Scoping review of instruments measuring attitudes toward disability

Twelve tips for including disability education in undergraduate medical education

Disability is a large and growing minority population worldwide. People with disabilities continue to experience health and healthcare disparities. Despite multiple calls to action to provide disability education within undergraduate medical education as a strategy to mitigate ongoing inequities, robust disability education is not routinely provided across medical schools. This article provides twelve tips that any medical school faculty can utilize to integrate meaningful disability education within existing core medical education.

Australasian genetic counselors' attitudes toward disability and prenatal testing: Findings from a cross-sectional survey

Diagnostic genetic testing and non-invasive prenatal testing (NIPT) for conditions associated with disability are becoming increasingly available to consumers. This genetic information can be used in the disability setting to inform factors such as prognosis, management, and reproductive decision-making. Genetic counselors (GCs) play an important role in the provision of genetic testing and NIPT, and their attitudes toward disability can influence how genetic information is communicated and shape patients' responses. This study aimed to evaluate and describe Australasian GCs' experience with and attitudes toward disabilities to identify potential biases and training needs. A cross-sectional survey was distributed to 400 GCs registered with the Human Genetics Society of Australasia. Of the 106 respondents (participation rate: 26%), a significantly greater proportion were more comfortable interacting with individuals with physical disability as compared to intellectual disability (p < 0.001). GCs with personal experiences with disabilities reported significantly greater comfort interacting with people with intellectual disability than those without experience (p = 0.012). Qualitative analysis revealed discomfort was less reflective of bias than inexperience and apprehension about communicating disrespectfully. GCs believed people with disabilities experience discrimination and that having a disability could make a person stronger, wiser, and more motivated. Most GCs viewed prenatal testing for disabilities positively as it allowed for decisions regarding continuing the pregnancy and/or provided opportunity to prepare. Challenges identified for prenatal counseling included negative societal attitudes and the low visibility of disability. GCs felt that 'personal beliefs' was the primary factor influencing the decision to terminate a pregnancy affected by disability. These findings highlight important education and training needs for GCs to improve preparedness and comfort when communicating with people with a disability.

Evaluation of a Student-Led Community-Based Veterinary Clinic for Disabled Low-Income Clients: A Case Study of the University of Florida PAWS Program

People with disabilities experiencing low socioeconomic position are priority populations when considering access to veterinary care. In this population, intersectional inequities lead to adverse health outcomes for both those individuals and the companion animals they care for. Community-based veterinary clinics provide an opportunity to target these inequities from a culturally sensitive lens, intending to improve human and animal outcomes. We conducted a process evaluation of a student-led community-based clinic for this population to better understand client satisfaction, assess learning outcomes among veterinary students, and improve program delivery and services. During academic year 2020-2021, the monthly clinics had 162 appointments in total with a median 15 DVM candidates volunteering at each clinic. Clients and volunteers responded to survey questionnaires designed to elicit information about their experiences with the clinic, including open-ended questions for further elucidation of measurable indicators of client-, patient-, and student-level impact. Clients attributed enrollment in the clinic with improved quality-of-life and reduction of financial burden; the program saved clients approximately $2,050 per pet during the evaluation year. Furthermore, the clinic widely facilitated completion of the college's core Primary Care and Dentistry learning outcomes. Beyond curriculum-standard learning objectives, students also reported positive attitude changes and increased readiness to provide care to people with disabilities and people experiencing low socioeconomic position. The results of this evaluation have significant implications for both veterinary and public health pedagogy. Especially, they highlight the significance of community health practice in veterinary trainee education.

Transformative care for people with disabilities: Empowering senior nursing students with competency based clinical education-A qualitative study of the impact

BACKGROUND

People with disabilities (PWD) constitute 26 % of the U.S. population yet no nursing schools have compulsory clinical education specific to PWD. Inadequate education and negative attitudes lead to lack of preparedness for working with PWD. To meet the needs of this highly underserved population, nursing students need training and experience in the care of PWD.

OBJECTIVE

The objective of this paper is to report three themes from the qualitative evaluation of two immersive clinical experiences with PWD for undergraduate nursing students designed to evaluate competencies for working with PWD.

DESIGN

Curriculum evaluation using qualitative methods.

METHODOLOGY

During and after the clinical experience, qualitative data (reflection papers, debriefing responses, and group interviews) were collected with a volunteer sample of senior nursing student participants of the clinical experiences with PWD. Thematic analysis was used to identify changes in students' attitudes, perceived competence, and motivation for working with PWD.

FINDINGS

Three major themes are reported in this paper: A positive shift in perspective of PWD (attitudes), impact of the experience on students' practice with PWD (comfort, confidence, awareness and motivation), and revelations from the experience (attitudes and resource awareness).

CONCLUSIONS

A comprehensive immersive clinical experience caring for PWD provides a real-world laboratory with important experiential learning activities that help students acquire and apply knowledge about the healthcare needs of PWD. Reflection activities facilitate synthesis of that knowledge. Results from this study suggest that this clinical experience can transform students' attitudes toward PWD, enhance their clinical skills, and motivate them to consider a nursing career with this highly under-served population.

Adaptation, validity, and reliability of the Interaction with Disabled Persons Scale in Spanish population

PURPOSE

To adapt the Interaction with Disabled Persons Scale (IDP) into Spanish and examine its factor structure.

METHODS

A forward and back translation of the IPD was performed by professional translators of scholarly articles. Spanish-speaking professional translators provided modifications in order to develop the final version of the scale. Participants filled in the Spanish version of the IDP, Positive and Negative Affect Schedule (PANAS), Multidimensional Attitudes Scale toward persons with disabilities (MAS), and Semantic Differential Technique (SDT).

RESULTS

A total of 523 persons (62.6% women), with a mean age of 29.22 (SD = 14.03) ranking from 18 to 81. The confirmatory factor analysis showed a reliable brief version of the IDP with adequate psychometric properties and two factors: (χ₍₁₉₎²=28.98, p < 0.001, CFI = 0.94, TLI = 0.91, RMSEA (90% IC)=0.05 (0.01, 0.08), SRMR = 0.06). The first factor solution was Coping/Succumbing Framework and the second factor was Discomfort in Social Interaction. The internal consistency reliability for the first factor was 0.63 and for the second 0.66.

CONCLUSIONS

Our findings provide evidence of the psychometric properties of the IDP as a brief measure of attitude toward individual with special needs in Spanish population.Implications for rehabilitationThe Interaction with Disabled Persons Scale (IDP) was successfully translated into Spanish language.The Spanish version of IDP Scale has a good acceptability, acceptable internal consistency, and high test-retest reliability.The Spanish version of IDP can been used to assist the clinicians, educators, and researchers in identifying the attitudes of the Spanish population toward persons with functional diversity in Spanish.Identifying the attitudes will permit to improve the inclusion polity and to design social programs toward greater inclusion.

Influencing Medical Students' Knowledge and Attitudes Related to Disability: A Randomized Controlled Trial

PURPOSES

The aims of the study were to evaluate and to compare the efficacy of an online and a traditionally delivered undergraduate elective course in improving medical students' disability-related knowledge and attitudes.

METHODS

A randomized controlled design was implemented. Participants were medical students randomly assigned into summer 8-wk disability and the society (OT100) online course, OT100 traditional course, or wellness and lifestyles (PT100) control. Demographics were collected in addition to participants' level disability knowledge and attitudes toward people with disability scale scores (1 wk before the semester and 1 wk after it). Multivariate analysis of covariance using general linear model was conducted to evaluate groups' differences in main outcome measures.

RESULTS

In total, 198 undergraduate medical students successfully completed the study conditions: OT100 online (n = 74), OT100 traditional (n = 59), and PT100 (n = 65). OT100 groups (traditional and online) change scores were statistical similar for disability knowledge (P = 0.966) and attitudes (P = 0.705) but significantly better (P < 0.001) than the control group.

CONCLUSIONS

OT100 course delivered traditionally or online seemed effective in improving medical students' disability knowledge and attitudes toward people with disability. More studies are needed to create effective methods improving healthcare professionals' disability-related knowledge and attitudes.

People with Disabilities in the Workplace: Results of a Survey Conducted among Polish and Finnish Employers

The key aspect of the inclusion of people with disabilities (PwD) in the workplace is how they are perceived by employers who make decisions on hiring employees. The article presents the results of CAWI (Computer Assisted Web Interview) research conducted among Polish and Finnish employers (n = 414) in 2021 using a proprietary questionnaire. Employers were asked to assess the state policy in the field of PwD’s inclusion, the social atmosphere in this respect, the level of acceptance of privileges/special solutions dedicated to PwD in the workplace and the knowledge of the specificity of disability. When analysing the obtained data, we verified the differentiation of Polish and Finnish employers’ assessments, the impact of respondents’ characteristics on their assessment and the relations between the assessments of various aspects of PwD’s inclusion. For the analysis, we used the t-test of independent samples for equality of means and the Pearson correlation coefficient. The results showed that Finnish respondents assess the conditions for the full inclusion of PwD much better than Polish ones. The characteristics most differentiating employers’ assessments is gender and the fact of employing PwD. There were also correlations between the responses of respondents in both countries to three out of four analysed questions from the questionnaire. The differences found in this study indicate that it would be worth extending the research to other European countries to generalize conclusions about the influence of cultural determinants on the situation of PwD on the labour market.

Attitudes of Polish Medical and Health Sciences Students towards Persons with Physical Disabilities Using the MAS-PL Scale

Discovering the role of negative attitudes in the social functioning of people with disabilities, tools were developed to measure these attitudes, of which the Multidimensional Attitude Scale of People with Disabilities (MAS) is a good one. It is particularly important to study the attitudes of people who are professionally involved in meeting the needs of people with disabilities. The aim of this study was to determine the attitudes towards people with physical disabilities among medical and health sciences students regarding gender, year of study, field of study, and place of residence. The study was conducted among 625 students in Poland with the use of the MAS-PL scale. The results obtained indicate that women display more positive attitudes towards people with disabilities than men in the cognition and behavioural domains. In the emotional domain, these attitudes were more negative than in the other domains and almost identical for both genders. The year of study, field of study, and place of residence did not differentiate students in terms of their MAS score. Since the sociodemographic variables studied do not determine a positive attitude, educational interventions to increase contact with people with disabilities should be undertaken in future research, and this factor should be investigated as an element of attitude modulation.

Appraisal of disability attitudes and curriculum of nursing students: a literature review

Worldwide, more than one billion people live with a disability (World Health Organization. (2011). World report on disability. Retrieved from https://www.who.int/disabilities/world_report/2011/report/en/). People with a disability (PWD) have unmet needs with the delivery of health care, secondary to nursing student's negative attitudes, knowledge, and skill deficits. This integrative literature review evaluated nursing student's education and attitudes towards PWD. Deficient education, attitudes, knowledge, and skills are addressed. Combined search terms utilized included: healthcare students; healthcare education; nursing students; clinical experience; clinical rotation; attitude of health care students; and exposure to PWD. Thirty articles were analyzed with common themes identified. Educational methods that produced improved attitudes, knowledge and skills included standardized patients with disabilities; phenomenological approaches; curriculum enhancement; empathy exercises and clinical experiences (Anderson, E. S., Ford, J., & Thorpe, L. (2011). Learning to listen: Improving students' communication with disabled people. Medical Teacher, 33(1), 44-52. doi: 10.3109/0142159X.2010.498491; Castro, S. S., Rowe, M., Andrade, L. F., & Cyrino, E. G. (2018). Developing competencies among health professions students related to the care of people with disabilities: A pilot study. Interface: Comunicacao, Saude, Educacao, 22(65), 551-563. doi: 10.1590/1807-57622016.0684; Hensel, D., Malinowski, C., & Watts, P. A. (2015). Implementing a pediatric camp clinical for pre-licensure education. Nursing Education Perspectives, 36(1), 60-61. doi: 10.5480/12-871.1; Levett-Jones, T., Lapkin, S., Govind, N., Pich, J., Hoffman, K., Jeong, S. Y., . . . Everson, N. (2017). Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the comprehensive state empathy scale. Nurse Education Today, 59, 75-81. doi: 10.1016/j.nedt.2017.09.007; Smith, P., Ooms, A., & Marks-Maran, D. (2016). Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives. Nurse Education in Practice, 16(1), 111-118. doi: 10.1016/j.nepr.2015.09.010). Nursing schools must incorporate disability education to fully realize its impact and eliminate barriers to transform care.

Perception and Acceptance of People with Disabilities by Employers and Co-Workers

The perception of people with disabilities is crucial for their full inclusion and in order that they might stay economically active. The measurement tools used should be resistant to the demographic or professional characteristics of the research participants. The article attempts to test this resistance for one of the most popular tools measuring the perception of people with disabilities in everyday life—the Attitudes to Disability Scale (ADS) test developed by the WHOQOL Group. Another issue raised in the article is the acceptance of people with various types of disabilities in terms of their possible employment. We checked the differentiation of acceptance among employers from different countries. This article uses representative samples of respondents from two studies—the CATI research (2019) on samples of Polish employers and co-workers, and the CAWI research (2021) on samples of employers from Poland and Finland. The analysis methods used included confirmatory factor analysis, nested models and nonparametric analysis of variance. The research confirmed the resistance of the ADS scale to respondents’ characteristics, and found no differences for nested models constructed for groups based on categorical variables characterizing the respondents. As for acceptance of various types of disability in the workplace, significant differences were found in the statements of employers from Poland and Finland.

Development of the workplace inclusion questionnaire (WIQ)

Aims:

To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market.

Methods:

A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N=485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case.

Results:

Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories.

Conclusions:

The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion.

Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem

Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals, the inclusion of persons with disabilities in humanitarian interventions and development policies remains elusive. Persons with disabilities face high risks of poverty, poor nutrition, limited inclusion in labor markets and poor mental health as a result. Stigma is likely to play a negative role in this regard and yet, no study has investigated the impact of stigma on depression and self-esteem of persons with disabilities. To address this gap in the literature, we conducted in June 2017 a random sample disability case control household study in Soweto, a township in Johannesburg, South Africa. Using propensity score analysis and structural equation modeling, we investigated the relationship between disability, stigma, depression and self-esteem controlling for socioeconomic covariates. Our main empirical results showed that stigma significantly mediates the association between disability and higher depression on the one hand and between disability and lower self-esteem on the other. This mediating effect exists even after controlling for age, gender, marital status, education, employment and wealth. We also found strong direct associations between disability and depressive mood, somatic indicators and negative feelings such as unhappiness and low self-esteem. Unemployment aggravates depression and low self-esteem while low education worsens self-esteem only. In addition, depression exacerbates low self-esteem. Both unemployment and low education are more common among persons with disabilities aggravating the disability, depression, poor self-esteem nexus. Similarly, persons with disabilities who are more likely to be depressed are also at higher risk of low self-esteem. These results point to a vicious reinforcing circle of exclusion from society, despair and self-deprecation, which could prove difficult to break. Substantial psycho-social support and anti-stigma policies anchored in local cultural values, engaging persons with disabilities and their communities, are required to break this vicious circle.

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Disability is associated with high depression and low self-esteem in South Africa.

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Stigma partially mediates links between disability, depression and self-esteem.

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Unemployment exacerbates depression and low self-esteem.

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Education increases self-esteem.

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Anti-stigma policies are needed to achieve Sustainable Development Goals for all.

Public attitudes to the rights and community inclusion of people with intellectual disabilities: A transnational study

BACKGROUND

Public support for the rights of persons with intellectual disability (ID) and their acceptance in local communities has been rarely studied internationally and the variables associated with more positive attitudes remain to be confirmed.

AIMS

To develop and test a model that brought together personal, organisational and national predictors related to public attitudes that have been previously identified in past research.

METHODS AND PROCEDURES

Self-completed, online surveys were undertaken with market research panels in 17 countries and in eight cities in the USA with a total of 36,508 respondents who were representative in terms of gender and age. Path analysis was used to explore the inter-relationships among the predictor, possible mediating and outcomes variables.

OUTCOMES AND RESULTS

The resulting model was a good fit for the data. Support for the rights and community acceptance of people with ID was highest among university educated respondents, those who were comfortable at meeting people with ID and those living in countries with very high ratings on the Inequality Adjusted Human Development Index.

CONCLUSIONS AND IMPLICATIONS

The model could guide further research into public attitudes alongside the development of interventions to promote more positive attitudes. Further research into the validity of the model is proposed.

Ambassador of People with Disabilities in the Workplace-Conducive Demographic and Professional Characteristics

This paper introduces into the analysis the concept of the ambassador of people with disability in the workplace. A kind and friendly person in the workplace, who creates a positive atmosphere around people with disabilities, may play a crucial role in their adaptation on the open labor market. Presence of such a person is especially important in entities that did not previously employ people with disabilities. It is vital that employers who would like to employ people with disability possess knowledge about demographic and professional characteristics that predispose employees to perform this special role. On the one hand, in this article we attempted to evaluate the differentiation in the perception of the issue of disability due to demographic and professional characteristics of respondents, and, on the other hand, to identify features that favor being an "ambassador of people with disabilities" in the workplace. The study was conducted in 2019 on the representative samples of Internet users from 8 European countries using Computer-Assisted Internet Interviews. For the purposes of the study, we used the Attitudes to Disability Scale WHOQOL Group test and a proprietary questionnaire. As for the methods of analysis, we relied on the classical analysis of variance and logistic regression. The conducted study showed that the perception of the issue of disability is significantly related to demographic and professional characteristics of respondents, and that the role of the ambassador is the most appropriate for a middle-aged woman with a good knowledge of disability issues, indecisive in the workplace.

Measurement of Factors Affecting the Perception of People with Disabilities in the Workplace

The issue of employing people with disabilities is crucial from both a social and economic perspective, and is often influenced by the social perception of this group of people. In this article, we attempted to examine attitudes towards the disabled in eight European countries by using one of the most popular tools that measures the perception of such people in everyday life—the Attitudes to Disability Scale (ADS) developed by the WHOQOL Group. We checked the general attitude towards disability according to the ADS scale and the specific perception of disability in the workplace using a scale created ad hoc. The research was conducted in 2019 using the CAWI (computer-assisted web interview) method on representative samples of Internet users, whereas the analysis methods included the measurement reliability analysis, confirmatory factor analysis (CFA) and structural equation modelling (SEM). The obtained results allow for the acceptance of the measurement model of the ADS scale in the societies of the analyzed countries. No significant differences were found between models created for people with a disability experience (a group from the WHOQOL Group research) and without such experience. The measurement using the original ADS scale factor structure is of good reliability, whereas CFA is of good fit. We also examined the impact of ADS scale factors on the perception of people with disabilities in the workplace using the SEM model, and obtained good fit of the model. The results show that the dimensions of perception, such as inclusion, discrimination and prospects, affect the evaluation of people with disabilities in the workplace.

A meta-analysis of the effect of adapted physical activity service-learning programs on college student attitudes toward people with disabilities

Aim: The purposes of this study were to examine the effect of service learning on changes in college student attitudes toward disability and identify potential factors to improve the quality of service learning using meta-analysis.Method: A total of 1984 potential studies were identified through 6 different databases and 14 studies met the necessary criteria for quantitative analysis. Effect sizes were estimated as Hedges' g using random effects, and heterogeneity among effect sizes was assessed with Q and I² statistics.Results: The overall effect size was positive but small (δ = .41, SE = .05, 95% CI [.33, .50], p < 0.05). Additionally, the results confirmed that different programs have different levels of impact on the student attitudes toward disability (Q = 25.71, p < 0.05, I² = 45.54). Service-learning programs that were part of a course requirement, on-campus, included a lecture component, and emphasized teacher-centered goals had smaller impacts than programs that were voluntary, off-campus, did not include lecture, and emphasized the achievement of common goals.Conclusion: The present analysis suggests that different service-learning programs have different effects, and factors like requirement status and type of involvement may lead to greater changes in attitudes toward disability.IMPLICATIONS FOR REHABILITATIONAdapted physical activity service learning has positive, yet small, effects on college student attitudes toward disability.Service-learning practitioners should aim to increase autonomy within service learning by providing multiple choices and opportunities to college students, such as a variety of practicum types, locations, and disability populations to choose from.Service-learning practitioners should encourage the development of common goals between college students and people with disabilities and integrate shared activities that are familiar to both groups in order to promote optimal contact conditions and enhance attitude change.Programs that intend to change attitudes toward people with disabilities should incorporate strategies specifically designed to target attitude change.

Developing the Co-Worker Acceptance of Disabled Employees (CADE) Scale

There are a number of scales intended to measure workplace attitudes toward people with disabilities. However, there is limited demonstration of validity evidence, especially theoretical validity. This article reports on the development of the Co-Worker Acceptance of Disabled Employees (CADE) Scale, including an examination of theoretical and empirical validity evidences. Theoretical validity is supported by screening each scale item through the difference model of disability. Empirical validity evidence is generated through a content validity study and an initial validity study. Exploratory factor analysis reveals that workplace attitudes toward employees with disabilities are based on perceived differences between those with disabilities and others. The CADE Scale will support workplace training and provide evidence of attitude change subsequent to workplace disability-related interventions.

Attitudes Toward Employees with Disabilities: A Systematic Review of Self-Report Measures

Accurate measures of changes in workplace attitudes toward people with disabilities are required to determine whether employee training and other interventions are effective. This critical systematic review searched Medline, PsycInfo, Google Scholar, Cinahl, and Cochrane Collaboration for suitable instruments published between 2005 and 2015, and for those published earlier if still indicated to be in active use. In total, 13 scans were conducted. Inclusion criteria included wildcard and free text variations ofworkplace attitudes,adults with disabilities, andcompetitive employment. In total, 9 of 49 studies were selected for review. Data from each of these were categorized through the PICO model (Population,Intervention,Comparison, andOutcome), mapped within a PRISMA flow chart, and analyzed through an 18-point weight of evidence framework for empirical quality, relevance, and evidence of theoretical validity. Weight of evidence scores for empirical quality ranged from 10 to 16 out of a possible score of 18. None of the studies provided an explicit evidence of theoretical validity. Measures of responsiveness to change in workplace attitudes appear less well validated than those for single timeframes.