Improving Staff Attitudes and Care for People With Dementia: eLearning

The primary objective of this study is to determine whether a Person Centred Care online training programme confers significant benefit in terms of improving staff attitudes and quality of care of residents with dementia living in care homes, in comparison to enhanced usual training for professional care staff.

There is considerable interest in e-learning and dementia from care home providers. Significant investment has been made into the production of resources for care staff but to date there appears to be no, or very limited, evaluation of their effectiveness.

The aim is to provide a cost-effective, simple and practical evidence-based intervention, improving staff attitudes towards residents with dementia and quality of care provision. The trial will be a randomized controlled 3-arm cluster single blind trial that will take place over 9 months in 24 care homes in the UK.

The National Institute for Health Research (NIHR) funded Well-being and Health for People with Dementia (WHELD) programme, An Optimized Person Centred Intervention to Improve Quality of Life for People with Dementia Living in Care Homes. This optimized intervention is based on a factorial study and qualitative evaluation, to combine: training on person-centred care, promoting person-centred activities and interactions, and providing care home staff and general practitioners with updated knowledge regarding optimal use of psychotropic medications for persons with dementia in care homes. Using a train-the-trainer model, the intervention was delivered by trained therapists, who trained 2 lead care staff members (WHELD champions) within each care home to implement the intervention over a 9-month period.

The primary objective of this study involving 24 care homes, with approximately 240 care staff, is to determine whether an online version of the optimized WHELD intervention, with or without supervision support, confers significant benefit in terms of improving attitudes of care staff caring for people with dementia and quality of care of residents with dementia living in care homes.

There is considerable interest in e-learning and dementia. Significant investment has been made into the production of resources for care staff but to date there appears to be no, or very limited, evaluation of the effectiveness of e-learning in either raising awareness amongst care staff, or increasing outcomes of care for people with dementia. In spite of the lack of evidence, e-learning remains popular with care home providers and managers, as they are perceived to be low-cost, can be delivered to staff on-site or even at home, and with minimal disruption to staffing routines and schedules.

The e-learning programme is based on the aforementioned WHELD RCT programme, which included over 80 care homes and 1000 participants in the study, and has already shown significant benefits in improvements in quality of life and agitation. This study will provide pilot testing to evaluate the effectiveness of an e-learning version.

Key secondary objectives will be to determine the specific impact of the e-learning intervention on a range of outcomes including quality of care, quality of the interaction of care staff with people with dementia, person-centered practice, staff knowledge about dementia and staff general health, work stress and experience working with residents with dementia.

The investigators hypothesize that the intervention (in particular with supervision support) will significantly improve several key outcomes. Specifically, the investigators hypothesize that, compared to enhanced usual training, the optimized e-learning intervention will:

• Improve staff attitudes towards people with dementia

The secondary hypotheses are that the WHELD e-learning intervention will:

* Improve quality of care
* Improve quality of interactions between staff and residents
* Improve person-centred practice
* Increase staff knowledge about dementia
* Improve staff general health
* Reduce staff work stress
* Improve satisfaction in caring for people with dementia

Baseline, post intervention and 4-month follow up data will be collected on all consented participants who meet the inclusion criteria at each participating care home.

Eligibility Criteria:
Care Home Selection:

Inclusion Criteria:

* Care homes that have residential or nursing status and are registered to provide care for people with dementia.
* Care homes randomly selected from the Care Home Research Network
* Research enabled and actively engaged in ENRICH programme
* Care homes should be able to demonstrate an acceptable standard of care according to Care Quality Commission (CQC).
* Prepared to release staff to complete training and to implement interventions
* Have a manager in post who is willing/able to act as key link person for trial
* "Tech ready" home - staff have access to PCs or tablets in the care home

Exclusion criteria:

* Less than 60% of the residents have dementia
* Care home is receiving special support from their local authority
* Care home has failed to meet more than 1 of the 5 CQC care home quality standards checks
* Insufficient staffing resource: Care home unable to provide care staff for training

Participant Selection:

Inclusion Criteria:

* Sufficient competence in English to undertake the training programme
* Qualified and unqualified paid care staff
* Permanent or contract employees providing direct care to residents
* Has basic computer literacy

Exclusion Criteria:

• Bank or agency staff