Knowledge, attitudes, and practices of primary care physicians regarding dementia diagnosis and management in the Philippines: A national cross- sectional survey

Abstract

Background & Objective: Dementia is increasing in low- and middle-income countries, including the Philippines, where underrecognition and limited system capacity may delay diagnosis and constrain care. Primary care physicians are central to early detection and longitudinal management, yet local evidence on preparedness remains limited. The objective of this study was to assess dementia- related knowledge, attitudes, confidence, and clinical practices among primary care physicians in the Philippines, including training needs and cultural perceptions.

Methods: A nationwide cross-sectional online survey (August 2024–June 2025) was conducted among non-neurology physicians providing primary care using a validated questionnaire. Descriptive statistics summarized responses. Exploratory factor analysis (minimum residual extraction, promax rotation) evaluated the 16-item attitude scale. Spearman correlations assessed associations among knowledge, attitudes, confidence, years in practice, and dementia case exposure. Open-ended responses underwent conventional content analysis.

Results: Among 275 respondents, the mean knowledge score (maximum 13) was 8.14 ± 2.11; 11.3% met the predefined threshold for high knowledge (≥11/13), although the 13-item checklist showed low internal consistency and item-level findings were more informative than score categories. Attitudes were generally favorable (mean 56.83 ± 6.13), and factor analysis supported a four-factor structure (KMO = 0.801; Bartlett p < 0.001), explaining 56.5% of variance. Confidence in managing behavioral and psychological symptoms of dementia was low-to-moderate (mean 2.64 ± 0.84; α = 0.91). Most physicians primarily referred suspected cases for diagnosis and management (83.1%), whereas 16.9% reported independent diagnosis and management. Among the 42 respondents who provided usable open-ended descriptions of self-management, history/collateral history and functional assessment (78.6%) and cognitive screening tools (59.5%) were most commonly reported, whereas neuroimaging (9.5%) and formal diagnostic criteria (4.8%) were uncommon. Knowledge correlated weakly with attitudes (ρ = 0.17, p < 0.01). Nearly all respondents reported needing additional training (97.5%), and online delivery was preferred (86.2%). Local terms such as ulyanin reflected normalization of dementia as aging and perceived stigma.

Conclusions: Philippine primary care physicians showed supportive attitudes but uneven dementia- related knowledge, limited confidence, and high referral dependence. Findings support skills-based primary care training and system supports to strengthen timely dementia recognition and longitudinal management.