The impact of experiential learning on healthcare students’ attitudes towards dementia: a systematic review and meta-analysis

Abstract

Background and aims

Healthcare students' attitudes towards dementia are crucial to the quality of care. Experiential learning is a promising strategy; however, the comparative effectiveness of its various modalities remains unclear. This systematic review and meta-analysis aimed to evaluate the impact of experiential learning interventions on healthcare students' attitudes towards dementia.

Methods

A comprehensive literature search was conducted across eight databases (e.g., PubMed, Embase, Cochrane Library) for studies published up to August 2024. A total of 2,350 articles were initially identified using the keywords “experiential learning,” “students,” “attitude,” and “dementia.” Only studies that evaluated the impact of experiential learning on attitudes towards dementia using the Dementia Attitude Scale (DAS) were included.

Results

Thirteen studies involving 1,861 healthcare students were included. Experiential learning significantly improved attitudes towards dementia (WMD = 9.46, 95% CI [6.33–12.58], p < 0.001). Both short-term (single-session) and long-term programs (multiple-session) demonstrated comparable levels of improvement (p = 0.49). Artistic interventions (e.g., storytelling, visual arts) produced significantly greater effects than non-artistic interventions (WMD = 13.44 vs. 7.58, p = 0.02). Interdisciplinary interventions were associated with greater improvement in attitudes, whereas virtual learning formats showed inconsistent outcomes and lacked sufficient representation for robust subgroup analysis.

Conclusion

Experiential learning, particularly artistic and interdisciplinary approaches, significantly enhances healthcare students’ attitudes towards dementia. Even brief interventions proved effective, underscoring their applicability in resource-limited settings. However, methodological limitations, such as quasi-experimental designs, short-term follow-ups, and limited disciplinary and geographic diversity, restrict generalizability. Future studies should employ rigorous designs, explore virtual innovations, and assess long-term outcomes to inform scalable, evidence-based dementia education.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-026-07573-w.

Introduction

Dementia is a rapidly growing global public health challenge, with its prevalence projected to rise from 55.2 million cases in 2020 to 78 million by 2030, and 139 million by 2050 [2]. As the burden of dementia intensifies, the demand for a well-prepared healthcare workforce capable of delivering high-quality, person-centered dementia care becomes increasingly urgent. Despite the crucial role that healthcare professionals play in dementia care, many students demonstrate limited knowledge and unfavorable attitudes towards individuals with dementia, which can adversely affect the quality of care delivered [10, 28, 40]. For example, several studies have shown that healthcare students often perceive people with dementia as unpredictable, dependent, and difficult to communicate with, leading to avoidance behaviors and reduced confidence in providing care [25, 43]. Nursing and medical students have also reported discomfort, fear, or frustration when interacting with individuals with dementia, reflecting persistent stigma and low perceived competence [21, 31]. Attitudes towards dementia are particularly important, as they influence students' willingness to engage in dementia care, their empathy for individuals with dementia, and ultimately their ability to deliver effective and compassionate care services [20, 25]. Ensuring that healthcare students develop positive attitudes and a comprehensive understanding of dementia during their training is therefore essential for improving patient outcomes and preparing a competent future workforce [11].

To address these educational gaps, experiential learning has emerged as an effective pedagogical strategy to strengthen dementia care competencies among healthcare students and professionals [1, 20]. Unlike traditional didactic teaching methods, which rely heavily on lectures and textbook-based instruction, experiential learning promotes active engagement, critical reflection, and the real-world application of knowledge [44]. Various experiential learning modalities, including simulation-based training, role-playing exercises, clinical placements, and interprofessional education, have been shown to enhance students’ competence, empathy, and confidence in working with people with dementia [1, 25]. For example, the “Time for Dementia” program in the UK, which pairs students with people living with dementia and their families, significantly improved students’ empathy and reduced anxiety about dementia care [4, 9]. Similarly, arts-based interventions such as “TimeSlips” and “Opening Minds through Art” have been shown to foster positive attitudes and enhance understanding of personhood through creative interaction with people living with dementia [17, 29]. Moreover, direct interaction with people with dementia has been shown to significantly enhance students’ attitudes, willingness to provide care, and long-term commitment to the field [20, 25].

While previous studies have highlighted the benefits of experiential learning in dementia education, significant research gaps remain. First, the overall impact of experiential learning approaches on healthcare students’ attitudes towards dementia remains inconsistent across studies [21, 31, 32, 37, 43]. Second, the lack of comparative analyses across different experiential learning modalities hinders efforts to identify the most effective strategies.

To address these gaps, this study was conducted as a systematic review and meta-analysis to synthesize the available evidence and provide a comprehensive understanding of the impact of experiential learning on healthcare students’ attitudes toward dementia. The specific objectives of this review are to:

1. Assess the overall impact of experiential learning on healthcare students' attitudes towards dementia; and

2. Compare the effectiveness of different experiential learning modalities in fostering positive attitudes towards dementia.

The findings of this study will provide valuable insights for educators, policymakers, and healthcare institutions, guiding the development and implementation of evidence-based educational interventions that better prepare future healthcare professionals to deliver high-quality, person-centered dementia care.

Methods

Data search

A systematic literature search was conducted following the PRISMA guidelines [33] and Cochrane recommendations [22]. The analysis methods and eligibility criteria were pre-specified and documented in a protocol registered with PROSPERO (CRD 42024511367). Relevant articles published from inception to 14 August 2024 were systematically retrieved from eight databases: PubMed, Embase, Web of Science, Cochrane Library, CINAHL, ProQuest, Ovid, and Scopus, with no language restrictions. The search strategy was developed using both controlled vocabulary (e.g., MeSH terms) and free-text keywords, tailored to the indexing structure and thesaurus of each database. Boolean operators (AND, OR) were applied to combine search terms across the following key domains: (1) experiential learning (e.g., “experiential learning,” “simulation,” “internship,” “problem-based learning”), (2) student populations (e.g., “undergraduate,” “trainee,” “pre-licensure”), (3) attitudes and related psychological constructs (e.g., “attitude,” “empathy,” “perception”), and (4) dementia-related terms (e.g., “dementia,” “Alzheimer’s disease”). Full search strategies for each database are detailed in Supplementary Material. Grey literature (e.g., dissertations, conference abstracts, and preprints) was not included in the search strategy to ensure methodological consistency and to focus on peer-reviewed, published studies. In addition, the reference lists of key review articles, meta-analyses, and original studies were screened to identify any additional relevant publications. After removing duplicates, a total of 2,350 unique articles were identified for screening (Fig. 1).

Fig. 1.

PRISMA flow diagram of the study selection process

Study selection

The literature search was independently conducted by two reviewers using the predefined search strategy across eight databases. After retrieving all records, duplicate entries were identified and removed using Zotero 7. The two reviewers then independently screened the titles and abstracts of the remaining records against the pre-specified inclusion and exclusion criteria. Discrepancies during this stage were resolved through discussion, and unresolved cases were adjudicated by a third reviewer. Following the title and abstract screening, both reviewers independently performed full-text assessments of the potentially eligible studies. Any disagreements arising at this stage were similarly resolved through discussion, with the third reviewer providing the final decision when necessary. Key study information including study design, setting, participant demographics, intervention characteristics, and reported outcomes was independently extracted by three reviewers using a structured data extraction form. Discrepancies in data extraction were discussed and resolved by consensus, with the principal researcher consulted for final decisions when required. In addition, the reference lists of all included studies were screened to ensure comprehensive coverage of relevant literature.

Inclusion criteria

Studies examining the impact of experiential learning interventions on attitudes towards dementia among healthcare students were considered for inclusion. The eligibility criteria were as follows: (1) Participants were healthcare undergraduates (e.g., medical, nursing, gerontology, social work, physiotherapy, dentistry, occupational therapy, pharmacy students). (2) Interventions involving experiential learning (e.g., face-to-face interaction, dementia simulation, virtual dementia experience) aimed to improve students’ attitudes toward individuals with dementia. (3) The DAS was used to assess students’ attitudes towards individuals with dementia before and after the interventions. DAS was selected to ensure conceptual consistency in the outcome measure across studies. It is a validated and widely used instrument that captures both cognitive and affective dimensions of dementia-related attitudes. Other commonly used instruments in the literature (e.g., Alzheimer's Disease Knowledge Scale (ADKS), Dementia Knowledge Assessment Scale (DKAS), Dementia Knowledge Assessment Scale (DKQ), Dementia Knowledge Assessment Scale (DKAT2) assess knowledge; Confidence in Dementia Scale (CODE) assesses confidence; Empathy Quotient Scale (EQS) and Jefferson Scale of Empathy (JSE) assess empathy; and UCLA Geriatric Attitude Scale (UCLA-GAS) evaluates attitudes toward older adults in general rather than dementia specifically. Therefore, only studies using DAS were included in the meta-analysis to minimize outcome construct heterogeneity. (4) Included studies were restricted to publications in English. (5) Studies were not excluded based on intervention duration, follow-up time, or study design.

Exclusion criteria

Studies were excluded if they (1) were not original research (e.g., secondary analyses, commentaries, or editorial perspectives); (2) lacked an experiential learning intervention component focused on dementia care; or (3) did not report sufficient data for analysis and no additional data could be obtained after contacting the authors.

Data extraction

Data extraction was performed independently by three reviewers using a structured data extraction form that was developed and refined through pilot testing. For articles requiring full-text retrieval, key study characteristics (e.g., country, publication year, study design, participant features, and intervention details such as type of experiential learning interventions, frequency, duration, and number of sessions) and outcome measurement tools were recorded. Decisions regarding inclusion and reasons for exclusion were also documented. In cases where the full text lacked necessary data for meta-analysis, the authors were contacted to obtain supplementary information. If multiple interventions were evaluated within a single study, the sample size of the shared control group was divided according to the number of relevant experimental groups, following the Cochrane Review Handbook [22]. Discrepancies among reviewers were resolved through consensus discussions, involving the principal researcher when necessary. To calculate the effect sizes of the interventions, the sample size, mean, and standard deviations of the outcomes were used.

Risk of bias evaluation

The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool, which evaluates bias across seven domains: confounding factors, selection of participants, classification of interventions, deviations from intended interventions, missing outcome data, outcome measurements, and selection of reported results [39]. Two reviewers independently evaluated each study and assigned domain-specific risk ratings. Inter-rater reliability was assessed using Cohen’s Kappa statistic across all domains. Discrepancies were resolved through discussion, with a third reviewer consulted when necessary.

Outcome measurement

The primary outcome assessed in this study was attitudes towards individuals with dementia. Only studies using the DAS to measure this outcome were included in the data analysis. Additional outcomes, such as knowledge, empathy, and confidence, were evaluated in some studies using validated instruments, including the Alzheimer's Disease Knowledge Scale (ADKS), Dementia Knowledge Questionnaire (DKQ), Dementia Knowledge Assessment Tool 2 (DKAT2), Jefferson Scale of Empathy (JSE), and Confidence in Dementia Scale (CODE), among others.

Data analysis

Meta-analysis was conducted using RevMan 5 and Stata 17.0. Given that the DAS was consistently used across all included studies to assess attitudes, Weighted Mean Differences (WMDs) were calculated and reported with 95% confidence intervals (Cls). To facilitate cross-study comparison, standardized mean differences (Cohen’s d) were also computed. The DAS ranges from 20 to 140, with higher scores indicating more positive attitudes towards individuals with dementia. Statistical heterogeneity among the included studies was assessed using the I² statistic and corresponding p-values. A fixed-effect model was applied when heterogeneity was low (I² < 50%); otherwise, a random-effects model was used [22]. Standardized effect sizes were interpreted based on Cohen’s conventional thresholds: small (0.20—0.30), medium (~ 0.5), and large (> 0.80) [8]. To ensure the robustness of the findings, subgroup analyses were conducted based on participant characteristics and types of experiential learning interventions. Sensitivity analyses were performed to examine the influence of individual studies, study design, and participant variability on the overall effect size. Potential publication bias was assessed using funnel plots and Egger's regression test.

Results

Study characteristics

Thirteen studies that examined the effects of experiential learning interventions and used the DAS to evaluate healthcare students’ attitudes towards people with dementia were included in this meta-analysis (Table 1). Most studies were conducted in the United States (n = 7, 53.85%), followed by the United Kingdom (n = 3, 23.08%), Turkey (n = 1, 7.69%), Germany (n = 1, 7.69%), and Australia (n = 1, 7.69%). Eleven studies employed quantitative quasi-experimental designs, while two studies adopted a mixed-methods approach. Nine studies included healthcare students from a single discipline (e.g., medicine, nursing, or gerontology) [4, 7, 14, 15, 17, 23, 26, 34, 36], while four included students from multiple disciplines (e.g., physical therapy, pharmacy, social work) [5, 9, 18, 29], involving a total of 1,861 healthcare students.

Table 1.

Characteristics of studies for dementia experiential learning

Author (Year)	Study Design	Setting	Sample sizea	Female N (%)	Study population	Intervention	Duration	Outcomes	Follow-up
Banerjee et al. [4]	Quantitative; Quasi-experimental	UK	262/142	166 (60.6%)	Medical students	"Time for Dementia" (TFD) program: students visit a person with dementia and their family in pairs	2 h 3 times a year for 2 years	ADQ, ADKS, DKQ, DAS, JSE, MCRS	Yes (after one & two years)
Berning et al. [5]	Quantitative; Quasi-experimental	USA	102/102	70 (68.6%)	Medical, physical, and pharmacy students	Offered Dementia Friends (DF) information sessions in-person or via video conference, learn how to live and communicate with dementia through interactive activities	1 h	DAS	No
Çetingök et al. [7]	Quantitative; Quasi-experimental	Turkey	116/116	91 (78.4%)	Gerontology Department students	Theoretical education and practical education (Dementia Simulation Toolkit)	Theoretical education: 8 sessions in 2 days Practical education: not mentioned	DAS, EQS, ESEP	No
Daley et al. [9]	Quantitative; Quasi-experimental	UK	2549/1196	2095 (78.5%)	Medical, Nurse, Paramedic and AHP students	"Time for Dementia" program (TFD): students visit a person with dementia and their family carer	2 h every 3–4 months for 5–6 visits in 2 years	ADQ, ADKS, DKQ, DAS, MCRS, JSE	Yes (after two years)
Garrie et al. [14]	Mixed methods	USA	11/11	-	Medical students	A poetry workshop with Alzheimer’s disease and related dementias (ADRD)	3.5 h	DAS, IPA for qualitative data	No
George et al. [17]	Mixed methods	USA	22/22	10 (45.5%)	Medical students	“TimeSlips” sessions, a collective storytelling program co-authored with persons with ADRD	4 sessions in 1 month (time was not mentioned)	DAS, Thematic Analysis for qualitative data	No
George et al. [15]	Quantitative; Quasi-experimental	USA	33/33	23 (70%)	Medical students	“Opening Minds through Art (OMA)” program, Students were paired one-on-one with persons living with dementia (PLWD) in nursing homes to create visual artworks, such as printmaking, painting, and collage	1–8 visits, 45–120 min per session. Total engagement time ranged from 90 to 840 min	DAS, Allophilia Scale, UCLA-GAS	No
Gilmartin-Thomas et al. [18]	Quantitative; Quasi-experimental	Australia	83/80	55 (68.8%)	Medical and pharmacy students	“Virtual Dementia Experience (VDE)”, a multi-sensory virtual simulation to immerse participants in the cognitive and perceptual challenges faced by people with dementia	1.5 h	DAS	No
Jones et al. [23]	Quantitative; Quasi-experimental	UK	41/32	23 (71.9%)	Paramedic students	A dementia education program combined didactic teaching with collaborative and reflexive learning and was delivered face-to-face by a specialist dementia educator	6 h	DAS, DKAT2, CODE	No
Lokon et al. [29]	Quantitative; Quasi-experimental	USA	26/26	25 (96.1%)	Gerontology, social work, and education students	“Opening Minds through Art (OMA)” program, students were paired with older adults with dementia to support their creative artmaking	Weekly for 10–12 weeks (time was not mentioned)	DAS	No
Roberts and Noble et al. [34]	Quantitative; Quasi-experimental	USA	19/19	-	Medical students	A museum-based art-centered program, students worked with dementia patients and caregivers and participated in all program activities	1.5 h	DAS	No
Seltmann and Teichmann et al. [36]	Quantitative; Quasi-experimental	Germany	34/34	NA	Nursing students	A dementia training program included two modules: an introduction to dementia and communication skills for interacting with people with dementia	2.5 h	DAS, DKAS, CODE	Yes (after four weeks)

Most participants were female (76%), with a mean age of 22.83 years across the included studies [4, 5, 7, 9, 15, 17, 18, 29, 36]. Three studies reported only the age range of the participants [23, 31, 34], and one study did not provide age data [14]. A variety of experiential learning interventions were implemented, including the following:

1. Interactive visits and continuous contact with individuals with dementia and their families [4, 9];

2. Art and creative activities with individuals with dementia [14, 15, 17, 29, 34];

3. Simulations and virtual experiences [18, 26];

4. Structured educational programs, such as video conferencing incorporating interactive activities, didactic teaching, and collaborative and reflective learning [5, 23]; and

5. Programs combining theoretical education and simulation [7].

The duration and frequency of interventions varied widely, from one hour [5] to two years [4, 9]. Some studies did not report intervention duration or session length [7, 14, 17, 26, 29]. Several studies completed interventions over one or two days [5, 7, 18, 23, 34, 36], while others delivered interventions weekly [29] or every three to four months [4, 9]. In addition to using the DAS to measure attitudes towards individuals with dementia in all included studies, some studies also assessed knowledge [4, 9, 23, 26, 36], confidence [23, 26, 36], and empathy [4, 7, 9].

Risk of bias

According to the ROBINS-I assessment, 10 of the 13 included studies were rated as having a serious overall risk of bias, while the remaining three were rated as having moderate risk (Fig. 2). Most studies did not report how potential confounding variables such as prior experience with people with dementia, baseline empathy levels, or previous related training were addressed in either the study design or analysis. Moreover, statistical control for confounders (e.g., regression analysis) was absent [5, 7, 14, 15, 17, 26, 29, 34, 36]. The kappa statistic of interrater reliability was 0.779. The overall funnel plot showed visible asymmetry, with most studies clustered on the right of the pooled estimate. Egger’s test was statistically significant (p = 0.013), suggesting the presence of small-study effects or potential publication bias.

Fig. 2.

Risk of bias of nonrandomized trials

Impact of experiential learning on healthcare students’ attitudes toward dementia

Overall effect

The overall effect of the meta-analysis (Fig. 3) indicated a significant improvement in students’ attitudes towards dementia following experiential learning [WMD = 9.46, 95% CI (6.33–12.58), p < 0.001]. However, significant heterogeneity was observed (I² = 91%, p < 0.001); therefore, a random-effects model was applied.

Fig. 3.

Forest plot of the overall effect on students' attitudes towards dementia

Subgroup analysis

Subgroup analyses were conducted to explore the effects of program duration (short-term vs. long-term), intervention modality (artistic vs. non-artistic), delivery format (face-to-face vs. non-face-to-face), and participant discipline (single vs. multidisciplinary) on changes in DAS scores. Subgroup classifications were defined as follows: short-term programs were single-session interventions such as workshops, simulations, or one-day educational activities, while long-term programs referred to multi-session or longitudinal interventions delivered over several weeks, months, or years. Artistic interventions included those incorporating creative or expressive art-based activities (e.g., storytelling, poetry, or visual arts), whereas non-artistic interventions involved experiential learning without creative components (e.g., simulation, clinical placement, or video-based learning). Face-to-face interventions involved direct interaction with people with dementia, while non-face-to-face interventions referred to online or simulated experiences. Finally, single-discipline interventions included students from one health profession, and multidisciplinary interventions involved students from multiple professional backgrounds.

Both short-term (WMD = 8.51, 95% CI: 3.63–13.39, p = 0.0006) and long-term (WMD = 10.88, 95% CI: 6.15–15.60, p < 0.001) interventions were associated with significant improvements in DAS scores (Fig. 4). The between-group difference was not statistically significant (p = 0.49), suggesting that short- and long-term formats (where short-term refers to single-session interventions and long-term refers to multi-session) may be similarly effective in enhancing students’ attitude towards dementia. Similarly, both face-to-face (WMD = 10.92, 95% CI: 6.84–15.00, p < 0.001) and non-face-to-face interventions (WMD = 7.77, 95% CI: 2.04–13.50, p = 0.008) significantly improved attitudes, with no significant difference observed between delivery modes (p = 0.38) (Fig. 5). When examining virtual versus non-virtual interventions, only the latter demonstrated a consistent and significant positive effect (WMD = 9.66, 95% CI: 6.33–12.98, p < 0.001), while the single study representing virtual learning yielded a non-significant result (WMD = 8.11, 95% CI: –7.33 to 23.54, p = 0.30) and exhibited high heterogeneity (I² = 87.2%) (Fig. 6).

Fig. 4.

Forest plot of subgroup analysis (short-term program/long-term program)

Fig. 5.

Forest plot of subgroup analysis (Face-to-face interaction/non-face-to-face interaction)

Fig. 6.

Forest plot of subgroup analysis (Virtual intervention/non-virtual intervention)

Notably, artistic interventions (e.g., storytelling, creative arts) produced significantly greater effects (WMD = 13.44, 95% CI: 10.50–16.38, p < 0.001) compared to non-artistic approaches (WMD = 7.58, 95% CI: 3.86–11.30, p < 0.001), with a significant subgroup difference (p = 0.02), highlighting the potential added value of creative modalities (Fig. 7). In addition, both single-discipline (WMD = 10.53, 95% CI: 7.40–13.66, p < 0.001) and multidisciplinary groups (WMD = 8.05, 95% CI: 2.87–13.23, p = 0.002) experienced meaningful improvements, with no significant difference between them (p = 0.42), suggesting that attitudinal gains were consistent across single and multidisciplinary participants (Fig. 8).

Fig. 7.

Forest plot of subgroup analysis (Artistic intervention/non-artistic intervention)

Fig. 8.

Forest plot of subgroup analysis (single-discipline participants/multidisciplinary participants)

Sensitivity analysis and meta-regression

To assess the robustness of the overall pooled effect and identify potential outlier studies contributing to heterogeneity, a leave-one-out sensitivity analysis was conducted. The pooled weighted mean differences (WMDs) ranged from 8.63 to 9.93 across the 13 re-analyses, demonstrating high overall stability and minimal influence of individual studies on the pooled effects. The most notable reduction in heterogeneity occurred when Daley et al. [9] and Berning et al. [5] were excluded, with I² values dropping from 91% to 72.7% and 81.2%, respectively, and Tau² declining to 12.37 and 12.41. These patterns suggest that these two studies may have disproportionately contributed to between-study heterogeneity, potentially due to their large sample sizes, diverse participant compositions, or differences in intervention format. In contrast, excluding studies such as Gilmartin-Thomas et al. [18] or Seltmann and Teichmann [36] resulted in minimal changes to effect size or heterogeneity, indicating their stabilizing influence within the overall model.

Ten studies were initially excluded because they did not use the Dementia Attitudes Scale. These studies were subsequently re-examined to assess whether they could be included in a supplementary sensitivity analysis. Among them, two studies (Griffiths et al. 2020 & Craig et al., 2024) reported sufficient quantitative data using alternative validated attitude instruments (Adolescent Attitudes towards Dementia Scale (AADS) and Approaches to Dementia Questionnaire (ADQ) and were therefore included in the supplementary meta-analysis. One study reported only descriptive findings without sufficient statistical parameters, while the remaining seven studies were excluded due to incompatible study designs, differing research objectives, or the unavailability of full texts.

To further examine the robustness of the findings, an additional sensitivity analysis was conducted by including two studies that assessed dementia-related attitudes using non-DAS instruments. Standardized mean differences (SMDs) were calculated to enable comparability across different scales. The pooled effect (SMD = 0.68, 95% CI [0.43–0.93], p < 0.001) remained significant and directionally consistent with the primary analysis based on DAS studies (WMD = 9.46, 95% CI [6.33–12.58], p < 0.001) (Supplementary Material 7). These findings indicate that the inclusion of non-DAS studies did not substantially alter the overall conclusion, confirming the robustness and generalizability of the main results.

Meta-regression showed that several moderators jointly explained a large proportion of the between-study variance (Adj R² = 87.96%), with a statistically significant model fit [F (5,7) = 4.68, p = 0.034). Specifically, a higher percentage of female participants was significantly associated with greater improvements in attitudes (β = 0.116, p = 0.014), and studies with larger total sample sizes tended to report smaller effect sizes (β = –0.003, p = 0.011). Interdisciplinary interventions also showed a significant positive association with effect size (β = 6.96, p = 0.039), suggesting that programs involving students from multiple professional backgrounds may enhance attitudinal change. However, other moderators, including artistic format and face-to-face interaction did not reach statistical significance when adjusted for covariates.

Discussion

This study represents the first systematic review and meta-analysis to evaluate the impact of experiential learning on healthcare students’ attitudes toward dementia. The analysis showed a significant positive effect of experiential learning on enhancing attitudes, reinforcing the value of immersive educational strategies in shaping attitudinal outcomes. These findings align with prior reviews that emphasized the effectiveness of experiential learning approaches in dementia education [1, 44]. Subgroup analysis indicated that both short-term and long-term experiential learning programs yielded comparable benefits, suggesting that even brief exposure to real-world dementia care settings or simulations can foster meaningful changes in attitudes. Additionally, both face-to-face interactions involving direct contact with people with dementia, and non-face-to-face approaches (e.g., simulations or virtual experiences), were associated with significant improvements in students’ attitudes.

Notably, among all modalities, artistic interventions (e.g., storytelling, poetry workshops, and creative arts activities) were the most effective (WMD = 13.44, 95% CI [10.50—16.38], p < 0.001), with consistent effects and low heterogeneity (I² = 0%). These findings underscore the potential of integrating emotionally engaging, creative modalities into dementia education, particularly in contexts aiming to foster compassion and humanistic understanding. However, when comparing virtual and non-virtual formats, only non-virtual formats showed consistent significance (WMD = 9.71, 95% CI [6.54–12.87]), whereas virtual formats yielded smaller, non-significant improvements (WMD = 8.11, 95% CI [–7.33–23.54]) and substantial heterogeneity (I² = 82%). These discrepancies highlight the need for better-designed virtual tools and warrant further exploration of modalities development and evaluation of virtual experiential learning in dementia education.

The overall impact of experiential learning on healthcare students’ attitudes towards dementia

Overall, experiential learning demonstrates a positive impact (WMD = 9.46) on healthcare students’ attitudes towards dementia. These attitudinal improvements may be interpreted through multiple theoretical frameworks. Kolb’s Experiential Learning Theory posits that learning is most effective when learners actively engage with experiences, reflect, abstract conceptual knowledge, and apply it in practice [27]. This supports the finding that direct, hands-on interactions with people with dementia foster empathy and deepen understanding. Additionally, Construal Level Theory [41] suggests that psychological distance shapes how people construe social phenomena, with closer proximity promoting more concrete and personalized representations. Students with limited exposure to dementia may initially perceive it as a distant, unfamiliar, and stigmatized condition. Experiential learning reduces this distance, replacing abstract stereotypes with tangible, empathetic impressions [45]. This perceptual shift may explain why immersive interventions such as face-to-face interactions and dementia simulations are particularly effective in transforming students' attitudes.

Both short-term (single-session) and long-term (multiple-session) programs can be effective

A key finding of this meta-analysis is that even short-term programs can yield significant benefits insight with practical implications for curriculum design in settings where prolonged placements are impractical. While previous literature suggested that long-term interventions (typically over six months) were required for fostering sustained attitudinal change [3], our results indicate that short-term interventions can be equally impactful. Specifically, single-session formats, such as simulations, activities centered around people living with dementia, or immersive conference-style teaching, yielded significant improvements in attitudes (WMD = 8.51, 95% CI [3.63–13.39], p = 0.0006). A possible explanation for the effectiveness of short-term interventions lies in the Affect Heuristic, a psychological theory suggesting that people often rely on affective impressions rather than analytical reasoning when forming judgments [13, 38]. Brief but emotionally impactful experiences, such as dementia simulations or firsthand narratives, may evoke strong affective responses (e.g., empathy, discomfort, compassion) that rapidly shift attitudes. Unlike cognitive learning, which often requires sustained repetition, emotionally charged experiences can catalyze immediate attitudinal change by bypassing rational deliberation and directly influencing perception and evaluation. This emotion-driven pathway may underlie the potency of even single-session experiential formats. This finding is particularly beneficial for curriculum design in educational settings constrained by time or resources, as it suggests that even brief exposure to experiential learning can be beneficial [7, 14, 18, 23].

Artistic activity-centered programs may be the most effective method

Among the various experiential learning modalities analyzed, artistic interventions emerged as the most effective in improving healthcare students’ attitudes towards dementia (WMD = 13.44 vs. 7.58, p = 0.02). These included storytelling programs (e.g., TimeSlips), visual arts projects (e.g., Opening Minds through Art), and poetry workshops. Interventions that promote creative expression and emotional connection with people with dementia are believed to engage learners on a deeper affective level, fostering empathy, perspective-taking, and a sense of shared humanity [15]. Unlike clinical simulations or didactic lectures, which often emphasize biomedical knowledge and disease-centered care, arts-based interventions redirect attention toward personhood, creativity, and meaningful interaction. This paradigm shift may explain their heightened effectiveness in transforming students’ attitudes. It may also be understood through the lens of neuroplasticity theory, which posits that emotionally rich, novel, and meaningful experiences can stimulate neural remodeling and cognitive-emotional integration. Engaging in creative activities such as storytelling, music, or visual arts activates brain regions associated with affective processing, empathy, and perspective-taking, such as the medial prefrontal cortex and the mirror neuron systems. This neurobiological engagement may enhance learners’ capacity to form emotional connections with people living with dementia, thereby facilitating deeper and more lasting attitude change [24]. Such mechanisms help explain why arts-based interventions may be especially effective in shifting learners’ perspectives beyond biomedical framings and towards more person-centered views of dementia care.

Implications for practice

The findings of this study provide robust evidence that experiential learning significantly enhances healthcare students’ attitudes towards dementia, with several important implications for educational practice. Given the substantial overall effect size observed, the integration of experiential components into healthcare curricula is strongly recommended to cultivate empathy, reduce stigma, and foster person-centered care competencies [42]. This aligns with findings from dementia education research in primary care, where person-centered training programs improved communication, prescribing practices, and patient satisfaction, underscoring the value of regular and context-specific dementia education for healthcare providers [35]. In addition, both short-term and long-term interventions were found to be effective, indicating that even brief immersive experiences, such as dementia simulations or single-session artistic workshops, can produce meaningful attitudinal improvements. This finding is particularly relevant for institutions facing time or resource constraints, as it supports the scalability and adaptability of experiential formats across different program contexts. Furthermore, artistic interventions, including storytelling and visual arts, demonstrated the most pronounced effects on attitude change, highlighting the importance of incorporating creative, affective learning strategies into dementia education. Notably, interdisciplinary interventions were also positively associated with greater attitudinal improvements, as shown in meta-regression findings. This suggests that collaborative, cross-professional learning environments may enrich the experiential learning process. Clinical education programs may benefit from prioritizing such models to maximize impact. These finding not only offer practical guidance for curriculum development but also align with the strategic objectives outlined in the World Health Organization (WHO) Global Action Plan on the Public Health Response to Dementia 2017–2025, which advocates for the integration of dementia-related education in health and social care training systems worldwide [19]. By demonstrating the effectiveness of interdisciplinary artistic experiential learning models, this study provides evidence-based support for national and institutional education policies aimed at fostering dementia-friendly practices and reducing societal stigma on a broader scale.

In contrast, virtual experiential learning showed more variable outcomes, underscoring the need for continued refinement of virtual tools to ensure consistency. It is noteworthy that methodological differences between the two virtual simulation studies may have contributed to the observed heterogeneity. In Kimzey et al. [26], both the intervention and control groups viewed brief videos sharing the perspectives of a person with dementia and a caregiver before the intervention, whereas in Gilmartin-Thomas et al. [18], the control group did not receive such exposure. According to the Intergroup Contact Theory, even indirect or vicarious contact such as watching narratives of people with dementia may also can positively influence attitudes. Therefore, the lack of a significant between-group difference in Kimzey’s study may partly reflect an attenuation effect resulting from empathic video sharing for both groups. Future reviews could therefore consider distinguishing purely virtual simulations from hybrid or mixed-format experiential interventions to improve subgroup classification accuracy.

Due to the limited number of studies evaluating virtual experiential formats (only two studies met inclusion criteria), further subgroup synthesis was not conducted. Nevertheless, sensitivity analysis demonstrated stable overall results when these studies were excluded, suggesting they did not disproportionately influence the main findings. Future research should examine a greater number of well-designed virtual interventions to determine their consistent effectiveness across settings.

To support effective implementation, the development of standardized implementation guidelines is recommended. Such guidelines should draw upon best practices from successful studies. For example, art-based programs may be delivered once weekly over 4 to 8 weeks, with each session lasting approximately 90 min, and incorporating key components such as direct interaction with people living with dementia, guided creative expression (e.g., storytelling, visual arts), and facilitated reflective discussion. These elements are thought to promote affective engagement and perspective-taking, which are considered central mechanisms for attitudinal transformation [5, 12, 16, 23, 29]. In the case of virtual experiential learning, future development should consider the integration of immersive virtual reality (VR) platforms equipped with multi-sensory features, including spatial audio, haptic feedback, and dynamic narrative content. Such enhancements may increase psychological realism and emotional salience, potentially addressing the inconsistent outcomes observed in current digital formats [6, 30]. Furthermore, the inclusion of structured debriefing sessions and emotion-focused reflection activities is recommended to support meaning-making and long-term attitudinal consolidation.

Limitations

Despite these promising findings, several limitations must be acknowledged. The high heterogeneity observed across studies (I² = 91%) indicates substantial variability in intervention methods, participant characteristics, and study designs. This inconsistency complicates data synthesis and hinders the identification of the most effective components within experiential learning programs. In addition, many included studies lacked detailed descriptions of their intervention protocols, which reduces transparency and impedes replication efforts.

Another key methodological limitation concerns the overall study quality. The majority of studies employed quasi-experimental designs and failed to adequately control for potential confounding variables such as baseline DAS score, year of study, or prior experience with people with dementia. These limitations contributed to moderate to high risk of bias identified by the ROBINS-I tool. Moreover, the participant composition across studies was often unbalanced. Nursing students constituted the majority of samples, while students from other healthcare disciplines (e.g., pharmacy, physiotherapy, dentistry) were underrepresented. This skewed distribution may limit the generalizability of findings to multidisciplinary training environments. Geographically, most studies were conducted in high-income countries, with limited representation from low- and middle-income countries. Given the cultural variability in perceptions of dementia, as well as differences in healthcare systems and educational infrastructure, the transferability of these findings to other global contexts remains uncertain.

In addition, several limitations related to statistical inference that warrant careful consideration. First, potential publication bias, as indicated by Egger’s test (p = 0.013) and an asymmetrical funnel plot, suggests that studies with null or unfavorable findings may be underrepresented, which could inflate the overall effect size. Sensitivity analyses further revealed that certain studies (e.g., [5, 9]) contributed disproportionately to heterogeneity, possibly due to variations in sample size, intervention complexity, or participant composition. This variability raises concerns regarding the consistency and comparability of intervention designs across studies. Furthermore, although meta-regression identified significant moderators, including gender distribution, interdisciplinary participation, and sample size, these results should be interpreted with caution. The limited number of included studies limits statistical power and increases the risk of model overfitting. It should also be noted that multicollinearity among covariates and the influence of unmeasured confounding variables may have compromised the stability and interpretability of the moderator analysis.

Finally, nearly all included studies evaluated outcomes only immediately following the intervention, with few studies incorporating longitudinal follow-up assessments. This short-term focus limits the ability to determine whether the observed attitudinal improvements are maintained over time. To address this gap, future research should include follow-up evaluations at multiple time points (e.g., three or six months post-intervention) to assess the sustainability and long-term effectiveness of experiential learning. Such evidence is essential for informing the design of sustainable and effective educational curricula.

Conclusion

This systematic review and meta-analysis provides robust evidence that experiential learning significantly improves healthcare students’ attitudes towards individuals with dementia. Both short-term and long-term interventions demonstrated meaningful effects, indicating that even brief immersive experiences such as dementia simulations or single-session artistic workshops can foster positive attitudinal change. Among the various approaches examined, artistic interventions including storytelling, creative arts, and poetry were especially impactful, highlighting the importance of emotionally engaging, person-centered education in cultivating empathy and reducing stigma. Subgroup and meta-regression analyses also showed that interdisciplinary interventions were associated with greater attitudinal improvements. In addition, the analysis suggested that larger studies tend to report smaller but potentially more precise effects, underscoring the importance of considering both study quality and sample size when interpreting intervention outcomes. However, the presence of considerable heterogeneity in study design, intervention format, and participant composition, along with the predominance of quasi-experimental methods, limits the consistency and generalizability of the findings. In addition, most studies assessed outcomes only immediately after the intervention, which restricts understanding of long-term effects.

To build a stronger evidence base, future research should emphasize methodologically rigorous designs such as randomized controlled trials with extended follow-up periods. More studies are also needed in underrepresented disciplines and regions to explore the cultural and contextual dimensions of experiential learning. By advancing high-quality research and refining implementation strategies, educators and institutions can better prepare healthcare students to deliver compassionate, person-centered dementia care across diverse settings.

Authors’ contributions

I.H.W. and J.W. conceived and designed the study. Y.F., Z.T. and M.T. performed the literature search and data screening. I.H.W., X.G., and Z.T. extracted the data and assessed risk of bias. Statistical analysis was conducted by I.H.W., X.G. Visualization and graphical outputs were prepared by I.H.W. The initial draft was written by I.H.W. and reviewed by all authors. Q.W., W.I.L., N.L. and I.K.V. supervised the project. All authors critically revised the manuscript and approved the final version for submission.

Funding

This research was funded by Macao Foundation (Grant No.: 0544/DGAF/2024–02). Sponsor’s role: The sponsors did not participant in the design, methods, data collection, analysis, or in the preparation of this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.