Abstract
BACKGROUND:
Dementia is a severe global health issue closely related to population aging. Nurses are mainly responsible for dementia care, but gaps in knowledge, attitudes, and practices (KAP) can affect the quality of care. This study conducted to dementia-related knowledge, attitudes, and practices among student nurses and staff nurses, and identified demographic and professional factors associated with these competencies.
MATERIALS AND METHODS:
A hospital-based cross-sectional comparative study was adopted with total enumerative sampling technique among 350 participants (150 student nurses and 200 staff nurses) at Sum Nursing College and IMS and SUM Hospital Bhubaneswar, Odisha. Data were collected using a Dementia Knowledge Assessment Scale (DKAS), the Attitudes toward Alzheimer’s disease and Related Dementias Scale, and Self-reported Dementia Care Practice scale. Data were analyzed using descriptive and inferential statistics.
RESULTS:
The mean knowledge score ranged from 9.18 ± 3.35 to 10.22 ± 2.99. Attitude scores ranged from 74.92 ± 14.70 to 86.36 ± 15.37. Practice scores were between 35.60 ± 7.70 and 39.30 ± 6.40. Knowledge strongly correlated with attitude (r = 0.41, P < .001) and practice (r = 0.38, P < .001). The strongest correlation was between attitude and practice (r = 0.62, P < .001). Older age, higher education, more work experience, dementia-care experience, and prior training were all significantly associated with higher scores (P < .05).
CONCLUSION:
Nurses’ dementia care competencies were moderate and influenced by their experience and training. Further research is needed to determine whether targeted educational and training interventions can lead to meaningful improvements in dementia care.
Keywords: Alzheimer’s, dementia, health knowledge, health personnel attitude, nursing
Introduction
Dementia is a clinical syndrome characterized by progressive cognitive decline, affecting one or more domains such as learning and memory, language, executive functioning, complex attention, perceptual-motor abilities, and social cognition. This condition profoundly impacts the individual’s quality of life.[1,2] More than 50 million people worldwide are currently living with dementia, and this number is projected to rise to over 152 million by 2050.[3,4] Worldwide this demographic transition reflects increase life longevity and India has progressively increased from 42.9 years in 1960 to 70.4 years in 2020. Low- and middle-income countries like India are projected to witness a significant and concerning rise in the number of individuals with dementia.[5,6,7]
An elderly with dementia with cognitive declination leads to become more and more dependent on their caregiver for overall functioning.[8] Enhancing the knowledge and skills of caregivers with dementia has emerged as a global challenge and nurses must be competent enough to provide care.[9,10,11] Globally, literature highlighted the knowledge gap among nurses. Nurses should be enriched with knowledge and favorable attitude toward care of patient as they are accountable for enhancing their quality of life.[12,13] Nurses spend more time providing direct patient care in acute settings compared to other healthcare professionals. However, literature explores that nurses frequently lack confidence, competence, and dementia-specific knowledge when addressing such individuals and reported negative experiences with these patients in clinical practice.[14,15] A review of the aforementioned studies highlights the need to conduct a comparative assessment between student and staff nurses, focusing on patient-centered care.[16,17]
The conceptual framework [See Figure 1] for this study integrates the relationships between knowledge, practice, and attitudes (KAP model) toward dementia with theory of planned behavior (TPB) among student and staff nurses at IMS and SUM Hospital, Odisha, India. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior.[18]
Figure 1.
Theoretical framework (KAP Model) of the study in a conceptual figure based on theory of planned behavior (TPB)
Study novelty
After doing extensive review and best of our knowledge we did not find studies related to knowledge, attitude, and practice of nursing professionals toward dementia care in Bhubaneswar, Odisha. The present study will be able to identify the gap of KAP among nurses and which will bring the fresh regional insight into grey area. This study will highlights and help the Nursing educators and stakeholders who can strengthen the need of dementia care through training, exposure, and simulation based care.
Materials and Methods
Study design and setting
This study was reported in accordance with the STROBE guideline. Here, a single-center, cross-sectional survey design was undertaken at Tertiary care Hospital, Bhubaneswar, Odisha, India, to determine KAP of student and staff nurses. The study took place in a clinical setting that provides training for nursing students and employs nurse practitioners and registered nurses.
Study participants and sampling
Final-year undergraduate students and staff participated, allowing comparison of student nurses, nurse practitioners, and registered nurses. Those were absent and did not consent were excluded. All the participants were recruited using the total enumerative sampling technique for the present study.
Sample size calculation
The required sample size for this study was calculated using the standard formula for estimating a proportion in cross-sectional studies:
where:
n = required sample size
Z = standard normal deviate at 95% confidence level (1.96)
p = estimated prevalence or proportion from previous studies
q = 1 − p
d = margin of error (precision)
Based on previous studies assessing nurses’ knowledge and attitudes toward dementia, the expected proportion (p) was set to 0.5 to obtain the maximum sample size. The precision (d) was set to 0.05 at the 95% confidence level. The estimated sample size was 384.
Considering participant availability, and institutional settings, a total of 350 participants were included in the study, comprising 150 student nurses and 200 staff nurses working at Tertiary care Hospital.
Data collection tools and techniques
Data collection carried out by using structured socio demographic questionnaire, DKAS, DAS, and Self-reported Dementia Care Practice scale.
Sociodemographic information
It is used to collect demographic and professional data from participants, including age, sex, educational level, marital status, years of work experience, prior training in dementia care, and family history of dementia.
Dementia knowledge assessment scale (DKAS)
It is a standardized tool comprising 21-item scale to measure knowledge across the domains of symptoms, causes, risk factors, and management. One point is awarded for each correct response, score ranges between 0 and 21. The scores were 0-7 = poor knowledge, 8-14 = moderate knowledge and 15-21 = Good knowledge. The tool validated by 5 experts and the reliability of the tool was 0.82 by using Cronbach’s alpha.
Dementia attitude scale (DAS)
It was used to measure attitudes toward dementia. It consists of 20 items scored on the same 7-point Likert-type scale ranging from (1) strongly disagree to (7) strongly agree. Scores scale ranges from 20 (most negative attitude toward caring for people with dementia) to 140 (most positive attitude toward caring for individuals with dementia) with high psychometric properties (Cronbach’s alpha 0.86).
Self-reported dementia care practice scale
To assess clinical practice regarding dementia care, a structured practice questionnaire was applied. The tool assesses dementia care-related behaviors, such as communication style with patients, behavioral symptom management, and person-centered care for the individual. Responses were rated on a five-item Likert-type scale, with higher scores indicating better dementia care practices among nurses.
A pilot study was conducted from 15 May 2025 to 22 May 2025 at IMS and SUM Hospital, Phulnakhara, Bhubaneswar, to determine the feasibility among 40 subjects (20 student nurses and 20 staff nurses) and found to be feasible. For main study, eligible subjects were approached and the researcher explained the objectives and written informed consent was obtained from all subjects before participation. Data collection carried out from 2 June to 1 July 2025.
Statistical analysis method
After data collection, data were entered to the master sheet. Data were analyzed using SPSS 20. Descriptive statistics and independent t-tests (i.e., comparisons between groups) applied for analysis. Pearson correlation and multivariable regression was used to assess correlation and associations at P < .05 level of significance.
Ethical consideration
This study was approved by the Institutional Review Board, Sum Nursing College (SOADU/SNC/IRB/466/2025). Permissions were also secured from the medical superintendent, the head of the mental health department. Participants were assured of confidentiality and anonymity and freedom to withdraw at any point during the study after obtaining the informed consent.
This study was conducted under the institutional project ID SOADU/SNC/IRB/466/2025, as approved by institutional ethical committee.
Result
Baseline characteristics
Sociodemographic characteristics of the participants, including student nurses (n = 150) and staff nurses (n = 200) from IMS and SUM Hospital, Odisha, India, are presented in Table 1.
Table 1.
Sociodemographic characteristics of student nurses and staff nurses (n=350)
| Variables | Category | Student Nurses (n=150) n (%) | Staff Nurses (n=200) n (%) | |||
|---|---|---|---|---|---|---|
| Age (years) | 20–25 | 145 (96.7) | 87 (43.5) | |||
| 26–30 | 5 (3.3) | 89 (44.5) | ||||
| 31–35 | – | 19 (9.5) | ||||
| ≥36 | – | 5 (2.5) | ||||
| Gender | Male | 49 (32.7) | 68 (34.0) | |||
| Female | 101 (67.3) | 132 (66.0) | ||||
| Educational qualification | Diploma | – | 16 (8.0) | |||
| BSc Nursing | 150 (100.0) | 173 (86.5) | ||||
| MSc Nursing | – | 11 (5.5) | ||||
| Marital status | Married | 5 (3.3) | 61 (30.5) | |||
| Unmarried | 145 (96.7) | 139 (69.5) | ||||
| Work experience | <1 year | 128 (85.3) | 73 (36.5) | |||
| 1–5 years | 22 (14.7) | 94 (47.0) | ||||
| 6–10 years | – | 11 (5.5) | ||||
| >10 years | – | 22 (11.0) | ||||
| Experience in caring for patients with dementia | Yes | 49 (32.7) | 130 (65.0) | |||
| No | 101 (67.3) | 70 (35.0) | ||||
| Previous dementia-related training | Yes | 25 (16.7) | 77 (38.5) | |||
| No | 125 (83.3) | 123 (61.5) | ||||
| Family history of dementia | Yes | 12 (8.0) | 32 (16.0) | |||
| No | 138 (92.0) | 168 (84.0) |
Dementia knowledge levels
As shown in Figure 2, the distribution of knowledge levels revealed that most participants had an average level of knowledge. The results showed that more than half (60.7%) of student nurses had fair knowledge, and one-third (33.3%) had a knowledge deficiency. The knowledge level among staff nurses was poor (17%), good (74%), and 8.5% indicating staff nurses had limited knowledge of dementia.
Figure 2.
Distribution of dementia knowledge levels among student and staff nurses
Mean comparison of knowledge and attitude
Staff nurses demonstrated significantly higher mean knowledge scores (10.22 ± 2.99) compared to student nurses (9.18 ± 3.35), and this difference was statistically significant (t(348) = -3.05, P = .003). Similarly, staff nurses had significantly more positive attitudes toward dementia care (86.36 ± 15.37) than student nurses (74.92 ± 14.70) at (t(348) = -7.01, P < .001). In terms of practice, staff nurses also scored higher (38.20 ± 6.80) than student nurses (36.10 ± 7.50), at (t(348) = 2.04, P = .041) and found to be significant. The study revealed that staff nurses possess better knowledge, attitudes, and practices compared to student nurses. [See Table 2]
Table 2.
Mean comparison of dementia related knowledge and attitude among student and staff nurses (n=350)
| Dementia | Student Nurses | Staff Nurses | t | df | P | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Knowledge | 9.18±3.35 | 10.22±2.99 | -3.053 | 348 | 0.003** | |||||
| Attitude | 74.92±14.70 | 86.36±15.37 | -7.019 | 0.001** | ||||||
| Practice | 36.10±7.50 | 38.20±6.80 | 2.04 | 0.041* |
Correlations between the knowledge, attitude, and practice scores
The findings demonstrated a stronger positive association between knowledge and attitude scores (r = 0.41, P < .001), indicating that higher levels of knowledge were associated with more constructive attitude. There was also a positive correlation between practice scores and knowledge (r = 0.38, P < .001), indicating that greater prealpha knowledge was associated with better practices. The strongest association was found between attitude and practice scores (r = 0.62, P < .001), indicating that a positive attitude toward dementia care is closely associated with better clinical practice [Table 3].
Table 3.
Correlation analysis of knowledge, attitude, and practice scores
| Variables | Knowledge | Attitude | Practice | |||
|---|---|---|---|---|---|---|
| Knowledge | 1 | |||||
| Attitude | 0.41* | 1 | ||||
| Practice | 0.38* | 0.62* | 1 |
Values represent Pearson correlation coefficients (r) between the three dimensions of the questionnaire, *P<0.001, indicating statistically significant positive correlations
Factor association among knowledge, attitude, and practice scores
The multivariable regression analysis demonstrated that age was strongly associated with all three outcomes, individuals aged 31–35 years had higher knowledge (β = 0.89, 95% CI: 0.11–1.67, P = .025), attitude (β = 7.44, 95% CI: 1.36–13.52, P = .017), and practice scores, respectively, compared with those aged between 18 and 30 years and also determined that age was strongly associated with all three outcomes. Participants aged ≥36 years had higher scores across all domains (knowledge: β = 1.04, P = .018; attitude: β = 9.21, P = .011; practice: β = 3.00, P < .05). Individuals with MSc Nursing reported greater knowledge (β = 1.15, P = .015), attitude (β = 8.41, P = .020), and practice scores (β = 1.20, P = .021). However, BSc Nursing was correlated only with practice scores (β = −1.60, P = .033). Participants with 6–10 years of experience showed improved knowledge (β = 1.01, P = .022), attitude (β = 7.84, P = .015), and practice scores (β = 2.80, P = .011). Similarly, those with more than 10 years of experience scored significantly higher across all domains.
Participants with experience had significantly higher knowledge (β = 1.04, P = .001) and attitude (β = 8.73, P < .05). [See Table 4] The association of professional characteristics with KAP suggests that nurses may undergo higher education and experience to improve their attitudes and clinical practices.
Table 4.
Multivariable analysis of factors associated with knowledge, attitude, and practice scores
| Variable | Knowledge β (95% CI) | P | Attitude β (95% CI) | P | Practice β (95% CI) | P | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age (years) | ||||||||||||
| 20–25 | Ref. | Ref. | Ref. | |||||||||
| 26–30 | 0.12 (−0.54, 0.78) | 0.721 | 2.31 (−3.05, 7.68) | 0.398 | 0.30 (−0.80, 1.40) | 0.612 | ||||||
| 31–35 | 0.89 (0.11, 1.67) | 0.025 | 7.44 (1.36, 13.52) | 0.017 | 2.10 (0.60, 3.60) | 0.008 | ||||||
| ≥36 | 1.04 (0.18, 1.91) | 0.018 | 9.21 (2.11, 16.30) | 0.011 | 3.00 (1.20, 4.80) | 0.002 | ||||||
| Gender | ||||||||||||
| Male | Ref. | Ref. | Ref. | |||||||||
| Female | 0.06 (−0.51, 0.63) | 0.842 | 1.21 (−3.14, 5.56) | 0.585 | −0.40 (−1.70, 0.90) | 0.463 | ||||||
| Educational qualification | ||||||||||||
| Diploma | Ref. | Ref. | Ref. | |||||||||
| BSc Nursing | 0.73 (−0.18, 1.63) | 0.115 | 5.92 (−0.41, 12.24) | 0.067 | −1.60 (−3.10, −0.10) | 0.033 | ||||||
| MSc Nursing | 1.15 (0.22, 2.08) | 0.015 | 8.41 (1.36, 15.46) | 0.020 | 1.20 (0.20, 2.20) | 0.021 | ||||||
| Marital status | ||||||||||||
| Unmarried | Ref. | Ref. | Ref. | |||||||||
| Married | 0.96 (0.18, 1.74) | 0.017 | 6.81 (1.21, 12.41) | 0.018 | 2.60 (0.90, 4.30) | 0.026 | ||||||
| Work experience | ||||||||||||
| <1 year | Ref. | Ref. | Ref. | |||||||||
| 1–5 years | 0.55 (−0.13, 1.23) | 0.111 | 4.63 (−0.44, 9.70) | 0.073 | 1.10 (−0.20, 2.40) | 0.098 | ||||||
| 6–10 years | 1.01 (0.15, 1.87) | 0.022 | 7.84 (1.54, 14.13) | 0.015 | 2.80 (0.80, 4.80) | 0.011 | ||||||
| >10 years | 1.18 (0.33, 2.04) | 0.007 | 9.12 (2.61, 15.63) | 0.006 | 3.50 (1.40, 5.60) | 0.004 | ||||||
| Experience caring for patients with dementia | ||||||||||||
| No | Ref. | Ref. | Ref. | |||||||||
| Yes | 1.04 (0.41, 1.67) | 0.001 | 8.73 (3.85, 13.61) | <0.001 | 2.80 (1.20, 4.40) | 0.012 | ||||||
| Previous dementia training | ||||||||||||
| No | Ref. | Ref. | Ref. | |||||||||
| Yes | 1.22 (0.57, 1.87) | <0.001 | 9.41 (4.27, 14.54) | <0.001 | 3.10 (1.50, 4.70) | 0.008 | ||||||
| Family history of dementia | ||||||||||||
| No | Ref. | Ref. | Ref. | |||||||||
| Yes | 0.18 (−0.55, 0.92) | 0.628 | 1.42 (−4.21, 7.04) | 0.620 | 0.60 (−0.80, 2.00) | 0.355 |
Discussion
This study aimed to determine the knowledge, attitudes, and practices (KAP) of student and staff nurses regarding dementia care, as well as the factors associated with these competencies.
The findings indicated that both student nurses and staff nurses predominantly exhibited an average level of knowledge regarding dementia, with 60.7% of students and 74% of staff nurses falling within this category. However, a considerable proportion of student nurses (33.3%) demonstrated a poor level of knowledge compared to 17% among staff nurses, suggesting a potential gap in foundational understanding. This study finding is consistent with other study where nursing professionals had inadequate knowledge score.[13,17,18,19] These results also indicate that both groups demonstrated generally positive attitudes toward dementia. These findings are consistent with a study of Jordanian nurses reported positive attitude and indicated a well-informed understanding of Alzheimer’s disease and dementia.[20,21]
In relation to practice staff nurses exhibited significantly better practice scores (38.20 ± 6.80) than student nurses (36.10 ± 7.50), (t(348) = 2.04, P = .041). These findings are similar with another study reported proactive practices toward dementia.[21]
Positive correlations were observed between knowledge and attitude (r = 0.41), knowledge and practice (r = 0.38), and attitude and practice (r = 0.62, P < .001). The strong association between attitude and practice suggests that improving attitudes may directly enhance caregiving behaviors, consistent with previous research.[22,23,24]
Multivariable analysis identified age, higher education, work experience, dementia-care exposure, and training as independent predictors of higher KAP scores. Interestingly, BSc Nursing showed a negative association with practice (β = −1.60), which may reflect differences in clinical exposure compared to diploma-trained nurses, who often receive more practical training than BSc Nursing.[25] MSc-qualified nurses had higher scores than BSc nurses, consistent with evidence that advanced education strengthens dementia care capacity.[26]
The key limitation of this study is the use of the Self-Reported Dementia Care Practice Scale, which relies on participants’ self-reported behaviors. Such measures are inherently subject to social desirability bias, where respondents may over report favorable practices or underreport undesirable ones. Consequently, the reported practice scores may not fully reflect actual clinical behaviors. Overall, improving dementia care requires a combined approach involving education, training, and clinical exposure.
Strength, limitation and recommendation
The key strength of the study is to explore the regional evidence from Odisha where very limited number of studies has been conducted related to dementia. This study offers deeper insight into the gap between theoretical knowledge, attitude, and clinical practice, although the study has some limitations, which need to be acknowledged. The single setting cross-sectional design restricts the ability to establish causal relationships and generalizability. The conceptual framework presented in Figure 1 was used to guide the study; however, it was not empirically tested. Additionally, the use of self-report tool may introduce response bias or social desirability bias.
This study recommends the nursing personnel should undergo various educational training programs to address the defined gap. Longitudinal and interventional study designs with subgroup analyses should be applied for better understanding of differential predictors across training levels.
Conclusion
This study reveals critical gaps in KAP among the student and staff nurses, falling short of benchmarks set by the World Health Organization Global Dementia Action Plan (2017–2025) and India’s National Programme for Health Care of the Elderly. Strengthening competency through structured education, skill-based training, and continuous professional development is essential to meet these standards. Addressing these gaps will support the achievement of Sustainable Development Goals Goal 3 by improving quality, accessibility, and person-centered dementia care for the aging population.
AI tool usage disclosure statement
The author has used some AI tools to assist with language refinement and grammatical corrections, but No AI tools have been used for data generation, analysis and image production. The author takes all accountability for the data accuracy, integrity, and ethical standard of the total manuscript.
Abbreviation
KAP: knowledge, attitude and Practice, DKAS: Dementia Knowledge Assessment Scale, DAS: Dementia attitude scale, STROBE: Strengthening the Reporting of Observational studies in Epidemiology.
Ethical approval
This study was approved by the Institutional Review Board, Sum Nursing College (SOADU/SNC/IRB/466/2025).
Author’s contributions
SP and SD conceptualize the study. SP and SS collected and analyze the data. SP and SD drafted the manuscript. All three authors critically reviewed the final manuscript.
Data availability statement
All the supporting data are available with the corresponding author and can be available on a reasonable require.
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
The authors acknowledge the cooperation and support received from schools authorities, parents, and students who participated in the study.
Funding Statement
Nil.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All the supporting data are available with the corresponding author and can be available on a reasonable require.