From Pilot To Implementation: Advancing Dementia Literacy In Brazilian Public Schools To Reduce Stigma

Author:Karen Leticia Pulgatti¹, Lea Veras¹, Giulianna Bueno Denari¹, Ari Alex Ramos¹, Lucas Pelegrini Nogueira de Carvalho¹, Marcia Regina Cominetti, PhD^1,2.

¹Department of Gerontology, University Federal of São Carlos, São Carlos, Brazil, 

²Gerontology, UFSCar, São Carlos, Brazil.

Abstract:

Background: Population aging and the increasing prevalence of dementia, particularly Alzheimer’s disease, represent major global public health challenges and highlight the need for effective strategies to reduce stigma. Schools are strategic settings for dementia literacy, as teachers play a central role in shaping students’ and families’ knowledge, attitudes, and dialogue. This study builds on a previously piloted teacher training program (doi: 10.1002/dad2.70208) and aimed to evaluate the effectiveness of its scaled, self-paced version in reducing dementia-related stigma using the knowledge and attitudes toward dementia instrument developed by Alzheimer’s Disease International.

Methods: This pre-post intervention study recruited 69 elementary school teachers (65% female; mean age 47.8 years, SD = 9.4) from Brazilian public schools. Participants completed the stigma scale at baseline and at follow-up after completing the training program. Poisson generalized linear mixed models with random intercepts were used to account for within-participant repeated measures. Models were adjusted for age, sex, and academic attainment to examine factors associated with stigma levels and changes over time.

Results: At baseline, 32.6% of teachers reported no stigmatizing attitudes, whereas 67.4% endorsed at least one stigmatizing belief. Mean stigma scores declined from baseline (M = 1.78; 95% CI, 1.35-2.22) to follow-up (M = 1.33; 95% CI, 0.98-1.69). In adjusted Poisson mixed-effects models, follow-up assessments were associated with a 25% reduction in stigma scores compared with baseline (rate ratio [RR] = 0.75; 95% CI, 0.57-0.98). Teachers holding a Master’s and/or Doctoral degree showed a 61% lower rate of stigma relative to those with undergraduate education (RR = 0.39; 95% CI, 0.19-0.77). No statistically significant associations were observed for age (RR = 1.01; 95% CI, 0.99-1.04) or sex (RR = 0.71; 95% CI, 0.45-1.13).

Conclusion: The scaled implementation of a previously piloted, self-paced teacher training program was associated with a meaningful reduction in dementia-related stigma among elementary and high school teachers in Brazil. These findings reinforce the value of school-based educational interventions as scalable strategies to advance dementia literacy, promote inclusive educational environments, and support broader societal preparedness for population aging, particularly in low- and middle-income country contexts.