Self-efficacy as a mediator between dementia knowledge and screening intention among American Indian adults

Heehyul E Moon; Yeon-Shim Lee; Soonhee Roh; Cole Allick; James E Galvin; Sasheen T Stone

doi:10.1093/geroni/igaf131

Self-efficacy as a mediator between dementia knowledge and screening intention among American Indian adults

Innov Aging. 2025 Dec 4;10(1):igaf131. doi: 10.1093/geroni/igaf131. eCollection 2026.

Authors

Heehyul E Moon¹, Yeon-Shim Lee², Soonhee Roh³, Cole Allick⁴, James E Galvin⁵, Sasheen T Stone⁶

Affiliations

¹ Kent School of Social Work and Family Science, University of Louisville, Louisville, Kentucky, United States.
² School of Social Work, San Francisco State University, San Francisco, California, United States.
³ Department of Social Work, University of South Dakota-Sioux Falls, Sioux Falls, South Dakota, United States.
⁴ College of Veterinary Medicine, Washington State University, Everett, Washington, United States.
⁵ Department of Neurology, Comprehensive Center for Brain Health, Miller School of Medicine, University of Miami, Boca Raton, Florida, United States.
⁶ Yankton Sioux Tribe, Wagner, South Dakota, United States.

Abstract

Background and objectives: While early detection of Alzheimer's disease and related dementias (ADRD) can help delay progression and improve outcomes, limited research is available on dementia-related health behavior, such as screening intention among American Indian/Alaska Native communities. Guided by the Theory of Reasoned Action, the Theory of Planned Behavior, and the Health Belief Model, this study examines whether self-efficacy mediates the association between dementia knowledge and intention to seek ADRD screening among American Indian adults.

Research design and methods: Using a community-based participatory research approach, a cross-sectional survey was conducted with 248 American Indian adults (18 years and over) from a partner tribal community in the Northern Plains region in 2024. Measures included dementia knowledge, self-efficacy, screening intention, perceived susceptibility, stigma, and demographic factors. Mediation was tested using the Baron and Kenny framework and Sobel-Goodman tests.

Results: Dementia knowledge significantly predicted both ADRD screening intention and self-efficacy. Self-efficacy also significantly predicted screening intention and partially mediated the relationship between knowledge and intention. Approximately 32% of the effect of dementia knowledge on screening intention was mediated by self-efficacy.

Discussion and implications: Findings underscore self-efficacy as a critical mechanism through which dementia knowledge translates into ADRD screening intention in American Indian communities. Interventions to promote early ADRD detection could enhance both knowledge and individual confidence. Future research should include more diverse groups within American Indian communities to identify common and unique dynamics among knowledge, self-efficacy, and screening intention, informing effective intervention strategies to reduce stigma and confidence in seeking timely ADRD screening.

Keywords: ADRD screening intention; American Indian communities; Median analysis.