ABSTRACT
Objectives
Despite evidence and guidelines supporting rehabilitation, people with dementia experience limited access due to health professionals’ attitudes, knowledge gaps, and systemic barriers. The INCLUDE package is an interdisciplinary online training programme and Community of Practice (CoP) designed to address these barriers. The aim of this study was to evaluate the impact of the INCLUDE package on health professionals’ knowledge, attitudes, confidence, advocacy, and practice change in dementia rehabilitation.
Methods
A pre-post longitudinal study involved two groups of health professionals across Australia. Group 1 (n = 103) completed the online training and an 8-month CoP; Group 2 (n = 373) completed training only. Surveys administered at pre-training (T1), post-training (T2), and 10-month follow-up (T3; Group 1 only) assessed knowledge, attitudes and confidence towards dementia and dementia rehabilitation. Multilevel mixed-effects regression models were used to examine changes over time. Content analysis was used to explore advocacy, practice changes, barriers, and sustainability.
Results
476 health professionals participated. The largest groups were physiotherapists (n = 121, 26.7%), occupational therapists (n = 120, 26.5%) and nurses (n = 37,13.6%). The Dementia Attitudes Scale (coefficient 10.4, 95% CI 9.4–11.4), Dementia Rehabilitation Questionnaire (3.8, 95% CI 3.0–4.5), and Confidence in Delivering Dementia Rehabilitation Scale (3.2, 95% CI 2.8–3.5) improved from T1 to T2. In Group 1, improvements in attitudes towards dementia and confidence in rehabilitation were sustained at T3, but knowledge and attitudes towards dementia rehabilitation declined from T2 to T3. Participants advocated for dementia rehabilitation and made changes in their workplace including revising rehabilitation access criteria, advertising dementia rehabilitation to referrers, and developing interdisciplinary programs.
Conclusions
The INCLUDE package improved health professionals’ attitudes, knowledge and confidence in dementia rehabilitation. Although participants made changes in their workplace, barriers still existed. Organisational and system-level changes are also required to improve access to dementia rehabilitation.
Trial Registration
This study is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12623001029684