Health professionals’ implicit attitudes towards dementia

Background: The quality of dementia care has been shown to be positively associated with the attitudes of staff providing care. Research to date has involved explicit attitudes, which has identified negative, neutral and positive biases amongst staff working with those with dementia. Whilst explicit attitudes have been outlined as informing deliberate processes, implicit attitudes have been argued to inform spontaneous behaviours, ranging from facial reactions to judgements on care. Implicit attitudes are argued to inform behaviour when there is insufficient motivation, opportunity and cognitive capacity to deliberate upon information. Within busy care environments staff may have limited cognitive capacity, which may lead to more instances of implicit attitudes informing behaviour. There have been no studies to date investigating implicit attitudes towards dementia. The study investigated the following objectives; (1) whether there was evidence of implicit bias in professional responses to individuals with dementia; (2) to ascertain whether implicit attitudes diverge from explicit attitudes; and (3) to test whether attitudes are sensitive to the amount of professional experience with individuals who have dementia. Methods: A total of 25 staff completed the Implicit Relational Assessment Procedure (IRAP) along with an explicit paper questionnaire version of the IRAP stimuli and the Approaches to Dementia Questionnaire (ADQ). Participants were grouped according to their experience with dementia (low or high). Results: A positive bias was present across both experience groups using the IRAP, which indicated positive evaluations towards individuals with dementia. When comparing experience groups, a higher positive bias was observed in the high experience group; however, this was not statistically significant. No statistically significant correlation was found between the explicit measures and the IRAP. The IRAP also demonstrated good internal reliability, supporting this as a measure of implicit cognition. The explicit version of IRAP stimuli and the ADQ were correlated, demonstrating convergent validity. Discussion: A positive bias present in staff groups may indicate that this area of healthcare attracts those with positive attitudes towards dementia. Differences observed between the groups may be the result of length of experience and the amount of contact with patients, which may improve knowledge and attitudes. The lack of correlation between the implicit IRAP measure and the explicit measures provided discriminative validity, supporting IRAP as an implicit measure. A difference between implicit and explicit data also suggests that dementia attitudes need further research to be understood along with their impact upon behaviour. Whilst an overall positive bias was present across groups, a negative bias was recorded for five participants. Given that implicit bias is argued to inform spontaneous behaviours, the presence of a negative implicit bias highlights the need for further investigation regarding what specific dementia care behaviours this may influence. Other possible implications include further investigation regarding the malleability of these implicit biases in order to affect change in bias