Capacity building and resilience for the community-based dementia care workforce

Projected increases in dementia prevalence worldwide have focused attention on the need to build capacity to support the workforce in order to avert formal care shortages. Dementia care is characterised by a low qualified workforce with low levels of recruitment and retention. The thesis expands the view of workforce capacity building, from a focus on knowledge and skills, to include adjustment to work roles and coping in the face of high job demands. This approach will inform the design of effective interventions and quality of training to develop and retain dementia care workers. Understanding aspects of worker resilience will help define ways to enhance the capacity of workers with low qualifications. The series of studies explored different aspects of capacity building, applying theories from organisational, clinical and social psychology to offer a multi-disciplinary approach. The job-demands and resources model, self-efficacy and communion were concepts applied to the experience of community-based dementia care workers. Study One compared the effectiveness of dementia training interventions for both workforce and organisational climate variables, in a systematic review of the most rigorous research. Study Two used a mixed methods design and described community-based dementia care workers' resilience and vocational experiences. Workers' job roles, training, employer agenda, organisational support and commitment to work were investigated. While Study Two examined the workforce, Study Three explored informal dementia carers' experience of present and future community-based service delivery, and followed a mixed methods design. The findings informed recommendations for service providers to improve capacity for workers and organisations. Collectively, the results identified variables relevant for capacity building intervention research and health service delivery. There was a consensus between paid workers and informal carers that improvements in community dementia awareness, workforce, and organisational systems would reform future dementia care services. Specifically, dementia knowledge and stress management were areas consistently identified as ways to improve worker skills and capabilities. Whereas, organisational factors such as, better employment conditions, collaboration, and quality supervision were identified to improve worker commitment and performance. Intrapersonal factors that formed a resilient profile of adjustment were found to be essential for coping with high job demands at work. A sense of belonging based in social connectedness at work typified this experience and was proposed as a core construct, called occupational communion. A conceptual model was presented where occupational communion mediated the effects of job demands on capacity building and resilience. The thesis expanded the view of capacity building to include both intrapersonal coping and organisational factors to enhance worker development and resilience. In this way, the findings of the thesis offer a significant contribution to workforce capacity building for health and dementia care services. Future health care practice that recognises and aims to enhance occupational communion is needed, in order to attract and retain workers, and improve care for people with dementia.