Abstract
Objectives
Speech-language pathologists (SLPs) have a crucial role in assisting individuals with dementia due to the communication and swallowing challenges associated with the disease. As the number of dementia cases rises in India at an increasing rate, investigating the level of dementia knowledge of SLP students can offer insight into the preparedness of the healthcare system to meet this emerging demand.
Method
A cross-sectional survey was conducted on SLP students pursuing their final year undergraduate, postgraduate and doctoral degrees from four universities across India. Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale (DKAS) and information about previous dementia exposure (both formal and informal) was collected. The collected data were analysed using quantitative methods.
Results
A total of 220 students (64.70% response rate) completed the survey. Overall dementia knowledge was inadequate with an average score of 22.08 ± 10.06. Previous dementia exposure among the students was also found to be low and did not affect dementia knowledge scores.
Discussion
Despite the fundamental role SLPs play in the care of individuals with dementia, the lack of knowledge in this area emphasizes the need for enhancing dementia training programs through educational curricula and clinical placements.
Introduction
Ageing-related diseases have seen an upward trend in recent years as a consequence of a rapid increase in life expectancy and low fertility rates. The aforementioned alterations, combined with relatively steady prevalence rates across different age groups and population expansion, result in significant upsurges in the prevalence of dementia. As these demographic patterns are projected to persist in the long run, the incidence of dementia is expected to keep increasing (Nichols et al., 2022). Dementia is one of the most common diseases associated with the ageing population. It is a neurodegenerative disorder that affects almost all cognitive abilities, including the ability to perform activities of daily living (Cao et al., 2020). The most common underlying pathologies include Alzheimer’s disease (AD), followed by vascular dementia, Lewy body dementia and frontotemporal dementia (Kalaria et al., 2008). The disability and dependency due to dementia affect the individual, and their caregivers, posing a debilitating burden not only on their families but also on the global economy (Patterson, 2018; WHO, 2017). According to estimates, the cost of dementia on a global scale each year is approximately 818 billion U.S. dollars which is expected to rise with the increase in the number of older adults (Prince et al., 2015). The World Alzheimer Report which provides an analysis of the global impact of dementia, including prevalence, incidence, cost, and trends, reports that India, being the world’s second most highly populated country, will be a major contributor to the increasing economic burden (Lynch, 2020). The percentage of individuals aged 60 years and above in India is expected to reach 19.1% by 2050, equivalent to a population of around 316 million. To put it in perspective, this is roughly the same size as the current population of the United States (United Nations, 2017). Alzheimer’s Disease International (2019) reports that people living with dementia in low and middle-income countries have exceeded 50 million, and a steady rise is expected to over 15 million by 2050. More dementias occur in low-income and middle-income countries due to the higher number of risk factors. These include less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, low social contact, excessive alcohol consumption, traumatic brain injury and air pollution (Livingston et al., 2020). The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) is a continuing investigation in India that intends to evaluate cognition in late life and several other health and lifestyle aspects in both rural and urban areas (Hu et al., 2020). It was found that the prevalence of most of the risk factors was higher in the LASI-DAD cohort compared to a similar study carried out in the USA (Hu et al., 2020; Prabhakaran et al., 2018). Owing to the presence of vast risk factors associated with developing dementia, a study reported that dementia prevalence in India will only keep rising (Kumar et al., 2019; Ravindranath & Sundarakumar, 2021). As the number of individuals with dementia is expected to rise, there will be a need to prepare for the anticipated surge in demand for health and social care services, as well as to enhance the support and resources available to those affected by dementia. Handling such a large population affected by dementia will be burdensome and challenging to the country as well as healthcare services. Hence, preparing healthcare professionals to address this upcoming need becomes critical.
Of the many professionals that are involved in providing service to individuals with dementia, Speech-Language Pathologists (SLPs) play a significant role (American Speech-Language-Hearing Association, 2016). Dementia is a cognitive communication disorder in which the affected individual gradually undergoes cognitive decline and exhibits language deficits affecting daily communication. The impact of cognitive decline due to dementia on everyday communication (Klimova & Kuca, 2016; Maxim & Bryan, 2006; Reilly et al., 2010), eating and swallowing will be pronounced as the disease progresses (Alagiakrishnan et al., 2013; Groher, 2015; Park et al., 2013). Communication and swallowing require intact cognitive abilities due to the wide array of processes involved in both acts. Communication depends on the individual’s ability to comprehend and produce language that is widely dependent on cognition. Whereas, dysphagia can be defined as any disturbance in the swallowing process, which is a common symptom of dementia. In individuals with dementia, language comprehension deficits, memory decline, slowed processing and word-finding difficulties result in restricted communication. Consequently, the communication breakdown negatively impacts the quality of life by affecting self-worth, personal relationships, mental well-being and social participation (Nickels & Croot, 2014). In fact, linguistic changes can appear early predicting mild cognitive impairment and AD (Jokel et al., 2019). Therefore, language assessments not only play a vital role in addressing the communication difficulties and needs of persons with dementia but also in the diagnosis of dementia (Boschi et al., 2017).
With regard to swallowing difficulties, generally, changes in swallowing physiology occur with advancing age (Sura et al., 2012). Dysphagia occurs in several types of dementia (Bine et al., 1995; Langmore et al., 2007; Suh et al., 2009) where age-related changes in eating and swallowing function may appear early (Groher, 2015) followed by slowed swallowing process, self-feeding difficulties and increased meal time (Arrighi et al., 2013; Hickey & Bourgeois, 2011). Individuals with dementia often experience symptoms such as retaining food in the mouth, challenges with chewing, coughing or choking when consuming food or fluids, and requiring prompts to swallow food (Priefer & Robbins, 1997). In addition, as the disease progresses, around 45% of institutionalized patients with dementia exhibit some form of dysphagia (Homer et al., 1994). Long-term effects of dysphagia can result in poor nutritional status, weight loss and dehydration (Hanson et al., 2013; Jensen et al., 2013). Furthermore, these difficulties place individuals with dementia at higher risk for choking and aspirational pneumonia leading to death (Hickey & Bourgeois, 2011; Brunnstrom & Englund, 2009). Considering the risks associated with the comorbidities of dementia it is crucial to have professional support.
Recently, more and more often, persons with dementia who experience problems with communication and swallowing are seeking support from SLPs. Additionally, SLPs also serve as integral members of an interdisciplinary team working with individuals with dementia and their families. For instance, to identify the most suitable interventions, healthcare providers can use a thorough evaluation of communication and swallowing issues. Speech-language pathologists have a critical role to play not just in assessments, but also in the management of communication and swallowing disorders associated with dementia (American Speech-Language-Hearing Association, 2016). Speech-language pathologists have the capability to offer diverse communication interventions for individuals with dementia having communication breakdowns. A few therapeutic techniques include reminiscence therapy (Woods et al., 2018), simulated presence therapy (Abraha et al., 2017), cognitive stimulation therapy (Chen et al., 2019), validation therapy (Neal & Barton Wright, 2003) and computer-based cognitive interventions (Klimova & Maresova, 2017). In advanced cases, assistive technology or communication aids and strategies can be provided. These can address a range of objectives such as enhancing social involvement, reducing responsive behaviours, improving performance in daily living activities, or facilitating the expression of needs and desires.
While there are various intervention methods used to manage dysphagia in dementia (Alagiakrishnan et al., 2013), some studies suggest that the percutaneous endoscopic gastrostomy (PEG) may be appropriate for individuals with moderate to severe dementia presenting with malnutrition and aspiration (Nunes et al., 2016). However, the general consensus is that oral intake, with appropriate modifications, should remain the primary treatment goal for individuals with feeding difficulties (Saunders, 2010). Therefore, SLPs are critical to the management of patients with dysphagia, particularly in behavioural management and therapy (Brush & Camp, 1998). For instance, modifications to food consistencies (Logemann et al., 2008) and postural techniques (Robbins et al., 2008) have been supported by research to reduce the risk of aspiration and improve swallow function in individuals with dementia.
The role of SLPs is not limited to screening, assessment, diagnosis, treatment and referrals but also prevention, counselling, advocacy and education (American Speech-Language-Hearing Association, 2016). Although SLPs have the potential to make a substantial impact on the management and care of persons with dementia, they may not always be able to provide such assistance due to inadequate training in dementia care (Hopper et al., 2007; Saccasan & Scerri, 2020). Currently, there is a lack of information on dementia knowledge among SLP students in India, which hinders the ability to determine how this may impact future dementia management. Given the increasing prevalence of dementia among older Indians, evaluation of knowledge of dementia among SLP students is necessary to determine the need for clinical training, advocacy initiatives, and future research directions. Hence, this study aimed to assess dementia knowledge in Indian students pursuing an undergraduate degree (SUD), students pursuing a postgraduate degree (SPD) and students pursuing a doctoral degree (SDD) in speech-language pathology who were in the final year of their respective degrees.
Methods
Data collection
This was a cross-sectional study conducted on final-year SUD, SPD and SDD in speech-language pathology in India from September 2022 to February 2023. Students from four universities with campuses across northern, southern, eastern and western India were considered for the study. The universities were chosen based on the location to cover all four parts of India and approval from the universities was obtained to participate in the study.
The present study was approved by the Ethical Committee for bio-behavioural research involving human subjects at the All India Institute of Speech and Hearing (AIISH), Mysuru, India (Basavaraj & Venkatesan, 2009) (Reference code: No.DOR.9.1/Ph.D/PC/930/2021-22). The study was conducted in strict adherence to the ethical guidelines set forth by the Ethical Committee for bio-behavioural research involving human subjects at the AIISH, Mysuru, India and the Declaration of Helsinki. The ethical considerations and guidelines were meticulously followed throughout the research process, ensuring the protection of the participant’s rights and welfare. Enrolment of participants was done exclusively after securing their written consent to voluntarily participate in the study.
In India, the undergraduate and postgraduate program consists of 4 years and 2 years of full-time study courses respectively. With respect to undergraduate and postgraduate programs, formal lectures and clinical placements are the typical methods of delivering academic and clinical education to students. They are further exposed to various courses relevant to speech-language pathology and cases presenting with challenges in speech, language, and swallowing abilities. Admission into the doctoral program is contingent upon the completion of both undergraduate and postgraduate degrees. Doctoral students primarily engage in research and clinical placements as they work full-time towards their degree, which typically requires 3–6 years for completion. All full-time final-year undergraduate, postgraduate, and doctoral students pursuing their respective programs from the participating universities were included in the target population.
The measures were distributed through program representatives and faculty members from the four universities. They were requested to circulate the measures among the students. Students who were interested to fill out the measures were asked to do so. To access the self-administered virtual measures, participants were provided with links that were sent to their email or mobile smartphones. To prevent incomplete surveys from being submitted, the online data-gathering system required all respondents to answer all items on the measures before proceeding to the subsequent questions. Only one attempt was allowed per respondent. To prevent duplicate responses from the same participant, only the initial entry with the earliest timestamp was utilized in the analysis, and no post-measure editing was permitted. Respondents were advised to read each statement carefully in the measure and choose the best option available.
Instrument
A measure was created on an online platform using the Google Forms portal. The introductory page presented comprehensive information regarding the study’s objectives, the length of the survey, the method of data storage, the level of anonymity guaranteed to the respondents, the voluntary nature of participation, and the contact information of the authors.
Participation in the survey was completely voluntary and informed consent to participate in the study was obtained from each respondent. The data was collected anonymously from the respondents. The measure consisted of two sections. Respondents who decided to proceed were directed to the first section. The initial section of the survey collected demographic data, including age, gender, current academic level and previous dementia exposure. To evaluate previous exposure to dementia, participants were asked about their attendance at formal dementia education sessions or training courses/workshops, whether they had any immediate family members diagnosed with dementia, and whether they had any direct occupational or working experience in caring for patients with dementia.
The second section of the survey comprised the DKAS. The original English version of the DKAS was used in the present study as it has previously demonstrated superior psychometric properties relative to the existing measures (Annear et al., 2015, 2016). The DKAS is a Likert scale that assesses knowledge about dementia through a 25-item questionnaire with correct and incorrect statements about the condition. The questionnaire was permitted to use in our study by the authors from the University of Tasmania, Australia. The questionnaire measures four subscales related to dementia, including Causes and Characteristics, Communication and Behaviour, Care Considerations, and Risks and Health Promotion. The questionnaire has a total score of 50 points, and respondents are scored using a Likert scale scoring system. For each item, respondents receive 2 points for a correct answer of “true” or “false”, 1 point for an answer of “probably true” or “probably false”, and zero points for an answer of “I don’t know” or for an incorrect response of “true” or “false”. The responses were stored automatically via the survey forms and then exported to a statistical software program for analysis.
Statistical analyses
Data analysis of this study was performed using the Statistical Package for Social Science (SPSS) version 20. Demographic data and the DKAS scores are presented using descriptive statistics including mean and standard deviations. Following data analysis for normality of distribution by the Shapiro–Wilk test, it was found that the total DKAS scores were normally distributed. The differences in results were analysed for individual DKAS subscales (Causes and Characteristics, Communication and Behaviour, Care Considerations, Risks and Health Promotion). Gender comparisons, as well as Previous Dementia Exposure, Previous Formal Dementia Education Exposure (Lectures/Workshops), Previous Informal Dementia Exposure (Family members) and Previous Informal Exposure (Occupational/working experience in caring for dementia patients) comparisons, were carried out using independent sample t-tests. One-way analysis of variance (ANOVA) with post hoc Scheffe’s tests was employed for the significance of the mean difference between the groups of respondents (SUD, SPD and SDD). Mean data were expressed as mean ± SD with a significance level set at 0.05.
Results
Data characteristics and demographic information
Characteristics of study respondents (N = 220).
DKAS subscales analysis between groups
Scores of Subscales of DKAS with different education levels.
Note. Mean values with different superscripts are significantly different, as indicated by Scheffe’s post hoc test (alpha = .05).
Comparison of dementia knowledge with previous dementia exposure
Differences of scores between previous dementia exposure and individual subscales and total scores of DKAS.
The p values obtained for the difference between respondents with and without previous dementia exposure were also found to be non-significant for individual subscales and total scores on DKAS (p = .833). This was found to be true for Previous Formal Dementia Education Exposure (Lectures/Workshops) (p = .501), Previous Informal Dementia Exposure (Family members) (p = .394) and Previous Informal Exposure (Occupational/working experience in caring for dementia patients) (p = .722). In other words, the selected variables of gender, Previous Dementia Exposure, Previous Formal Dementia Education Exposure (Lectures/Workshops), Previous Informal Dementia Exposure (Family members) and Previous Informal Exposure (Occupational/working experience in caring for dementia patients) did not have significant influence over individual subscales and total scores of DKAS.
Discussion
The current study aimed to assess dementia knowledge in final-year Indian students pursuing speech-language pathology. We considered three different levels of education from lowest to highest which included undergraduate, postgraduate and doctoral degree programs. The findings of this study indicate a lack of dementia knowledge in all three groups of respondents considered in the study. Our findings are in line with the previous studies that have demonstrated low levels of dementia knowledge among various professionals and students from different disciplines who play an essential role in serving individuals with dementia. The study conducted by Kwok et al. (2011) revealed that undergraduate students in health and social care professions in Hong Kong had poor knowledge about dementia, as reflected in their mean score of 7.4 out of 20 on the Alzheimer’s Disease Knowledge test (ADKS). Similar results were obtained in other healthcare professionals including general practitioners (Ahmad et al., 2010). Although the lack of dementia knowledge found in this study is similar to what has been previously reported by Malaysian undergraduate medical students (Chan et al., 2019), nursing and medical students in China (Wang et al., 2020), the Maltese medical and pharmacy students (Scerri, 2017), and the undergraduate SLP students and practising SLPs in Malta (Saccasan & Scerri, 2020), it is in contrast with the Norwegian findings. A study on undergraduate health and social care students in Norway was carried out to assess dementia knowledge using the ADKS. Although the students had several erroneous beliefs about dementia, the findings reported moderate dementia knowledge with a mean score of 23.51 out of 30 (Kada, 2015). Another study aimed to evaluate dementia knowledge in Norwegian psychologists using the ADKS. The participants demonstrated good dementia knowledge with an average mean performance score of 24.10 out of 30 (Nordhus et al., 2012). Similar results were observed, with the Maltese nursing students where the participants showed sufficient knowledge about dementia (Scerri & Scerri, 2013). To explain the observed variations in dementia knowledge levels across different studies, factors such as differences in target populations, measurement tools, exposure, and educational policies could be considered. However, further investigation is needed to better understand the underlying reasons for these differences.
Furthermore, we found that SDD scored significantly higher total DKAS scores followed by SPD and SUD. This is in line with the previous studies where the level of education positively affected dementia knowledge scores (Scerri & Scerri, 2013). It has been reported that as the participants progressed to more advanced courses, their level of knowledge on dementia increased (Shin et al., 2015). The AD knowledge scores of medical students in the United States were also observed to improve with higher levels of education. Specifically, final-year students scored significantly better than first-year students on all items on the University of Alabama at Birmingham Alzheimer’s Disease Knowledge Test (UAB ADKT) (Nagle et al., 2013). It is possible that the higher level of dementia knowledge gained through academic programs and clinical placements could have contributed to the differences. Additionally, some SDD may have previously worked as SLPs after obtaining their previous degrees, which could have provided them with an advantage in achieving better scores compared to the other respondent groups.
Based on the results of the four subscales of DKAS, our respondents scored highest in the Care and Considerations and Causes and Characteristics subscales. SDD also scored significantly higher scores only in the Causes and Characteristics and Care and Considerations subscales of DKAS replicating the findings of previous studies. A study on South Korean nursing students showed comparable outcomes where their mean accuracy rates were highest in the domains of caregiving, symptoms and diagnosis, and dementia causes, followed by prevention and treatment (Shin et al., 2015). Least scores were obtained by all three groups of respondents in the Communication and Behaviour and Risks and Health Promotions subscales. On similar lines, although different Australian professionals involved in dementia care showed moderate levels of knowledge about AD on the ADKS, their understanding of dementia risk factors was relatively low (Smyth et al., 2013). Similar results are stated elsewhere (Scerri, 2017).
Our respondents obtaining low scores on the Communication and Behaviour subscale reinforced the notion that healthcare professionals lack knowledge on how to communicate with persons with dementia. The provision of dementia care necessitates communication skills that are specific to the needs of the individuals with the condition. Effective communication skills are essential for healthcare professionals involved in dementia care. Communication barriers between individuals with dementia, professionals and their caregivers can greatly impact their quality of life, the quality of care provided, and their overall relationships (Eggenberger et al., 2013). Insufficient knowledge of communication skills can result in communication breakdown, anxiety and confusion in individuals living with dementia. Training and education on communication skills have been stressed as vital for professionals who work with people with dementia (Doyle, 2009). According to a recent review, training professionals in communication skills for dementia enhanced positive behaviour and improved the well-being of persons with dementia by promoting satisfying interactions (Eggenberger et al., 2013). Despite being in the profession that other health care professionals look up to while needing assistance to communicate with persons with dementia our respondents lacked the required knowledge in the most crucial subsections of DKAS. Usually, individuals are allowed to practice as SLPs after the completion of their undergraduate degree in speech-language pathology. But in our study, SPD and SDD, despite completing their undergraduate program lacked fundamental dementia knowledge. This implies that the future SLPs of India lack the necessary skills to provide quality care to persons with dementia and their caregivers. In addition, the results indicated a dearth of understanding of Risks and Health Promotions. Quality dementia care is typically founded on a fundamental comprehension of the risk factors associated with dementia. Despite the expectation for SLPs to serve as advocates of dementia prevention (American Speech-Language-Hearing Association, 2016), they exhibited insufficient knowledge of essential concepts deemed necessary. Hopper et al. (2007) conducted a survey to investigate the delivery of SLP services to individuals with dementia in Canada. The findings revealed that 60% of participants believed that people with dementia could benefit from SLP services, but providing these services was challenging due to caseload demands. Additionally, 76.3% of respondents identified competing priorities for other patients with acute needs such as dysphagia as a significant barrier to service provision. These findings suggest that although SLPs acknowledge the potential benefits of their services for people with dementia, they face obstacles in providing these services due to other urgent conditions taking precedence. We postulated that our respondents may have prioritized gaining knowledge on disorders such as dysphagia, potentially at the expense of knowledge related to dementia. The SLP curriculum in India focuses mainly on Child Language Disorders (CLD) for undergraduate programs and the number of CLD cases dealt with by SLPs is considerably larger than adults with communication disorders. Also, the possibility of students having a greater interest in other communication disorders, such as voice and phonological disorders cannot be neglected.
An interesting finding of our study is that previous dementia exposure had no impact on dementia knowledge which is contrary to the previous studies that have indicated that participants with previous dementia exposure have earned better scores on measures of dementia knowledge (Nagle et al., 2013; Nordhus et al., 2012; Scerri & Scerri, 2013; Smyth et al., 2013). A recent study demonstrated that 50.4% of Malaysian medical undergraduates had previous dementia exposure and scored significantly higher scores than those without previous dementia exposure (Chan et al., 2019). South Korean nursing students who had received educational training, had experience in patient care and had been exposed to information on dementia, had higher levels of dementia knowledge. Additionally, students who had family members with dementia showed significantly higher levels of knowledge compared to those who did not have family members with dementia (Shin et al., 2015). We also found that the number of respondents with previous dementia exposure was low (24.5%) in our study. Respondents with family members having dementia in our study were also very low (19.5%). This can be due to delayed or undetected dementia diagnoses in India (Hurzuk et al., 2022). The under-detection rate is found to be more pronounced in China and India as compared to Europe and North America implying that the current prevalence estimates of dementia are likely to be lower than the actual prevalence worldwide (Lang et al., 2017). Recently there have been reports of delayed diagnosis of dementia, even in urban areas of India (Ellajosyula et al., 2022). The reason behind such findings may be multifarious. People in India may underreport symptoms of dementia due to the negative stigma and discrimination associated with mental illnesses. The lack of awareness and knowledge about the typical symptoms of dementia could have led many individuals to perceive it as a natural part of the ageing process (Prince, 2009). People living in India fear institutionalization as a consequence of mental illness (Samuel et al., 2016). Compared to Western countries, the institutionalization of the elderly is relatively uncommon in India as the majority of older adults prefer to live with their children and family. They often engage in a variety of activities, including taking care of their grandchildren, managing finances, and performing household tasks, which help keep them active and provide them with a sense of involvement (Alam et al., 2012). The cross-cultural differences in India compared to the Western countries giving rise to ethical issues in providing dementia care have been well established (Sowmini & De Vries, 2009). Hence, all these reasons collectively contribute to the differences in prevalence rates in India (Choudhary et al., 2021). The proportion of respondents with previous dementia exposure through lectures and experience in caring for individuals with dementia was found to be limited in our study. A possible explanation for such low rates of exposure could be due to academic speech-language programs frequently offering inadequate training and clinical placements for serving individuals with dementia (Mahendra et al., 2013). The need for more targeted training on dementia has been expressed by both practising SLPs and SLP students in various studies (Davies, 2017; Hopper et al., 2007; Saccasan & Scerri, 2020). The lack and need for dementia care education has been expressed by several professionals including general practitioners (Caruana-Pulpan & Scerri, 2014), primary care physicians (Cherry et al., 2009), healthcare assistants (Chapman & Law, 2009), and aged care workers (Flemming & FitzGerald, 2009). Studies investigating the impact of dementia training programs on professionals and students have demonstrated significant improvement in dementia knowledge after the completion of the program (Jackson et al., 2008; Kang et al., 2013; Mulyani et al., 2021; Scerri & Scerri, 2019; Sullivan & O’Conor, 2001). It has been reported that there are insufficient comprehensive policies regarding dementia prevention, and also limited evidence of the implementation of such policies at the clinical level (Collins et al., 2019). These findings strengthen our belief to propagate dementia-related education to professionals involved in dementia care, particularly SLPs. We suggest that this should not only be offered in the form of short-term courses but also incorporated into a comprehensive continuing education program for professional training along with clinical placements. The quality of dementia care provided to individuals with dementia is closely tied to the knowledge and skills possessed by SLPs. According to the Code of Ethics (ASHA, 2016a), it is crucial for SLPs working in this area to be particularly educated and trained to ensure quality services for individuals affected by dementia. Therefore, the importance of dementia education cannot be overstated as it has a significant impact on the well-being of persons with dementia and their caregivers. The outcomes of our study emphasize the significance and necessity of ongoing initiatives to enhance the education of SLP students in preparation for the increasing challenge of managing dementia within our healthcare system.
Strengths and limitations of the study
To our knowledge, this study is the first to evaluate dementia knowledge among final-year Indian SLP students with all three levels of education programs ranging from undergraduate degrees to doctoral degrees. We included four universities from different geographic locations in our study to have a fair representation of the SLP students. The online survey platform used in our study successfully prevented unnecessary and incomplete responses using forced-choice answer options. Although the majority of the data came from SUD, they can be viewed as a benchmark against which future educational programs can be compared. The self-report from the respondents may have introduced a bias in the outcomes of the study such as providing responses that they perceive desirable, leading to an inaccurate representation of their true knowledge, unable to accurately recall information at the time of the study, or tendencies to respond in a certain way based on the questions or the context of the study that may have influenced the results. The convenience sampling method used in the study may result in a non-representative sample lacking diversity and limits generalizability of the findings to a broader population. Future research could benefit from recruiting participants from diverse regions, settings and universities in India, as they may have different caseloads and experiences with various populations of communication disorders.
Conclusions
In conclusion, dementia knowledge and exposure among Indian SLP students is low. In order to enhance dementia knowledge it may be necessary to evaluate and modify the existing curriculum. Incorporating formal education and clinical placements as early as undergraduate programs may help prepare future SLPs to provide better services to individuals with dementia.
Footnotes
Acknowledgements
The authors acknowledge all the students who participated in the study.
Author contributions
(Hema Nagaraj): Assisted in the study design, and provided critical revisions to the manuscript.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical statement
Data availability statement
The data sets generated during the current study are not publicly available as permission to share datasets publicly was not obtained from the participating universities but are available from the corresponding author, [PC], upon reasonable request.