Discussion
Dementia-friendliness, dementia, ReDeSign
RECRUITMENT
The present study found that a dementia-friendly training program using a mobile microlearning approach for convenience store workers significantly improved attitudes toward people living with dementia and their knowledge of dementia. In addition, a significant increase in helping behavior was observed after the intervention; however, it could not be concluded that this gain was caused by the intervention.The main results of the significant improvement in knowledge and attitude are consistent with those of several existing pre–post or qualitative studies (The effect size on the primary outcome was 0.70 for attitude and 0.59 for knowledge, interpreted as medium (One of the new findings of this study is that helping behavior increased after the intervention. The program design based on the bystander intervention model and measurement of behavior are strengths of this study. The group difference was not significant because of the slight increase in the control group, which suggested that the sensitivity analysis was caused by contamination. For example, if the store manager was allocated to the intervention group, they might have instructed their staff in the control group to help or report on customers with dementia. While individual-level randomization was adopted in this study to facilitate recruitment, future evaluations could adopt a cluster-randomized design to improve the estimation accuracy of the intervention effects on helping behavior. In the future dissemination phase, as the training program will be introduced organizationally, the intervention would resemble cluster randomization. Store-level engagement might enhance the intervention effect through collaborative learning, organizational awareness, and goal setting.This study contributes to the development of the model for promoting helping behavior, though the lack of a significant increase in helping behavior did not allow us to test the program theory. The small increase in helping behavior suggests the need for other approaches, including intervention on responsibility. Our program did not include any content that affected the participants’ feeling of responsibility (the third step in the bystander intervention model), assuming that store workers are more likely to feel responsible for helping than public bystanders. In Japan, more than half of local governments have concluded agreements with companies to share their common goal of supporting older people and stipulates store staff activities that support older adults directly or indirectly (There are several limitations to this study other than the possibility of contamination. First, the representativeness of the participants was restricted, even though it is unlikely that the stigma levels were biased. The participation rate at the store level was 2.7%. Based on the fact that the average number of workers in a convenience store is 15.6 (Despite these limitations, to the best of our knowledge, the present study is the first RCT to demonstrate the effectiveness of dementia-friendly training for the general public. This is also the first study to demonstrate an increase in helping behaviors. Improved knowledge and attitudes are beneficial not only in their role as store workers but also in their help-seeking when their family members or they experience dementia (Adopting a mobile microlearning approach, ReDeSign has a relative advantage over existing dementia-friendly training in terms of time constraints, and thus, dissemination. Dementia-friendly training for employees is often implemented as a corporate social responsibility, but it is also expected to increase a company’s competitive advantage and revenue (While this study focused only on convenience stores, similar programs could be applied to other general occupations in which workers interact with people living with dementia. Dementia-friendliness is not always a priority for general occupations, which include supermarkets, transportation, and banks. Additionally, dementia-friendly training always faces time constraints. Effective dementia-friendly training, when disseminated in the community, would help enable people living with dementia to maintain social participation.