Understanding the Path from Dementia Knowledge to Screening Intention: The Impact of Self-Efficacy Among American Indians in the Northern Plains

Background and Purpose

Up to one-third of Native American older adults may develop Alzheimer’s disease and related dementias (ADRD), and with increasing life expectancy, the number of American Indian (AI) individuals aged 65 and older with dementia is projected to quadruple by 2060. Research suggests a potentially higher prevalence of dementia among AI/AN Medicare beneficiaries compared to their White and Black counterparts. Despite the benefits of early diagnosis, dementia screening rates remain low due to barriers such as underdiagnosis, cultural beliefs, and limited health literacy. Guided by the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB), and given the persistently low screening rates, this study used screening intention as a proxy for actual screening behavior. The primary aim was to examine whether self-efficacy mediates the relationship between ADRD knowledge and screening intention among AI adults in the Yankton Sioux Tribe (YST) in South Dakota, while controlling for age, gender, perceived susceptibility, and perceived stigma and social impact of ADRD.

Methods

A community-based participatory research (CBPR) approach was employed. The data used in the current analysis are part of a larger CBPR effort. A cross-sectional survey was conducted in September 2024 among adults from the YST (N = 248), recruited through community events (e.g., powwows) using convenience and snowball sampling methods. All data are considered joint property of the investigators and the Tribe.

Results

Participants had a mean age of 45 years (range: 18–81); 55% were female, and 65% had a bachelor’s degree or less. Additionally, 57% of respondents reported monthly household incomes below $2,499. A mediation analysis was conducted using the Sobel-Goodman method. Results indicated that ADRD knowledge was significantly associated with self-efficacy (b = 0.25, SE = 0.05, p < .001), and both self-efficacy (b = 0.16, SE = 0.05, p = .001) and ADRD knowledge (b = 0.08, SE = 0.04, p = .015) significantly predicted screening intention, controlling for covariates. The indirect effect of ADRD knowledge on screening intention through self-efficacy was statistically significant (b = 0.04, SE = 0.01, z = 2.92, p = .003), confirming mediation. The total effect was also significant (b = 0.13, SE = 0.03, p < .001), and the direct effect remained significant (b = 0.09, p = .014), indicating partial mediation. Approximately 31.8% of the total effect was mediated by self-efficacy, with the indirect effect equal to 46.5% of the direct effect.

Conclusion and Implications

This study provides clear evidence that self-efficacy functions as a key mechanism connecting ADRD knowledge to screening intention among American Indian adults. The significant mediating effect (31.8% of the total effect) shows that increasing knowledge alone is not enough—building self-efficacy is essential. Culturally tailored interventions that not only educate AI adults about ADRD but also strengthen their confidence in navigating health care systems may improve screening uptake. Future research should further investigate other modifiable psychosocial and structural factors influencing screening behaviors, to inform the design of effective, community-based interventions that promote early detection and improve long-term health outcomes in American Indian communities.