The Quality of Care and Support (QOCS) for people with disability scale: development and psychometric properties

This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify themes that were relevant for their quality of care. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centers worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. The outcome of the two rounds of data collection and analysis is a 17-item module for assessment of quality of care in physically or intellectually disabled people. Further modifications are also proposed for the use of the QOCS with adults with intellectual disabilities, including simplification of wording of some of the items, the use of a three-point response scale, and the inclusion of smiley faces.     

Differential attitudes of Chinese students toward people with disabilities: a cross-cultural perspective

The purpose of this study was to examine the attitudes of 338 Chinese secondary school students toward three major disability groups (people who are physically disabled, emotionally disturbed, and mentally retarded) using an adaptation of the American Scale of Attitudes toward Disabled Persons (SADP). We found that physically disabled persons were rated higher across the three subscales of the SADP compared to either emotionally disturbed and mentally retarded individuals, who were rated similarly low by the students. The lack of differentiation between the two mental handicapping conditions is at variance with contemporary western findings. The overall negative attitudes toward people with mental disabilities may have significant implications for community rehabilitation programming for this population.     

Measurement of attitudes of trainee professionals to people with disabilities

The importance of measuring attitudes of trainee professionals to people with disabilities was addressed. A questionnaire which included the Scale of Attitudes towed Disabled Persons (SADP) and the Intellectual Disability Misconceptions Scale (IDMS) was completed by first and final year tertiary students enrolled in a 3-year course on intellectual disability. The attitude measures did not discriminate between the two groups of students, psychometric properties were poor and the factor structure of the SADP did not replicate previous findings. As expected, there was some convergence between the two attitude measures, and relationships to subject variables were consistent with previous research. Recommendations for subsequent research were discussed.     

Effects of short-term disability awareness training on attitudes of adolescent schoolboys toward persons with a disability

Background Schoolboys (N = 156, M age = 13 years) participated in a disability awareness training program that included guest speakers (athletes from the Paralympics and the Special Olympics), a documentary about people with a disability, a disability simulation activity, and factual information about different disabilities.

Method Participants were allocated to a training program or a control condition. Subsequently, control participants completed the training program. Attitudes toward disability were measured by the Chedoke–McMaster Attitudes Towards Children With Handicaps (CATCH) Scale and the scale from the “Just Like You” disability awareness intervention, before and after training.

Results Training improved attitude scores, and gains were retained at one-month follow-up.

Conclusions Disability awareness training that delivered relevant information by involving guest speakers with a disability, included documentary evidence about the lives of people with a disability, and included interactive discussion, was successful. CATCH and “Just Like You” are useful tools for measuring self-reported attitudes about disability.     

Physical education teachers' attitudes towards children with intellectual disability: the impact of time in service,gender, and previous acquaintance

Background This study investigated attitudes towards teaching students with intellectual disability (ID) within a representative sample of secondary school physical education (PE) teachers, and to determine the effects of age, gender, teaching experience, and having acquaintance with ID and students with ID on their attitudes. Methods Participants were 729 secondary school PE teachers who worked in 81 major cities of Turkey. The Teachers Attitudes towards Children with Intellectual Disability Scale was administered. Results The statistical analysis revealed that there was no significant effect on factors and total attitudes scores of gender and having students with ID. Significant effects on factors and total attitudes score were found in teaching experiences and having acquaintance with ID. Conclusions It is encouraged to maintain and further develop in‐service education programmes of adapted physical activity for PE teachers.     

Staff characteristics and attitudes towards the sexuality of people with intellectual disability(*)

Background The identification of individual staff characteristics that have a relationship with specific attitudes of staff caring for people with intellectual disability (ID) may enable targeted training and better support. Method Sixty-six participants from services for people with ID in metropolitan Melbourne, Australia, completed a survey, including the Attitudes to Sexuality Questionnaire (Individuals with an Intellectual Disability; Cuskelly & Gilmore, 2007 ). Results Staff attitudes towards the sexuality of people with ID were quite positive. Age, program agency position, and training uptake were all associated with positive staff attitudes. Conclusion Targeted training programs in sexuality can benefit direct care workers in general, and older staff more specifically. Emphasis is warranted in the area of training for managing male sexual behaviours.     

Do contacts make a difference? The effects of mainstreaming on student attitudes toward people with disabilities

This article examines the effects of mainstreaming on the attitudes of non-disabled students, in a secondary school, toward people with disabilities. Responses from 389 Form 1 and Form 2 students were analyzed. A 47-item Students' Attitudes toward People with a Disability Scale was used to measure student attitudes at the beginning and end of the school year. The effect of educational intervention and daily classroom contacts on student attitudes was examined. The competitive and achievement orientation of Hong Kong's educational environment poses formidable barriers to the adoption of effective inclusive practices in the classroom. The results of this study indicate that educational intervention outside the classroom has a small effect in changing students' attitudes.     

A study of behaviour profiles among intellectually disabled people in residential care in Hungary

The authors investigated the behavioural dimensions of 269 intellectually disabled (ID) people in residential care in specialized institutions in Tolna county (South-West Hungary) with the aim of screening the frequency and severity of the relevant behavioural symptoms associated with intellectual disability and depending on the level of intellectual impairment. Only 120 residents had an International Classification of Disease (ICD) diagnosis of “mental retardation (MR)” and a valid IQ grading either by means of the Hungarian standard version of the HAWIK or by the coloured Raven test. 4 IQ groups were created: borderline (B), mild (MID), moderate (MOD) and profound (PID) intellectual disability subgroups. The Hungarian pilot version of the Behaviour Problem Inventory (BPI) was used. Senventy-two percent of the residents displayed behavioural problems. All scale score means exhibited an enhancing tendency with IQ loss, as both frequency and severity increased linearly towards the more severe groups, but significantly only in the category of stereotyped behaviour. The authors focussed on problems of patient recruitment and discussed the measurement of behavioural and other psychiatric symptoms when researchers reported on the increased occurrence of behaviour and psychiatric symptoms in ID populations.     

Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability

Background Self‐rating scales are widely used in general adult practice; however, there is no reliable and valid method for assessing state anxiety in people with intellectual disability (ID). The present study describes the development and psychometric evaluation of a new scale, the Glasgow Anxiety Scale for People with an Intellectual Disability (GAS‐ID). Methods First, an item pool was generated from focus groups, a review of the literature and clinician feedback. Secondly, a draft scale was administered to 19 anxious and 16 non‐anxious people with ID for further validation and appraisal of reliability. Thirdly, the scale was completed by 19 anxious, non‐ID people for cross‐validation with the Beck Anxiety Inventory (BAI). Finally, physiological concomitants were validated by pulse‐oximetry. Results The 27‐item GAS‐ID discriminated anxious from non‐anxious participants, had good test–retest reliability (r = 0.95) and internal consistency (α = 0.96), and was reasonably correlated with the BAI (ρ = 0.75). The correlation between the physiological subscale of the GAS‐ID and changes in pulse rate was moderately significant (ρ = 0.52). Conclusions This preliminary study suggests that the GAS‐ID offers a psychometrically robust and practical (5–10 min) approach to the appraisal of anxiety in this population.     

Attitudes of children and adolescents toward persons who are deaf,blind, paralyzed or intellectually disabled

This study aimed to explore Dutch students’ attitudes toward deaf, blind, paralyzed or intellectually disabled persons and to determine whether age, self-esteem, gender, religion and familiarity with a disabled person have a significant effect on these attitudes. The attitudes of 200 high school and 144 university students were determined with two questionnaires, the CATCH and MAS. Only the CATCH was applicable with all four disabled groups. Two factors were found: behavior–positive affect and cognition–negative affect. With regard to the first factor respondents had more positive attitudes toward deaf, blind and paralyzed persons than toward intellectually disabled persons. The cognition and negative affect factor showed that respondents had more positive attitudes toward deaf and blind persons than toward paralyzed and intellectually disabled persons. Being older and familiarity with a disabled person had a significant positive effect on attitudes, while self-esteem and gender had only a partial effect and having religious beliefs was not a significant predictor in this study.     

Understanding disability in mental and general medical conditions

OBJECTIVE: This study characterized the prevalence, characteristics, and impact of mental and general medical disabilities in the United States. METHOD: The 1994-1995 National Health Interview Survey of Disability was the largest disability survey ever conducted in the United States. A national sample was screened for disability, defined as limitation or inability to participate in a major life activity. Analyses compared cohorts who attributed their disability to physical, mental, or combined conditions. RESULTS: Of 106,573 adults, 1.1% reported functional disability from mental conditions, 4.8% from general medical conditions, and 1.2% from combined mental and general medical conditions. Disabilities attributed to a mental condition were predominantly associated with social and cognitive difficulties, those attributed to general medical conditions with physical limitations, and combined disabilities with deficits spanning multiple domains. In multivariate models, comorbid medical and mental conditions were associated with a twofold increase in odds of unemployment and a two-thirds increase in odds of support on disability payments compared to respondents with a single form of disability. More than half the nonworking disabled reported that economic, social, and job-based barriers contributed to their inability to work. One-fourth of working disabled people reported discrimination on the basis of their disability during the past 5 years. CONCLUSIONS: An estimated three million Americans (one-third of disabled people) reported that a mental condition contributes to their disability. Mental, general medical, and combined conditions are associated with unique patterns of functional impairment. Social and economic factors and job discrimination may exacerbate the functional impairments resulting from clinical syndromes.     

Police attitudes toward people with intellectual disability: an evaluation of awareness training

It is argued that more favourable police attitudes to people with intellectual disability (ID) are essential in meeting the police code of ethics, which stresses impartiality and respect for human dignity. The need to acknowledge and investigate the extent of support for eugenic attitudes in other key professionals who have a significant role in the successful inclusion of people with ID in community settings is discussed. The present paper reports on the evaluation of an awareness training event conducted by the Royal Ulster Constabulary in terms of the impact on attitudes towards people with ID held by police officers. The quasi‐experimental design involved the measurement of participants' attitudes prior to and following awareness training, and the comparison of these data with a control group of participants who did not undertake awareness exercises. The Attitudes toward Mental Retardation and Eugenics (AMRE) scale was the instrument used to measure attitudes. Analysis identified the presence of varying degrees of support for the application of eugenic principles to people with ID. Furthermore, the results indicate that participation in the awareness exercise and subsequent discussions is associated with a significant reduction in support for eugenic‐based attitudes towards people with ID by the police officers involved. Investment in training events which target attitudes towards people with ID can bring about a shift in reported attitudes. The importance of evaluating such awareness‐raising exercises and their impact on police behaviour is highlighted.     

The Attitudes to Ageing Questionnaire (AAQ): development and psychometric properties

OBJECTIVE: This paper describes the development of the Attitudes to Ageing Questionnaire (AAQ) which is a self-report measure with which older people themselves can express their attitudes to the process of ageing. METHOD: The development of the AAQ followed a coherent, logical and empirical process taking full account of relevant gerontological knowledge and modern and classical psychometric analytical methods. Pilot testing with 1,356 participants from 15 centres worldwide refined the scale and provided the basis for a field test. A total of 5,566 participants from 20 centres worldwide contributed to the further development of this new scale with the derivation involving both classical and modern psychometric methods. RESULTS: The result is a 24-item cross-cultural attitudes to ageing questionnaire consisting of a three-factor model encompassing psychological growth, psychosocial loss, and physical change. The three-factor model suggests a way of conceptualizing and measuring successful ageing in individuals. CONCLUSIONS: The AAQ provides researchers, clinicians and policy makers with a unique scale to measure the impact of successful ageing interventions. It also provides a vehicle for the measurement of how individuals age across cultures and under different economic, political and social circumstances.     

Children's attitudes toward peers with disabilities: the Israeli perspective

Attitudes toward peers with disabilities were compared in two groups of elementary school children, Israeli (2845 children) and Canadian (1831 children), using the Chedoke-McMaster Attitudes Toward Children with Handicaps (CATCH) scale. Israeli children expressed significantly more positive general attitudes (P=0.0001). The more favourable attitudes were seen in both areas evaluated by the CATCH, the cognitive and the affective-behavioural. In both groups, children who had had previous experience with a disabled person expressed more positive attitudes (P=0.001). An effect of gender was seen in the Canadian but not in the Israeli children. Cultural factors appear to play a role in modelling children's attitudes toward their disabled peers and therefore should be considered before educational programmes are implemented.     

Therapists with disabilities: theoretical and clinical issues

Disability as a characteristic of the therapist needs to be addressed for several reasons. First, substantial evidence indicates that people without visible disabilities or physical differences regard persons who diverge from ideals of physical perfection and norms of physical acceptability with a variety of emotions which--at the very least--alter ordinary social interaction. Second, the psychoanalytic literature on therapy with disabled patients and the developmental literature about people with disabilities reinforce the generally negative or ambivalent attitudes about the mental well-being and potential for productivity and intimacy of people with disabilities. As a consequence of both general acculturation and professional training in psychology and psychoanalysis, professionals in charge of admissions have frequently denied competent disabled people the graduate education which is prerequisite to psychoanalytic training and professional employment. Mental health practitioners who make up the training committees of analytic institutes have frequently been reluctant to accept a disabled candidate for psychotherapy or psychoanalytic training. Once trained, many disabled clinicians have faced hurdles in obtaining employment, in advancing within their profession, in being selected as faculty members or supervisors, and even in obtaining referrals from nondisabled colleagues. After briefly describing the literature on attitudes of the nondisabled toward people with physical impairments, we will present the reasons for the reluctance to train disabled people as therapists. We will include material on how disabled people work with their disabilities in the analytic process and will bring in analogies to practitioners who are members of racial or cultural minority groups.     

Factorial validity of the Chedoke-McMaster Attitudes towards Children with Handicaps Scale (CATCH)

The Chedoke-McMaster Attitudes towards Children with Handicaps Scale (CATCH) has been developed to measure the attitudes of children toward peers with disabilities. The present study aims to evaluate the factorial validity of the CATCH in a sample of 2396 students in 7th grade, including 179 students with disabilities and 2217 typically developing students. Each classroom included at least one student with a disability. The structure of the scale, as proposed by the developers, was tested and its stability was evaluated across gender, disability status, awareness of the disability status of classmates and having a classmate with a disability as a friend. Confirmatory factor analysis did not support the originally proposed subscale structure. Instead of the three proposed subscales, a single subscale including seven items was found. Strict factorial invariance was obtained across gender, disability status, awareness of the disability status of classmates and being friends with a classmate with a disability. Implications of these findings will be discussed.     

The development of the QUALITRA‐ID: a user‐orientated interview to assess the quality of care and service trajectories for intellectually disabled persons

Background Care and service trajectories for people with intellectual disabilities (ID) are routes within the healthcare delivery system that consist of all the steps that people with ID and their families have to take in order to realise the needed care and services. In contrast to the growing system‐orientated knowledge concerning quality of care delivered through collaborative relationships between care providers, specific user‐orientated knowledge regarding the quality of care and service trajectories is largely lacking. Aim This article aims to describe the development of the QUALITRA‐ID; a user‐orientated interview concerning the quality of care and service trajectories for people with ID. Methods First, the phenomenon ‘care and service trajectories’ is conceptualised on the basis of document analysis and semi‐structured interviews with key informants in the field of health care for people with ID. Second, the quality of care and service trajectories is operationalised by means of eight focus group discussions with intellectually disabled persons and their parents/relatives and a review of the literature. Third, the QUALITRA‐ID is constructed using the results of the conceptualisation and operationalisation of the phenomenon. Fourth, the QUALITRA‐ID is refined in two stages that were concerned with examining the feasibility, understandability and completeness of the QUALITRA‐ID. The second stage was also concerned with the first quality assessment among people with ID. Results The final result is a 24‐item QUALITRA‐ID consisting of a personal conversation and a closed‐ended part.     

Validation of the attitudes toward intellectual disability – ATTID questionnaire

Background Individuals with an intellectual disability (ID) continue to experience major obstacles towards social, educational and vocational integration. Negative attitudes toward persons with ID has remained relevant over time and has led to discrimination and stigma. Objective The present study describes the development of a new questionnaire for tapping into the general population's attitudes toward individuals with ID and addresses its psychometric properties. Methods Adopting a multidimensional perspective, the Attitudes Toward Intellectual Disability Questionnaire (ATTID) was developed from a series of previously validated instruments and principles from the Montreal Declaration on Intellectual Disability (2004). The ATTID was administered by phone to 1605 randomly selected adult men and women, stratified by region in the Province of Quebec, Canada. Results The ATTID yielded a five‐factor structure overlapping the tri‐partite model of attitudes. The cognitive component was represented by two factors: knowledge of capacity and rights and knowledge of causes of ID. The affective component tapped into two factors: discomfort and sensitivity/compassion. Finally, the behavioural component emerged as a single factor. The ATTID had good internal consistency with Cronbach's alpha coefficients ranging from 0.59 to 0.89 for the five factors and of 0.92 for the overall questionnaire. Test–retest reliability yielded correlations from 0.62 to 0.83 for the five factors. Conclusion The ATTID can be used to measure attitudes among different populations and allows comparisons over time within the same population as a function of various intervention strategies for de‐stigmatising ID.     

Attitudes towards people with intellectual disabilities: A comparison of young people from British South Asian and White British backgrounds

Research with South Asian families of individuals with intellectual disabilities (ID) suggests an increased fear of stigma and isolation from the community. Evidence on attitudes towards ID among the wider community is very limited and was the focus of the present study. Responses were collected from 737 college students aged 16–19 using the Community Living Attitudes Scale – ID version. Results indicated that British South Asians (n = 355) were less in favour of the social inclusion of people with ID than White British young people (n = 382). British South Asian adolescents were more likely to hold the view that people with ID should be sheltered and not empowered. It is proposed that future inclusion policies integrate ethnic minority views whose religious and cultural values do not always conform to the core values of social inclusion policies. It is also proposed that culturally specific school based interventions could be introduced with the aims of decreasing stigma and fostering attitudes in line with the aims of normalisation.