Feasibility of a nurse-led online video intervention for mealtime assistance in dementia care: a quasi-experimental mixed-methods study

Abstract

Background: Mealtime assistance is essential in long-term care for older adults with dementia, as it promotes autonomy, social interaction, and dignity. Flexible and accessible training for direct care workers (DCWs) is crucial in improving mealtime support. This study aimed to develop and evaluate the effectiveness of a YouTube-based mealtime assistance education program for dementia care based on the cognitive theory of multimedia learning. The intervention was designed to provide accessible and flexible training for DCWs in care facilities. Methods: A quasi-experimental, mixed-methods design was used. Twenty-four DCWs and five supervising nurses from two long-term care facilities participated in this study. To maximize participation, DCWs were non-randomly assigned to the intervention based on facility recommendations and individual work schedules. The effectiveness of the program was evaluated using Kirkpatrick’s four-level model. Reactions were measured by collecting satisfaction data from the DCWs through surveys and focus group interviews (FGIs). Learning outcomes were assessed using self-reported questionnaires to measure mealtime assistance knowledge with pre- and post-intervention comparisons. Behavioral changes were evaluated by supervising nurses using an observation-based questionnaire and analyzed using pre- and post-intervention data. Organizational results and the dissemination effect were explored through FGIs with nurses and thematically analyzed. Results: The median mealtime assistance knowledge score increased significantly (Pre: 91.67, Post: 100.00, p =.002, effect size = 0.45, interquartile range: 83.3–97.92). The median mealtime assistance behavior score showed significant improvement (Pre: 67.00, Post: 92.00, p <.001, effect size = 0.56, interquartile range: 82.33–92.00). Supervising nurses observed enhanced ethical attitudes and behavioral changes among DCWs during mealtime assistance. Conclusion: YouTube-based multimedia learning interventions effectively improved the knowledge, attitudes, and behaviors of DCWs in mealtime assistance for older adults with dementia. Its accessibility and practicality suggest that this approach can be a useful educational model in long-term care settings. Further studies are needed to explore the role of opinion leaders in sustaining and expanding these effects. © The Author(s) 2025.