Support workers knowledge, skills and education relating to dementia – a national survey

Abigail J Hall; Richard Griffin; Fay Manning; Victoria A Goodwin

doi:10.3310/nihropenres.13671.1

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Research Article

Support workers knowledge, skills and education relating to dementia – a national survey

[version 1; peer review: 2 approved with reservations]

Abigail J Hall ¹, Richard Griffin², Fay Manning³, Victoria A Goodwin¹

PUBLISHED 24 Sep 2024

Author details Author details

¹ Public Health and Sports Science Department, University of Exeter, Exeter, England, EX1 2LU, UK
² Kings Business School, Kings College London, London, UK
³ Department of Health and Care Professions, University of Exeter, Exeter, England, UK

Abigail J Hall
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Richard Griffin
Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing

Fay Manning
Roles: Formal Analysis, Writing – Review & Editing

Victoria A Goodwin
Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Dementia affects over 55 million people globally, projected to double by 2050. In the UK, non-registered staff, including healthcare assistants (HCAs) and clinical support workers, provide a significant portion of dementia care, yet receive limited training. This study explores the knowledge, training, and attitudes of support workers towards dementia.

Methods

A cross-sectional web-based survey was conducted from February 1 to April 1, 2024, targeting support workers in England. The survey included demographic information, dementia knowledge (using the Dementia Knowledge Assessment Scale, DKAS), and attitudes (using the Dementia Attitudes Scale, DAS). Data were analysed using descriptive statistics, ANOVA, t-tests, and Pearson’s correlation.

Results

One hundred and nine support workers responded, predominantly female (90%) and white British (76.4%), from various NHS settings and occupational groups. The majority (79.8%) had received dementia training, primarily from their organisations. Challenges included managing behavioural and psychological symptoms and communication difficulties. There was no significant correlation between years of experience and dementia knowledge (r = -0.019) or attitudes (r = -0.057). However, higher occupational grades were associated with greater dementia knowledge (p = <0.01). A moderate positive correlation was found between dementia knowledge and attitudes (r = 0.35, p = <0.01).

Despite high levels of knowledge, support workers often feel inadequately prepared to provide optimal dementia care, indicating a need for more comprehensive training. Challenges in communication and managing symptoms highlight areas for improvement. The study suggests that better training can improve both knowledge and attitudes, enhancing care quality for people living with dementia.

Conclusion

Support workers play a crucial role in dementia care but require more robust training programs to meet the growing demands. Enhanced training can improve their knowledge and attitudes, leading to better care outcomes for people with dementia.

Plain Language Summary

Dementia is a condition that affects millions of people worldwide, with numbers expected to double by 2050. In the UK, many people with dementia are cared for by non-registered staff like healthcare assistants (HCAs) and clinical support workers. These workers provide a lot of direct care but often receive very little training. This study looks at what support workers know about dementia, the training they have received, and their attitudes towards people living with dementia.

We conducted an online survey from February to April 2024, asking support workers across England about their experience, training, and attitudes towards dementia.

We found that how long someone had worked did not significantly affect their knowledge or attitudes about dementia. However, those in higher job positions tended to know more about dementia. There was also a positive link between having more knowledge about dementia and having better attitudes towards people with dementia.

Keywords

Dementia, support workers, healthcare assistants, training, knowledge, attitudes, NHS.

Corresponding author: Abigail J Hall

Competing interests: No competing interests were disclosed.

Grant information: This project is funded by the National Institute for Health and Care Research (NIHR) by a School of Primary Care Post-doctoral fellowship (Grant reference number NIHR119247) and supported by the NIHR Applied Research Collaboration South West Peninsula. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Hall AJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Hall AJ, Griffin R, Manning F and Goodwin VA. Support workers knowledge, skills and education relating to dementia – a national survey [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2024, 4:54 (https://doi.org/10.3310/nihropenres.13671.1) First published: 24 Sep 2024, 4:54 (https://doi.org/10.3310/nihropenres.13671.1) Latest published: 27 Nov 2024, 4:54 (https://doi.org/10.3310/nihropenres.13671.2)

Background

It is estimated that over 55 million people were living with dementia worldwide in 2020 and this number is projected to approximately double every twenty years, reaching 78 million in 2030 and 139 million in 2050¹. Dementia is rapidly becoming a global epidemic. With cognitive decline, there is often an associated physical decline² and thus an increase in healthcare demands. As it is estimated that 60% of face-to-face patient care in the NHS is provided by non-registered staff³, it can be presumed that a large proportion of people living with dementia (PLwD) will receive face-to-face care from a non-registered professional. There are almost 400,000 healthcare assistants (HCAs) and clinical support workers in the UK who work alongside nurses and other health professionals⁴ and despite providing the majority of face-to-face care, evidence suggests that non-registered staff only receive 5% of the NHS’ training budget³.

There is little evidence investigating the effectiveness of support workers working with PLwD⁵, nor is there any evidence about the knowledge of support workers about dementia. One systematic review⁶ suggested the positive effect of support workers on the quality of life for PLwD and the reduction in carer burden – however, it also highlighted the lack of high-quality evidence. The NHS Long Term Plan⁷ and the NHS Long Term Workforce Plan⁸ recognise the importance of support workers to deliver effective and safe NHS services. The Long Term Workforce Plan particularly emphasises the importance of promoting routes to professional qualifications for support workers to expand their scope of practice. However, the availability and uptake of training for support workers relating to dementia remains unclear despite the increasing demand for healthcare professionals to be able to effectively treat PLwD. Thus, this study aimed to explore the knowledge that support workers have relating to dementia and the access to training and support that they have received. It also sought to understand the thoughts and attitudes of support workers toward dementia and whether there is any correlation between knowledge and attitudes toward people working with dementia.

Methods

Patient and Public Involvement

The basis for this study was informed by patients and the public, who reported that often clinicians did not seem to have a good understanding about dementia, nor did they always understand how best to approach and support them or their relatives.

A cross-sectional web-based survey was undertaken using JISC Online Surveys, which is subscribed to by the University of Exeter. The survey was open from 1^st February 2024 to 1^st April 2024 and employed a convenience sampling strategy.

An introduction and a link to the participant information sheet including the inclusion criteria was provided on the first page of the survey. There was also information provided about GDPR. To complete the survey, individuals were asked to confirm that they were a support worker working in England and regularly meet patients/clients who are living with dementia.

Respondents consented to participate by clicking the final submit button once the survey was completed. Survey responses were anonymous unless contact details were provided for study updates or other research opportunities. These details were stored securely and separately from the survey responses. Although it was anticipated that there would be little identifying data given by respondents, there was the option for free text where identifying data could be entered, therefore, all data were checked and any identifiable data was removed/anonymised to prevent identification. This anonymisation was completed before the analysis.

Inclusion criteria

- Support worker with current or previous experience of working in the NHS
- Regularly work with older adults who may have dementia or cognitive impairment

Recruitment & consent

A targeted social media campaign using “X” (formerly Twitter) was used to advertise the survey. Relevant professional bodies were contacted and asked if they could disseminate to their associate (non-registered) members and an email was sent to regional Allied Health Profession leads to disseminate to their support worker networks within their regions and organisations.

The survey included demographic information relating to the sampling strategy (gender, ethnicity, professional background, location of work, years of experience etc) and to ensure maximum variation, several waves of promotion of the study occurred focusing on groups or characteristics that were underrepresented. This included support workers who work alongside a particular profession that had received fewer responses.

Data collection

JISC Online Surveys was used to collect responses to the survey. JISC Online Surveys (formerly Bristol) online survey tool (https://www.onlinesurveys.ac.uk/) has been used by the research team previously to undertake a national survey. The survey was piloted with a small number of support workers (n=10) before roll out. These were selected from a support worker advisory group we have developed to identify any issues with understanding, formatting, and time to complete. Their data were included in the analysis. It was estimated that the survey would take 15 minutes to complete which was explained on the Participant Information Sheet (PIS). Following the pilot, no revisions were needed to be made to the survey. There were no incentives offered to take part in the survey. The survey was open for two months following approval to begin data collection. A total of 58 questions were asked, over three separate pages. JISC allows the participant to move back to a previous page should they have wished to review their answers before submitting the survey.

The survey included questions on professional background, qualifications, and role. We then sought to understand their knowledge about dementia and any training they have received to support them in their role. Further to this, we aimed to understand their attitude towards dementia. The survey included both open and closed questions. Closed questions involved a tick box, multiple choice answers, or a Likert rating scale. Respondents were also allowed to answer “other” where the pre-specified options may not have applied. There were also open questions offering the opportunity for the respondent to offer free text answers. All questions were optional to allow respondents to feel free to answer the questions they felt comfortable with.

We used the Dementia Knowledge Assessment Scale (DKAS)⁹ and the Dementia Attitudes Scale¹⁰. The DKAS is a 25-item measure of understanding dementia that is comprised of verifiably true and false statements about dementia. The scale has been validated with large Australian and international samples (n > 3,500) of health professionals (nurses, aged care workers, physiotherapists, occupational therapists, health educators, and students) and lay respondents⁹. It comprises statements about dementia that are factually correct or incorrect, which were developed following a Delphi study with dementia experts. We used an adapted version of the Dementia Knowledge Assessment Scale (DKAS), developed by Annear et al.⁹, which offered the options of ‘True’, ‘False’, or ‘Don’t know’ to ensure ease of completion. Additionally, we explored the attitudes of the support worker to PLwD using the Dementia Attitude Scale (DAS), developed by O'Connor and McFadden¹⁰). The seven-point scale includes twenty items ranging from strongly disagree to strongly agree scoring between 20 and 140.

Analysis

Before analysis, all data were checked and cleaned. Two responses were excluded as the participant noted that they were not working as a support worker. Any duplicate entries were removed if evident. Descriptive statistics (mean, standard deviation, frequencies, and percentages) were calculated for closed questions using the analysis function provided by JISC.

For the validated questionnaires, we compared continuous data with categorical relationships (e.g mean DKAS/DAS scores vs. years of experience etc) parametric tests such as the Analysis of variance (ANOVA) were undertaken. We also sought to explore whether there was any correlation between knowledge and attitude towards dementia using Pearson’s correlation. To determine the relationships, the variables “years of experience” and “occupational grade” were converted into a numerical format for analysis. The conversion assigned specific numerical values to the ranges provided (e.g., 20+ years was assigned a value of 25, 16–20 years was assigned a value of 18, etc.).

Before comparing variables, the Kolmogorov–Smirnov test was used to determine the normality of the distribution to guide the statistical analysis. Independent t-tests were used to compare between group differences.

For questions involving free text responses, answers were collated and grouped into themes. Data were downloaded into Excel, each row representing individual respondents and each column the research questions. Survey results were reported according to the Checklist for Reporting Results of Internet E-surveys (CHERRIES)¹¹.

Ethical approval and consent

Ethical approval was granted on the 11^th January 2024 from the Kings College London – reference MRA-23/24-41002 .Informed consent was obtained electronically from all participants. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Data protection and participant confidentiality

All data were stored on Kings College London’s One-Drive. Only the primary researchers had access to this. Storing all data on this central server prevented the need to share data between the University of Exeter and Kings College London.

JISC online was used to collect responses to the survey. JISC Online Surveys (formerly Bristol) online survey tool (https://www.onlinesurveys.ac.uk/). The JISC data is secure and strict information security standards are followed (ISO27001) and data is processed in compliance with GDPR.

Data will be stored for 5 years after the end of the study.

Results

One hundred and nine unique respondents completed the survey (Table 1) representing a variety of professional groups working in a variety of different settings. The support workers were spread over the seven geographical regions as categorised by NHS England.

Table 1. Characteristics of participants.

		N (%)
Gender	Male (including transgender men)	7 (6.4)
	Female (including transgender women)	97 (90)
	Non-binary	2 (1.8)
	Other	1 (0.9)
	Prefer not to say	1 (0.9)
Ethnicity	White – British, Irish or any other background	88 (81)
	Mixed – White and Black Caribbean, African Asian or any other background	4 (3.6)
	Asian or Asian British	6 (5.4)
	Black or Black British–Caribbean, African, any other	6 (5.4)
	Chinese	1 (0.9)
	Any other groups	2 (1.8)
	Not stated	1 (0.9)
Location of work (by NHS England region)	East of England	7 (6.4)
	London	7 (6.4)
	Midlands	22 (20)
	North East and Yorkshire	4 (3.6)
	North West	18 (16.4)
	South East	18 (16.4)
	South West	33 (31.8)
Occupational group	Nursing	52 (48)
	Occupational Therapy	20 (18.3)
	Physiotherapy	18 (16.5)
	Other	20 (18.3)
	Speech and language therapy	9 (8.3)
	Radiography	5 (4.6)
	Dietetics	4 (3.7)
	Social care	3 (2.8)
	Pharmacy	1 (0.9)
	Public Health	1 (0.9)
	Healthcare science	1 (0.9)
	Prefer not to say	2 (1.8)
NHS Grade	2	24 (22)
	3	34 (31)
	4	3 (32.1)
	5	8 (7.3)
	6	4 (3.7)
	Other/unsure	3 (2.7)
Setting of Work	Acute hospital	55 (50.5)
	Rehabilitation hospital	13 (11.9)
	Community Hospital	11 (10.1)
	Community team	28 (25.7)
	GP Surgery	2 (1.8)
	Other	11 (10.1)
Length of NHS service	< 1 year	10 (9.5)
	1 – 5 years	30 (28)
	6-10 years	21 (20)
	11 – 15 years	8 (7.6)
	16 – 20 years	9 (8.6)
	20+ years	25 (23.8)

Challenges

Participants were asked to identify the main challenges they faced when working with individuals with dementia. While the challenges were diverse and multifaceted, several common themes emerged from their responses. Of the 109 responses, 90 participants (83%) reported challenges supporting PLwD.

The most frequently reported challenge (32% of participants) was behavioural and psychological symptoms that make it challenging to care for this group of people, including physical and verbal aggression as well as fluctuating levels of confusion.

Some of the patients can be very aggressive and more recently the patients we get in our ward have been the worst we’ve ever had and with no restraints we are now often getting injured also they can be verbally aggressive and swear a lot not all but when there’s a ward of 21 dementia patients and you have around 8 both male and female then the work is very hard and challenging

Communication issues were also significant, with 29% of support workers struggling to communicate with the person with dementia and 11% finding it difficult to communicate with the person's family or relatives, either due to difficulty reaching them or supporting them to understand the situation. Additionally, 7% of participants reported that getting individuals with dementia to follow instructions hindered their ability to perform their roles effectively.

Communication can be challenging when working with people with dementia. If their dementia is more advanced, it can be difficult to obtain coherent responses to the questions we ask. I often rely on a carer/relative being present at home visits as they are able to provide essential information about their loved one.

A lack of time and resources was noted by 13% of participants, which directly impacted their ability to get to know the person and understand their preferences. Other challenges included addressing physical needs, such as meeting nutritional requirements (4/92), ensuring physical safety (3/92), and providing adequate care. Furthermore, 13% of participants reported difficulties in accessing social care or obtaining support for the person with dementia.

Training

Participants were asked if they had received any specific training relating to dementia. Eighty-seven (79.8%) respondents reported that they had received specific training and 54 (49.1%) reported that they had completed mandatory training relating to dementia. While most participants had received some training, many (78%) felt that further training would be useful to effectively manage PLwD. Several participants felt that dementia training should be mandatory.

I think Dementia training should be mandatory for all health and social care professionals. This should include how to support the person, and their family, dealing with behaviours that may challenge you

Of those who had received specific training, the majority had received training from their organisation (or previous organisations) (89%) with only a small number (11%) having been able to attend any external training. External training included diplomas, stand-alone courses at Higher Education Institutes or one person reported having undertaken a Master's degree in dementia. Other specialist courses were rarely undertaken by our participants – Teepa Snow (1%) and the “Dementia Bus” (6%). Sixty-seven percent of participants who responded reported that they had received training in other mental health conditions such as Autism, Schizophrenia, depression, and anxiety. Participants reported that further training would be useful, particularly around improving communication skills with PLwD and simulation to allow them to get a better understanding of how it feels to live with dementia.

Yes, simulation would be nice. Most people do not understand how the person living with dementia communicate their needs. I think this should be where focus on training should lie, on interpreting challenging behaviours instead of just generalising that challenging behaviour is a normal part of the disease.

Many participants reported that without the availability of in-depth training related to dementia, much of their knowledge was self-taught through many years of experience working with this population.

Experience

We sought to evaluate whether the level of experience of the support worker affected the knowledge or attitudes towards dementia.

Years of experience and attitude towards people with dementia

The analysis revealed a Pearson correlation coefficient of -0.057 between years of experience and DAS score. This value indicates a very weak negative correlation, suggesting that there is no meaningful relationship between the years of experience and the DAS score in this sample.

For NHS workers with 1–5 years of experience, the mean DAS score was 107.2 (95% CI 102.30 - 112.10). In contrast, those with 20+ years of experience had a mean DAS score of 105.65 (95% CI 97.85 - 113.45). The independent two-sample t-test yielded a t-statistic of 0.36 and a p-value of 0.719, indicating no statistically significant difference between the two groups (p > 0.05).

These results suggest that the attitudes towards dementia, as measured by the DAS, do not significantly differ between NHS workers with less than 5 years of experience and those with over 20 years of experience. These results imply that the length of time an individual has worked within the NHS does not significantly influence their attitudes towards dementia as measured by the DAS score.

Years of experience and knowledge of dementia

The analysis revealed a Pearson correlation coefficient of -0.019 between years of experience and DKAT score. This value indicates an extremely weak negative correlation, suggesting that there is no significant relationship between the years of experience and the DKAT score in this sample.

For NHS workers with 1-5 years of experience, the mean DKAT score was 38.0, ( 95% CI 35.94 - 40.06). In contrast, those with 20+ years of experience had a mean DKAT score of 36.96 (95% CI - 34.30 to 39.61). The independent two-sample t-test yielded a t-statistic of 0.65 and a p-value of 0.519, indicating no statistically significant difference between the two groups (p > 0.05).

These results suggest that the level of dementia knowledge, as measured by the DKAT, does not significantly differ between NHS workers with less than 5 years of experience and those with over 20 years of experience.

The extremely weak negative correlation observed between years of experience and DKAT score, much like the DAS score, indicates that years of experience within the NHS do not significantly influence dementia-related knowledge. The weak negative correlation observed between years of experience and DAS score indicates that other factors might play a more significant role in shaping attitudes towards dementia among support workers.

Occupational grade

We further sought to determine whether there was any difference in knowledge and attitudes between occupational grades

Occupational grade and knowledge of dementia

The analysis revealed a Pearson correlation coefficient of 0.076 between occupational grade and DKAT score. This value indicates a very weak positive correlation, suggesting that the occupational level of NHS employees has little impact on their knowledge about dementia. Additionally, the p-value for this correlation was 0.452. This high p-value indicates that the observed correlation is not statistically significant.

An independent two-sample t-test was conducted to compare the DKAT scores between Band 2 and Band 4. The mean DKAT score for Band 2 was 34.92 (95% CI ranging from 32.46 - 37.37), while the mean score for Band 4 was 39.18 (95% CI 37.11 - 41.25). The independent two-sample t-test yielded a t-statistic of -2.72 and a p-value of <0.01. These results indicate a statistically significant difference in DKAT scores between the two occupational grades (p < 0.05).

The analysis revealed a significant difference in DKAT scores between NHS workers in Band 2 and Band 4, with Band 4 workers scoring higher on average. This suggests that workers in higher occupational grades may possess greater knowledge about dementia.

Occupational grade and attitude towards dementia

To explore the relationship between occupational grades (NHS bands) and attitudes towards dementia, as measured by the DAS score, a Pearson correlation analysis was performed. The “occupational grade” variable was numerically coded for this analysis.

The analysis revealed a Pearson correlation coefficient of 0.004 between occupational grade and DAS score. This indicates a very weak positive correlation. The p-value for this correlation was found to be 0.967 which indicates that the observed correlation is not statistically significant.

An independent two-sample t-test was conducted to compare the DAS scores between Band 2 and Band 4. The mean DAS score for Band 2 was 101.67 (95% CI 92.99 - 110.35), while the mean score for Band 4 was 107.59 (95% CI 102.06 - 113.12). The independent two-sample t-test yielded a t-statistic of -1.24 and a p-value of 0.221. These results indicate that there is no statistically significant difference in DAS scores between the two occupational grades (p > 0.05). The results indicate that there is no significant relationship between the occupational grade of NHS employees and their attitudes towards dementia.

Knowledge of dementia and attitude towards dementia

A Pearson correlation analysis was conducted to evaluate the relationship between DAS and DKAT scores. The Pearson correlation coefficient between DAS and DKAT scores was found to be approximately 0.35 (p=<0.01), indicating a moderate positive correlation. This suggests that higher knowledge about dementia is associated with more positive attitudes towards dementia.

Discussion

This study aimed to explore the knowledge that support workers have relating to dementia and the access to training and support that they have received. It also sought to understand the thoughts and attitudes of support workers toward dementia and whether there is any correlation between their knowledge and attitudes. Our data suggests that while the majority of participants had received training relating to dementia, they did not feel it was sufficient to be able to give patients the optimum care, despite their knowledge generally being high.

There is evidence to suggest that training programs enhance support workers’ understanding of dementia, leading to better care practices. Approaches such as “Dementia Care Mapping” have been shown to improve caregivers’ skills in recognising and responding to the needs of PLwD¹². Many of our participants reported challenges communicating effectively with PLwD. Evidence suggests that training improves communication skills, enabling support workers to interact more effectively. This can lead to improved patient outcomes, such as reduced agitation and improved cooperation with care routines¹³. Further challenges cited were around the challenges of managing behavioural and psychological symptoms (BPSD) and studies indicate that bespoke training can aid support workers to better manage these symptoms of dementia¹⁴.

Our analysis was conducted to explore the relationship between years of experience, occupational banding, and attitudes and knowledge about dementia found no significant relationship between years of experience and attitudes (DAS score) or knowledge (DKAT score) about dementia. Similarly, there was no significant relationship between occupational level and attitudes towards dementia. However, a significant difference in dementia knowledge was observed between different occupational levels, with higher occupational levels showing greater knowledge. These findings suggest that neither years of experience nor occupational grading levels significantly influence attitudes towards dementia, though higher bands may have better dementia knowledge.

Studies indicate that those who receive specialised training in dementia care tend to have more positive attitudes and are better equipped to provide high-quality care¹³. The World Alzheimer Report 2019 by Alzheimer's Disease International highlights the varying attitudes towards dementia, including those of support workers. The report found significant differences in attitudes, with some caregivers showing high levels of empathy and others expressing stigmatising beliefs about dementia¹⁵.

Our data suggested a correlation between knowledge and attitude toward PLwD. This supports other findings which suggest that training programs provide support workers with a better understanding of dementia, including its symptoms, progression, and the needs of those affected¹⁶. By addressing common myths and stigma associated with dementia, training may help support workers develop more accurate views of PLwD and strategies to help support them. Educational sessions that highlight the abilities and potential of PLwD, rather than just their limitations, can reduce stigmatising beliefs¹⁷.

Conclusion

Our findings indicate that while most participants had received dementia training, they often felt it was insufficient to provide optimal care, despite generally high knowledge levels. Many participants reported challenges in effectively communicating with PLwD, a skill that evidence suggests can be improved through targeted training.

The study also highlighted difficulties in managing behavioural and psychological symptoms of dementia (BPSD). Bespoke training has been shown to aid support workers in better managing these symptoms, contributing to improved care quality.

Our analysis found no significant relationship between years of experience or NHS banding levels and attitudes or knowledge about dementia. However, a significant difference in dementia knowledge was observed between different banding levels, with higher bands showing greater knowledge. This suggests that while neither experience nor banding significantly influences attitudes, higher banding levels are associated with better dementia knowledge.

In conclusion, while knowledge levels among support workers are generally high, there is a need for more comprehensive and specialized training programs to ensure they feel adequately prepared to provide the highest quality care for PLwD. Enhanced training not only improves dementia knowledge but also positively influences attitudes, leading to better care outcomes.

Strengths and limitations

We recognise that the relatively small number of respondents could not be considered representative to the whole population of support workers in England, however, the survey offers insights into the training needs and requirements for our support workforce. However, we were able to sample a wide range of different groups of support workers across a variety of different settings to gain insights into the workforce as a whole.

Ethical approval and consent

Data availability

Underlying data

The anonymised dataset is accessible for review.

Open Science Framework: Support workers knowledge, skills and education relating to dementia – a national survey DOI: osf.io/rwty7¹⁴

This project contains the following underlying data:

Cleansed anonymised data (Excel spreadsheet with anonymised data set)

Extended data

The survey questions are accessible for review.

Open Science Framework – DOI: osf.io/rwty7¹⁴

This project contains the following extended data:

Survey questions (Word document detailing questions used in the survey)

Data are available under the terms of the CCO 1.0 Universal license.

Software availability statement

The online survey used in this study was conducted using JISC Online Surveys. The survey tool is accessible at [https://www.jisc.ac.uk/online-surveys] (https://www.jisc.ac.uk/online-surveys). It is a commercial tool available under a subscription license. Data collected through the survey is stored securely and complies with relevant privacy regulations, including GDPR. Documentation for the survey tool can be found at [https://www.jisc.ac.uk/online-surveys] (https://www.jisc.ac.uk/online-surveys). For further inquiries, please contact the JISC support team at help@jisc.ac.uk.

Acknowledgements

The authors would like to thank the participants for taking the time to complete the survey.

Faculty Opinions recommended

References

1. Alzheimers' Disease International: Dementia statistics. 2021. Reference Source
2. Kulmala J, Nykänen I, Mänty M, et al.: Association between frailty and dementia: a population-based study. Gerontology. 2013; 60(1): 16–21. PubMed Abstract | Publisher Full Text
3. Health Education England: A national strategic framework to develop the healthcare support workforce. 2014. Reference Source
4. UNISON: Care on the cheap. A UNISON survey of clinical support workers. 2016. Reference Source
5. Prince M, Bryce R, Ferri C: World Alzheimer Report 2011: The benefits of early diagnosis and intervention. Alzheimer's Disease International London, 2011. Reference Source
6. Goeman D, Renehan E, Koch S: What is the effectiveness of the support worker role for people with dementia and their carers? A systematic review. BMC Health Serv Res. 2016; 16(1): 285. PubMed Abstract | Publisher Full Text | Free Full Text
7. NHS England: The NHS long term plan. NHS England; 2019. Reference Source
8. NHS England: NHS long term workforce plan. 2023. Reference Source
9. Annear MJ, Toye CM, Eccleston CE, et al.: Dementia knowledge assessment scale: development and preliminary psychometric properties. J Am Geriatr Soc. 2015; 63(11): 2375–81. PubMed Abstract | Publisher Full Text
10. O'Connor ML, McFadden SH: Development and psychometric validation of the dementia attitudes scale. International Journal of Alzheimer’s Disease. 2010; 2010: 454218. Reference Source
11. Eysenbach G: Improving the quality of Web surveys: the checklist for reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004; 6(3): e34. PubMed Abstract | Publisher Full Text | Free Full Text
12. Brooker D, Surr C: Dementia care mapping: principles and practice. Bradford Dementia Group, University of Bradford, 2005. Reference Source
13. Eggenberger E, Heimerl K, Bennett MI: Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings. Int Psychogeriatr. 2013; 25(3): 345–58. PubMed Abstract | Publisher Full Text
14. Fossey J, Ballard C, Juszczak E, et al.: Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ. 2006; 332(7544): 756–61. PubMed Abstract | Publisher Full Text | Free Full Text
15. Alzheimer's Disease International: World Alzheimer Report 2019. 2019. Reference Source
16. Spector A, Orrell M, Goyder J: A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res Rev. 2013; 12(1): 354–64. PubMed Abstract | Publisher Full Text
17. Werner P, Goldstein D, Buchbinder E: Subjective experience of family stigma as reported by children of Alzheimer’s disease patients. Qual Health Res. 2010; 20(2): 159–69. PubMed Abstract | Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 24 Sep 2024

Author details Author details

Abigail J Hall
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Richard Griffin
Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing

Fay Manning
Roles: Formal Analysis, Writing – Review & Editing

Victoria A Goodwin
Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This project is funded by the National Institute for Health and Care Research (NIHR) by a School of Primary Care Post-doctoral fellowship (Grant reference number NIHR119247) and supported by the NIHR Applied Research Collaboration South West Peninsula. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (2)

version 2

Revised

Published: 27 Nov 2024, 4:54

https://doi.org/10.3310/nihropenres.13671.2

version 1

Published: 24 Sep 2024, 4:54

https://doi.org/10.3310/nihropenres.13671.1

© 2024 Hall AJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Hall AJ, Griffin R, Manning F and Goodwin VA. Support workers knowledge, skills and education relating to dementia – a national survey [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2024, 4:54 (https://doi.org/10.3310/nihropenres.13671.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

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PUBLISHED 24 Sep 2024

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Reviewer Report 13 Nov 2024

Julie Nightingale, CARe Research Centre, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, England, UK

Sarah Etty, CARe Research Centre, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, England, UK

Approved with Reservations

https://doi.org/10.3310/nihropenres.14844.r33223

Thank you for the opportunity to review this interesting article. Most of the comments provided are stylistic or requesting additional clarity, however there are some suggestions to enhance the discussion and recommendations of the work.

Background:
Para 2, 1^st sentence: “There is little evidence investigating” should be – “there is little research investigating”/”there is little evidence to show the effectiveness…”
Para 2, 2^nd sentence: “One systematic review suggested the positive effect…” – suggest ‘the’ replaced with ‘a’
Para 2, 5^th sentence: “effectively treat PLwD” – should this be ‘care for’?
Para 2, final sentence: “It also sought to understand the thoughts and attitudes of support workers toward dementia and whether there is any correlation between knowledge and attitudes toward people working with dementia.” – I think this must be an error – should it be “living with dementia”?

Methods:
Patient and public involvement – sentence 1 is rather anecdotal. Was this specific PPIE engagement concerned with this project, or was it drawn from literature (if so, cite it)?
Paragraph 2 – JISC online surveys – needs a TM mark or company link. This is provided later in the section.
Can you specify that higher scores for measures indicate higher levels of knowledge and more positive attitudes for the DKAS and DAS respectively? If that is in fact what higher scores indicate.
Recruitment and consent – paragraph 1 - It isn't clear if this is just AHP support workers that you targeted or if it also includes nursing. If so, how did you publicise to nursing support workers?
Data Collection – para 1 – ‘used by research team previously’ – is that relevant?
Data Collection - para 1 - “Their data were included in the analysis” – this would be better coming later, after you say that no revisions were needed.
Data Collection, p5 top paragraph - “All questions were optional to allow respondents to feel free to answer the questions they felt comfortable with.” – What was the rationale for this? This topic is arguably not a highly sensitive topic and this was probably unnecessary and may have led to incomplete information. Unless all questions were answered and none missed, I would add this as a limitation.
Data collection – final paragraph - This is a style issue, but I suggest this can easily be described in third person (e.g. The DKAS was used…), rather than ‘we/our’.

Analysis:
Para 2 - “For the validated questionnaires, we compared continuous data with categorical relationships (e.g mean DKAS/DAS scores vs. years of experience etc) parametric tests such as the Analysis of variance (ANOVA) were undertaken.” – is there a word missing here? Please reword for clarity.

Results:
Table 1 - The inclusion of a relatively high proportion (11%) of band 5/6 support workers is concerning. It is extremely unusual to have support workers in bands 5 and 6 positions – does this mean they are no longer working as support workers? If so, I think these participants should be excluded from the sample as their views and knowledge as support workers are likely to now be influenced by their more senior positions.
P7 Years of experience and attitude towards people with dementia – final paragraph - “These results imply that the length of time an individual has worked within the NHS does not significantly influence their attitudes towards dementia as measured by the DAS score.” – not necessarily, suggest that the attitudes of those who remain in the role do not change over time. Attitudes may change in some individuals which may then result in them leaving their roles.
P8 Occupational grade and knowledge of dementia - final sentence. “This suggests that workers in higher occupational grades may possess greater knowledge about dementia.” As the correlation between knowledge and occupational grade was weak and statistically non-significant, I would argue that the significant difference in knowledge scores between band 2 and 4 does not suggest that higher bands have more knowledge, but rather that those in band 2 are in starter positions and less likely to have increased knowledge of dementia due to a shorter period of experience. This is also mentioned in the discussion. Also, why were differences in knowledge level not examined between the other bandings? If there is a reason for this please provide it, if not, please complete the appropriate analysis.
P8 Knowledge of dementia and attitude towards dementia - “The Pearson correlation coefficient between DAS and DKAT scores was found to be approximately 0.35 (p=<0.01)” – I am concerned by the use of the word “approximately”? If this means you have rounded the figure to two decimal places, I would remove the word “approximately”.

Discussion:
General comment – This section does not appear to have fully engaged with the published literature. I am surprised that if the setting is the NHS that the authors haven't referenced any existing training resources, e.g. a quick search yielded a Dementia Training Standards Framework https://www.hee.nhs.uk/our-work/dementia-awareness/core-skills and further information here: https://www.hee.nhs.uk/our-work/dementia What training is already 'out there' in the NHS (or charities), and what might be recommended? You say that support workers need 'more training' - we can always do with more training but what would be effective (and cost-effective)?
The final sentence of the discussion appropriately discusses the importance of training which highlights abilities and potential of PLwD, but as mentioned above I am left wondering if these courses are already ‘out there’. Are there existing training programmes that do this, and would it be feasible for the support workforce to tap into these (or are they too costly or too much time away from the ward)? Alternatively, do we need to create specific training for support workers? I think we need to see some more detail to be able to have a stronger take away message from this work.
Final paragraph – “Our data suggested a correlation between knowledge and attitude toward PLwD.” You noted earlier that this was a moderate positive correlation, so this should be added to this sentence.

Conclusion
Final paragraph – “a need for more comprehensive and specialised training programs” – I think the message to readers / professions / policy makers could be stronger. Are the programs already available, whose responsibility is it to produce/deliver them, who should fund them, might they be online, in person, simulations? How can we deliver this training if support workers have such a small amount of the NHS training budget yet are one of the biggest groups of staff?

Data availability
I prefer to see the survey questions (or a precis of them) housed within the article as these are essential to understanding the rigour and results of the study, e.g. as an appendix. However, that may depend on journal style and preferences.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Hall A, Griffin R, Manning F, Goodwin V: Support workers knowledge, skills and education relating to dementia – a national survey. NIHR Open Research. 2024; 4. Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Reviewer 1- Workforce research, support worker research; Reviewer 2 - support worker research, quantitative analysis

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

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Report a concern

Author Response 02 Dec 2024

Abi Hall, Public Health and Sports Science Department, University of Exeter, Exeter, EX1 2LU, UK

02 Dec 2024

Author Response

The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of ... Continue reading The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of dementia care. Feedback from these sessions indicated that many patients and families felt clinicians often lacked a strong understanding of dementia and effective communication strategies. This input directly informed our study design and the survey content, helping us focus on areas where support workers might need additional training and resources.”

TM/company link for JISC has been added

We have added detail to explain that higher scores correlate to higher knowledge and more positive attitudes.

Additional text has been added to clarify about recruitment “A targeted social media campaign using “X” (formerly Twitter) was used to advertise the survey, specifically aiming to reach Allied Health Professional (AHP) support workers and nursing support workers. Relevant professional bodies were contacted and asked to disseminate the survey link to their associate (non-registered) members, including those in nursing roles. Additionally, an email was sent to regional Allied Health Profession leads, who were asked to share the survey with both AHP and nursing support worker networks within their regions and organisations.”

We have removed reference to this

We have changed this

Having all questions being optional has been added as a limitation

This has been edited

This has been reworded

Some text has been added to the methods to clarify the inclusion of band 5/6 support workers – “Participants self-identified as support workers within the NHS, including those in Bands 2 to 6. Although Band 5 and 6 roles typically carry more senior responsibilities, we included these individuals as their primary role was reported as a support worker. This inclusion allows for a broader understanding of the knowledge and attitudes across the spectrum of support workers, although it may reflect a wider scope of experience.”

And also to the limitations section “A small proportion (11%) of participants identified as Band 5 or Band 6, levels which generally entail more senior responsibilities beyond traditional support worker duties. While these participants identified as support workers, it is possible their views and knowledge could be influenced by higher-band responsibilities, which may differ from those in lower-band roles. Future studies might consider eligibility criteria to focus on Bands 2–4, ensuring the sample aligns closely with typical support worker roles.”

While it is unusual, there are examples of support workers who do work at these banding and therefore, we would not wish to exclude them from the analysis, rather we have made reference to it in the text as a possible limitation

We have added some additional text to clarify information about years of experience and attitudes towards dementia “These results suggest that, among those who remain in support worker roles, the length of time working within the NHS does not significantly influence attitudes toward dementia as measured by the DAS score. However, it is also possible that changes in attitudes could influence career trajectory, with some individuals who develop different perspectives or attitudes over time potentially leaving support worker roles. This potential attrition effect may mean that our sample reflects the attitudes of those who remain in the role, rather than capturing attitude changes over time within the broader population.”

We have revised the occupational grade and knowledge section to highlight the weak correlation “The analysis revealed a significant difference in DKAS scores between Band 2 and Band 4 workers, with Band 4 workers scoring higher on average (mean DKAS score for Band 2 = 34.92, 95% CI: 32.46–37.37; mean DKAS score for Band 4 = 39.18, 95% CI: 37.11–41.25; t = -2.72, p < 0.01). However, given the weak, statistically non-significant overall correlation between occupational grade and dementia knowledge (Pearson correlation coefficient = 0.076, p = 0.452), this finding may reflect the relatively early career stage of Band 2 workers, who likely have less experience and fewer training opportunities specific to dementia. This difference, therefore, may not suggest that higher grades inherently possess greater dementia knowledge but rather that those in Band 2 are often in starter roles where dementia-specific knowledge is less developed.
We chose to compare Bands 2 and 4 due to the clear delineation in occupational responsibilities and training levels typical of these grades. However, further analysis between other bands will be conducted to explore any additional differences in knowledge levels across occupational grades.
“

Addiditonal reference to relevant literature has been added in the next version.

Additional text has been added to our discussion section “While our findings indicate gaps in knowledge and confidence, it is possible that some support workers may not have full access to or awareness of the DTSF resources. Therefore, improving accessibility and awareness of these established training pathways may be a cost-effective strategy for enhancing knowledge across support worker roles. Additionally, given that the DTSF and similar training frameworks are designed to provide standardised skills across different care roles, targeted reinforcement of the DTSF competencies could be beneficial, especially if integrated into routine supervision or mentorship programs within the NHS.
To ensure training is both effective and cost-effective, future initiatives might consider integrating simulation-based training and peer support, which have been shown to improve practical skills in dementia care (Eggenberger et al., 2013). Simulation exercises could help support workers experience the challenges faced by individuals with dementia, fostering empathy and improving their ability to respond to challenging behaviours. Peer-led reflective sessions, where workers share experiences and discuss strategies for managing symptoms, could also support practical application of the DTSF competencies without requiring extensive additional resources.”

This has been added

We have revised the conclusion to add additional detail

Thank you for your suggestion regarding the inclusion of survey questions. We agree that access to the survey items is important for understanding the study’s rigor and results. Due to space constraints and to maintain the readability of the main article, we have opted not to include the full survey within the text. Instead, we propose making the survey questions available as supplementary material, or as part of an online appendix, depending on journal style and guidelines. This approach would ensure that interested readers can review the questions in full without compromising the flow and structure of the article.
The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of dementia care. Feedback from these sessions indicated that many patients and families felt clinicians often lacked a strong understanding of dementia and effective communication strategies. This input directly informed our study design and the survey content, helping us focus on areas where support workers might need additional training and resources.”

TM/company link for JISC has been added

We have added detail to explain that higher scores correlate to higher knowledge and more positive attitudes.

Additional text has been added to clarify about recruitment “A targeted social media campaign using “X” (formerly Twitter) was used to advertise the survey, specifically aiming to reach Allied Health Professional (AHP) support workers and nursing support workers. Relevant professional bodies were contacted and asked to disseminate the survey link to their associate (non-registered) members, including those in nursing roles. Additionally, an email was sent to regional Allied Health Profession leads, who were asked to share the survey with both AHP and nursing support worker networks within their regions and organisations.”

We have removed reference to this

We have changed this

Having all questions being optional has been added as a limitation

This has been edited

This has been reworded

Some text has been added to the methods to clarify the inclusion of band 5/6 support workers – “Participants self-identified as support workers within the NHS, including those in Bands 2 to 6. Although Band 5 and 6 roles typically carry more senior responsibilities, we included these individuals as their primary role was reported as a support worker. This inclusion allows for a broader understanding of the knowledge and attitudes across the spectrum of support workers, although it may reflect a wider scope of experience.”

And also to the limitations section “A small proportion (11%) of participants identified as Band 5 or Band 6, levels which generally entail more senior responsibilities beyond traditional support worker duties. While these participants identified as support workers, it is possible their views and knowledge could be influenced by higher-band responsibilities, which may differ from those in lower-band roles. Future studies might consider eligibility criteria to focus on Bands 2–4, ensuring the sample aligns closely with typical support worker roles.”

While it is unusual, there are examples of support workers who do work at these banding and therefore, we would not wish to exclude them from the analysis, rather we have made reference to it in the text as a possible limitation

We have added some additional text to clarify information about years of experience and attitudes towards dementia “These results suggest that, among those who remain in support worker roles, the length of time working within the NHS does not significantly influence attitudes toward dementia as measured by the DAS score. However, it is also possible that changes in attitudes could influence career trajectory, with some individuals who develop different perspectives or attitudes over time potentially leaving support worker roles. This potential attrition effect may mean that our sample reflects the attitudes of those who remain in the role, rather than capturing attitude changes over time within the broader population.”

We have revised the occupational grade and knowledge section to highlight the weak correlation “The analysis revealed a significant difference in DKAS scores between Band 2 and Band 4 workers, with Band 4 workers scoring higher on average (mean DKAS score for Band 2 = 34.92, 95% CI: 32.46–37.37; mean DKAS score for Band 4 = 39.18, 95% CI: 37.11–41.25; t = -2.72, p < 0.01). However, given the weak, statistically non-significant overall correlation between occupational grade and dementia knowledge (Pearson correlation coefficient = 0.076, p = 0.452), this finding may reflect the relatively early career stage of Band 2 workers, who likely have less experience and fewer training opportunities specific to dementia. This difference, therefore, may not suggest that higher grades inherently possess greater dementia knowledge but rather that those in Band 2 are often in starter roles where dementia-specific knowledge is less developed.
We chose to compare Bands 2 and 4 due to the clear delineation in occupational responsibilities and training levels typical of these grades. However, further analysis between other bands will be conducted to explore any additional differences in knowledge levels across occupational grades.
“

Addiditonal reference to relevant literature has been added in the next version.

Additional text has been added to our discussion section “While our findings indicate gaps in knowledge and confidence, it is possible that some support workers may not have full access to or awareness of the DTSF resources. Therefore, improving accessibility and awareness of these established training pathways may be a cost-effective strategy for enhancing knowledge across support worker roles. Additionally, given that the DTSF and similar training frameworks are designed to provide standardised skills across different care roles, targeted reinforcement of the DTSF competencies could be beneficial, especially if integrated into routine supervision or mentorship programs within the NHS.
To ensure training is both effective and cost-effective, future initiatives might consider integrating simulation-based training and peer support, which have been shown to improve practical skills in dementia care (Eggenberger et al., 2013). Simulation exercises could help support workers experience the challenges faced by individuals with dementia, fostering empathy and improving their ability to respond to challenging behaviours. Peer-led reflective sessions, where workers share experiences and discuss strategies for managing symptoms, could also support practical application of the DTSF competencies without requiring extensive additional resources.”

This has been added

We have revised the conclusion to add additional detail

Thank you for your suggestion regarding the inclusion of survey questions. We agree that access to the survey items is important for understanding the study’s rigor and results. Due to space constraints and to maintain the readability of the main article, we have opted not to include the full survey within the text. Instead, we propose making the survey questions available as supplementary material, or as part of an online appendix, depending on journal style and guidelines. This approach would ensure that interested readers can review the questions in full without compromising the flow and structure of the article.
Competing Interests: N/A Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 02 Dec 2024

Abi Hall, Public Health and Sports Science Department, University of Exeter, Exeter, EX1 2LU, UK

02 Dec 2024

Author Response

The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of ... Continue reading The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of dementia care. Feedback from these sessions indicated that many patients and families felt clinicians often lacked a strong understanding of dementia and effective communication strategies. This input directly informed our study design and the survey content, helping us focus on areas where support workers might need additional training and resources.”

TM/company link for JISC has been added

We have added detail to explain that higher scores correlate to higher knowledge and more positive attitudes.

Additional text has been added to clarify about recruitment “A targeted social media campaign using “X” (formerly Twitter) was used to advertise the survey, specifically aiming to reach Allied Health Professional (AHP) support workers and nursing support workers. Relevant professional bodies were contacted and asked to disseminate the survey link to their associate (non-registered) members, including those in nursing roles. Additionally, an email was sent to regional Allied Health Profession leads, who were asked to share the survey with both AHP and nursing support worker networks within their regions and organisations.”

We have removed reference to this

We have changed this

Having all questions being optional has been added as a limitation

This has been edited

This has been reworded

Some text has been added to the methods to clarify the inclusion of band 5/6 support workers – “Participants self-identified as support workers within the NHS, including those in Bands 2 to 6. Although Band 5 and 6 roles typically carry more senior responsibilities, we included these individuals as their primary role was reported as a support worker. This inclusion allows for a broader understanding of the knowledge and attitudes across the spectrum of support workers, although it may reflect a wider scope of experience.”

And also to the limitations section “A small proportion (11%) of participants identified as Band 5 or Band 6, levels which generally entail more senior responsibilities beyond traditional support worker duties. While these participants identified as support workers, it is possible their views and knowledge could be influenced by higher-band responsibilities, which may differ from those in lower-band roles. Future studies might consider eligibility criteria to focus on Bands 2–4, ensuring the sample aligns closely with typical support worker roles.”

While it is unusual, there are examples of support workers who do work at these banding and therefore, we would not wish to exclude them from the analysis, rather we have made reference to it in the text as a possible limitation

We have added some additional text to clarify information about years of experience and attitudes towards dementia “These results suggest that, among those who remain in support worker roles, the length of time working within the NHS does not significantly influence attitudes toward dementia as measured by the DAS score. However, it is also possible that changes in attitudes could influence career trajectory, with some individuals who develop different perspectives or attitudes over time potentially leaving support worker roles. This potential attrition effect may mean that our sample reflects the attitudes of those who remain in the role, rather than capturing attitude changes over time within the broader population.”

We have revised the occupational grade and knowledge section to highlight the weak correlation “The analysis revealed a significant difference in DKAS scores between Band 2 and Band 4 workers, with Band 4 workers scoring higher on average (mean DKAS score for Band 2 = 34.92, 95% CI: 32.46–37.37; mean DKAS score for Band 4 = 39.18, 95% CI: 37.11–41.25; t = -2.72, p < 0.01). However, given the weak, statistically non-significant overall correlation between occupational grade and dementia knowledge (Pearson correlation coefficient = 0.076, p = 0.452), this finding may reflect the relatively early career stage of Band 2 workers, who likely have less experience and fewer training opportunities specific to dementia. This difference, therefore, may not suggest that higher grades inherently possess greater dementia knowledge but rather that those in Band 2 are often in starter roles where dementia-specific knowledge is less developed.
We chose to compare Bands 2 and 4 due to the clear delineation in occupational responsibilities and training levels typical of these grades. However, further analysis between other bands will be conducted to explore any additional differences in knowledge levels across occupational grades.
“

Addiditonal reference to relevant literature has been added in the next version.

Additional text has been added to our discussion section “While our findings indicate gaps in knowledge and confidence, it is possible that some support workers may not have full access to or awareness of the DTSF resources. Therefore, improving accessibility and awareness of these established training pathways may be a cost-effective strategy for enhancing knowledge across support worker roles. Additionally, given that the DTSF and similar training frameworks are designed to provide standardised skills across different care roles, targeted reinforcement of the DTSF competencies could be beneficial, especially if integrated into routine supervision or mentorship programs within the NHS.
To ensure training is both effective and cost-effective, future initiatives might consider integrating simulation-based training and peer support, which have been shown to improve practical skills in dementia care (Eggenberger et al., 2013). Simulation exercises could help support workers experience the challenges faced by individuals with dementia, fostering empathy and improving their ability to respond to challenging behaviours. Peer-led reflective sessions, where workers share experiences and discuss strategies for managing symptoms, could also support practical application of the DTSF competencies without requiring extensive additional resources.”

This has been added

We have revised the conclusion to add additional detail

Thank you for your suggestion regarding the inclusion of survey questions. We agree that access to the survey items is important for understanding the study’s rigor and results. Due to space constraints and to maintain the readability of the main article, we have opted not to include the full survey within the text. Instead, we propose making the survey questions available as supplementary material, or as part of an online appendix, depending on journal style and guidelines. This approach would ensure that interested readers can review the questions in full without compromising the flow and structure of the article.
The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of dementia care. Feedback from these sessions indicated that many patients and families felt clinicians often lacked a strong understanding of dementia and effective communication strategies. This input directly informed our study design and the survey content, helping us focus on areas where support workers might need additional training and resources.”

TM/company link for JISC has been added

We have added detail to explain that higher scores correlate to higher knowledge and more positive attitudes.

Additional text has been added to clarify about recruitment “A targeted social media campaign using “X” (formerly Twitter) was used to advertise the survey, specifically aiming to reach Allied Health Professional (AHP) support workers and nursing support workers. Relevant professional bodies were contacted and asked to disseminate the survey link to their associate (non-registered) members, including those in nursing roles. Additionally, an email was sent to regional Allied Health Profession leads, who were asked to share the survey with both AHP and nursing support worker networks within their regions and organisations.”

We have removed reference to this

We have changed this

Having all questions being optional has been added as a limitation

This has been edited

This has been reworded

Some text has been added to the methods to clarify the inclusion of band 5/6 support workers – “Participants self-identified as support workers within the NHS, including those in Bands 2 to 6. Although Band 5 and 6 roles typically carry more senior responsibilities, we included these individuals as their primary role was reported as a support worker. This inclusion allows for a broader understanding of the knowledge and attitudes across the spectrum of support workers, although it may reflect a wider scope of experience.”

And also to the limitations section “A small proportion (11%) of participants identified as Band 5 or Band 6, levels which generally entail more senior responsibilities beyond traditional support worker duties. While these participants identified as support workers, it is possible their views and knowledge could be influenced by higher-band responsibilities, which may differ from those in lower-band roles. Future studies might consider eligibility criteria to focus on Bands 2–4, ensuring the sample aligns closely with typical support worker roles.”

While it is unusual, there are examples of support workers who do work at these banding and therefore, we would not wish to exclude them from the analysis, rather we have made reference to it in the text as a possible limitation

We have added some additional text to clarify information about years of experience and attitudes towards dementia “These results suggest that, among those who remain in support worker roles, the length of time working within the NHS does not significantly influence attitudes toward dementia as measured by the DAS score. However, it is also possible that changes in attitudes could influence career trajectory, with some individuals who develop different perspectives or attitudes over time potentially leaving support worker roles. This potential attrition effect may mean that our sample reflects the attitudes of those who remain in the role, rather than capturing attitude changes over time within the broader population.”

We have revised the occupational grade and knowledge section to highlight the weak correlation “The analysis revealed a significant difference in DKAS scores between Band 2 and Band 4 workers, with Band 4 workers scoring higher on average (mean DKAS score for Band 2 = 34.92, 95% CI: 32.46–37.37; mean DKAS score for Band 4 = 39.18, 95% CI: 37.11–41.25; t = -2.72, p < 0.01). However, given the weak, statistically non-significant overall correlation between occupational grade and dementia knowledge (Pearson correlation coefficient = 0.076, p = 0.452), this finding may reflect the relatively early career stage of Band 2 workers, who likely have less experience and fewer training opportunities specific to dementia. This difference, therefore, may not suggest that higher grades inherently possess greater dementia knowledge but rather that those in Band 2 are often in starter roles where dementia-specific knowledge is less developed.
We chose to compare Bands 2 and 4 due to the clear delineation in occupational responsibilities and training levels typical of these grades. However, further analysis between other bands will be conducted to explore any additional differences in knowledge levels across occupational grades.
“

Addiditonal reference to relevant literature has been added in the next version.

Additional text has been added to our discussion section “While our findings indicate gaps in knowledge and confidence, it is possible that some support workers may not have full access to or awareness of the DTSF resources. Therefore, improving accessibility and awareness of these established training pathways may be a cost-effective strategy for enhancing knowledge across support worker roles. Additionally, given that the DTSF and similar training frameworks are designed to provide standardised skills across different care roles, targeted reinforcement of the DTSF competencies could be beneficial, especially if integrated into routine supervision or mentorship programs within the NHS.
To ensure training is both effective and cost-effective, future initiatives might consider integrating simulation-based training and peer support, which have been shown to improve practical skills in dementia care (Eggenberger et al., 2013). Simulation exercises could help support workers experience the challenges faced by individuals with dementia, fostering empathy and improving their ability to respond to challenging behaviours. Peer-led reflective sessions, where workers share experiences and discuss strategies for managing symptoms, could also support practical application of the DTSF competencies without requiring extensive additional resources.”

This has been added

We have revised the conclusion to add additional detail

Thank you for your suggestion regarding the inclusion of survey questions. We agree that access to the survey items is important for understanding the study’s rigor and results. Due to space constraints and to maintain the readability of the main article, we have opted not to include the full survey within the text. Instead, we propose making the survey questions available as supplementary material, or as part of an online appendix, depending on journal style and guidelines. This approach would ensure that interested readers can review the questions in full without compromising the flow and structure of the article.
Competing Interests: N/A Close
Report a concern

Views

Reviewer Report 08 Nov 2024

Jan Oyebode, University of Bradford, Bradford, England, UK

Approved with Reservations

https://doi.org/10.3310/nihropenres.14844.r32973

This paper reports the findings of an online survey of dementia support workers, asking about challenges faced in dementia care, knowledge, attitudes and dementia training. The survey was open for two months and recruited 109 participants. The findings showed quite high levels of knowledge and quite positive attitudes on standardized scales. Most staff had received in-house dementia training. The study revealed that key challenges were managing behavior that challenges and communication issues. There was a moderate correlation between attitudes and knowledge; no significant relationship between years of experience and knowledge or attitudes; but dementia knowledge was higher for those in grade 4 posts compared with those in grade 2 posts. Conclusions are drawn about the need for more training in communication and in behavior management.

The report is very clearly written, well expressed, easy to follow and addresses an important topic . I would prefer the authors to avoid reference to the 'global epidemic' as this term is seen as reinforcing fears and stigma around dementia. The article is generally well situated in the context of the wider literature, although team and organizational levels of context were not addressed. So, for example, the study assumes that training is what provides knowledge and enhances attitudes but actually ongoing support, supervision and organizational culture may be important factors in enabling support staff to know how to respond to challenging behavior or how to communicate, over and above any formal training. I would like to see this acknowledged and see some recommendations or implications that address solutions other than training to address staff needs. A further omission is mention of the Dementia Training Standards Framework. All staff should be completing level 1 and 2 modules of this. This could be mentioned in the introduction or discussion, in relation to any recommendations around dementia training

The data collection was well designed and was piloted. I think the survey was limited to England rather than being open across the UK. This may need stating more plainly. Online surveys may not be readily accessible to some groups, including those with limited resources, limited literacy or English fluency. These are all characteristics which may apply to some support workers. It is notable that the respondents were mainly of white ethnicity and this could reflect that limitation. This could be acknowledged in the limitations section with recommendations for how to address these 'EDI' issues in future research.

The relatively small number of staff responding was probably affected by timelines, as the survey was only open for 8 weeks. However, there were sufficient respondents to conduct descriptive and correlational statistics.

The findings section is well structured. I did not understand the statement that the “occupational grade” variable was numerically coded, as the comparison was between grades 2 and 4.

I would have liked to see some additional brief information about the basic levels of knowledge and nature of attitudes in the sample. I think the knowledge levels exceed those found in support workers in the standardization studies, which could imply the training in the UK has had a good effect.

There is a crucial typographical error in table 1 where it says that only 3 respondents were at grade 4 - I think it should be 30 something?

In the discussion there is an assumption that the correlation between knowledge and attitudes shows training leads to knowledge which leads to positive attitudes. This should be softened, given correlations are only associations and that also we do not know that training was responsible for the knowledge.

Overall, this is a good article and only minor changes to intro and discussion are needed to enhance its content.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dementia care research including young onset dementia, ethnicity and dementia, dementia training and education.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

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Author Response 27 Nov 2024

Abi Hall, Public Health and Sports Science Department, University of Exeter, Exeter, EX1 2LU, UK

27 Nov 2024

Author Response

Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including ... Continue reading Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including supervision, ongoing support, and a supportive organisational culture, play critical roles in enabling support staff to respond effectively to challenging behaviour and communicate effectively with individuals living with dementia. Although our study primarily focused on the role of formal training, we recognise that a holistic approach—encompassing these additional elements—may have a more profound impact on staff preparedness and resilience.

Additional text has been added to the discussion
“While our study highlights the role of training in enhancing dementia knowledge and improving attitudes among support workers, we recognise that training alone may not be sufficient to prepare staff for the complexities of dementia care. Existing literature suggests that a supportive organisational environment, regular supervision, and access to mentorship are essential in reinforcing knowledge and sustaining positive attitudes. Organisational culture that fosters openness, empathy, and collaboration may empower support workers to address challenging behaviours and communication barriers in ways that training alone cannot achieve. Ongoing support from supervisors and peers, along with structured opportunities for reflection and feedback, can be especially effective in helping staff apply learned skills in real-world contexts. This layered approach, integrating formal training with organisational and team-based support, is likely to build resilience and confidence, ultimately improving the quality of dementia care.”

Text has been added to the introduction referencing the DTSF

“The Dementia Training Standards Framework (DTSF) , provides a structured guide for dementia training across health and social care sectors. The framework outlines key competencies at various levels, recommending that all staff, including support workers, complete level 1 (awareness) and level 2 (intermediate) training to ensure a foundational understanding of dementia care. Although the DTSF is widely recognised for setting baseline competencies in dementia care across health and social care roles, but specific evaluations of its impact on support workers, especially in terms of long-term outcomes, are limited.”

We reference the fact that the survey was undertaken for support workers in England in several places in the abstract and methods sections.

The following text has been added to the limitations section “Our study relied on an online survey platform, which may not have been readily accessible to all support workers. Barriers such as limited digital resources, literacy challenges, and English fluency could have restricted participation among certain groups, potentially skewing the demographics of our sample. Notably, the majority of respondents identified as white British, which may reflect an accessibility limitation that could affect the applicability of our findings.”

Unfortunately we were under significant time limitations for this work so the survey was only open for a short period of time.

Further clarification and explanation has been added – “For the purpose of statistical analysis, the "occupational grade" variable was numerically coded to enable comparisons. Each NHS band (e.g., Bands 2, 3, 4) was assigned a corresponding numeric value to facilitate statistical testing. For example, comparisons were made between Bands 2 and 4 by using these coded values to compute t-tests and correlations, allowing us to examine potential differences in knowledge and attitudes between these groups.”

We have added some detail about the basic levels of knowledge and attitudes in the sample. “The knowledge levels observed in our sample, as measured by the DKAS, appear higher than those reported in previous standardisation studies among support workers . This may suggest that dementia training programs in England, guided by frameworks like the DTSF, have a positive effect on knowledge levels. Similarly, the attitudes observed in our sample align with positive attitudes reported by O’Connor and McFadden in their work with the Dementia Attitudes Scale (DAS), indicating that training may also support compassionate attitudes in dementia care settings.”

We have checked our data and we did only have 3 respondents who reported they were Band 4

We have edited the text to reflect this the assumption that there is a correlation between knowledge and attitudes. “Our data suggested a positive correlation between knowledge and attitudes toward people living with dementia (PLwD). However, it is essential to note that correlation does not imply causation, and the association should not be interpreted as direct evidence that increased knowledge causes improved attitudes. While training may contribute to the knowledge levels observed, our study did not assess the specific sources of knowledge, meaning we cannot confirm that training alone is responsible. Other factors, such as previous experience with PLwD or supportive organisational culture, may also influence knowledge and attitudes. Future research could explore these factors further, using longitudinal designs to assess how training, experience, and support mechanisms interact to shape both knowledge and attitudes.”
Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including supervision, ongoing support, and a supportive organisational culture, play critical roles in enabling support staff to respond effectively to challenging behaviour and communicate effectively with individuals living with dementia. Although our study primarily focused on the role of formal training, we recognise that a holistic approach—encompassing these additional elements—may have a more profound impact on staff preparedness and resilience.

Additional text has been added to the discussion
“While our study highlights the role of training in enhancing dementia knowledge and improving attitudes among support workers, we recognise that training alone may not be sufficient to prepare staff for the complexities of dementia care. Existing literature suggests that a supportive organisational environment, regular supervision, and access to mentorship are essential in reinforcing knowledge and sustaining positive attitudes. Organisational culture that fosters openness, empathy, and collaboration may empower support workers to address challenging behaviours and communication barriers in ways that training alone cannot achieve. Ongoing support from supervisors and peers, along with structured opportunities for reflection and feedback, can be especially effective in helping staff apply learned skills in real-world contexts. This layered approach, integrating formal training with organisational and team-based support, is likely to build resilience and confidence, ultimately improving the quality of dementia care.”

Text has been added to the introduction referencing the DTSF

“The Dementia Training Standards Framework (DTSF) , provides a structured guide for dementia training across health and social care sectors. The framework outlines key competencies at various levels, recommending that all staff, including support workers, complete level 1 (awareness) and level 2 (intermediate) training to ensure a foundational understanding of dementia care. Although the DTSF is widely recognised for setting baseline competencies in dementia care across health and social care roles, but specific evaluations of its impact on support workers, especially in terms of long-term outcomes, are limited.”

We reference the fact that the survey was undertaken for support workers in England in several places in the abstract and methods sections.

The following text has been added to the limitations section “Our study relied on an online survey platform, which may not have been readily accessible to all support workers. Barriers such as limited digital resources, literacy challenges, and English fluency could have restricted participation among certain groups, potentially skewing the demographics of our sample. Notably, the majority of respondents identified as white British, which may reflect an accessibility limitation that could affect the applicability of our findings.”

Unfortunately we were under significant time limitations for this work so the survey was only open for a short period of time.

Further clarification and explanation has been added – “For the purpose of statistical analysis, the "occupational grade" variable was numerically coded to enable comparisons. Each NHS band (e.g., Bands 2, 3, 4) was assigned a corresponding numeric value to facilitate statistical testing. For example, comparisons were made between Bands 2 and 4 by using these coded values to compute t-tests and correlations, allowing us to examine potential differences in knowledge and attitudes between these groups.”

We have added some detail about the basic levels of knowledge and attitudes in the sample. “The knowledge levels observed in our sample, as measured by the DKAS, appear higher than those reported in previous standardisation studies among support workers . This may suggest that dementia training programs in England, guided by frameworks like the DTSF, have a positive effect on knowledge levels. Similarly, the attitudes observed in our sample align with positive attitudes reported by O’Connor and McFadden in their work with the Dementia Attitudes Scale (DAS), indicating that training may also support compassionate attitudes in dementia care settings.”

We have checked our data and we did only have 3 respondents who reported they were Band 4

We have edited the text to reflect this the assumption that there is a correlation between knowledge and attitudes. “Our data suggested a positive correlation between knowledge and attitudes toward people living with dementia (PLwD). However, it is essential to note that correlation does not imply causation, and the association should not be interpreted as direct evidence that increased knowledge causes improved attitudes. While training may contribute to the knowledge levels observed, our study did not assess the specific sources of knowledge, meaning we cannot confirm that training alone is responsible. Other factors, such as previous experience with PLwD or supportive organisational culture, may also influence knowledge and attitudes. Future research could explore these factors further, using longitudinal designs to assess how training, experience, and support mechanisms interact to shape both knowledge and attitudes.”
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Author Response 27 Nov 2024

Abi Hall, Public Health and Sports Science Department, University of Exeter, Exeter, EX1 2LU, UK

27 Nov 2024

Author Response

Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including ... Continue reading Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including supervision, ongoing support, and a supportive organisational culture, play critical roles in enabling support staff to respond effectively to challenging behaviour and communicate effectively with individuals living with dementia. Although our study primarily focused on the role of formal training, we recognise that a holistic approach—encompassing these additional elements—may have a more profound impact on staff preparedness and resilience.

Additional text has been added to the discussion
“While our study highlights the role of training in enhancing dementia knowledge and improving attitudes among support workers, we recognise that training alone may not be sufficient to prepare staff for the complexities of dementia care. Existing literature suggests that a supportive organisational environment, regular supervision, and access to mentorship are essential in reinforcing knowledge and sustaining positive attitudes. Organisational culture that fosters openness, empathy, and collaboration may empower support workers to address challenging behaviours and communication barriers in ways that training alone cannot achieve. Ongoing support from supervisors and peers, along with structured opportunities for reflection and feedback, can be especially effective in helping staff apply learned skills in real-world contexts. This layered approach, integrating formal training with organisational and team-based support, is likely to build resilience and confidence, ultimately improving the quality of dementia care.”

Text has been added to the introduction referencing the DTSF

“The Dementia Training Standards Framework (DTSF) , provides a structured guide for dementia training across health and social care sectors. The framework outlines key competencies at various levels, recommending that all staff, including support workers, complete level 1 (awareness) and level 2 (intermediate) training to ensure a foundational understanding of dementia care. Although the DTSF is widely recognised for setting baseline competencies in dementia care across health and social care roles, but specific evaluations of its impact on support workers, especially in terms of long-term outcomes, are limited.”

We reference the fact that the survey was undertaken for support workers in England in several places in the abstract and methods sections.

The following text has been added to the limitations section “Our study relied on an online survey platform, which may not have been readily accessible to all support workers. Barriers such as limited digital resources, literacy challenges, and English fluency could have restricted participation among certain groups, potentially skewing the demographics of our sample. Notably, the majority of respondents identified as white British, which may reflect an accessibility limitation that could affect the applicability of our findings.”

Unfortunately we were under significant time limitations for this work so the survey was only open for a short period of time.

Further clarification and explanation has been added – “For the purpose of statistical analysis, the "occupational grade" variable was numerically coded to enable comparisons. Each NHS band (e.g., Bands 2, 3, 4) was assigned a corresponding numeric value to facilitate statistical testing. For example, comparisons were made between Bands 2 and 4 by using these coded values to compute t-tests and correlations, allowing us to examine potential differences in knowledge and attitudes between these groups.”

We have added some detail about the basic levels of knowledge and attitudes in the sample. “The knowledge levels observed in our sample, as measured by the DKAS, appear higher than those reported in previous standardisation studies among support workers . This may suggest that dementia training programs in England, guided by frameworks like the DTSF, have a positive effect on knowledge levels. Similarly, the attitudes observed in our sample align with positive attitudes reported by O’Connor and McFadden in their work with the Dementia Attitudes Scale (DAS), indicating that training may also support compassionate attitudes in dementia care settings.”

We have checked our data and we did only have 3 respondents who reported they were Band 4

We have edited the text to reflect this the assumption that there is a correlation between knowledge and attitudes. “Our data suggested a positive correlation between knowledge and attitudes toward people living with dementia (PLwD). However, it is essential to note that correlation does not imply causation, and the association should not be interpreted as direct evidence that increased knowledge causes improved attitudes. While training may contribute to the knowledge levels observed, our study did not assess the specific sources of knowledge, meaning we cannot confirm that training alone is responsible. Other factors, such as previous experience with PLwD or supportive organisational culture, may also influence knowledge and attitudes. Future research could explore these factors further, using longitudinal designs to assess how training, experience, and support mechanisms interact to shape both knowledge and attitudes.”
Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including supervision, ongoing support, and a supportive organisational culture, play critical roles in enabling support staff to respond effectively to challenging behaviour and communicate effectively with individuals living with dementia. Although our study primarily focused on the role of formal training, we recognise that a holistic approach—encompassing these additional elements—may have a more profound impact on staff preparedness and resilience.

Additional text has been added to the discussion
“While our study highlights the role of training in enhancing dementia knowledge and improving attitudes among support workers, we recognise that training alone may not be sufficient to prepare staff for the complexities of dementia care. Existing literature suggests that a supportive organisational environment, regular supervision, and access to mentorship are essential in reinforcing knowledge and sustaining positive attitudes. Organisational culture that fosters openness, empathy, and collaboration may empower support workers to address challenging behaviours and communication barriers in ways that training alone cannot achieve. Ongoing support from supervisors and peers, along with structured opportunities for reflection and feedback, can be especially effective in helping staff apply learned skills in real-world contexts. This layered approach, integrating formal training with organisational and team-based support, is likely to build resilience and confidence, ultimately improving the quality of dementia care.”

Text has been added to the introduction referencing the DTSF

“The Dementia Training Standards Framework (DTSF) , provides a structured guide for dementia training across health and social care sectors. The framework outlines key competencies at various levels, recommending that all staff, including support workers, complete level 1 (awareness) and level 2 (intermediate) training to ensure a foundational understanding of dementia care. Although the DTSF is widely recognised for setting baseline competencies in dementia care across health and social care roles, but specific evaluations of its impact on support workers, especially in terms of long-term outcomes, are limited.”

We reference the fact that the survey was undertaken for support workers in England in several places in the abstract and methods sections.

The following text has been added to the limitations section “Our study relied on an online survey platform, which may not have been readily accessible to all support workers. Barriers such as limited digital resources, literacy challenges, and English fluency could have restricted participation among certain groups, potentially skewing the demographics of our sample. Notably, the majority of respondents identified as white British, which may reflect an accessibility limitation that could affect the applicability of our findings.”

Unfortunately we were under significant time limitations for this work so the survey was only open for a short period of time.

Further clarification and explanation has been added – “For the purpose of statistical analysis, the "occupational grade" variable was numerically coded to enable comparisons. Each NHS band (e.g., Bands 2, 3, 4) was assigned a corresponding numeric value to facilitate statistical testing. For example, comparisons were made between Bands 2 and 4 by using these coded values to compute t-tests and correlations, allowing us to examine potential differences in knowledge and attitudes between these groups.”

We have added some detail about the basic levels of knowledge and attitudes in the sample. “The knowledge levels observed in our sample, as measured by the DKAS, appear higher than those reported in previous standardisation studies among support workers . This may suggest that dementia training programs in England, guided by frameworks like the DTSF, have a positive effect on knowledge levels. Similarly, the attitudes observed in our sample align with positive attitudes reported by O’Connor and McFadden in their work with the Dementia Attitudes Scale (DAS), indicating that training may also support compassionate attitudes in dementia care settings.”

We have checked our data and we did only have 3 respondents who reported they were Band 4

We have edited the text to reflect this the assumption that there is a correlation between knowledge and attitudes. “Our data suggested a positive correlation between knowledge and attitudes toward people living with dementia (PLwD). However, it is essential to note that correlation does not imply causation, and the association should not be interpreted as direct evidence that increased knowledge causes improved attitudes. While training may contribute to the knowledge levels observed, our study did not assess the specific sources of knowledge, meaning we cannot confirm that training alone is responsible. Other factors, such as previous experience with PLwD or supportive organisational culture, may also influence knowledge and attitudes. Future research could explore these factors further, using longitudinal designs to assess how training, experience, and support mechanisms interact to shape both knowledge and attitudes.”
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Version 2

VERSION 2 PUBLISHED 24 Sep 2024

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Jan Oyebode, University of Bradford, Bradford, UK
Julie Nightingale, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, UK

Sarah Etty, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, UK
Stephen M Quick, La Trobe University School of Allied Health Human Services and Sport (Ringgold ID: 110570), Melbourne, Australia; Northern Health (Ringgold ID: 3235), Epping, Australia

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07 Jan 2025 | for Version 2

Julie Nightingale, CARe Research Centre, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, England, UK

Sarah Etty, CARe Research Centre, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, England, UK

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Approved

The amendments made have strengthened the article. No further amendments suggested.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Reviewer 1- Workforce research, support worker research; Reviewer 2 - support worker research, quantitative analysis

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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28 Nov 2024 | for Version 2

Jan Oyebode, University of Bradford, Bradford, England, UK

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Approved

I have just re-read through the report and appreciate the changes made by the authors. I think it reads well and is a very useful addition to the literature.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dementia care research including young onset dementia, ethnicity and dementia, dementia training and education.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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28 Nov 2024 | for Version 2

Stephen M Quick, La Trobe University School of Allied Health Human Services and Sport (Ringgold ID: 110570), Melbourne, Victoria, Australia; Allied Health Research, Northern Health (Ringgold ID: 3235), Epping, Victoria, Australia

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Approved With Reservations

Thank you for the opportunity to review this article.

The paper looks at the incredibly important topic of support worker knowledge and training in dementia care, and presents findings from a national survey.

In summary, the study is well written overall and addresses an important area of research. Please see below for some more specific information and thoughts as a reader of this article. I note on submitting this review that there have been revisions made in the last 48 hours in relation to feedback from other reviewers, so I will endeavour to not be repetitive in these already addressed areas.

Abstract:

Background section: Consider revising the discussion on prevalence between the abstract and the beginning of the background for improved coherence. The abstract highlights ‘Dementia affects over 55 million people globally, projected to double by 2050’, whilst the start of the background mentions ‘It is estimated that over 55 million people were living with dementia worldwide in 2020 and this number is projected to approximately double every twenty years, reaching 78 million in 2030 and 139 million in 2050’. There is quite a disparity between 110 million (double 55 million) and the projected 139 million in the background. Perhaps changing the abstract to ‘Dementia affects over 55 million people globally, with projections suggesting this will increase to approximately 139 million by 2050’ or similar may assist in consistency.

Background section: Consider referring to UK as the United Kingdom (UK) in the first instance.

Plain language summary: ‘We found that how long someone had worked did not significantly affect their knowledge or attitudes about dementia.’ Perhaps ‘….worked as a support worker did not significantly affect their….’ may add some clarity here?

Background:

Page 4 Para 1: Consider referring to the National Health Service (NHS) in the first instance. This may improve context and understanding, particularly for international readers of the research.

Page 4 Para 1: Consider if the last sentence of the first paragraph would better fit as the second sentence of the second paragraph. This may allow for a linking sentence at the end of paragraph one highlighting the impact of increased prevalence may have on the NHS into the future, and setting up for the second paragraph regarding support workers.

Page 4 Para 1: Is it possible for more of a description of the role of healthcare assistants/support workers in the UK context? These roles have different names and definitions in different countries, so it would be good to even have a brief understanding of the key roles generally played by a support worker in general care, particularly as an international reader.

Methods

Page 4 Para 3: ‘The basis for this study was informed by patients and the public, who reported that often clinicians did not seem to have a good understanding about dementia, nor did they always understand how best to approach and support them or their relatives.’ – is there further supporting evidence or context to this statement? Reads quite anecdotal in the current form.

Page 4 Para 4: It may be worth mentioning General Data Protection Regulation (GDPR) on first mention in the paper.

Page 4 Para 10 (Data Collection): The authors note that 'Following the pilot, no revisions were needed to be made to the survey.' It would be helpful to understand how this conclusion was reached - what criteria or feedback from the pilot participants indicated that the survey was ready to be sent out in its original form, or was it based solely on understanding, formatting and time to complete?

Page 5 Para 3: Were there any duplicate entries, and if so, how were they determined? Was it IP address, responses etc.?

Page 5 Para 6: Can you provide more information about the process of collating and grouping into themes? How many authors were involved, what steps comprised the overall process to arrive at these themes, and what were the themes identified?

Results

Page 5 Para 12: ‘several common themes emerged from their responses’. Although it is not completely clear the analysis method used for the free text data, themes generally do not emerge from the data, with the authors constructing themes through their analysis and understanding of the material. Perhaps something along the lines of ‘…through analysis, we identified several common themes…’ or something similar could be considered.

Page 5 Para 12: This section may benefit from a mention of the topics to be discussed in the following paragraphs (ie. Behavioural and psychological symptoms, communication, and lack of time and resources) if it fits with the flow of the results in your opinion.

Table 1: The layout of Occupational Group isn’t clear. All rows add to up well over 109 unique respondents, or is each option below ‘other’ then listing the professions that make up ‘other’? In this instance, Nursing (52), OT (20), PT (18) and Other (20) adds up to 110 and not 109. Were participants able to provide multiple responses? More clearly presenting the data in table form (or detailing where people may have been able to select multiple response or did not answer the question) may assist with reading and interpreting this table for the audience.

Table 1: NHS Grade – assuming the percentages are correct, this should be 35 NHS Grade 4 support workers? This equals 108 – was this skipped by one participant? Listing the number of respondents (if different to the full sample of 109) may help with interpretation of the table for the reader in some instances.

General: Is it possible to add more contexts to the quotes? For example, a quote on a challenge may have more of an impact on a reader if it is coming from a Grade 6 than perhaps a Grade 2, given experiential learning, experience etc. and the support worker still highlighting such challenges.

Consistency: The results section would benefit from consistency in reporting either numbers/percentages or n=, or both. For example, lack of time and resources was noted by 13% of participants, however I am not sure if the full 109 participants responded to this question. Including % and n= may help with consistency of reading and interpretation for the reader.

Consistency: Likewise with reporting of CI’s and data, there is variation paragraph to paragraph. Some have a space between the ‘(‘ and ‘CI’ (see years of experience and knowledge of dementia’), others have a ‘-‘ between the numbers, whereas others have ‘ranging from’. Consistency in how the information is delivered will assist with the readability of the section.

Discussion:

This is also discussed in the abstract and plain language statement, however I do feel on reading that the phrasing that better training ‘can’ improve both knowledge and attitudes may need to be softened a touch based off these findings alone. From my understanding, cross-sectional correlations cannot prove causation. Therefore I would suggest softening of the language around the results, and this could also lead to potential future directions of the research.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

PhD completed in the area of physiotherapy and the care of people living with dementia.

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13 Nov 2024 | for Version 1

Julie Nightingale, CARe Research Centre, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, England, UK

Sarah Etty, CARe Research Centre, Sheffield Hallam University College of Health Wellbeing and Life Sciences (Ringgold ID: 111995), Sheffield, England, UK

13 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Hall A, Griffin R, Manning F, Goodwin V: Support workers knowledge, skills and education relating to dementia – a national survey. NIHR Open Research. 2024; 4. Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Reviewer 1- Workforce research, support worker research; Reviewer 2 - support worker research, quantitative analysis

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Author Response

02 Dec 2024

Abi Hall, Public Health and Sports Science Department, University of Exeter, Exeter, EX1 2LU, UK

The PPIE involvement has been clarified in the text “For this study, specific patient and public involvement (PPIE) engagement was conducted to gather insights from individuals with lived experience of dementia care. Feedback from these sessions indicated that many patients and families felt clinicians often lacked a strong understanding of dementia and effective communication strategies. This input directly informed our study design and the survey content, helping us focus on areas where support workers might need additional training and resources.”

TM/company link for JISC has been added

We have added detail to explain that higher scores correlate to higher knowledge and more positive attitudes.

Additional text has been added to clarify about recruitment “A targeted social media campaign using “X” (formerly Twitter) was used to advertise the survey, specifically aiming to reach Allied Health Professional (AHP) support workers and nursing support workers. Relevant professional bodies were contacted and asked to disseminate the survey link to their associate (non-registered) members, including those in nursing roles. Additionally, an email was sent to regional Allied Health Profession leads, who were asked to share the survey with both AHP and nursing support worker networks within their regions and organisations.”

We have removed reference to this

We have changed this

Having all questions being optional has been added as a limitation

This has been edited

This has been reworded

Some text has been added to the methods to clarify the inclusion of band 5/6 support workers – “Participants self-identified as support workers within the NHS, including those in Bands 2 to 6. Although Band 5 and 6 roles typically carry more senior responsibilities, we included these individuals as their primary role was reported as a support worker. This inclusion allows for a broader understanding of the knowledge and attitudes across the spectrum of support workers, although it may reflect a wider scope of experience.”

And also to the limitations section “A small proportion (11%) of participants identified as Band 5 or Band 6, levels which generally entail more senior responsibilities beyond traditional support worker duties. While these participants identified as support workers, it is possible their views and knowledge could be influenced by higher-band responsibilities, which may differ from those in lower-band roles. Future studies might consider eligibility criteria to focus on Bands 2–4, ensuring the sample aligns closely with typical support worker roles.”

While it is unusual, there are examples of support workers who do work at these banding and therefore, we would not wish to exclude them from the analysis, rather we have made reference to it in the text as a possible limitation

We have added some additional text to clarify information about years of experience and attitudes towards dementia “These results suggest that, among those who remain in support worker roles, the length of time working within the NHS does not significantly influence attitudes toward dementia as measured by the DAS score. However, it is also possible that changes in attitudes could influence career trajectory, with some individuals who develop different perspectives or attitudes over time potentially leaving support worker roles. This potential attrition effect may mean that our sample reflects the attitudes of those who remain in the role, rather than capturing attitude changes over time within the broader population.”

We have revised the occupational grade and knowledge section to highlight the weak correlation “The analysis revealed a significant difference in DKAS scores between Band 2 and Band 4 workers, with Band 4 workers scoring higher on average (mean DKAS score for Band 2 = 34.92, 95% CI: 32.46–37.37; mean DKAS score for Band 4 = 39.18, 95% CI: 37.11–41.25; t = -2.72, p < 0.01). However, given the weak, statistically non-significant overall correlation between occupational grade and dementia knowledge (Pearson correlation coefficient = 0.076, p = 0.452), this finding may reflect the relatively early career stage of Band 2 workers, who likely have less experience and fewer training opportunities specific to dementia. This difference, therefore, may not suggest that higher grades inherently possess greater dementia knowledge but rather that those in Band 2 are often in starter roles where dementia-specific knowledge is less developed.
We chose to compare Bands 2 and 4 due to the clear delineation in occupational responsibilities and training levels typical of these grades. However, further analysis between other bands will be conducted to explore any additional differences in knowledge levels across occupational grades.
“

Addiditonal reference to relevant literature has been added in the next version.

Additional text has been added to our discussion section “While our findings indicate gaps in knowledge and confidence, it is possible that some support workers may not have full access to or awareness of the DTSF resources. Therefore, improving accessibility and awareness of these established training pathways may be a cost-effective strategy for enhancing knowledge across support worker roles. Additionally, given that the DTSF and similar training frameworks are designed to provide standardised skills across different care roles, targeted reinforcement of the DTSF competencies could be beneficial, especially if integrated into routine supervision or mentorship programs within the NHS.
To ensure training is both effective and cost-effective, future initiatives might consider integrating simulation-based training and peer support, which have been shown to improve practical skills in dementia care (Eggenberger et al., 2013). Simulation exercises could help support workers experience the challenges faced by individuals with dementia, fostering empathy and improving their ability to respond to challenging behaviours. Peer-led reflective sessions, where workers share experiences and discuss strategies for managing symptoms, could also support practical application of the DTSF competencies without requiring extensive additional resources.”

This has been added

We have revised the conclusion to add additional detail

Thank you for your suggestion regarding the inclusion of survey questions. We agree that access to the survey items is important for understanding the study’s rigor and results. Due to space constraints and to maintain the readability of the main article, we have opted not to include the full survey within the text. Instead, we propose making the survey questions available as supplementary material, or as part of an online appendix, depending on journal style and guidelines. This approach would ensure that interested readers can review the questions in full without compromising the flow and structure of the article.

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Competing Interests

N/A

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Reviewer Report

20 Views

08 Nov 2024 | for Version 1

Jan Oyebode, University of Bradford, Bradford, England, UK

20 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dementia care research including young onset dementia, ethnicity and dementia, dementia training and education.

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Responses (1)

Author Response

27 Nov 2024

Abi Hall, Public Health and Sports Science Department, University of Exeter, Exeter, EX1 2LU, UK

Thank you for your comprehensive review. We have made the following changes.

We have removed reference to the global epidemic.

We agree that team and organisational factors, including supervision, ongoing support, and a supportive organisational culture, play critical roles in enabling support staff to respond effectively to challenging behaviour and communicate effectively with individuals living with dementia. Although our study primarily focused on the role of formal training, we recognise that a holistic approach—encompassing these additional elements—may have a more profound impact on staff preparedness and resilience.

Additional text has been added to the discussion
“While our study highlights the role of training in enhancing dementia knowledge and improving attitudes among support workers, we recognise that training alone may not be sufficient to prepare staff for the complexities of dementia care. Existing literature suggests that a supportive organisational environment, regular supervision, and access to mentorship are essential in reinforcing knowledge and sustaining positive attitudes. Organisational culture that fosters openness, empathy, and collaboration may empower support workers to address challenging behaviours and communication barriers in ways that training alone cannot achieve. Ongoing support from supervisors and peers, along with structured opportunities for reflection and feedback, can be especially effective in helping staff apply learned skills in real-world contexts. This layered approach, integrating formal training with organisational and team-based support, is likely to build resilience and confidence, ultimately improving the quality of dementia care.”

Text has been added to the introduction referencing the DTSF

“The Dementia Training Standards Framework (DTSF) , provides a structured guide for dementia training across health and social care sectors. The framework outlines key competencies at various levels, recommending that all staff, including support workers, complete level 1 (awareness) and level 2 (intermediate) training to ensure a foundational understanding of dementia care. Although the DTSF is widely recognised for setting baseline competencies in dementia care across health and social care roles, but specific evaluations of its impact on support workers, especially in terms of long-term outcomes, are limited.”

We reference the fact that the survey was undertaken for support workers in England in several places in the abstract and methods sections.

The following text has been added to the limitations section “Our study relied on an online survey platform, which may not have been readily accessible to all support workers. Barriers such as limited digital resources, literacy challenges, and English fluency could have restricted participation among certain groups, potentially skewing the demographics of our sample. Notably, the majority of respondents identified as white British, which may reflect an accessibility limitation that could affect the applicability of our findings.”

Unfortunately we were under significant time limitations for this work so the survey was only open for a short period of time.

Further clarification and explanation has been added – “For the purpose of statistical analysis, the "occupational grade" variable was numerically coded to enable comparisons. Each NHS band (e.g., Bands 2, 3, 4) was assigned a corresponding numeric value to facilitate statistical testing. For example, comparisons were made between Bands 2 and 4 by using these coded values to compute t-tests and correlations, allowing us to examine potential differences in knowledge and attitudes between these groups.”

We have added some detail about the basic levels of knowledge and attitudes in the sample. “The knowledge levels observed in our sample, as measured by the DKAS, appear higher than those reported in previous standardisation studies among support workers . This may suggest that dementia training programs in England, guided by frameworks like the DTSF, have a positive effect on knowledge levels. Similarly, the attitudes observed in our sample align with positive attitudes reported by O’Connor and McFadden in their work with the Dementia Attitudes Scale (DAS), indicating that training may also support compassionate attitudes in dementia care settings.”

We have checked our data and we did only have 3 respondents who reported they were Band 4

We have edited the text to reflect this the assumption that there is a correlation between knowledge and attitudes. “Our data suggested a positive correlation between knowledge and attitudes toward people living with dementia (PLwD). However, it is essential to note that correlation does not imply causation, and the association should not be interpreted as direct evidence that increased knowledge causes improved attitudes. While training may contribute to the knowledge levels observed, our study did not assess the specific sources of knowledge, meaning we cannot confirm that training alone is responsible. Other factors, such as previous experience with PLwD or supportive organisational culture, may also influence knowledge and attitudes. Future research could explore these factors further, using longitudinal designs to assess how training, experience, and support mechanisms interact to shape both knowledge and attitudes.”

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Competing Interests

N/A

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Alzheimers' Disease International: Dementia statistics. 2021. Reference Source

[2] 2. Kulmala J, Nykänen I, Mänty M, et al.: Association between frailty and dementia: a population-based study. Gerontology. 2013; 60(1): 16–21. PubMed Abstract | Publisher Full Text

[3] 3. Health Education England: A national strategic framework to develop the healthcare support workforce. 2014. Reference Source

[4] 4. UNISON: Care on the cheap. A UNISON survey of clinical support workers. 2016. Reference Source

[5] 5. Prince M, Bryce R, Ferri C: World Alzheimer Report 2011: The benefits of early diagnosis and intervention. Alzheimer's Disease International London, 2011. Reference Source

[6] 6. Goeman D, Renehan E, Koch S: What is the effectiveness of the support worker role for people with dementia and their carers? A systematic review. BMC Health Serv Res. 2016; 16(1): 285. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. NHS England: The NHS long term plan. NHS England; 2019. Reference Source

[8] 8. NHS England: NHS long term workforce plan. 2023. Reference Source

[9] 9. Annear MJ, Toye CM, Eccleston CE, et al.: Dementia knowledge assessment scale: development and preliminary psychometric properties. J Am Geriatr Soc. 2015; 63(11): 2375–81. PubMed Abstract | Publisher Full Text

[10] 10. O'Connor ML, McFadden SH: Development and psychometric validation of the dementia attitudes scale. International Journal of Alzheimer’s Disease. 2010; 2010: 454218. Reference Source

[11] 11. Eysenbach G: Improving the quality of Web surveys: the checklist for reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004; 6(3): e34. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Brooker D, Surr C: Dementia care mapping: principles and practice. Bradford Dementia Group, University of Bradford, 2005. Reference Source

[13] 13. Eggenberger E, Heimerl K, Bennett MI: Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings. Int Psychogeriatr. 2013; 25(3): 345–58. PubMed Abstract | Publisher Full Text

[14] 14. Fossey J, Ballard C, Juszczak E, et al.: Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ. 2006; 332(7544): 756–61. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Alzheimer's Disease International: World Alzheimer Report 2019. 2019. Reference Source

[16] 16. Spector A, Orrell M, Goyder J: A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res Rev. 2013; 12(1): 354–64. PubMed Abstract | Publisher Full Text

[17] 17. Werner P, Goldstein D, Buchbinder E: Subjective experience of family stigma as reported by children of Alzheimer’s disease patients. Qual Health Res. 2010; 20(2): 159–69. PubMed Abstract | Publisher Full Text

Support workers knowledge, skills and education relating to dementia – a national survey

Abstract

Background

Methods

Results

Conclusion

Plain Language Summary

Keywords

Background

Methods

Patient and Public Involvement

Inclusion criteria

Recruitment & consent

Data collection

Analysis

Ethical approval and consent

Data protection and participant confidentiality

Results

Table 1. Characteristics of participants.

Challenges

Training

Experience

Occupational grade

Knowledge of dementia and attitude towards dementia

Discussion

Conclusion

Strengths and limitations

Ethical approval and consent

Data availability

Underlying data

Extended data

Software availability statement

Acknowledgements

References

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