Relationship among intention-to-seek-help in dementia, dementia literacy, acculturation and social network : a mixed-method study

Abstract

Introduction Africans are a growing minority group in China's megacities, and there are more than 3000 permanent residents and 167,000 African visitors each year to Hong Kong as of 2014. People of African descent have a higher risk of developing dementia. Many Africans seldom use dementia services and mostly rely on their family members to support the persons with dementia in their own homes. The rationale behind such actions is uncertain. Examining factors that may delineate the lack of early help-seeking for dementia among Africans is urgently needed. Cultural belief may be one of the influencing factors, while their mental health literacy level could be another factor. The current study investigates the relationship between dementia literacy, acculturation, social network, and intention-to-seek-help in dementia among Africans in Hong Kong. Methods: This is a three-phase mixed-method design incorporating a scale development (dementia literacy scale), a qualitative study and a cross-sectional survey. Participants were Africans from Sub-Saharan Africa living in various districts in Hong Kong. A semi-structured interview guide was used to collect data for the study. Thematic analysis was used to analysis data from the study. DLS was modified from Mental Health Literacy Scale, considering the items from The Dementia Knowledge Assessment, Alzheimer's Disease Knowledge Scale (ADKS) and based on findings from qualitative study. Content and construct validity were checked by exploratory factor analysis. Quantitative data were collected using questionnaires measuring dementia literacy, acculturation, social networks, intention-to-seek-help, and participants' sociodemographic data. Descriptive statistics, correlation, and path analysis were used. Results: Thirty participants were interviewed individually. Four themes emerged from the study: (a) Navigating cultural identity and contesting social exclusion, (b) changing beliefs and perceptions about dementia, (c) Pluralistic help-seeking for dementia, and (d) factors influencing intention-to-seek-help. Qualitative findings show that despite limited social contact with locals, dementia practices in Hong Kong significantly influenced Africans' perception, knowledge, and help-seeking for dementia. Contextual factors (such as availability of dementia services, health professional attitude, social ties and societal norms, perception, and practices of dementia) influenced dementia help-seeking among Africans in Hong Kong. A total of 461 Africans aged 18 and above living in Hong Kong were recruited for the survey, with 90% expressing the intent to seek help from health professionals. Survey results also indicated that, contrary to previous literature, the total score of dementia literacy (r=.02, p=0.609) and acculturation (r=.02, p=0.621) are not associated with intention-to-seek-help. However, two (risk factors (r=-.16, p= 0.049) and knowledge of how to access dementia information (r=-.13, p=0.007)) out of the five domains of dementia are inversely associated with intention-to-seek-help. Also, of the four acculturation strategies, only the assimilation strategy (r=.13, p=0.007) showed a significant association with intention-to-seek-help. However, social network (r=.11, p=0.014) was positively associated with intention-to-seek­-help. Path analysis revealed that assimilation had a significant positive mediating effect on the relationship between dementia literacy (Risk factors (β = 0.025, p<0.001) and how to get dementia information (β=0.031, p<0.001)) and intention-to-seek-help. Social networks (β=-­0.011, p=0.048) showed a negative and significant mediating effect on the relationship among dementia literacy (information seeking) and intention-to-seek-help. Conclusion: The current findings demonstrate that possession of sufficient dementia literacy does not manifest in higher intention to seek help. Despite a high level of support, the family was identified as a potential barrier to dementia help-seeking. To improve dementia help-seeking efficacy, enhancing social networks and assimilation of Africans into Hong Kong society is imperative. The current study contributed to two main aspects: (1) the development of a validated dementia literacy scale and (2) updating the current theoretical underpinning of the relationship between dementia literacy, acculturation, social network, and intention-to­-seek-help for dementia.