Education Program for Enhancing Health Care Students' Attitudes Toward People Living With Dementia: Protocol for a Single-Arm Pre-Post Study.

BACKGROUND: Health care students are instrumental in shaping the future of dementia care. Cultivating a positive attitude and understanding toward people living with dementia is crucial for diminishing the stigma associated with the condition, providing effective and person-centered care, and enhancing the quality of life for people living with dementia. Educational programs about dementia are increasingly recognizing the potential of gaming tools. OBJECTIVE: This study aimed to evaluate the effectiveness of gaming-based dementia educational programs in improving attitudes toward people living with dementia among health care students. METHODS: This single-arm pre-post study will be conducted among health care students in Indonesian universities. This educational program based on gaming tools will consist of a lecture on dementia, the use of N-impro (gaming tool), and the enactment of short dramas depicting desirable and undesirable communication with people living with dementia behaviors. We will assess attitudes toward people living with dementia, intention to help people living with dementia, knowledge of dementia, and the stigma associated with people living with dementia. The gaming-based dementia education program will be integrated into the curriculum of the health care students. The program will be implemented once with a duration of 90 minutes. RESULTS: Data collection will occur from August 2023 to March 2024. Analysis of the data will be finalized by May 2024, and the outcome will be determined by July 2024. The impact of the gaming-based dementia educational program on improving attitudes toward people living with dementia will be reported. The study findings will be published in a peer-reviewed journal. CONCLUSIONS: The gaming education program demonstrates significant potential in enhancing attitudes toward people living with dementia across various countries, introducing an innovative method for the community-based support of people living with dementia. TRIAL REGISTRATION: ClinicalTrials.gov NCT06122623; https://clinicaltrials.gov/study/NCT06122623. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/62654.

Universal Ultrasound Screening for Developmental Dysplasia of the Hip Among Infants in Community Settings in Japan: A Scoping Review.

Introduction: Early identification of developmental dysplasia of the hip (DDH) is necessary to minimize its negative effects. Ultrasound screening is useful for detecting DDH in hospitals. Awareness about community-based screening systems is low in Japan. Despite established nationwide home visiting services and child health checkups in the country, more than 10% of DDH patients are diagnosed at the age of ≥1 year. This review aimed to clarify the status of universal ultrasound screening for DDH among infants in community settings in Japan. Methods: The electronic databases of Igaku Chuo Zasshi, MEDLINE, CHINAL, ERIC, and APA PsycInfo were searched for articles published between 2002 and 2022. Articles were evaluated with the reach, effectiveness, adoption, implementation, and maintenance framework. Results: In total, 148 articles were identified. Two articles were manually added, and 67 articles were excluded through abstract reviews, of which 20 were duplicates. Finally, 18 articles were included in the analysis. There are two types of universal ultrasound screening in community settings: municipality-led and hospital-led. Since 1992, municipality-led screening has been conducted during public infant health checkups in five municipalities. Six hospitals implemented ultrasound screening. The participation rate was around 90%. The Graf method is typically used for this purpose. The prevalence of abnormal hips was 3.6%-16.6%. Owing to limited human resources and skills in ultrasound, all studies mentioned the necessity of a universal screening system for the early detection of DDH. Conclusion: Embedding universal ultrasound screening in community health checkup systems enables collaboration between healthcare professionals and caregivers to improve health inequities and ensure early detection of DDH cases.

A Dementia-Friendly Educational Program Using Virtual Reality for the General Public in Japan: A Randomized Controlled Trial for DRIVE.

BACKGROUND AND OBJECTIVES: Raising dementia awareness is essential for building a dementia-friendly community. However, existing studies have underexplored the effects of virtual reality (VR) dementia educational programs for the general public on enhancing positive attitude toward dementia. This study aimed to examine the effectiveness of a VR dementia-friendly educational program called the Drive for Dementia Readiness Inside Virtual Reality (DRIVE) program to improve attitude toward dementia of the general public. RESEARCH DESIGN AND METHODS: A two-arm randomized controlled trial was conducted. Eligibility criteria for participants included being 16 years old and above in Japan and having no professional license in healthcare and social care. We randomized individuals to attend a multi-element VR dementia-friendly educational program (intervention), including simulation, VR films, short films, lectures, and discussions or a lecture-based program (control). Data were collected three times, including at baseline, post-intervention, and 3-month follow-up. The primary outcome was attitude toward dementia. The secondary outcomes were intention of helping behavior for people living with dementia and knowledge of dementia. RESULTS: We recruited 157 community residents, among whom 130 were included in the analysis. Although the mean changes in attitude score were not significantly different between the groups (Hedge's g = .26), the intention of helping behavior score was significantly higher in the intervention group (g = .49). DISCUSSION AND IMPLICATION: The DRIVE, a VR-based multi-element dementia-friendly educational intervention, was shown as a promising tool for significantly impacting the intention of helping behavior for people living with dementia to establish dementia-friendly communities.

Development of Four-Item Attitudes toward People Living with Dementia Scale for population surveys.

BACKGROUND: This study developed a short version of a scale measuring attitudes toward people living with dementia, the Four-Item Attitudes toward People Living with Dementia Scale (APDS4), that could be included in a large population survey. METHODS: We used three datasets from Japan: a web panel survey, a community-based mail survey, and data from a randomised controlled trial on dementia education. The original scale used was the Attitudes toward People Living with Dementia Scale developed by Kim and Kuroda. Test-retest reliability and item response theory analyses were used to reduce the number of items. The reliability, internal consistency, validity, and responsiveness of the short version were evaluated. RESULTS: Six items with low test-retest reliability and four items with low discrimination parameters were removed from the 14-item scale. The APDS4, consisting of four items, had test-retest reliability and internal consistency comparable to those of the original scale. Confirmatory factor analysis indicated that the APDS4 fit a unidimensional model. The validity of the APDS4 was confirmed by significant associations between the APDS4 scores and the original scale scores, knowledge of dementia, helping behaviour intentions toward people living with dementia, helping behaviour experience, attending the Dementia Supporter Training Course, and engagement in healthcare jobs. In a randomised controlled trial dataset, the APDS4 was more responsive to educational interventions than the original scale. CONCLUSION: The shortened APDS4 was established as a reliable, validated, and responsive scale. This scale can be used efficiently in population surveys to evaluate dementia-friendly initiatives at the community level.

Effects of a dementia educational programme using virtual reality on nurses in an acute care hospital: A pre-post comparative study.

BACKGROUND: Poor awareness of dementia care by healthcare professionals affects the quality of care for people living with dementia in acute care settings. OBJECTIVES: This study examined the effectiveness of a virtual reality-based educational programme for dementia for nurses working in acute care hospitals in Japan. METHODS: A dementia education programme for nurses was designed. The programme comprised short movies, virtual reality videos based on the short movies, a lecture, discussions and role-playing based on the experimental learning model. Virtual reality video content was created to promote empathy for people living with dementia through a first-person experience of dementia. The educational programme involved nurses working in an acute care hospital in the Tokyo Metropolitan area. Before and after the programme, we employed structured questionnaires using validated instruments to assess participants' attitudes towards people living with dementia, their intentions of helping behaviour and their confidence in providing dementia care. RESULTS: Seventy-six nurses participated in and completed the pre- and post-tests. The mean age was 34.9 ± 9.2 years, and 90.8% of the participants were female. A paired t-test showed significant before-after improvement in the participants' attitudes towards people living with dementia (41.9 ± 5.1 vs. 44.5 ± 4.8), intentions of helping behaviour towards people living with dementia (10.8 ± 2.5 vs. 12.8 ± 2.1) and confidence in providing dementia care (25.9 ± 6.7 vs. 29.2 ± 6.0). CONCLUSION: The programme effectively improved nurses' attitudes towards people living with dementia and confidence in providing dementia care in acute care settings. Future research is important to explore the long-term effects of this programme and its effects on actual dementia care. IMPLICATIONS FOR PRACTICE: The dementia education programme may promote person-centred care in acute hospitals. Future studies should consider the provision of more flexible programs so that nurses can more easily participate in them.

Implicit attitudes towards dementia after education: Preliminary trial results from Japan.

OBJECTIVE: This study aimed to investigate the feasibility and validity of measuring implicit attitudes towards dementia in adults and older adults and evaluate the impact of dementia-friendly education using virtual reality (VR) on implicit attitudes. METHODS: This study was a secondary analysis of data from a randomised controlled trial. Community members in Tokyo aged 20-90 years participated in dementia-friendly education with or without VR. At the end of the dementia-friendly education programs, implicit attitudes towards dementia were measured using the Implicit Relational Assessment Procedure (IRAP). RESULTS: Of the 145 participants, 89 (61%) started the IRAP, and 21 (15%) completed it. Lower age was significantly associated with the start/completion of the IRAP, and the age thresholds at which 50% of participants would not start/complete it were estimated to be 72.3/44.8 years, respectively. Those who had experience interacting with people with dementia other than family members had lower IRAP scores than those who had no such experience. The intervention group participating in the VR program had lower IRAP scores than the control group (p = .09). CONCLUSIONS: Although measuring implicit attitudes using IRAP is deemed not feasible for people in their 70s and older, the differences in interaction experience would be evidence supporting the validity of the measurements of implicit attitudes towards dementia. The results suggest that dementia-friendly education, using VR, improves implicit attitudes towards dementia.

Developing an Educational Program for Ultrasound Hip Screening during Newborn and Infant Home Visits: A Protocol Paper.

Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).

Helping behaviours of community members towards older adults and the related factors: a cross-sectional study.

BACKGROUND: Community members can play important roles in helping older adults in their community. This study aimed to clarify the actual situation of community members' helping behaviours towards older adults and examine the related factors. METHODS: This cross-sectional study was conducted using an online survey system with a sample of 1000 community members in the Tokyo metropolitan area selected using quota sampling. Participants were asked about their experiences with helping an older adult, involvement with older adults with dementia, knowledge of dementia and care resources in the community, and perceptions regarding the community. Content analysis was used to classify participants' freely answered responses about helping behaviours, with logistic regression analysis subsequently used to examine the related factors. RESULTS: Community members provided older adults with various types of spontaneous help, including help with walking (20.0%), accident care (16.8%), giving directions to a destination (11.6%), accompanying them to a destination (12.9%), and support in daily life (10.4%). In the multinominal logistic regression analysis, advanced helping behaviours were associated with having a family member with dementia, experiences involving people living with dementia, knowledge of dementia and community support centres, and a stronger sense of community integration (P < 0.05). The reasons for not being able to help included being physically unable to (42.5%), not feeling responsible (19.3%), not knowing how to help (17.4%), and hesitating to help (14.4%). CONCLUSION: The results suggest that providing learning opportunities for community members could further promote their helping behaviours for older adults. These could include interacting with older adults, especially those living with dementia; promoting a sense of community integration; or receiving training in helping actions. Such efforts could support the development of an effective community-based care system for older adults.

Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups.

OBJECTIVE: This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months. DESIGN AND SAMPLES: This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded. MEASUREMENTS: Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup. RESULTS: Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months. CONCLUSIONS: To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.

Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey.

Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.

Building Relationships Between Community Care Professionals and Convenience Stores in Japan: Community-Based Participatory Research.

BACKGROUND: Convenience stores play an important role in supporting community-dwelling older adults' lives. We started community-based participatory research (CBPR) in Nerima City, Tokyo Metropolitan area in Japan to develop a collaborative relationship to support older adults in the community-based integrated care system. OBJECTIVES: This study aimed to describe the CBPR process and evaluate building face-to-face relationships between health/social care professionals and the owners/employees of convenience stores. METHODS: Using CBPR, health/social care professionals in community general support centers (CGSCs) directly approached convenience stores based on the public support agreement between the convenience store chain company and the municipality. To evaluate the face-to-face relationship building between convenience store owners/employees and CGSCs' staff, we administered questionnaire surveys to convenience stores in Nerima City and two control cities from 2017 to 2019, and about 100 convenience stores completed the survey each year. RESULTS: Statistical analyses showed significant improvements in their knowledge for relationships with the CGSCs in Nerima City, including "knowledge of the CGSCs' function" (P = 0.001), "knowing individual professionals in the CGSCs" (P = 0.023), and "knowledge of when to contact the CGSCs" (P = 0.002), compared with control cities. Helping behavior for older adults at convenience stores also increased significantly in Nerima City (P = 0.034). CONCLUSIONS: The CGSCs' direct approach based on the public support agreement would effectively promote building relationships at convenience stores, leading to an age-friendly community.

Family caregiver's concerns and anxiety about unaccompanied out-of-home activities of persons with cognitive impairment.

BACKGROUND: Although people with cognitive impairment highly value social participation in out-of-home activities, their families typically perceive concerns and experience anxiety over such activities. This study aimed to elucidate the underlying concerns and factors associated with family caregivers' anxiety over the individual's unaccompanied out-of-home activities. METHODS: In December 2021, we conducted a cross-sectional e-survey of family caregivers of individuals with early-stage cognitive impairment. Caregivers' concerns about ten common risks related to out-of-home activities were cross-tabulated by specific anxiety levels to examine trend associations. With the variables of caregivers and their individuals across the five domains, we ran logistic regression analyses to determine explanatory models for anxiety. RESULTS: The study participants were 1,322 family caregivers of people whose cognitive function varied from intact to possible mild dementia according to the Dementia Assessment Sheet for Community-based Integrated Care System 8-item. Significant associations were found between the prevalence of concerns and the degree of anxiety, even without actual experience with the issues of concern. Among the five domains, individual dementia characteristics and social behaviors were the predominant factors attributed to caregiver anxiety. Caregivers' no anxiety state was significantly associated with: younger age (OR 4.43, 95% CI 1.81-10.81), no detectable cognitive decline (OR 3.34, 95% CI 1.97-5.64), free from long-term care (LTC) (OR 3.52, 95% CI 1.72-7.21), no manifestation of behavioral and psychological symptoms of dementia (BPSD) (OR 13.22, 95% CI 3.06-57.01), and not engaging in unaccompanied out-of-home activities (OR 3.15, 95% CI 1.87-5.31). Their severe anxiety was positively associated with being on LTC (OR 3.39, 95% CI 2.43-4.72) and minor BPSD (OR 1.43, 95% CI 1.05-1.95), and negatively associated with engagement in unaccompanied out-of-home activities (OR 0.31, 95% CI 0.23-0.43). CONCLUSIONS: The study found that family caregivers' anxiety was associated with concerns about behavioral issues, regardless of actual experiences. There were two significant associations in opposite directions between caregivers' anxiety and the individual's engagement in out-of-home activities. In the early phase of cognitive impairment, caregivers may intuitively interpret the individual's behavior and feel anxious. Educational support may provide reassurance and enable caregivers to facilitate out-of-home activities.

New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design.

BACKGROUND: Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients' and nursing interventions' classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan's lagging digitalization, supervisory PHNs face difficulties in monitoring each department's activities and staff members' performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices. OBJECTIVE: We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices. METHODS: We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system's architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments. RESULTS: This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones. CONCLUSIONS: This study will reveal PHNs' tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management. TRIAL REGISTRATION: UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45342.

Dementia education and training for the general public: A scoping review.

The lack of public awareness and understanding of dementia affects the experiences of people living with dementia and their families. Dementia education and training for the general public have been gradually disseminated. We conducted a systematic scoping review guided by PRISMA-ScR to map existing evidence and identify dementia education and training available to the general public. From the four electronic databases, 41 articles were identified. Dementia education has three main purposes: dementia friendliness (n = 25), early diagnosis/help-seeking (n = 10), and prevention (n = 6). Education aimed at dementia friendliness was delivered in the community (n = 6), schools/universities (n =14), workplaces (n = 2), and online (n = 3). Interventions aimed at early diagnosis and prevention were often conducted in communities with middle-aged and older people or specific ethnic groups. Eleven dementia-friendliness studies reported on the interaction with people living with dementia to reduce stigma. Dementia knowledge, attitudes, and preventive behaviors were assessed as outcomes. Though randomized controlled trials were conducted in early diagnosis and prevention studies via e-learning, they were not performed in dementia-friendliness studies. Therefore, there is a need to further accumulate evidence of dementia education for each of these purposes.

A Randomized Control Trial for ReDeSign: A Dementia-Friendly Mobile Microlearning Training for Store Workers in Japan.

BACKGROUND AND OBJECTIVES: Dementia-friendly training should be incorporated in neighborhood stores for people living with dementia to maintain engagement in social activities. However, there is a lack of evidence of dementia-friendly training in these workplaces, and existing trainings have time constraints. We developed a mobile microlearning program based on stigma theory and the bystander intervention model. This study aimed to evaluate the microlearning program's effectiveness. RESEARCH DESIGN AND METHODS: Convenience store workers in Tokyo were recruited for a randomized, waiting-list, and controlled trial. The intervention group completed a 50-min online course. The primary outcome was an attitude toward people living with dementia. The secondary outcomes were knowledge of dementia and helping behavior toward customers suspected of having dementia. Data were collected at baseline, after 1 month, and 4 months following the randomization. RESULTS: Process evaluations confirmed satisfaction and high completion rates of the program. In total, 150 participants were included in the analysis. The intervention group showed significantly greater improvements in attitude (Hedge's g = 0.70) and knowledge (g = 0.59) after 1 month, compared to the control group. Helping behavior increased in the intervention group, although it did not differ significantly between the groups. All outcomes remained significantly improved after 4 months. DISCUSSION AND IMPLICATIONS: The findings provide evidence that dementia-friendly training reduces the general public's stigma and increases helping behavior in stores. Mitigation of time constraints through mobile microlearning is expected to contribute to the dissemination and help people living with dementia maintain their social participation in the communities. Clinical Trials Registration Number: UMIN000043623.

A Two-Step Model for Encouraging the General Public to Exhibit Helping Behaviors Toward People Living With Dementia.

Background and Objectives: Dementia awareness initiatives aim to promote helping behaviors toward people living with dementia. We applied the bystander intervention process model in the context of the general public's helping behaviors toward people living with dementia, and we sought to identify the mechanisms underlying the association between dementia knowledge and helping behaviors. Research Design and Methods: In a survey featuring vignettes for the general public in Japan (N = 904), we presented four situations in which people could exhibit helping behaviors toward a person with dementia. Guttman scale analysis was used to test this sequential ordering of the bystander intervention process model: (a) interpreting the need to help, (b) perceiving personal responsibility, and (c) intention to provide help. Mediation analysis was used to examine whether the effects of knowledge on helping behaviors were mediated by attitude toward people living with dementia and the bystander intervention process. Results: The results support the two-step model in which interpreting the situation as one where assistance is required is a prerequisite of helping behavior. Dementia knowledge had a significant total effect on intention to provide help (ß = 0.136, p < .001). Interpretation (indirect effect: ß = 0.092, p < .001), as well as attitude (indirect effect: ß = 0.044, p < .001), was found to completely mediate the effect of dementia knowledge on intention to provide help. Discussion and Implications: Dementia awareness initiatives designed to promote helping behaviors should focus on knowledge transfer, improving the general public's attitudes toward people living with dementia, and their ability to interpret when such people need assistance.

Relational Design for Dementia and Job Significance (ReDeSign): Study protocol for a randomized controlled trial of an online dementia training for retail workers.

BACKGROUND: The need for dementia training for retail workers has been recognized by dementia-friendly initiatives. However, evidence for dementia training in non-healthcare workplaces is lacking, and dissemination is challenging due to constraints on private companies' time and finances. The online training program ReDeSign (Relational Design for Dementia and Job Significance) applies mobile micro-learning methods and Relational Design Theory against time and financial constraints, respectively, and is designed to improve work-related outcomes. METHODS: This study will evaluate the effectiveness of ReDeSign with a randomized controlled trial. One hundred and twenty-four convenience store workers in Tokyo will be recruited and randomly assigned to the intervention or control groups. ReDeSign consists of four contents relevant to the job: simulation games, lectures and quizzes, virtual contacts, and information about benefits to others. Self-reported surveys will be conducted for individual workers at baseline, one month later, and three months later. ReDeSign will be delivered to workers in the intervention (n = 62) and control (n = 62) groups immediately after the baseline survey and after the one-month survey, respectively. The primary outcome is the change of attitude toward people with dementia, and the secondary outcomes are dementia knowledge, helping behavior, job satisfaction, workers' intention to stay, and persistence. DISCUSSION: ReDeSign provides dementia training to convenience store workers and contributes to developing an inclusive community for people with dementia. The results of this study may provide a new strategy for the dissemination of dementia training in non-healthcare workplaces.

Older Adults Used Fewer Home Care Services during the COVID-19 Pandemic: Findings from a Secondary Analysis of an Urgent Survey in Japan.

BACKGROUND: This study aimed to identify reduced home care use among older people and its impact on user numbers and service provider revenues during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted this secondary analysis of cross-sectional data from long-term care providers in Japan and estimated the probability of client cancellations and service contraction for institutional and home care services adjusted for the service type, area, size, infection occurrence, and staff employment impacts. We then estimated the rate of change in user numbers and revenue related to reduced usage. RESULTS: Seventy-two percent of home care providers experienced client cancellations and 42.1% experienced service contraction, both of which were more prevalent in home care than in institutional care (adjusted odds ratio [AOR]=11.09 and 1.60). Home-visit (AOR=0.70) and short-term stay (AOR=0.38) services were less likely to experience client cancellations compared with adult day services. Service contraction was less likely in home-visit services (AOR=0.60) but were more likely in short-stay services (AOR=1.49) compared to adult day services. The estimated reductions in user numbers and revenue related to service contraction for adult day services were 9.1% and 7.1%, respectively. Home-visiting services decreased by an estimated 3.4% owing to service contraction. CONCLUSION: The secondary effects of the COVID-19 pandemic include reduced use of home care services, especially adult day services that include social contact. These secondary effects of the COVID-19 pandemic may cause functional deterioration in non-infected clients and financially impact service providers.