Abstract / Summary
Abstract Background Behavioural and psychological symptoms of dementia (BPSD) are common and place demands on long-term care. BPSD knowledge supports early intervention and person-centred care, but staff knowledge gaps and practical management challenges remain insufficiently understood. This study measured care staff knowledge of Alzheimer’s disease and BPSD, identified BPSD knowledge gaps, explored care management challenges, and integrated the findings to identify educational priorities. Methods A quantitatively driven mixed-methods design with sequential data collection was used in a Swedish municipality. A web-based cross-sectional survey included 196 care staff in nursing homes, home care, and home-based healthcare. Five assistant care staff participated in two focus groups. Quantitative data were analysed using descriptive statistics, non-parametric tests, Spearman’s correlation, and Cronbach’s alpha. Qualitative data underwent manifest content analysis. Item-level BPSD findings and qualitative categories were integrated using a joint display matrix. Results Mean scores were 23.45/30 (78.2%) for general Alzheimer’s disease knowledge and 13.75/18 (76.4%) for BPSD knowledge; the scores were moderately correlated (ρ = .598, p < .001). Scores were higher among university-educated participants and home-based healthcare staff, and lower among those who did not report Swedish as their mother tongue. Recent dementia education was not associated with BPSD knowledge. Item-level analysis identified the main gaps as early intervention, psychological needs in daily care, and awareness that appropriate BPSD management can reduce care staff burden; only 49.7% answered the latter item fully correctly. Staff described BPSD management as relational and situational work aimed at creating relational trust through knowledge of the person, calm communication, and flexible adaptation. This work was constrained by fragmented continuity, insufficient information and documentation, time pressure, and limited shared learning. Integration suggested that explicit knowledge and practical competence were complementary but not equivalent, and that organisational conditions shaped staff’s reported ability to apply knowledge. Conclusions Care staff’s ability to manage BPSD cannot be understood from general knowledge scores alone, as gaps remained in knowledge of early intervention, psychological needs, and how appropriate BPSD management may reduce care staff burden; additionally, organisational conditions limited the consistent application of knowledge and practical competence. Education should therefore be targeted, practical, and linguistically accessible training accompanied by continuity of care, effective documentation, shared strategies, and team reflection to support person-centred BPSD care.