suggest solutions for the problem.


Subjects and Methods

A cross-sectional survey-based study was carried out among health care staff working in and outside Gurayyat General Hospital, Saudi Arabia. Convenient sample size and a random sampling technique were included. Human research ethics approval was obtained from Gurayyat General Hospital before beginning the study, in addition to an informed consent that was obtained from each participant before participating in this study. A link of a self-administered online questionnaire was provided at Google Forms. The data were collected using Alzheimer’s Disease Knowledge Scale (ADKS) as one of the recently developed tools for assessing the knowledge about Alzheimer [9]. This survey was selected to assess the knowledge, as it is easy, can be applied for different groups of participants and it has reliability and validity. The survey was composed of 30 items with true/false selection which can be divided into seven subscales; assessing life impact (items 1, 11, and 28), risk factors (questions 2, 13, 18, 25, 26, and 27), course of disease (items 3, 8, 14, and 17), assessment and diagnosis (items 4, 10, 20, and 21 ), caregiving (items 5, 6, 7, 15, and 16), treatment and management (items 9, 12, 24, and 29), and symptoms (items 19, 22, 23, and 30) [10]. This questionnaire contained some socio-demographic questions (age, sex, and level of education, profession, and the presence of a family member with dementia or being a caregiver) and the ADKS. A validated ADKS survey was distributed among healthcare staff and investigated their knowledge about Alzheimer disease.

A pilot study was conducted on 20 healthcare individuals to test the validation of the questionnaire before the start of the study. The data from the pilot study were analyzed as the data of the main study. The internal consistency of the questionnaire for the study variables was performed by applying Cronbach‘s alpha test. The data collected from all surveys filled by participants were saved into an excel sheet then were analyzed by SPSS program. Qualitative variables were represented using the number and percent, whereas quantitative variables were represented using mean ± SD. Correlations between different variables were performed using T-test or Chi-square according to the variables’ type. p-value was considered as significant at ≤ 0.05.

Table 1. Description of all study variables.

Description (n = 113)
Gender
Male 63 (55.8)
Female 50 (44.2)
Age
<30 40 (35.4)
30–50 52 (46)
>50 21 (18.6)
Professional group
Medicine 59 (52.2)
Nursing 26 (23)
Support 16 (14.2)
Allied health 12 (10.6)
Work setting
Hospital 72 (63.7)
Community 41 (36.3)
Family history of dementia
Yes 19 (16.8)
No 94 (83.2)
Personal caring experience
Yes 66 (58.4)
No 47 (41.6)
Professional caring experience
Yes 58 (51.3)
No 55 (48.7)
Tertiary education
Yes 59 (52.2)
No 54 (47.8)
Dementia training
Yes 42 (37.2)
No 71 (62.8)
Other dementia learning
Yes 61 (54)
No 52 (46)
Self-rated dementia knowledge
Yes 81 (71.7)
No 32 (28.3)

Results

A diverse staff group (N = 113), in terms of gender, age, professional group (medicine, nursing, support, and allied health staff), and work setting from a regional health service in Gurayyat General Hospital, Saudi Arabia responded to the online questionnaire. Most of the participants from Gurayyat General Hospital were male (55.8%) (Table 1). All the knowledge levels about Alzheimer’s disease was of a generally moderate level with a significant difference being observed by age group (<30, p = 0.03 and 30–50, p = 0.012) professional group (medicine, p = 0.000; support staff, p = 0.01) and even the participants had any caring experience (professional or personal) of dementia patients. These following variables showed a statistically significant relationship with ADKS score: gender, age, and professional group. The specified categories of respondents, those were between 30 to 50 years old and those in the medical professional group scored a highly significant score on the ADKS, and then those less than 30-year old and support staff displayed a significant score. Dementia had impacted the personal lives of many of the respondents; approximately 68% participants reported having non-work-related (personal experience) caring for someone with dementia and 15% had a family history of dementia (Table 2). Additionally, 53% of the respondents had cared for someone with dementia in the workplace (professional experience). Health district employees reported a highly significant knowledge of dementia (80%, p = 0.056, Table 2). Participants who rated themselves as having more knowledge of dementia had a score significantly higher on the ADKS (p = 0.05).

Table 2. Factors associated with Alzheimer’s awareness/knowledge.

Alzheimer awareness/knowledge
High (>75%) Low (<75%) p value*
Gender
Male 38 (69.1) 25 (43.1) 0.005
Female 17 (30.9) 33 (56.9)
Age
<30 14 (25.5) 26 (44.8) 0.031
30–50 32 (58.2) 20 (34.5) 0.012
>50 9 (16.4) 12 (20.7) 0.555
Professional group
Medicine 38 (69.1) 21 (36.2) 0.000
Nursing 10 (18.2) 16 (27.6) 0.235
Support 3 (5.5) 13 (22.4) 0.010
Allied health 4 (7.3) 8 (13.8) 0.261
Work setting
Hospital 39 (70.9) 33 (56.9) 0.122
Community 16 (29.1) 25 (43.1)
Family history of dementia
Yes 8 (14.5) 11 (19) 0.530
No 47 (85.5) 47 (81)
Personal caring experience
Yes 37 (67.3) 29 (50) 0.063
No 18 (32.7) 29 (50)
Professional caring experience
Yes 29 (52.7) 29 (50) 0.772
No 26 (47.3) 29 (50)
Tertiary education
Yes 29 (52.7) 30 (51.7) 0.915
No 26 (47.3) 28 (48.3)
Dementia training
Yes 21 (38.2) 21 (36.2) 0.828
No 34 (61.8) 37 (63.8)
Other dementia learning
Yes 32 (58.2) 29 (50) 0.383
No 23 (41.8) 29 (50)
Self-rated dementia knowledge
Yes 44 (80) 37 (63.8) 0.056
No 11 (20) 21 (36.2)

*Chi-square test

Analyzing each question individually (Table 3). The majority of participants responded “Yes” and less number of respondents answered “No” or “I don’t know.” Participants were asked about the Alzheimer’s disease (AD) patients memory loss and worsening of memory by years, 93 (82.3%) out of 113, and 79 (70%) out of 113, respectively, answered “Yes.” Most of the questions were answered with “Yes” with approximately 65% to 70% such as repeating of questions, taking over events, item misplacing more than one time per month, having trouble to remember the day or using cues, and feeling disoriented/confused outside the home in unfamiliar places, whereas the percentage of “Yes” decreased to 50% and the percentage were for “No” or “I don’t know” when participants asked about suspicion of patients from other to steal or hiding items, using appliances (oven, microwave, etc.). Also, by excluding physical limitations (e.g., tremor, hemiparesis, etc.), the participants were asked for the troubling of patients handling money, paying bills or doing any finance or had difficulties in home repairing, and reduction of activities. Other questions were answered with 55% to 60% “Yes,” e.g., troubling to take medications, driving difficulties, and decreased sense of directions. Other questions concerned with the AD patient’s family were answered with “Yes” 50% such as getting lost in familiar surroundings, confusion of family or friends names, recognizing people familiar to him, and trouble to find words other than names.

Table 3. Description of Alzheimer questionnaire questions.

No I do not know Yes
Does the patient have memory loss? 13 (11.5) 7 (6.2) 93 (82.3)
If so, is their memory loss worse than a few years ago? 12 (10.6) 22 (19.5) 79 (69.9)
Does the patient repeat questions OR statements OR stories in the same day? 18 (15.9) 30 (26.5) 65 (57.5)
Have you had to take over tracking events OR appointments? OR Does the patient forget appointments? 16 (14.2) 27 (23.9) 70 (61.9)
Does the patient misplace items more than once a month? OR Does the patient misplace objects so that he or she cannot find them? 13 (11.5) 29 (25.7) 71 (62.8)
Does the patient suspect others are moving, hiding or stealing items when they cannot find them? 21 (18.6) 38 (33.6) 54 (47.8)
Does the patient frequently have trouble knowing the day, date, month, year, time? OR Does the patient have to use cues like the newspaper or the calendar to know the day and date more than once a day? 15 (13.3) 28 (24.8) 70 (61.9)
Does the patient become disoriented in unfamiliar places? 16 (14.2) 25 (22.1) 72 (63.7)
Does the patient become more confused outside the home or when traveling? 12 (10.6) 28 (24.8) 73 (64.6)
Excluding physical limitations (e.g., tremor, hemiparesis, etc.), does the patient have trouble handling money (tips, calculating change?) 23 (20.4) 33 (29.2) 57 (50.4)
Excluding physical limitations (e.g., tremor, hemiparesis, etc.), does the patient have trouble paying bills or doing finances OR Are family members taking over finances because of concerns about ability? 20 (17.7) 35 (31) 58 (51.3)
Does the patient have trouble in remembering to take medications or tracking medications taken? 16 (14.2) 28 (24.8) 69 (61.1)
Is the patient having difficulty driving? OR Are you concerned about the patient’s driving? OR Has the patient stopped driving for reasons other than physical limitations? 15 (13.3) 35 (31) 63 (55.8)
Is the patient having trouble using appliances (e.g., microwave, oven, stove, remote control, telephone, alarm clock)? 20 (17.7) 36 (31.9) 57 (50.4)
Excluding physical limitations, is the patient having difficulty in completing home repair or other home-related tasks (housekeeping)? 25 (22.1) 34 (30.1) 54 (47.8)
Excluding physical limitations, has the patient gave up or significantly reduced activities, such as golfing, dancing, exercising, or crafts? 20 (17.7) 36 (31.9) 57 (50.4)
Is the patient getting lost in familiar surroundings (own neighborhood)? 15 (13.3) 37 (32.7) 61 (54)
Does the patient have a decreased sense of direction? 15 (13.3) 35 (31) 63 (55.8)
Does the patient have trouble finding words other than names? 17 (15) 38 (33.6) 58 (51.3)
Does the patient confuse names of family members or friends? 14 (12.4) 32 (28.3) 67 (59.3)
Does the patient have difficulty recognizing people familiar to him/her? 14 (12.4) 33 (29.2) 66 (58.4)

Discussion

Dementia is a public health concern as the prevalence is increasing worldwide with the significant increase being in low-middle income countries. However, these countries appear to be less prepared in handling this rise in terms of diagnosis and management. This study was conducted to investigate the level of knowledge about Alzheimer’s disease among Saudi healthcare staff at Gurayyat General Hospital. In the study, it was found that most of the respondents were male (63) (56%), this was in agreed with another study [11], which reported male participants were more than female participants. This study reported that a diverse group of health district staff showed a generally moderate level of knowledge. As predicted, those in professions with direct patient contact (medical, nursing) showed higher levels of knowledge than those in a supportive role (administrative, housekeeping, security and transport staff), according to ADKS, meaning that those who self-rated their knowledge to be good, scored well on ADKS as well. Overall results on the selected measure of dementia knowledge, these results closely resembled the results from the original study [9,12]. Similar results were reported in a study conducted among medical students in US [7] as well as in a study conducted in Queensland, Australia among different health care staffs [1]. In addition, the current study confirmed a higher ADKS score with those who self-assessed knowledge of dementia than attended a dementia-specific educational session.

The respondents of the current study were a self-selected group and tended to respond because of their interest, or knowledge of dementia, whereas in the current study, there were other dementia learnings among hospital staff and also highly personal and professional caring experiences so could deal and detect early diagnosis, this result was in harmony with another study [5], who said that presence of good knowledge lead to early diagnosis [5], hence dementia patients obtain more choices and opportunity regarding the plans for the disease management [6,13,14]. While the poor knowledge about dementia results in underutilization of treatment and support [15]. Because the current study was conducted in and out of the health service region, in the hospital, it is easy to know how closely the sample reflects the wider community. But, this is one of the major limitations of the current study because it assessed the knowledge of Alzheimer’s disease among health care staff of a single medical hospital. Hence, a multi-centric study among health care staff of various medical hospitals would give a better picture of the scenario.


Conclusion

According to this study, professionals with direct patient contact (medical, nursing) were found to have better knowledge regarding dementia than those in a supportive role (administrative, housekeeping, security, and transport staff), according to ADKS. The knowledge was found to be better among those who had attended either sessions or any classes on dementia and among those who had media exposure regarding the same. Staff who involved in direct patient care will need a condensed extended program of education, in addition to information about the severity of dementia, which provides participants with particular skillsets to enable the delivery of high-quality care in an acute setting. Furthermore, a possible area in need of further research is to examine the specific types or elements of dementia education or training that are associated with better attitudes toward the care of patients with dementia.


List of Abbreviations:

AD Alzheimer’s disease
ADKS Alzheimer’s disease Knowledge Scale

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The study was approved by the Local Research Ethics Committee, Qurayyat Health Affairs, Date: 24/3/2019 Letter Number: 0020


Author details

Ahmed Basheer Alazmi1, Ali Basheer Alazmi2

  1. Family Medicina Registrar, Qurayyat Health Affairs, Ministry of Health, Qurayyat, Saudi Arabia
  2. Consultant Family Medicine, Qurayyat Health Affairs, Ministry of Health, Qurayyat, Saudi Arabia

References

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How to Cite this Article
Pubmed Style

Alazmi AB, Alazmi AB. A survey-based study of knowledge of Alzheimer's disease among health care staff. IJMDC. 2020; 4(2): 389-394. doi:10.24911/IJMDC.51-1575932476


Web Style

Alazmi AB, Alazmi AB. A survey-based study of knowledge of Alzheimer's disease among health care staff. https://www.ijmdc.com/?mno=77354 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1575932476


AMA (American Medical Association) Style

Alazmi AB, Alazmi AB. A survey-based study of knowledge of Alzheimer's disease among health care staff. IJMDC. 2020; 4(2): 389-394. doi:10.24911/IJMDC.51-1575932476



Vancouver/ICMJE Style

Alazmi AB, Alazmi AB. A survey-based study of knowledge of Alzheimer's disease among health care staff. IJMDC. (2020), [cited October 15, 2021]; 4(2): 389-394. doi:10.24911/IJMDC.51-1575932476



Harvard Style

Alazmi, A. B. & Alazmi, . A. B. (2020) A survey-based study of knowledge of Alzheimer's disease among health care staff. IJMDC, 4 (2), 389-394. doi:10.24911/IJMDC.51-1575932476



Turabian Style

Alazmi, Ahmed Basheer, and Ali Basheer Alazmi. 2020. A survey-based study of knowledge of Alzheimer's disease among health care staff. International Journal of Medicine in Developing Countries, 4 (2), 389-394. doi:10.24911/IJMDC.51-1575932476



Chicago Style

Alazmi, Ahmed Basheer, and Ali Basheer Alazmi. "A survey-based study of knowledge of Alzheimer's disease among health care staff." International Journal of Medicine in Developing Countries 4 (2020), 389-394. doi:10.24911/IJMDC.51-1575932476



MLA (The Modern Language Association) Style

Alazmi, Ahmed Basheer, and Ali Basheer Alazmi. "A survey-based study of knowledge of Alzheimer's disease among health care staff." International Journal of Medicine in Developing Countries 4.2 (2020), 389-394. Print. doi:10.24911/IJMDC.51-1575932476



APA (American Psychological Association) Style

Alazmi, A. B. & Alazmi, . A. B. (2020) A survey-based study of knowledge of Alzheimer's disease among health care staff. International Journal of Medicine in Developing Countries, 4 (2), 389-394. doi:10.24911/IJMDC.51-1575932476