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'What works' in dementia education and training?
Identifying the programmes and approaches that lead to the best outcomes for people with dementia and their families.
The challenge
Having staff with the knowledge and skills to deliver good dementia care is a priority for governments globally, including the UK. Research has shown education and training can help staff to feel more confident about dementia care and improve their knowledge and skills. This can lead to better care. However, some studies have also shown training does not always lead to any benefits. Our research sought to understand 'What Works' when it comes to dementia training, by identifying the programmes and approaches that lead to the best outcomes for people with dementia and their families. This study, was funded by the Department of Health and Care Policy Research programme, and commissioned by Health Education England.
What did the research involve?
Part One: Review of all published evidence about training and education in dementia for the health and social care workforce to identify common effective dementia training.
Part Two: Conducting a national audit of people responsible for dementia training and education and find out what is provided. Survey staff who have completed dementia training to assess impact on their knowledge and attitudes. Identify barriers and facilitators to implementation. This established a national picture of dementia training and how it was being delivered.
Part Three: Conducting case studies in 10 care provider organisations selected from respondents to the national audit. We found out about their training approaches and culture. Looked at the impact on staff knowledge and skills. And the experiences of people with dementia and their families using the service. We looked for the components that need to be in place for training to be successfully implemented and impactful.
We involved experts by experience who are living with dementia or caring for someone with dementia throughout the research. This shaped what we did, how we gathered data, the findings we drew from the research and how we will disseminate the findings.
The results
Most published research on dementia training was carried out in care homes in the USA, United Kingdom, Canada and Australia and was of variable quality. Training was mainly delivered to nurses or nursing assistants/aides. Key components of training that was more impactful were identified (see below). The audit identified 386 separate training packages reported by 241 respondents, the majority working in acute hospitals, social care or universities.
There was a variation in the extent to which the packages aligned to The Dementia Training Standards Framework, with more specialist (Tier 3) content less likely to be covered.
The staff survey found respondents were generally very satisfied with their training. Analysis showed that the training packages themselves appeared to have a limited impact on staff dementia knowledge, attitudes or confidence in caring for someone with dementia.
The ten case studies Identified training design, content and delivery, as well as contextual factors, appeared to contribute to success. Staff reported feeling more confident and empowered to deliver person-centred care following training and more empathic towards people with dementia. Improved communication was consistently reported as a key area of staff behaviour change resulting from training attendance.
Data analysis for the staff survey included 18 training packages (553 respondents in total), where we had at least ten staff respondents. The majority were female, of white British origin, aged 45- 54 and mainly working in clinical roles. They were generally very satisfied with their training. Analysis showed that the training packages themselves appeared to have a limited impact on staff dementia knowledge, attitudes or confidence in caring for someone with dementia (accounting for only 9-25% of the variance in staff outcome scores.)
Ten case study sites participated: three acute hospitals, three care home providers, three mental health trusts and one primary care provider. Training design, content and delivery, as well as contextual factors, appeared to contribute to success. Staff reported feeling more confident and empowered to deliver person-centred care following training and more empathic towards people with dementia. We saw examples of good, person-centred practices across all sites, as well as examples where staff did not have a person-centred attitude or approach. Improved communication was consistently reported as a key area of staff behaviour change resulting from training attendance.
The evidence across all data sources suggests training most likely to be effective has the following features:
- Is tailored to be relevant and realistic to the role, experience and practice of the learners;
- Includes specific tools, methods/approaches to underpin care delivery;
- Presents the experience of living with dementia (through video, simulation or their direct involvement in training delivery).
- Is ideally more than half a day duration per subject area, with longer and more in-depth programmes (1-2 days) more likely to produce positive results;
- Where a programme is delivered over a number of sessions, individual sessions should be at least 2-hours duration.
- Uses small or large group face-to-face learning either alone or in addition to another learning approach avoiding didactic teaching methods;
- Includes interactive learning activities and opportunities for learner discussion and interaction, using case examples/video-based scenarios or drawing on examples from learners’ own practice;
- Avoids self-directed learning alone, for example through booklets or e-learning;
- Is delivered by a knowledgeable, skilled and experienced facilitator who is also an experienced clinician or practitioner and able to deliver the training flexibly.
- A supportive organisational context and learning culture, accompanied by strong, dedicated dementia training and practice leadership is crucial
- A dedicated training space
- A physical environment that is supportive of good dementia care.
'What Works' - Effective education and training
Outputs
- Surr, C. and Gates, C. (2017) What works in delivering dementia education or training to hospital staff? A synthesis of the evidence. International Journal of Nursing Studies. 75: pp172-188 DOI: 10.1016/j.ijnurstu.2017.08.002
- Surr, C., Gates, C., Irving, D., Oyebode, J., Smith, S.J., Parveen, S., Drury-Payne, M. and Dennison, A. (2017) Effective dementia education and training for the health and social care workforce: A systematic review of the literature. Review of Educational Research. DOI: 10.3102/0034654317723305
- Surr, C.A., Parveen, S., Smith, S.J., Sass, C., Drury, M., Burden, S. and Oyebode, J. (2020) Barriers and Facilitators to implementing dementia training in health and social care services. BMC Health Services Research. 20 (512) https://doi.org/10.1186/s12913-020-05382-4
- Sass, C., Burnley, N., Oyebode, J., Drury, M. and Surr, C. (2019) Factors associated with successful dementia education for Practitioners in Primary Care: An in-depth case study BMC Medical Education. 19: 393 doi: 10.1186/s12909-019-1833-2
- Smith, S.J., Parveen, S., Sass, C., Drury, M., Oyebode, J. and Surr, C. (2019) Cross Sector Audit of Dementia Education and Training in the UK: a comparison with national benchmark standards. BMC Health Services Research. 19: 711 doi: 10.1186/s12913-019-4510-6
- Surr, C.A., Sass, C., Drury, M., Burnley, N., Dennison, A., Burden, S., and Oyebode, J. (2019) A collective case study of the features of impactful dementia training for care home staff BMC Geriatrics 19:175 doi: 10.1186/s12877-019-1186-z
- Surr, C., Sass, C., Burnley, N., Drury, M., Smith, S., Parveen, S., Burden, S. and Oyebode, J. (2020) Components of impactful dementia training for general hospital staff: a collective case study Aging and Mental Health.24(3): pp511-21 First published on-line 29.12.18 doi: 10.1080/13607863.2018.1531382
- Parveen, S., Smith, S.J., Sass, C., Oyebode, J.R., Capstick, A., Dennison, A. and Surr, C.A. (2021) The impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: A cross-sectional study BMJ Open 11: e039939 doi: https://doi.org/10.1136/bmjopen-2020-039939
- Capstick, A., Dennison, A., Oyebode, J., Healy, L., Surr, C., Parveen, S., Sass, C and Drury, M. (2021) Drawn from life: Cocreating narrative and graphic vignettes of lived experience with people affected by dementia. Health Expectations. 25 (5):pp 1890-1900. https://doi.org/10.1111/hex.13332
Study outputs for use by care and training providers and commissioners
We have developed the Dementia Training Design and Delivery Audit Tool (DeTDAT). The accompanying manual can be used by care and training providers, commissioners and others involved in training design, delivery or purchasing to assess how well a training package meets good practice criteria identified in the What Works study.
We have also produced a spreadsheet that can be used to map one or more training programmes against the learning outcomes in the Dementia Training Standards Framework.
We are interested in hearing from organisations or individuals who are using any of the tools or outputs from this study. Please let us know how you are using them, raise any questions or give us feedback on them at dementia@leedsbeckett.ac.uk.
Funding
This study is independent research commissioned and funded by the NIHR Policy Research Programme (Understanding Effective Dementia Workforce Education and Training: A Formative Evaluation (DeWET Evaluation), PR-R10-0514-12006). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, ‘arms’ length bodies or other government departments.
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