Discussion
Cognitive Disorders, AD, dementia
REGRESSION, CORONAVIRUS
This is the first study to use ADKS to investigate the knowledge of Alzheimer's disease among community health service center staff in Jiaxing, and to conduct training and evaluate the effectiveness of the training. At present, the consultation rate of patients with dementia in China is not high, and most patients live in the community. In order that more patients with dementia can be identified, diagnosed, intervened and treated as soon as possible, the role of CHSC staff is of great importance. Understanding the current level of AD-related knowledge of CHSC staff in this area and their response and effectiveness to training is a favorable reference for designing training and formulating relevant policies in the future.The current study survey showed that the average ADKS score of 763 community staff members was 19.77, and the awareness rate was only 65.92%. This was similar to the results of studies conducted by Lin et al. (The multivariate regression analysis conducted for this study showed that education had an impact on ADKS scores, “assessment and diagnosis,” and “caregiving” aspects; additionally, a higher educational level yielded higher scores in the above areas, which was consistent with the results of various studies at home and abroad (Relatives or friends who suffered from dementia/AD had an impact on “symptoms,” and participants whose relatives/friends suffered from dementia or AD had higher scores. This was consistent with a study conducted by Liu et al. (The number of years staff members had been employed had an impact on “risk factors,” “assessment and diagnosis,” “life impact,” and “caregiving.” A longer period of employment indicated higher scores in the “assessment and diagnosis” and “life impact” categories but lower scores for “risk factors” and “caregiving.” The period of employment was positively correlated with age. Several foreign studies (The effect of gender on ADKS scores and all dimensions included was not determined. This study suggests that gender had an impact on “risk factors” and “symptoms,” and that males had higher scores in this instance. In a study conducted by Alacreu et al. (According to the present study, the awareness rate of AD knowledge among community health service center staff in Jiaxing was much lower than the national requirements. Therefore, targeted training is urgently needed to address this. This study showed that the ADKS scores for “treatment and management,” “assessment and diagnosis,” “risk factors,” and “symptoms” among the community health service center staff who volunteered to participate in the training had all been improved after completing the training. The ADKS scores of the offline and online training groups were both improved after the training compared with those before the training, with statistical significance. Accordingly, training indicated obvious importance. After completing the training, however, the awareness rate still did not meet the general requirements. Enhancement in different dimensions was unbalanced, as such, the role of one-time training was relatively limited. Hu et al. (Traditional training occurs offline and in person, and the place and time for its delivery are relatively fixed, and interaction during its delivery is relatively strong. The development of the Internet has gradually changed people's work, study and life, with online training has gradually entered people's attention. Particularly considering the outbreak of the novel coronavirus 2019, online teaching is useful for delivering training in a non-crowded (less contagious) environment. While the time and place in which online learning is delivered are highly selectivity, the interaction aspect is relatively poor and lacks supervision and management. In this study, staff members who volunteered to take part in the training were randomly divided into two groups (offline and online training, respectively). Due to the unit random grouping method, there were statistically significant differences between the two groups in terms of gender and current majors before the training, which is a common drawback of the current situation survey. Univariate linear regression analysis showed that gender and profession had no causal relationship with ADKS scores before and after training and, as such, they were not considered confounding factors. There was no significant difference in ADKS scores between the two groups before training and, as a result, the baseline data were comparable. There was no significant difference in ADKS scores between the two groups after training, either, suggesting a lack of significant difference in the training effect between the two methods (online and offline).An interprofessional team from the Department of Veterans Affairs, South Central Mental Illness Research (Houston, Texas, USA) designed the Program for Advancing Cognitive Disorders Education for Rural Staff to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, the team created six 1-h training modules, all of which are available for free The internet has become an important tool for learning and teaching. Training can be carried out online in the current pandemic environment, thereby reduce personnel gathering, save time, and complete the training task. In the present study, the majority of participants agreed that online training was acceptable. Xu et al. (The study also has some limitations. Firstly, a cross-sectional design of the present study could not determine the causal relationships, only associations between knowledge and related influence factors. Secondly, because of the stratified cluster sampling in this study, some bias might be present in the sample selection, thus the selected staff population may not reflect community health services centers (CHSCs) in other parts of Zhejiang Province or other parts of China when generalizing the findings. Thirdly, in the questionnaire survey, the offline training group completed hard copies of the survey, while the online training group completed it digitally using a provided link, which may have had a degree of influence. Fourthly, CHSC staff were also not enthusiastic about participating in training on AD knowledge. Fifthly, female participants outnumbered their male counterparts in the study; in the grouping study, the majority of the participants were female, which imbued the research with some limitations.