From Overload to Understanding: How Caregivers Experience and Use Information in Dementia Counselling

ABSTRACT

Background

Caregiver education is fundamental to dementia care, yet novice caregivers often receive large amounts of information immediately following diagnosis, when emotional adjustment and learning readiness may influence engagement. Less is known about how caregivers engage with, understand and apply dementia‐related information in this period. This study explored caregivers' experiences of receiving and applying information during nurse‐led dementia counselling, using Cognitive Load Theory as one interpretive lens alongside broader Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping.

Methods

A secondary qualitative descriptive study was conducted using semi‐structured interview data from 11 novice dementia caregivers recruited from a tertiary hospital's outpatient geriatric clinic. Data were analysed using reflexive thematic analysis, with multiple theoretical frameworks serving as sensitising lenses to inform interpretation.

Results

Three themes were identified: (1) ‘Navigating Informational Demands in Early Dementia Caregiving,’ reflecting difficulties engaging with complex information during emotional distress and uncertainty; (2) ‘Building Understanding Through Practical Experience and Repetition’, describing how caregivers gradually applied and contextualised information through practice and repeated exposure; and (3) ‘Preferences for Accessible, Individualised and Integrated Dementia Education’, highlighting preferences for staged, personalised, multimodal, and integrated educational support. Emotional readiness, prior experience, practical relevance and accessible support systems were identified as important influences on caregivers' learning experiences.

Discussion

Post‐diagnostic learning was shaped by the interaction between emotional adjustment, informational demands and available support. Findings suggest that dementia counselling may be better supported through staged, personalised and multimodal approaches rather than single information‐dense encounters. While Cognitive Load Theory offered one useful perspective, the findings more broadly reflected emotional, relational and transitional experiences, better understood through the complementary lenses of Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping, with practical implications for psychogeriatric nursing and post‐diagnostic caregiver support.

Abbreviations

CLT

Cognitive Load Theory

PWD

Persons with dementia

1. Introduction

The global population aged 65 years and over is projected to double by 2050, representing more than 20% of the total population by 2074 [1, 2, 3]. In Asia, 25% of the population will be aged over 60 by 2030, with developed nations like Singapore experiencing a particularly sharp rise in those aged 65 and above [4, 5, 6, 7]. This demographic shift is accompanied by a corresponding increase in age‐related diseases, most notably dementia. A 2013 national survey reported that dementia affects one in ten adults aged 60 and above in Singapore, reflecting a broader global trend where persons with dementia (PWD) require extensive and sustained care provided primarily by informal caregivers [8]. As populations age, reliance on informal family care is expected to intensify.

In Singapore, the ‘ageing‐in‐place’ policy framework promotes home‐based care supported by community services, aligning with Asian cultural values of filial piety while ensuring care continuity from hospital to home [9, 10]. Within this framework, informal caregivers assume central roles in managing daily routines and behavioural changes associated with dementia. For those newly assuming this role, these responsibilities are often overwhelming without structured preparation [11]. International evidence suggests that novice caregivers frequently experience significant informational and emotional strain, with one in three at risk of anxiety or depression [12, 13]. These pressures are further compounded by the responsibilities the ‘sandwiched generation’ have to bear, and caregivers' own ageing‐related vulnerabilities [14, 15]. Such challenges necessitate effective, nurse‐led interventions to support caregivers during this critical transition. A primary example is dementia counselling, typically initiated after diagnosis to equip caregivers with knowledge and practical skills [16].

Dementia counselling is an ‘umbrella term’ encompassing psychoeducation, emotional support, cognitive‐behavioural strategies and skills training [17]. Evidence suggests that psychoeducation, often synonymous with counselling, can mitigate caregiver burden and anxiety by enhancing knowledge of dementia, strengthening coping strategies, and supporting behavioural management [18]. Among the various healthcare professionals involved in dementia care, nurses frequently deliver dementia counselling interventions to caregivers across care settings. Nurse‐led dementia counselling, delivered either individually or dyadically, has been shown to significantly ease caregiver burden in both hospital and community settings [18, 19]. However, despite the prevalence of these educational interventions, less is known about how novice caregivers understand, make sense of and apply the large volume of information provided during the counselling sessions in the post‐diagnostic period. Existing research has largely focused on intervention outcomes like burden reduction and psychological distress, with comparatively little attention paid to how novice caregivers engage with and make sense of dementia‐related information in the immediate post‐diagnostic period. While interventions should be ideally tailored to caregivers' evolving needs over the disease trajectory [20, 21], systematic approaches to assessing and addressing these needs are underdeveloped [22]. To date, much of this care transition and its associated physical, emotional and psychosocial implications have been analysed through macro‐level lenses like Meleis' Transition Theory [23] and the Lazarus and Folkman's Transactional Model of Stress and Coping [24]. While these frameworks are vital for mapping the emotional landscape and identity shifts inherent in dementia caregiving, they often overlook the micro‐level, cognitive architecture of how clinical information is actually received, made sense of and applied during clinical encounters. Understanding how novice caregivers acquire, make sense of, and apply new caregiving knowledge may help nurses and other healthcare professionals design educational interactions that facilitate learning while minimising cognitive load, thereby supporting caregivers in dementia care. Therefore, this secondary qualitative data analysis sought to answer the following research questions:

1. How do novice dementia caregivers experience learning during nurse‐led dementia counselling?

2. What factors facilitate or hinder novice dementia caregivers' acquisition, understanding, and application of information received during the dementia counselling session?

While Cognitive Load Theory (CLT) provides one sensitising lens for examining information‐related challenges in educational contexts, its application within nurse‐led caregiver education remains limited and inconsistently applied [22, 25, 26]. This variability contributes to heterogeneity in the design and reported outcomes of patient education interventions. Rather than replacing broader theoretical perspectives such as Meleis Transition Theory [23] and Lazarus and Folkman's Transactional Model of Stress and Coping [24], CLT offers a complementary perspective for understanding one underexplored aspect of the caregiving transition: how novice caregivers receive, make sense of and apply dementia‐related information during nurse‐led counselling in the early post‐diagnostic period. Examining caregiver learning through this complementary cognitive lens may provide additional insights into how educational interventions can be better structured to support caregivers during this period.

1.1. Theoretical Framework

CLT, developed by Sweller in 1988 [27], is an instructional framework rooted in the architecture of human cognition. It centres on the limited capacity of working memory as the site of conscious cognitive processing and the processes by which information is acquired and stored in long‐term memory [27]. CLT identifies three distinct types of cognitive load: intrinsic load, which refers to the inherent complexity of the information itself, independent of its presentation; extraneous load, which refers to unnecessary cognitive demands imposed by suboptimal information delivery; and germane load, which reflects the cognitive effort directed towards schema construction and meaningful learning [27, 28]. The fundamental goal of CLT‐informed design is to minimise extraneous load, thereby freeing cognitive resources for germane processing and enhancing learning efficiency [27]. When information is successfully processed and transferred to long‐term memory, it becomes stored as retrievable schemas [28]. The ‘modality effect’ further suggests that presenting information across complementary sensory channels may optimise cognitive processing and facilitate learning and knowledge acquisition [25]. It is important to acknowledge, however, that CLT was developed primarily within structured, task‐based instructional settings, often experimentally controlled, and was not originally designed to account for the emotionally charged, relationally embedded and non‐linear nature of informal caregiving. Applying CLT to dementia caregiving therefore requires conceptual care. In this study, CLT is not used to reduce caregiving experiences to instructional design problems, nor to suggest that emotional distress represents a form of extraneous load to be engineered away. Instead, CLT concepts are used as sensitising tools to emphasise how the timing, organisation and complexity of information delivery may interact with caregivers' capacity to engage with counselling content. Where participants' accounts reflect experiences that extend beyond informational processing (e.g., grief, relational adjustment and identity transition), these are interpreted through the complementary lenses of Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping, rather than being conflated into CLT categories.

While CLT provides one useful sensitising lens for examining how caregivers experience informational demands during post‐diagnostic counselling, caregiver learning and adaptation following a dementia diagnosis occurs within a broader transitional and emotional context that extends beyond instructional design. Two complementary frameworks inform the study's broader interpretive context; Meleis' Transition Theory conceptualises the post‐diagnostic period as a situational transition, in which caregivers undergo a fundamental shift in role and identity from family member to caregiver [23]. Key properties of this transition, including awareness of the new role, engagement in transition behaviours (e.g., information‐seeking and the navigation of critical events like diagnosis disclosure) are fluid and directly relevant to understanding how caregivers in this study experienced and responded to post‐diagnostic counselling. Transition conditions, including personal factors like prior knowledge, beliefs, level of preparation and emotional readiness, and community factors like access to support services may either facilitate or hinder this process [23]. Lazarus and Folkman's Transactional Model of Stress and Coping further highlights that caregivers' responses to post‐diagnostic demands are shaped by cognitive appraisal; specifically, how caregivers evaluate the diagnosis and its implications as a threat, harm or challenge, and how they assess their available coping resources for managing these caregiving demands [24]. Coping responses, whether problem‐focused (e.g., actively seeking information and training) or emotion‐focused (e.g., managing distress), influence how caregivers engage with educational support during this period. Together, these frameworks complement CLT by situating informational challenges within the broader emotional, relational and transitional context of early dementia caregiving, and are drawn upon throughout the discussion where the findings extend beyond informational processing alone.

2. Methods

This study employed a secondary qualitative descriptive analysis to provide a theoretical reinterpretation of dementia caregiver narratives through multiple interpretive lenses, including CLT, Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping, enabling deeper conceptual insights into previously collected data. Secondary analysis involves the re‐use of existing datasets to address research questions not fully explored in the primary study, providing a resource‐efficient and ethically sound approach to uncovering new conceptual perspectives and generating additional insights from the rich qualitative data [29, 30]. The present study sought to explore how novice dementia caregivers acquired, made sense of and applied dementia ‐related information following diagnosis. Rather than testing or validating CLT, this study employed CLT as a sensitising lens to guide interpretation of caregivers' information‐related experiences during nurse‐led dementia counselling. Crucially, translating CLT from its origins in instructional psychology to the emotionality of psychogeriatrics necessitates a careful conceptual distinction between general emotional distress and cognitive processing. Caregiver distress (e.g., grief, post‐diagnostic anxiety, emotional shock) does not inherently constitute an instructional design flaw (i.e., extraneous load). Rather, the recognition that intensive affective states may reduce available cognitive bandwidth (working memory capacity) for processing complex clinical instructions meant that CLT can inform interpretation of how timing, structure and complexity of information delivery can shape caregivers' engagement with counselling content and learning experiences. Findings relating to emotional adjustment, caregiving transition and coping were interpreted through the complementary lenses of Meleis' Transition Theory [23] and Lazarus and Folkman's Transactional Model of Stress and Coping [24]. This multi‐theoretical approach enabled caregivers' informational experiences to be understood within the broader psychosocial context of early dementia caregiving rather than through a purely cognitive perspective. The primary study, conducted between 2019 and 2020, received ethics approval from the Domain‐Specific Institutional Review Board of the National Healthcare Group (Ref: 2019/00546) [30]. Informed consent was obtained from all participants prior to data collection. The dataset was rigorously assessed for suitability based on its relevance to the secondary research question, richness of informational content, methodological rigour and availability of contextual knowledge from the original study team. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.

2.1. Participants & Setting

Participants were recruited from a geriatric clinic in a tertiary acute care hospital in Singapore. The primary study used purposive sampling with maximum variation to capture diverse caregiving experiences across different age, gender, and ethnic backgrounds. Eligible participants were adult family caregivers of persons with newly diagnosed dementia (within two–four weeks), who were providing assistance with activities of daily living at home. In this clinical setting, patients undergo comprehensive cognitive assessment, following a referral for suspected cognitive decline. A diagnosis is disclosed by a geriatrician on a separate dedicated consultation. Following diagnosis, caregiver‐care recipient dyads typically receive a nurse‐led dementia counselling session focused on the management of behavioural changes, available support services, and community resources.

2.2. The Dementia Counselling Process

Caregivers attended a nurse‐led counselling at the hospital's geriatric clinic, typically during the same outpatient visit in which the diagnosis was disclosed. These sessions were conducted by registered nurses specialised in psychogeriatric care who had undergone training in dementia psychoeducation and therapeutic communication. Sessions ranged from approximately 20 to 50 minutes in duration, depending on the complexity of the case, the caregiver's informational needs and the number of enquiries and concerns raised during the encounter. While sessions did not follow a rigid standardised protocol, they broadly adhered to a consistent structure. Nurses began by reviewing the patient's clinical notes to familiarise themselves with the case before the session. The session then commenced with a baseline assessment of the patient's functional status, behavioural symptoms, and available support systems, alongside an exploration of the caregiver's current understanding of dementia and any immediate concerns. This was followed by the provision of foundational education covering the nature of dementia, its symptoms, disease progression and practical management strategies. Nurses subsequently assessed behavioural concerns specific to the patient, explored challenges encountered by the caregiver, and counselled accordingly. Sessions concluded with the nurses addressing additional queries, coordinating referrals to community resources like dementia support groups and hotlines, and scheduling follow‐up counselling where indicated. The initial educational component was relatively consistent across participants; however, the depth, focus and delivery of counselling varied according to individual caregiver and patient circumstances, as well as between nurse counsellors. During the counselling sessions, caregivers were also provided with supplementary educational materials including hospital‐based dementia care resources, brochures on falls prevention and printed materials with QR codes linking to digital applications and activity engagement resources. Guidance was also provided on lifestyle modifications, self‐care and respite arrangements where relevant.

2.3. Data Collection

In the primary study, semi‐structured interviews were conducted in Mandarin or English using a pre‐tested interview guide [30]. To ensure high‐quality data, the student co‐investigator underwent specific training in building rapport, interpreting non‐verbal cues, and qualitative interviewing techniques [31]. Each interview was conducted by the co‐investigator, accompanied by another team member to ensure comprehensiveness.

Interviews lasted 30–60 minutes and were audio‐recorded with consent. Field notes captured contextual and non‐verbal information. To enhance accuracy, clarifications and member‐checking were employed during the interviews [32]. Interviewers allowed pauses and emotional space when participants became distressed, enabling participants to regain composure before continuing [30].

2.4. Data Analysis

Reflexive thematic analysis was employed to identify, analyse, and report patterns across the dataset, following Braun and Clarke's six‐step framework to ensure a systematic process of familiarisation, coding, theme development, review, refinement and reporting [33]. Given the subjective nature of individual experiences and perspectives, this approach was well‐suited for summarising rich and meaningful data by generating codes and themes, facilitating an exploration of diverse perspectives [34]. As the study aimed to explore caregivers' experiences of engaging with and applying dementia‐related information, a secondary interpretive analysis informed by CLT as a sensitising lens, alongside Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping, was undertaken. The analysis incorporated both deductive and inductive elements, allowing theoretical concepts to inform interpretation while remaining grounded in participants' accounts, to surface phenomena not fully explored in the primary study [33, 34]. Deductively, CLT concepts (e.g., perceptions of information burden, clarity of educational materials, timing of information delivery, prior knowledge, and experiences of knowledge application in practice) informed initial analytic attention to information‐related experiences within the dataset. Simultaneously, three themes with six subthemes were developed inductively through close reading and engagement with participants' narratives, enabling findings that extended beyond CLT (i.e., emotional adjustment, relational caregiving and system navigation) to be identified and retained without being reinterpreted through a cognitive lens. The original study explored broad caregiving transitions, post‐diagnostic adaptation, informational needs and experiences of support following diagnosis, and the original interviews were not designed to explore cognitive load, learning theory or instructional psychology constructs; participants were never prompted using CLT terminology [30]. The dataset was assessed as suitable for secondary analysis because it contained rich accounts of information‐related experiences, including difficulties comprehending information, navigating resources, managing competing demands and applying caregiving knowledge in practice. Given the contextual distance between CLT's instructional origins and the psychogeriatric caregiving context, CLT was applied strictly as a sensitising lens rather than an explanatory framework. It guided interpretation of caregivers' experiences relating to the timing, organisation and complexity of information delivery, while findings extending beyond informational processing (e.g., emotional distress, relational adaptation, healthcare fragmentation and caregiving transition) were examined within their broader psychosocial contexts and interpreted in relation to Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping. This approach helped ensure that findings remained grounded in participants' narratives, while allowing CLT to function as one interpretive lens among several, rather than a totalising, deterministic explanatory framework.

2.5. Reflexivity and Positionality

The first two authors independently reviewed the transcripts to maintain contextual grounding. To reduce interpretive distance inherent in secondary analysis, analytic decisions were made iteratively in relation to both emerging themes and relevant educational concepts within CLT, with ongoing peer debriefing between the first author (not involved in the original study) and the second author (primary investigator of the original study) to ensure deep contextual immersion. This also ensured that theoretical reinterpretations remained grounded in the original participants' lived experiences while allowing for fresh perspectives to organically emerge, ensuring that theoretical overfitting was actively monitored and minimised, so as to avoid the risk of imposing CLT constructs onto data not originally collected for that purpose. Additionally, a reflexive journal maintained by the second author during the primary study was used for analytical triangulation to ensure that the theoretical lenses complemented rather than superseded the authentic perspectives of the caregivers. Reflexivity and positionality were considered integral to the analytic process, consistent with Braun and Clarke's reflexive thematic analysis framework [33, 34]. The first author, a registered nurse not involved in the original study, approached the dataset as an outsider, which supported fresh interpretive engagement while also introducing a degree of contextual distance from the original caregiving context. The second and third authors, both registered nurses involved in the primary study, provided ongoing contextual grounding through peer debriefing, ensuring that emerging interpretations remained anchored in participants' lived experiences and the clinical realities of the Singaporean psychogeriatric setting. All three authors share professional backgrounds in nursing and healthcare, which may have oriented analytic attention towards clinical and educational dimensions of caregiving while potentially limiting sensitivity to dimensions less visible within the nursing lens (e.g., family dynamics) or cultural nuances beyond the authors' own experiences. However, rather than treating subjectivity as a source of bias to be eliminated, it was recognised as an inevitable dimension of qualitative inquiry, made transparent through the aforementioned analytic strategies.

2.6. Ensuring Research Integrity

Trustworthiness was ensured through several strategies. Credibility was supported through verbatim transcriptions, field notes, and original member checks to confirm the accuracy of interview data. Peer debriefing with all members of the original research team supported validation of emerging interpretations and ensured that the theoretical frameworks functioned strictly as interpretive lenses without distorting or superseding the participants' authentic lived experiences [35]. Confirmability was maintained through an audit trail documenting coding decisions and interpretive consensus. Transferability was enhanced through detailed description of the Singaporean outpatient setting. Purposive sampling with maximum variation based on their sociodemographic characteristics was also chosen to further enhance the transferability of the results [35]. Artificial Intelligence Generate Content tools were used for linguistic refinement to improve readability. The authors ensured interpretive integrity and remained fully accountable for the content.

3. Results

Eleven participants (two males and nine females) were recruited and interviewed. Ten eligible individuals were excluded: five declined participation (n = 5), three expressed discomfort with being audio‐recorded (n = 3), and two were unwilling to participate in an interview (n = 2). Interviews lasted between 30 and 60 min. Participant ages ranged from 42 to 80 years; demographic characteristics are detailed in Table 1 [30].

TABLE 1.

Participant's demographic information.

Participant No.	Gender	Age	Ethnic group	Relationship with PWD	Highest level of education	Living with patient	PWD's dementia type
P01	Female	46	Chinese	Daughter	Tertiary education	Yes	Mild Alzheimer's Dementia
P02	Female	55	Chinese	Daughter in‐law	Tertiary education	Yes	Mild Alzheimer's Dementia
P03	Female	66	Chinese	Daughter	Secondary education	Yes	Mild Alzheimer's Dementia
P04	Female	80	Indian	Wife	Secondary education	Yes	Mild Alzheimer's Dementia
P05	Female	65	Chinese	Wife	Secondary education	Yes	Mild Alzheimer's Dementia
P06	Female	58	Chinese	Daughter	Tertiary education	Yes	Mild Alzheimer's Dementia
P07	Female	42	Indian	Daughter	Tertiary education	Yes	Mild Alzheimer's Dementia
P08	Male	78	Chinese	Husband	Tertiary education	Yes	Mild Alzheimer's Dementia
P09	Male	75	Chinese	Husband	Tertiary education	Yes	Mild Alzheimer's Dementia
P10	Female	44	Chinese	Daughter	Tertiary education	Yes	Mild Alzheimer's Dementia
P11	Female	79	Chinese	Wife	Secondary education	Yes	Mild Alzheimer's Dementia

Thematic analysis yielded three interrelated main themes and six subthemes describing caregivers' experiences of receiving and applying dementia‐related information following diagnosis. Across the narratives, caregivers described feeling overwhelmed during the initial post‐diagnostic period, gradually developing confidence through practical experience and repeated exposure to information, and identifying ways educational support could be delivered in a more manageable and tailored fashion. Although the participants did not explicitly describe their experiences using educational or cognitive terminology, their narratives suggested that the timing, organisation and relevance of information influenced how easily they could engage with, interpret and apply dementia‐related knowledge in daily caregiving. Alongside these informational experiences, caregivers' accounts also reflected broader emotional, relational and transitional dimensions of adapting to a new caregiver role following diagnosis. Table 2 summarises the themes and subthemes identified from caregivers' experiences of early post‐diagnostic dementia counselling.

TABLE 2.

Overview of themes and subthemes identified from caregivers' experiences of post‐diagnostic dementia counselling.

Themes	Subthemes
Navigating Informational Demands in Early Dementia Caregiving	1.1Post‐Diagnostic Shock and Information Saturation 1.2Challenges Revisiting and Applying Information After Counselling
2 Building Understanding Through Practical Experience and Repetition	2.1Relating Information to Personal Caregiving Goals 2.2Developing Understanding Through Experiential and Repeated Engagement
3 Preferences for Accessible, Individualised and Integrated Dementia Education	3.1Timing and Personalisation of Information 3.2Preferences for Multimodal Delivery and Integrated Healthcare Navigation

3.1. Theme 1: Navigating Informational Demands in Early Dementia Caregiving

This theme describes caregivers' encounters with nurse‐led dementia counselling immediately following diagnosis. Many participants described this period as emotionally intense and cognitively demanding, particularly when large amounts of unfamiliar information were delivered within a compressed timeframe.

3.1.1. Subtheme 1.1 Post‐Diagnostic Shock and Information Saturation

The close temporal proximity of the medical diagnosis to the nursing counselling session created an overwhelming informational threshold. Several participants described struggling to absorb information during the initial counselling session because they were still processing the emotional impact of the diagnosis. Participants often recalled feeling shocked, distressed, or mentally overwhelmed, which appeared to affect their ability to focus on detailed explanations and recommendations regarding dementia care. Consequently, some expressed a preference for the counselling sessions to be scheduled separately from the initial medical diagnosis.

The nurses actually give quite a fair bit of info, in fact it was like wow, it was quite a lot you know…I think the info(rmation) is too much at the point in time…because as a caregiver…less than half an hour ago, I was given this fact (dementia diagnosis)…I think it is better to do the dementia counselling during the next visit. (P01, daughter)

Caregivers also described becoming overwhelmed by the number of practical issues they had to suddenly consider, compounded by the complexities inherent in future planning, behavioural management, managing progressive cognitive decline, and maintaining the PWD's functioning.

Once we received the report, we started to think that there were many things we had to do to help her (PWD) maintain it (PWD's cognition) at this stage. (P02, daughter‐in‐law)

In contrast, caregivers with prior personal exposure to dementia through relatives or friends described feeling somewhat more familiar with dementia‐related concepts before attending the session, which appeared to support their engagement with the counselling content.

I think that the information given at that point of time (dementia counselling) is sufficient enough to prepare us. (P02, daughter‐in‐law).

These accounts suggest that prior familiarity with dementia may have influenced caregivers' readiness to engage with information during counselling in a positive manner. Apart from informational challenges, this also reflects the disorientation and emotional disruption characteristic of the early situational transition, where the critical event of diagnosis disclosure marks the beginning of a profound shift in role and identity.

3.1.2. Subtheme 1.2: Challenges Revisiting and Applying Information After Counselling

Many caregivers described difficulties engaging with educational materials after the counselling session. Participants often received multiple brochures, verbal explanations, and recommendations for external resources, but several found it challenging to review or integrate the disparate information afterwards.

No, I am not clear about these resources. (P11, Wife).

I was given a few brochures, I actually have not gone through it yet (at the point of the interview) (laughs) (P07, daughter).

Caregivers also expressed frustration with system‐level barriers, such as fragmented digital applications and complex hospital administrative processes. Difficulties accessing digital applications, navigating different websites, and applying for different services generated considerable mental fatigue and imposed further strain during an already stressful period.

I think the system; something is wrong somewhere in the system…getting a (self‐return card for identification purpose) is already such a hassle. (P01, Daughter).

Several participants additionally described struggling to extract protracted time from a relentless caregiving schedule to revisit educational materials while balancing work and caregiving responsibilities.

I think for the first week, I was pretty good at reading up…but these two weeks, I was busy at work, so I stopped. (P01, Daughter).

Apart from educational materials, similarly, participation in community‐based peer support and dementia support groups was often constrained by the relentless demands of the caregiving role.

I don't mind, but I don't have the time (to attend the dementia support groups), he (PWD) has to follow me, then how to go? (P05, Wife).

Taken together, these accounts suggest that caregivers' ability to engage with and consolidate information was influenced by multiple factors: the practical complexity of dementia care, emotional distress, competing responsibilities, time constraints and fragmented systems of support. These experiences not only reflect informational challenges, but also the broader transitional demands of adjusting to a new caregiving role and identity, and the accompanying emotional and practical disruption inherent in care transitions.

3.2. Theme 2: Building Understanding Through Practical Experience and Repetition

This theme illustrates how caregivers gradually developed confidence and understanding through repeated exposure to information, practical caregiving experiences and participation in educational activities. Rather than describing a passive absorption of facts, caregivers' accounts suggested active attempts to connect nursing guidance with their personal caregiving circumstances and values, reflecting deeper processing of knowledge.

3.2.1. Subtheme 2.1: Relating Information to Personal Caregiving Goals

Engagement with dementia‐related information appeared to become more meaningful when caregivers could connect it to their immediate caregiving priorities and future concerns. For several caregivers, learning felt more relevant when they could anchor new information to concrete personal goals, such as maintaining the PWD's well‐being and functioning.

I know his (husband) dementia is going downhill, but the doctor says (that) dementia cannot be healed, cannot be improved, but has to (be) maintain(ed). (P05, Wife).

Some caregivers also described actively seeking additional information to better prepare for future caregiving demands.

…read up more, understand more about dementia…then I know more about (dementia), (and)…it would be easier for me to do any planning. (P02, daughter‐in‐law).

These accounts suggest that caregivers were attempting to interpret new knowledge in relation to their own family circumstances and anticipated caregiving responsibilities, rather than simply memorising information. The process of connecting new information to personal context and goals may reflect a form of deeper, more meaningful and personal engagement with learning, though it is equally consistent with broader accounts in the transition literature of caregivers actively constructing meaning and identity during role transitions.

3.2.2. Subtheme 2.2 Developing Understanding Through Experiential and Repeated Engagement

Caregivers reported that nurse‐led counselling was most useful when reinforced by hands‐on workshops, simulation‐based learning, case studies, and experiential activities. These structured activities helped caregivers to contextualise, validate, refine their understanding, and apply information beyond what was discussed during the verbal counselling alone.

After the (dementia) was diagnosed…I went for some dementia programs… they have case studies… It actually helps a lot. There was (one dementia case study from the workshop) that was really frightening, and I thought my mother might be like that. But when the doctor told me otherwise, I felt relieved. (P10, Daughter).

This illustrates how caregivers compared workshop case studies with their own caregiving situations and harnessed these experiences to interpret and reassess expectations about dementia progression. It also suggests that effective knowledge consolidation and deeper processing may require repetition over time and diverse learning opportunities and tools, beyond solely receiving education at a single time‐point. However, systemic barriers like long waiting times for caregiver training programmes could potentially disrupt this learning curve and momentum.

The training for the caregiver… the fastest (and) earliest available course… is from 12 October. If I missed it, I would have to wait next year. (P01, Daughter).

Caregivers expressed their frustration over these delays because they limit opportunities to reinforce and apply newly‐acquired knowledge during the early caregiving period. The limited access to these coping resources heightens the burden of the caregiving transition.

3.3. Theme 3: Preferences for Accessible, Individualised and Integrated Dementia Education

This theme synthesises caregivers' recommendations for improving post‐diagnostic educational support. Tailoring content to individual needs, staggering information delivery across multiple time‐points, and improving the organisation and accessibility of resources (e.g., use of diverse learning modalities) were perceived as key strategies to facilitate understanding and retention.

3.3.1. Subtheme 3.1: Timing and Personalisation of Information

A central recommendation was the temporal decoupling of the diagnosis disclosure and the counselling session. Several caregivers felt that counselling delivered immediately after diagnosis was difficult to absorb because they were still emotionally overwhelmed.

…I was too overwhelmed to absorb everything…the next visit would be more appropriate. (P01, Daughter).

Participants commonly suggested providing a deliberate ‘breathing space’ between the doctor's visit and the nurse‐led counselling session, with information staggered across multiple timepoints to allow caregivers more time and cognitive and emotional capacity to adjust before engaging with detailed caregiving information and guidance. Generic information was also often perceived as redundant, particularly among caregivers with prior exposure to dementia.

Because there is a lot…we read about this in the papers and we read about this on the internet…there is nothing (the dementia counselling session) can offer. (P06, daughter).

No, for now I don't need anything (caregiving resources). (P11, Wife).

Caregivers strongly advocated for a learning model that assesses the family's baseline knowledge and current home and social environment, one that tailors information to their immediate concerns and caregiving stage rather than delivering standardised content uniformly to all caregivers.

We have read about (dementia) in the papers and…on the Internet…I think a lot boils down to how different members of the family can play their part. (P06, daughter).

Actually, before that I already (knew) a bit about dementia, because (my) friends' parents have gone through that. So, reading up about (other) information would be good. (P02, Daughter‐in‐law).

Participants also noted that certain topics were not always perceived as relevant at particular stages of caregiving. For example, discussions about dementia daycare or advance care planning were sometimes viewed as premature at early stages.

She (dementia nurse) did say that if we need, we can go to dementia daycare or something like that. But I told her that we do not need it right now, because he (loved one with dementia) is still quite independent. (P11, Wife).

These findings suggest that timing and personalisation of information were important factors shaping caregivers' readiness and ability to engage with post‐diagnostic counselling, with emotional state, prior knowledge, and the PWD's current functional status all influencing what felt relevant and manageable at each stage of the caregiving journey.

3.3.2. Subtheme 3.2: Preferences for Multimodal Delivery and Integrated Healthcare Navigation

Caregivers frequently described verbal counselling alone as insufficient, particularly during emotionally stressful periods. They advocated for a transition away from monolithic verbal counselling towards an integrated, multimodal delivery model that combined verbal explanations with practical examples, visual aids, case‐based scenarios, workshops, and peer support opportunities.

They have some case studies…it really helps a lot…Before the doctor's diagnosis (dementia), I actually have the background already. I went to see the case studies and joined all the groups already. (P10, Daughter).

Participants described these approaches as more accessible, easier to understand, and more relatable to and grounded in real‐life caregiving situations. Repeated and varied forms of learning appeared to help caregivers revisit information over time and apply it more confidently within their own home environments.

Beyond educational content, caregivers also strongly advocated for more integrated healthcare systems and simplified administrative processes. Rather than viewing administrative requirements as minor inconveniences, participants described fragmented systems and inconsistent information as additional burdens that compounded the cognitive and emotional demands of dementia caregiving, further stretching already depleting personal coping resources.

One side is telling me one side of the story…I think it is a bit confusing…I think something is wrong somewhere in the system…the way it is functioning…the process…Why can't the hospital just…do a one‐stop service for patients since (they) have already diagnosed (the patient)? (P01, Daughter).

Overall, caregivers preferred integrated ‘one‐stop’ systems that simplified access to educational resources and support services, reducing the effort required to navigate multiple services and allowing them to focus more on caregiving responsibilities.

4. Discussion

This study explored how novice dementia caregivers experienced and engaged with information from nurse‐led counselling following diagnosis. The findings suggest that caregivers' experiences of learning following diagnosis were shaped by the interaction between emotional adjustment, informational demands and available support. In the immediate post‐diagnostic period, caregivers often described feeling emotionally overwhelmed, which appeared to affect their ability to engage with, prioritise and apply dementia‐related information. Over time, caregivers gradually developed greater confidence through repeated exposure, practical caregiving experience and participation in experiential educational activities. Caregiver learning following diagnosis is influenced by multiple factors, ranging from the content provided during the counselling session, caregivers' emotional readiness, prior experience, competing responsibilities and the accessibility of healthcare systems and educational resources. These findings are consistent with existing dementia caregiver education literature and are examined through the complementary theoretical lenses of CLT, Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping.

The first theme highlights the emotional and informational challenges of the acute post‐diagnostic phase. The temporal proximity of diagnosis to counselling meant that caregivers struggled to engage with information while simultaneously managing emotional distress, uncertainty and the practical implications of a new dementia diagnosis. These experiences align with literature describing the emotional and informational burden experienced by novice dementia caregivers during care transitions, particularly the simultaneous demands of learning new caregiving responsibilities while experiencing anticipatory grief following diagnosis disclosure [28, 36, 37]. From a CLT perspective, the emotional demands associated with diagnosis, coupled with fragmented information delivery, multiple sources of information and administrative complexity, may have made it more difficult for caregivers to engage with, make sense of and understand counselling content during this demanding period [38, 39]. Prior educational research suggests that fragmented information delivery and the ‘split‐attention’ effect can make it more difficult for learners to process and integrate new information effectively [38, 39, 40]. Although CLT was originally developed within educational settings, its concepts offer a useful sensitising lens for understanding why information presented during periods of heightened emotional and cognitive demand may be more challenging to engage with effectively. However, these informational challenges are best understood as one dimension of a broader transitional and emotional experience rather than primarily as instructional design problems. Consistent with Meleis' Transition Theory, this period reflects the disorientation and role disruption characteristic of the early situational transition phase, where the critical event of diagnosis disclosure destabilises existing identity and routine before new patterns are established [41]. Variation in caregivers' readiness to receive and apply counselling information may be understood through transition properties, including awareness of role change and engagement in transition behaviours like information‐seeking [23, 42]. Additionally, caregivers with prior exposure to dementia‐related information often appeared more comfortable with counselling content, potentially reflecting more favourable transition conditions (e.g., prior knowledge and social exposure) and greater preparedness for learning, although this observation should be interpreted cautiously given the small sample size [39, 41, 42]. Beyond the initial counselling session, caregivers also described difficulty revisiting and applying information due to competing responsibilities, time constraints and fragmented support systems. The Stress and Coping Theory suggests that the simultaneous demands of emotional adjustment, uncertainty and perceived availability of support and cognitive processing may exceed available coping resources, particularly in the absence of adequate preparatory support; this may influence how caregivers engage with information during this period [24]. Together, these findings suggest that caregivers' ability to engage with educational content is influenced not only by how information is delivered, but also by the emotional, relational and contextual demands surrounding the caregiving transition.

The second theme suggests that caregivers' understanding developed gradually through practical application, repetition and ongoing exposure to information over time. Rather than describing learning as a passive absorption of facts, caregivers tried to actively interpret and apply new knowledge in relation to their caregiving priorities, family circumstances and future planning needs. Educational activities like workshops, case discussions and support groups appeared to help participants contextualise dementia‐related knowledge within lived caregiving experiences, consistent with broader literature describing caregiver learning as an iterative process shaped by a combination of experience, reflection and sustained engagement with support services [40, 41]. From a CLT perspective, these findings may suggest that caregivers were better able to engage with and make sense of information when it became personally meaningful and could be linked to existing experiences and emerging caregiving needs, moving beyond surface‐level retention towards more applied understanding in dementia care [40]. Learning therefore appeared not to occur as a single educational event, but as an ongoing process of knowledge construction across multiple encounters and contexts. Meleis' Transition Theory provides additional insight into this gradual movement towards a more adaptive transition pattern, as caregivers developed greater role awareness, increased engagement in transition behaviours, and the progressive establishment of new routines and competencies over time [23]. Similarly, the active information‐seeking described by participants is also consistent with Lazarus and Folkman's concept of problem‐focused coping, whereby individuals take deliberate steps to manage perceived stressors by seeking knowledge and building preparedness [24]. Taken together, these findings suggest that caregiving learning in dementia care is relational, emotionally situated and highly context‐dependent, extending beyond structured instructional settings in which CLT was originally conceptualised. Additionally, they highlight the value of sustained educational support throughout the caregiving journey rather than concentrating information provision at the point of diagnosis. Some caregivers also described systemic delays in accessing structured learning opportunities; this may leave caregivers navigating unfamiliar and complex demands without adequate scaffolding and support, potentially prolonging role uncertainty and increasing vulnerability to caregiver strain [23, 41]. This points to a broader tension between the clinical recognition of caregivers' educational needs and the structural capacity of healthcare systems to meet them in a timely manner.

The third theme highlights caregivers' preferences for more accessible, individualised and flexible educational support. Although the counselling sessions in this study incorporated some degree of tailoring, with nurses adapting content according to caregivers' presenting concerns, baseline knowledge and patient circumstances, caregivers reported difficulties; some consistently found information‐dense, single‐session counselling difficult to process, particularly immediately following diagnosis. Instead, they emphasised the need for scaffolded, repeated delivery across multiple timepoints, with content tailored to immediate concerns and baseline understanding. This suggests that the degree of personalisation and staging currently embedded within counselling, including the volume, timing and complexity of information delivered immediately following diagnosis, may have been challenging for caregivers to make sense of and engage with, particularly in a period characterised by emotional distress, uncertainty and competing demands [38, 39]. Caregivers consistently expressed a preference for information that was staged, personalised and delivered across multiple encounters rather than concentrated within a single counselling session. Such preferences may reflect attempts to manage cognitive burden by receiving information in smaller, more digestible segments that can be integrated progressively over time. Similar findings have been reported extensively in dementia caregiver education literature, where staged and individualised approaches have been associated with improved caregiver confidence and engagement [15, 43]. While CLT provides a useful lens for understanding why distributed and scaffolded educational approaches may support more manageable engagement with information, Meleis' Transition Theory suggests the importance of transition conditions, including emotional readiness, prior knowledge and social support, in shaping how individuals engage with educational support during role transitions [23]. Concurrently, counselling that is responsive to these conditions, rather than uniformly delivered, may better support adaptation by aligning with caregivers' evolving needs, experiences and capacity to engage across the transition process [23]. Additionally, from a Stress and Coping perspective, preferences for manageable, incremental information delivery may reflect an attempt to regulate the cognitive and emotional demands of the transition, reducing the perceived threat of information overload through emotion‐focused coping strategies such as selective engagement with information [24]. Participants also valued simplified, integrated resources and practical multimodal educational strategies, including case‐based discussions, workshops, visual aids and peer support opportunities, which helped translate abstract information into lived caregiving contexts. Although these are not by themselves novel findings, they are well‐established and broadly aligned with adult learning theory, psychoeducational research and dementia caregiver education literature suggesting that presenting information through multiple complementary formats (e.g., audio‐visual and text‐based modalities) may support comprehension, working memory and knowledge retention [15, 25, 44, 45]. Furthermore caregivers emphasised the importance of repeated engagement and follow‐up, allowing opportunities to revisit, consolidate and apply information as caregiving demands evolved. Such findings are consistent with broader educational literature suggesting that repeated exposure and reinforcement may support deeper learning over time [40, 46]. Beyond the content and structure of counselling, caregivers also highlighted the administrative complexity and fragmented healthcare navigation as additional burdens that compounded caregiving demands. These systemic barriers function as secondary stressors that may increase cognitive and emotional demands while simultaneously depleting coping resources available for learning and adaptation [24]. Consequently, efforts to improve post‐diagnostic caregiver education require not only better design and delivery of educational interventions, but also structural improvements in service coordination and accessibility within healthcare systems.

Taken together, these findings suggest that post‐diagnostic caregiver learning is not a discrete educational event, but an ongoing, emotionally embedded process shaped by the intersection of individual readiness, relational support and systemic accessibility. The three theoretical lenses applied in this study (i.e., CLT, Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping) each illuminate different dimensions of this process, yet none alone is sufficient to capture its full complexity. This underscores the value of pluralistic theoretical approaches in dementia caregiver education research, and points to the need for counselling models that are simultaneously responsive to caregivers' emotional states, adaptive to their evolving informational needs and supported by well‐coordinated healthcare systems.

The findings have several implications for psychogeriatric nursing practice. Psychogeriatric nurses are well positioned to identify caregivers who may be emotionally overwhelmed or struggling to engage with information following diagnosis, given their ongoing contact with PWD and their families. The combination of clinical assessment, therapeutic communication, ongoing relational support and care coordination is something that nurses can bring to post‐diagnostic support, capabilities that extend beyond information delivery alone. Nurses can advocate for and deliver dementia counselling that is strategically structured and aligned with caregivers' readiness, informational needs, and caregiving stage.

In practice, rather than relying primarily on single‐session information delivery, nurses may consider utilising temporal decoupling of diagnosis disclosure and counselling where feasible, incorporating brief emotional readiness check‐ins prior to counselling sessions to assess caregivers' immediate capacity to receive information. Prioritising essential ‘need‐to‐know’ information during early encounters and introducing advanced behavioural strategies only after improved emotional adjustment across follow‐up visits may better support learning while respecting individual variation in readiness and preferences. Rather than concentrating information within a single encounter, nurses can stage follow‐up discussions or telephone check‐ins to help caregivers gradually revisit, reinforce and apply information over a sustained period, better supporting caregiver understanding and confidence‐building. Gaining a holistic understanding of caregivers' relevant backgrounds, profiles, and tailoring educational content according to their prior knowledge, immediate concerns and caregiving stage is also necessary. For example, deferring discussions of advanced care planning until caregivers have had time to emotionally adapt to the diagnosis and establish basic caregiving routines reflects the kind of clinical judgement that psychogeriatric nurses are uniquely positioned to exercise. In the same vein, advocating the importance and incorporation of multimodal educational strategies such as verbal explanation, written materials and case‐based discussion to cater to diverse learning needs is also warranted. Beyond nursing education and counselling, participants also highlighted the importance of practical guidance and support in navigating healthcare systems, suggesting that psychogeriatric nurses play a central role in care coordination and resource facilitation, including simplifying referral pathways and helping families navigate available support services more efficiently.

Future research should evaluate staged and individualised dementia counselling models across different geriatric clinic and community psychogeriatric settings. There is also scope to examine how caregivers engage with, interpret and apply information following diagnosis using a range of theoretical perspectives, including the Meleis' Transition Theory [23] and Lazarus and Folkman's Transactional Model of Stress and Coping [24], alongside educational theories, to build a more comprehensive and holistic understanding of post‐diagnostic learning. Although CLT provided a useful interpretive lens for examining how caregivers experienced and managed information demands, the findings also reflected broader emotional, relational and transitional experiences associated with adapting to a dementia diagnosis. Caregiver learning in this context occurred within emotionally charged and socially situated caregiving relationships, extending beyond the structured instructional environments in which CLT was originally developed. As such, CLT should be viewed as one complementary perspective rather than a comprehensive explanatory framework for caregiver adaptation. On another note, the integration of technology‐based tools (e.g., virtual simulations and digital learning platforms) to support caregivers with limited time and competing responsibilities warrants further investigation, particularly given the pervasive role of technology in everyday life [47]. At a systems level, there is a need for tools that assess emotional and cognitive readiness to learn, rather than focusing predominantly on caregiver burden [48, 49]. Policies must recognise that newly diagnosed caregivers require time to make sense of the diagnosis before engaging meaningfully with the counselling information [30, 50]. Nursing curricula and continuing professional development should incorporate evidence‐informed principles relating to caregiver education, emotional readiness, multimodal learning and communication of complex information, to equip practitioners to design flexible and effective caregiver education.

Several limitations should be considered. The findings may be most transferable to settings with similar demographic and cultural characteristics as participants were recruited from a single tertiary geriatric clinic and were predominantly cohabiting Chinese family caregivers of PWD [51]. Experiences of caregivers in different cultural and healthcare contexts and those managing advanced dementia, behavioural symptoms, non‐family caregiving or non‐cohabitating roles, or lower literacy levels may differ substantially and require further subgroup analyses. Although thematic coverage was considered adequate for the exploratory aims and nature of this study, the modest sample size of eleven participants means that findings should be viewed as interpretive rather than theory‐generating and confirmatory. The use of secondary qualitative analysis also presents inherent challenges related to data fitness and contextual interpretation, as the original interviews were not specifically designed to explore cognitive processes or educational theory [29, 52]. To address this, the analysis focused closely on participants' descriptions of learning experiences and used CLT as a sensitising rather than explanatory framework guiding interpretation of information‐related aspects of the data. Additionally, as counselling delivery was not governed by a rigid standardised protocol and varied according to individual caregiver circumstances and between nurse counsellors, differences in the content and depth of sessions may have influenced participants' experiences of information burden and engagement with learning. Detailed information regarding variation in counselling delivery was also not systematically available given the secondary analytic design, and this should be considered when interpreting the findings. The involvement of the original study team also supported contextual familiarity with the dataset, while independent validation of the analytic process strengthened credibility, though interpretations should remain viewed as exploratory and theory‐informed rather than confirmatory evidence of specific cognitive mechanisms [53]. Rather than generating new recommendations, this study contributes qualitative insight into why these approaches matter from caregivers' own perspectives and in illustrating how CLT concepts may serve as a useful organising framework for psychogeriatric nurses and other healthcare professionals designing post‐diagnostic counselling.

In conclusion, the transition into dementia caregiving presents substantial emotional and informational challenges for novice caregivers, particularly during the immediate post‐diagnostic period. This study suggests that while nurse‐led dementia counselling is pivotal in supporting this transition, its effectiveness may be influenced by the timing, structure and complexity of information delivery. Findings suggest that caregivers generally preferred educational support that was staged, practical, personalised, multimodal and reinforced over time, rather than delivered through single information‐dense encounters. CLT offered one useful sensitising perspective for understanding informational challenges during post‐diagnostic counselling, though the findings equally reflect broader, emotional, relational and transitional dimensions of adapting to dementia that are better understood through the complementary lenses of Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping. Emotionally and informationally responsive, flexible and accessible approaches to post‐diagnostic dementia counselling may better support caregivers' engagement with dementia‐related information in real‐world clinical settings. These findings also highlight the important role psychogeriatric nurses play in supporting caregivers through a combination of education, ongoing guidance, clinical coordination and adaptation of support in response to caregivers' evolving needs over time.

Funding

The authors have nothing to report.

Disclosure

The authors have nothing to report.

Ethics Statement

Ethics approval was obtained from the Domain‐Specific institutional Review Board of the National Healthcare Group with the reference number 2019/00546 during the primary study. As this study uses anonymised qualitative data, ethics approval was waived. Consent to participate in the research was obtained from the participants from the primary study. Informed consent was obtained from all the participants prior to the interviews, and the primary study this secondary analysis was based on was conducted in accordance with the relevant guidelines and regulations.

Consent

Informed consent was obtained from all participants included in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.