Table 4 Summary of included studies and intervention effects

Bentley, Kerr et al. [60]

2019

Australia

Primary Care

IMG (n = 13), PN (n = 9)

• Knowledge

• Attitudes

Online learning using video, assessment questions, and additional learning sources.

Technological specifications not otherwise specified.

NA

DKAS

IMG

Pre-test Mean: 39.7

Post-test Mean: 43.7

PN

Pre-test Mean: 34.1

Post-test Mean: 43.6

GPACS-D

IMG

Pre-test Mean: 11.1

Post-test Mean: 13.1

PN

Pre-test Mean: 11.2

Post-test Mean: 13.0

?

?

Y

N

?

Chao, Kaas et al. [79] 2016

Taiwan

Long Term Care

Nurses (n = 107)

• Knowledge

• Attitudes

• Skills

• Behaviours

• Results

Blended learning approach using classroom / workshop with internet-based learning using videos, quizzes, online discussion and 360-degree reflective feedback.

Technological specifications not otherwise specified.

NA

CKS-C

Pre-test Mean: 62.42 (1.34)³, Sig: 0.00

Week 4 Mean: 69.79 (1.34)³, Sig: 0.00

Week 16 Mean: 73.25 (1.35)³, Sig:0.00

CSAS-C

Pre-test Mean: 102.93 (0.80)³, Sig: 0.00

Week 4 Mean: 102.78 (0.80)³, Sig: 0.84

Week 16 Mean:104.12 (0.81)³, Sig: 0.11

CCS

Pre-test Mean: 87.33 (1.02)³, Sig: 0.00

Week 4 Mean: 90.81 (1.02)³, Sig: 0.00

Week 16 Mean: 62.42 (1.34)³, Sig: 0.00

PREAS⁴

Pre-test Mean: 32.89 (0.43)³, Sig: 0.00

Week 4 Mean: 34.52 (0.43)³, Sig: 0.00

Week 16 Mean: 34.69 (0.43)³ Sig: 0.00

RMBP-C⁵

Pre-test Mean: 51.96 (1.44)³, Sig: 0.00

Week 4 Mean: 52.10 (1.44)³, Sig: 0.91

Week 16 Mean: 49.52 (1.44)³, Sig: 0.04

CSDD-C⁶

Pre-test Mean: 14.14 (0.62)³, Sig: 0.00

Week 4 Mean: 13.01 (0.62)³, Sig: 0.07

Week 16 Mean: 12.11 (0.63)³, Sig: 0.00

?

?

Y

N

?

Cobbett, Redmond et al. [74]

2016

Canada

Higher Education

Nursing Students (n = 129)

• Knowledge

• PRO

Online course with modules that include readings and online specific activities such as discussions, wikis, personal journals, and quizzes.

Technological specifications not otherwise specified.

Non-participation in ADODCC

(n = 106)

Pre- and post-test⁷

Intervention

Mean (Pre-Post): − 2.48 (1.56)

t = − 7.61, p = 0.000

Control

Mean (Pre-Post): − 0.46 (1.81)

t = − 2.64, p = 0.010

?

?

?

N

Y

De Witt Jansen, Brazil et al. [61]

2018

UK

Various⁸

Physician (n = 10), Nurses (n = 10)

HCA (post intervention data not available)

• Knowledge

Tele-mentoring by experienced clinicians providing brief, focused didactic training. Learners present anonymised real patient cases for discussion. Clinics are digitally recorded. Participants can attend using Zoom videoconferencing technology.

NA

ECHO Questionniares⁹

Physician

Pre-test Mean:41.4 (10.6)

Post-test Mean: 55.8 (10.2)

p = 0.014

Nurse

Pre-test Mean:37.9 (6.5)

Post-test Mean: 44.8 (7.0)

p = 0.035

Y

?

?

N

?

Downs, Turner et al. [65]

2006

UK

Primary Care

GP Practices (n = 35)

• Behaviours

CD-ROM using case analysis with emphasis on reflecting on knowledge and revisiting difficult and complex clinical problems.

The tutorial was an ‘electronic book’ with indexing system and navigation using hypertext links. Technological specifications not otherwise specified.

Decision support software (n = 8)

Practice based workshops(n = 9)

Control–no intervention (n = 10)

Detection Rates¹⁰

Intervention

Before: 43 (80); After: 11 (20)

Difference¹¹: 1.80, p = 0.18

Workshop

Before: 47 (69); After: 21 (31)

Difference¹¹: 6.55, p = 0.02

Decision Support

Before: 71 (70); After: 32 (30)

Difference¹¹: 7.31, p = 0.01

Control

Before: 49(89); After: 6 (11)

Y

N

N

N

Y

Helms, Denson et al. [78]

2009

USA

Higher Education

Medical Students (n = 92)

• Skills

Hybrid learning including an e-module (intervention) in conjunction with didactic presentations of dementia as a clinical problem. E-modules included video segments hyperlinked to explanatory text and external resources, quiz, and module evaluation.

E-module delivered using the ANGEL e-learning management system.

Neurology clerkship students not electing to participate in

e-module (n = 26)

OSCE (Performance)

Intervention Mean: 23.4 (3.3)

Control Mean: 21.7 (2.9)

p = 0.03

OSCE (Clinical Note Overall)

Intervention Mean: 12.4 (2.4)

Control group: 10.7 (1.9)

p = 0.002

?

?

Y

N

?

Hobday, Savik, and Gaugler [71]

2010

USA

Long Term Care

Direct Care Workers (n = 34)

• Knowledge

• PRO

Internet based training using text, real life videos, audio, and photographic content.

Browser-based computer program using Adobe Flash. The program required a web browser (such as Internet Explorer or Netscape) and a Flash Player plug-in (downloadable as required).

NA

Knowledge Inventory

Pre-test Mean: 10.6 (2.1)

Post-test Mean: 12.6 (1.2)

t = − 5.5, p < 0.001

?

?

N

N

?

Hobday et al. [72]

2010

USA

Long Term Care

Nurse Assistants (n = 40)

• Knowledge

• PRO

Web-based learning using text, graphics, and video.

Technological specifications not otherwise specified.

NA

Dementia Care Knowledge

Pre-test Mean: 12.4 (1.9)

Post-test Mean: 13.0 (2.0)

t = − 2.6, p = 0.013

?

Y

?

N

?

Hobday, Gaugler & Mittelman [73]

2017

USA

Hospital

Nursing Assistants and Allied Hospital Workers (n = 25)

• Knowledge

• PRO

Online learning using audio-narrated text, graphics, video interviews, real life video scenarios, interactive text-entry, and case study scenarios asking learners to synthesize knowledge learned in real case scenarios.

Learning completed on computers, tablets, or smartphones.

NA

Dementia Care Knowledge

Pre-test percent: 82.2 (10.71)

Post-test percent: 91.6 (6.08)

t = 11.5, p < 0.001

?

?

Y

N

?

Irvine, A. B., Bourgeois et al. [68]

2007

USA

Long Term Care

Nurse aides (n = 62)

• Knowledge

• Attitudes

• Skills

• PRO

Internet training using storyboards incorporating graphics, video vignettes, and testimonials. After watching a video vignette (staff reaction to aggressive behaviour) learners chose correct answers from MCQs about the appropriateness of the response. Correct answers were reinforced, and incorrect answers were remediated with explanations. The learner then saw correct modelling of how to deal with the aggressive situation. Respondents who answered incorrectly were re-tested until correct responses were elicited. Text were written at 2^nd-6^th grade reading level.

Technological specifications not otherwise specified.

Control group did not participate in training program (n = 28)

VST: Knowledge

Intervention

Pre-test Mean: 1.62(0.82)

Post-test Mean: 2.62(0.78)

Control

Pre-test Mean: 1.71 (1.05)

Post-test Mean: 1.93(0.94)

F17.02, p < 0.001

Attitude¹²

Intervention

Pre-test Mean: 4.64(0.46)

Post-test Mean: 5.08(0.44)

Control

Pre-test Mean: 4.61(0.42)

Post-test Mean: 4.53 (0.32)

F37.15, p < 0.001

Behavioural Intentions¹³

Intervention

Pre-test Mean: 5.31(1.15)

Post-test Mean: 6.17(0.96)

Control group

Pre-test Mean: 5.13(1.07)

Post-test Mean: 5.39(1.19)

F11.54, p < 0.001

VST: Self-efficacy

Intervention

Pre-test Mean: 3.15(0.80)

Post-test Mean: 4.10(0.78)

Control

Pre-test Mean: 2.95(0.77)

Post-test Mean: 3.25 (0.86)

F26.55, p = 0.001

Self-efficacy¹⁴

Intervention

Pre-test Mean: 4.92(1.13)

Post-test Mean: 6.07(0.92)

Control

Pre-test Mean: 4.68(1.19)

Post-test Mean: 4.97(1.26)

F30.37, p < 0.001

?

Y

Y

Y

?

Irvine, A. Blair, Beaty et al. [21]

2013

USA

Long Term Care

Non-direct care staff including Nurses (n = 25)

• Knowledge

• Attitudes

• Skills

• PRO

Internet training using video-modelling vignettes, right-way and wrong-way exemplars, testimonials, and narration. Text written at a sixth-grade reading level.

Technological specifications not otherwise specified.

NA

VST: Knowledge

Pre-test Mean: 1.9(0.9)

Post-test Mean: 2.3(0.6)

t = 2.53, p = 0.018

Attitudes

Pre-test Mean: 5.7(0.6)

Post-test Mean: 6.0(0.5)

t = 3.05, p = 0.005

Behavioural intentions¹⁵

Pre-test Mean: 5.5(0.7)

Post-test Mean: 5.9(0.8)

t = 2.02, p = 0.055

VST: Self-efficacy

Pre-test Mean: 3.6(0.7)

Post-test Mean: 3.8(0.5)

t = 1.74, p = 0.094

Self-efficacy¹⁶

Pre-test Mean: 5.9(0.6)

Post-test Mean: 5.9(0.8)

t = 0.27, p = 0.787

Y

?

Y

Y

Y

Jones, Moyle [62]

2016

Australia

Long Term Care

Nurses, Care Workers, and Students (n = 42)

• Knowledge

• Attitudes

E-learning (online) using case studies, activities, and resources.

Technological specifications not otherwise specified.

NA

ASKAS: Knowledge¹⁷

Pre-test: Mean: 57.57 (15.06)

Post-test Mean: 51.0 (8.56)

Z = − 2.82, p = 0.005

ASKAS: Attitude¹⁸

Pre-test Mean 48.76(16.51)

Post-test Mean 41.10(11.97)

Z = − 2.57, p = 0.01

SAID¹⁸

Pre-test Mean 41.90 (10.88)

Post-test Mean 37.38(7.48)

Z = − 3.14, p = 0.002

?

?

?

N

?

Kimzey, Mastel-Smith et al. [63]

2016

USA

Higher Education

Nursing Students (n = 94)¹⁹

• Knowledge

• Attitudes

Online learning. Characteristics not otherwise specified.

Experiential learning (n = 33)

Control group - no dementia-specific intervention (n = 30)

ADKS

Intervention

Pre-test Mean:24.50

Post-test Mean: 24.75

Experiential

Pre-test Mean: 23.42*

Post-test Mean:25.58*

Control

Pre-test Mean: 23.43

Post-test mean: 23.37

*p ≤ 0.05

DAS

Intervention

Pre-test Mean: 108.03

Post-test Mean: 107.52

Experiential

Pre-test Mean: 106.42*

Post-test Mean: 118.56*

Control

Pre-test Mean: 110.17

Post-test Mean: 111.77

*p ≤ 0.05

?

?

Y

N

?

Luconi [64]

2008

Canada

Primary Care

Family Physicians (n = 8)

• Knowledge

• PRO

Web-based resource using mini-lectures and a case study approach. Individual and collaborative activities include asynchronous discussions, and hypertext links to resources.

Designed and implemented on Web CT learning system. Basic hardware and software required are computer with internet access, a modem (56K or higher) or cable, and a web browser (Explorer 4 and up, or Netscape 6).

NA

MCQ²⁰

Mean (Pre-Post): − 4.16(2.10)

t = − 5.602, p0.001

Mean (Pre-FU): − 4.58(2.81)

t = − 4.622, p = 0.002

Mean (Post-FU): − 0.43(1.68)

t = − 0.716, p0.497

Clinical Cases²⁰

Mean (Pre-Post): − 1.13(4.76)

t = − 0.668, p = 0.526

Mean (Pre-FU): 0.50(5.53)

t = 0.256, p = 0.805

Mean (Post-FU): 1.63(4.98)

t = 0.922, p = 0.387

?

?

Y

N

Y

Matsumura, Shinno et al. [75]

2018

Japan

Higher Education

Medical Students (n = 79)

• Satisfaction

• Knowledge

Simulated learning in practice concept with various virtual patients with dementia. Case study approach. Responses to patient questions using multiple choice approach, ordering diagnostic tests, giving prescriptions etc. with immediate virtual feedback or human interaction where necessary.

Simulator can run in an internet browser or as a standalone system.

Conventional learning

(n = 43)

ARCS^{21, 22}

Pre-test Mean: 27.42(3.61)

Post-test Mean: 29.56(3.88)

t = 2.894, p = 0.007

Knowledge Test

Pre-test

Intervention Mean: 8.17(3.39)

Control Mean: 8.42(4.03)

t = 0.297, p = 0.767

Post-test

Intervention Mean: 18.08(4.35)

Control Mean: 15.51(4.32)

t = 2.627, p = 0.01

?

?

Y

N

Y

Rababa, Masha'al [67] 2020

Jordan

Higher Education

Nursing Students (n = 104)

• Skills

• PRO

Computer-based BPS.

BPS is an interactive learning method using case scenarios that guide the learner though a step-by-step decision-making process. BPS gives learners the opportunity to make decisions according to their level of skills and knowledge and get feedback immediately which help them to demonstrate critical thinking skills in a safe and supported environment before dealing with complex and real-life case scenarios.

Traditional learning and vignettes

(n = 52)

CTSAS

Intervention

Pre-test Mean: 337.67(13.44)

Post-test mean: 660.52(10.57)

p = <0.001

Control

Pre-test Mean: 309.77 (15.11)

Post-test mean: 499.64(14.78)

p = 0.970

?

Y

?

N

Y

Ruiz, Smith et al. [66]

2006

USA

Higher Education

Nursing Students (n = 38)

• Satisfaction

• Knowledge

• Attitudes

• Skills

Computerised learning using text, animations, video, audio, and interactive exercises.

CD-ROM for use on individual computers.

NA

Knowledge Test

Pre-test Mean: 0.72 (0.02)³

Post-test Mean: 0.80 (0.02)³

t = 5.425, p < 0.001

Attitude test

Pre-test Mean: 3.8 (0.15)³

Post-test Mean: 4.4 (0.13)³

t = 3.586, p < 0.001

Self-efficacy²³

Pre-test Mean: 4.0

Post-test Mean: 4.7

p < 0.001

?

?

?

Y

Y

Tomaz, Jose Batista Cisne, Mamede et al. [76]

2015

Brazil

Primary Care

Family Physicians (n = 50)

• Knowledge

• Skills

Online PBL (with blended approach) involving virtual tutorial groups supervised by a facilitator using asynchronous virtual forums and synchronous chat. Online learning tools included video-lectures, CD-ROM, and texts.

Online learning provided in learning management system (MOODLE).

Non-participation in online PBL (n = 25)

Knowledge Test

Intervention

Pre-test Mean: 6.38(0.96)

Post-test Mean: 7.75(0.95)

Control

Pre-test Mean: 6.87(1.28)

Post-test Mean: 7.15(0.77)

F=17.98, p < 0.001

MMSE

Intervention

Pre-test Mean: 6.31(1.23)

Post-test Mean: 8.22(0.60)

Control

Pre-test Mean: 5.93(1.12)

Post-test Mean: 6.07(0.98)

F=63.47, p < 0.001

DD

Intervention

Pre-test Mean: 5.31(1.71)

Post-test Mean: 8.70(0.92)

Control

Pre-test Mean: 5.25(2.38)

Post-test Mean: 5.66(2.59)

F = 43.98, p < 0.001

?

Y

Y

N

?

Tsai, Kitch et al. [77]

2018

USA

Long Term Care

Nursing Assistants and Residents (n = 9 dyads)

• Behaviours

• Results

• PRO

Simulated learning using videos of an elder actor who does not perform dressing activities until the correct level of assistance is offered (selected). If the user selects inappropriate assistance, the elder responds with noncompliance or agitation. The goal is to minimise agitation, maximise independence, and enable dressing with minimal decision-making delays.

Computer-based simulation on tablet device.

Face-to-face training module

(n = 3)

LOA / BDPS^{24, 25}

Intervention

Median (Post-Pre): 33%

Control

Median (Post-Pre): 14.3%

p = 0.42

BDPS²⁶

Intervention

Median (Post-Pre): -1.87

Control

Median (Post-Pre): -0.28

p = 0.38

?

Y

N

N

Y

Vollmar, Mayer et al. [69]

2010

Germany

Primary Care

General Practitioners (n = 166 at T₁ and n = 97 at T₂)

• Knowledge

Blended learning approach at GP quality circles using online learning with interactive case studies, tests, and printed material.

Technological specifications not otherwise specified.

Traditional lecture (and discussion in QC meeting)

T₁ (n = 82)

T₂ (n = 51)

Knowledge Test (Dementia Management)²⁷

T₁ (T₁-T₀)

Intervention Mean: 3.67

Comparator Mean: 3.60

t = 0.15, p = 0.881

T₂ (T₂-T₀)

Intervention Mean: 2.39

Comparator Mean: 2.00

t = 0.636, p = 0.526

Y

?

N

?

N

Westmoreland, Counsell et al. [70]

2010

USA

Higher Education

Medical Residents (n = 77)²⁸

• Knowledge

• Behaviours

Web-based training using case-based instruction. Modules were textual, with pictorial content. Video streaming was included to demonstrated how to administer the MMSE.

Web-based learning on ‘A New Global Environment for Learning’ (ANGEL) curriculum repository.

Paper-based learning

(n = 42)²⁸

Knowledge Test

Intervention

Mean (Post-Pre): 20.0(16.6)

Comparator

Mean (Post-Pre): − 7.5(14.5)

p < 0.001

Encounter Checklist²⁹

Intervention Score: 56(15)

Comparator Score: 56(18)

p = 0.93

Chart Abstraction²⁹

Intervention Score:41(12)

Comparator Score: 33(13)

p = 0.03

EOES²⁹

Intervention Score: 84(15)

Comparator Score: 79(20)

p = 0.33

?

Y

N

?

N