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Public stigmatisation of people with intellectual disabilities: a mixed-method population survey into stereotypes and their relationship with familiarity and discrimination

PELLEBOER-GUNNINK, Hannah A
VAN WEEGHEL, Jaap
EMBREGTS, Petri J C M
January 2019

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Purpose: Stigmatisation can negatively affect opportunities for people with intellectual disabilities to participate in society. Stereotyping, a first step in the process of stigmatisation, has been insufficiently explored for people with intellectual disabilities. This study examined the general public’s set of stereotypes that is saliently attributed to people with intellectual disabilities as well as the relationship of these stereotypes with discriminatory intentions and familiarity.

 

Materials and methods: A mixed-method cross-sectional survey within a representative sample of the Dutch population (n = 892) was used. Stereotypes were analysed with factor analysis of a trait-rating scale, and qualitative analysis of an open-ended question. The relationship between stereotypes and discrimination as well as familiarity with people with intellectual disabilities was explored through multivariate analyses.

 

Results and conclusions: Four stereotype-factors appeared: “friendly”, “in need of help”, “unintelligent”, and “nuisance”. Stereotypes in the “nuisance” factor seemed unimportant due to their infrequent report in the open-ended question. “Friendly”, “in need of help”, “unintelligent” were found to be salient stereotypes of people with intellectual disabilities due to their frequent report. The stereotypes did not relate to high levels of explicit discrimination. Yet due to the both positive and negative valence of the stereotypes, subtle forms of discrimination may be expected such as limited opportunities for choice and self-determination. This may affect opportunities for rehabilitation and might be challenged by protest-components within anti-stigma efforts.

Time to update the ICF by including socioemotional qualities of participation? The development of a “patient ladder of participation” based on interview data of people with early rheumatoid arthritis (the Swedish TIRA study)

SVERKER, Annette
THYBERG, Ingrid
VALTERSSON, Eva
BJORK, Mathilda
HJALMARSSON, Sara
OSTLUND, Gunnel
January 2019

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Purpose: The aim of was to identify and illustrate in what situations and with what qualities people with early RA experience participation in every day’s life.

 

Methods: Fifty-nine patients (age 18–63 years) were interviewed; 25 men and 34 women. Content analysis was used to identify meaning units that were sorted based on the type of situations described and later on, categories based on quality aspects of participation were developed.

 

Results: Participation was described as: 1. being part of a group, where a sense of belonging arose. 2. In doing activities with others for example at work or in leisure. 3. When sharing everyday chores and responsibilities for example in domestic duties. 4. When experiencing influence on actions such as when being asked for opinions on how to conduct a specific task. 5. When having the possibility to give direction of goals in rehabilitation, or elsewhere. 6. When sharing decision making and experiencing a high degree of influence in the situation.

 

Conclusions: Participation from an individual’s perspective is about belonging and having influence that mediates a positive feeling of being included and that you matter as a person. The results are important when using participation as a goal in clinical care. It is important to expand participation beyond the definitions in ICF and guidelines to include the patients’ socio-emotional participation in order to promote health.

Effect of Abacus Training on Numerical Ability of Students with Hearing Loss

JADHAV, Atul Kaluram
GATHOO, Varsha Shrikant
2018

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Purpose: The study focussed on the effect of Abacus training on numerical ability (comprising of counting and mathematical operations) of children with hearing loss.

 

Method: 90 students with hearing loss were sampled from 6 special schools in Mumbai, India. A quasi- experimental study was employed using two group pre-test and post-test design. Data were collected using the Numerical Ability Test (NAT) as an instrument. Six null hypotheses based on the objectives were formulated and tested at 0.05 level of significance using t-Test - Assuming Equal Variances.

 

Results: The findings revealed that the experimental group which was instructed through Abacus showed higher proficiency in numerical ability as compared to the control group instructed through the conventional method. Gender as a variable seems to influence the mean achievement of numerical ability of students with hearing loss. While girls and boys did not differ in simple tasks such as counting, boys were found to be better in mathematical operations and overall numerical ability.

 

Conclusions: The Abacus teaching method results in higher mathematical achievements among students with hearing loss. Gender also plays an important role in mathematical learning, as evidenced by boys demonstrating more numerical ability than girls in the study sample.

Cross-Cultural Adaptation and Evaluation of Psychometric Properties of Persian Version of Supports Intensity Scale among Adults with Intellectual and Developmental Disabilities

SALEHI, Sajed
JAVADIPOUR, Sheyda
NASSADJ, Gholamhossein
HAGHIGHI, Mohammad Hossein
SABOOR, Shiva
SHAKHI, Kamal
2018

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Purpose: This study was designed to translate and assess the psychometric properties of Supports Intensity Scale among adults with intellectual and developmental disability in Ahvaz and Tehran, Iran.

 

Method: The cross-sectional study was carried out in two stages. The first stage consisted of the forward-backward translation of Supports Intensity Scale - Adult Version) SIS-A(. In the second stage, 197 people with intellectual and developmental disabilities were recruited in order to assess the internal consistency and test-retest reliability, concurrent and content validity of SIS-A. The confirmatory factor analysis (CFA) was performed to approve the seven-factor model of the instrument.

 

Results: The intra-class correlation coefficient values varied between 0.85 and 0.99 (very good to excellent). All subscales of the SIS-A showed Cronbach’s alpha above 0.70. Correlation coefficient between SIS-A and Barthel index was about -0.65, which shows excellent concurrent validity of SIS-A. The findings showed SIS-A had high ability to discriminate between groups with different IQ (p<0.05). There was no significant correlation between SIS-A and the age of participants (p>0.05). The result of CFA confirmed that the seven-factor model of SIS-A is the fittest pattern for SIS-A.

 

Conclusion: The results indicated that the Persian version of SIS-A is a valid and reliable instrument to assess function and disability among people with intellectual and developmental disability.

Anticipated Barriers to Implementation of Community-Based Rehabilitation in Ribeirão Preto, Brazil

FIORATI, Regina Celia
CARRETTA, Regina Y Dakuzaku
JOAQUIM, Karine Pereira
PLACERES, Aline Ferreira
JESUS, Tiago Silva
2018

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Purpose: Disability is a global health and a global development concern. To address both issues, a community-based rehabilitation (CBR) approach is increasingly recommended to meet a spectrum of needs, especially for people with disabilities. It is first necessary to understand the perceptions of local, frontline providers, in order to design effective measures for implementing CBR programmes. This paper aimed to understand the conceptions of Primary Healthcare Providers (PHPs) - serving a sub-urban, socially-vulnerable territory in Brazil - about: 1) disability, 2) rehabilitation, and 3) the possible local implementation of a CBR strategy, including any anticipated barriers.

 

Method: Cross-sectional, exploratory qualitative research was based on focus groups conducted between 2013 and 2016. It involved a total of 78 PHPs serving the western region of the Ribeirão Preto municipality in São Paulo, Brazil. Data analysis was based on Habermas’ critical hermeneutics approach.

 

Results: PHPs understood disability mostly within the biomedical paradigm. Similarly, the predominant conception of rehabilitation was focussed on enabling individuals’ capacity, more than their environment. For local CBR implementation, the barriers that were anticipated were: 1) difficulties in managing and running action across sectors, and 2) the broader socio-political environment that hardly empowers civil society and is affected by power differentials.

 

Conclusion and Implications: While local PHPs identified important CBR implementation barriers which are contextual in nature, the predominant conceptions of disability and rehabilitation (i.e., biomedical, impairments-based) also act as a barrier. Contextual and cognitive barriers must both be addressed when envisioning a local CBR implementation

Participation Restriction due to Arm and Leg Motor Impairment after Stroke Rehabilitation in the Tamale Metropolitan Area, Ghana

TWUM, Frank
DOGBE, Joslin Alexander
EDUSEI, Anthony Kwaku
AMPRATWUM, Joseph
2018

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Purpose: The study was conducted to examine the relationship between arm and leg motor impairment in stroke survivors and participation restriction, post rehabilitation, within the Tamale metropolis.

 

Method: The participants were 102 stroke survivors from the Tamale metropolitan area, who had undergone at least 3 months of rehabilitation. Upper limb motor assessment was followed by lower limb motor assessment based on the Manual Muscle Test. Levels of participation restriction were measured using the London Handicap Scale. Correlation analysis of motor impairment and participation restriction were done using Spearman rank correlation analysis.

 

Results: The mean age of post-stroke participants was 62.08 years (95% CI= 59.77-64.39), with men comprising 67.65% and 32.35% women. The Spearman rank correlation co-efficient between arm motor impairment and participation was 0.8343, depicting a strong positive relationship between the aforementioned variables. The correlation between leg motor impairment and participation yielded 0.8013. Conversely, leg motor impairment was found to have a stronger relationship with participation restriction in comparison to arm motor impairment.

 

Conclusion and Implications: The strong relationship between limb motor impairment and participation restriction suggests that clinicians and disability experts involved in rehabilitation should take cognisance of the social implication of motor impairment in order to make informed decisions. Further to this, arm and leg assistive devices could be useful in reducing the levels of participation restriction among persons with stroke within the Tamale metropolis.

 

Limitations: A major limitation is that motor impairment was assessed solely on the ability to perform voluntary movement (muscle power). Sensory disturbances and motor coordination difficulties also have the potential to influence participation restriction, so the exclusion of stroke survivors who are unable to communicate implies that external validity of the research is limited.

Disability Inclusive Development Good Practices: Level of Commitment to Core Concepts of Human Rights

HENDERSON, Cheryl
MANNAN, Hasheem
POWER, Jessica
2017

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Aim: Good practices have been documented by International Non-Governmental Organisations (INGOs) to promote disability inclusive development and encourage the replication or scaling up of good practices that use rights based approaches. This study aimed to investigate the extent to which Core Concepts of human rights are illustrated in disability inclusive development good practices related to health.

 

Methods: This study analysed case studies of disability inclusive development good practices focusing on health that are available in the public domain using EquiFrame, an established content analysis framework in benchmarking health and social policies.

 

Results: A total of 42 health related good practices were identified from 3 different INGOs working in the field of disability inclusive development. The highest occurring human rights Core Concepts were; access 55%, individualised services 48%, capacity building 45% and participation 38%. The Core Concepts with the lowest levels of commitment were; autonomy 3%, cultural responsiveness 3%, accountability 3%, and efficiency 3%. Privacy and autonomy were not mentioned at all. The quality of reporting of the core concepts of human rights was low as they did not state specific programme actions or intentions to monitor Core Concepts.

 

Conclusion: Level of commitment to Core Concept coverage and quality of reporting was low. EquiFrame was successfully extended to analyse disability inclusive development good practices focusing on health. Its use in further analysis of inclusive good practice is advised.

 

Implications: These results can be used for advocacy in disability inclusive development and to guide programme staff training and documentation of disability inclusive development good practices.

Development and Standardization of a Test of Motor Proficiency in Children with Intellectual Disabilities in India

KALGOTRA, Ritu
WARWAL, Jaspal Singh
2017

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Purpose: To develop a scale for the assessment of gross and fine motor skills of the children with mild and moderate intellectual disabilities so that their skills could be assessed and accordingly interventions in physical activities could be specifically designed for them.

 

Method: Thirty-eight items for the Test of Motor Proficiency scale was developed after initial try out, pilot study and final try-out by the researchers. Fifty children with mild intellectual disabilities (n = 26), and moderate intellectual disabilities (n = 24) aged between 6 to 17 years fulfilling inclusion and exclusion criteria were selected from special schools in Jammu district, J&K (India).The Test of Motor Proficiency was administered on the selected sample.

 

Results: Internal consistency as calculated through Cronbach's Alpha was .906, indicating very good reliability. There was a highly significant correlation between the two independent assessments in inter-rater reliability r (48) = .95, p< .05 and  also within the domains of motor proficiency, Visual-Motor control r (48) =.728, p< .05, Upper limb speed and dexterity r (48) = .98, p< .05 , Running speed and agility r (48) =.99, p< .05, Bilateral coordination   r (48) =.96, p< .05, Strength r (48) =.95, p<.05, upper limb coordination r (48) =.62, p< .05. Concurrent validity of Test of Motor Proficiency was established against BASIC- MR; the correlation of BASIC-MR (M = 151.92, SD = 18.08, N = 50) and Test of Motor Proficiency (M = 49.22, SD = 12.23, N = 50) was highly significant r (48) = .76, p< .05. The construct validity assessed through test retest was r (48) =.97, p< .05.

 

Implications: The Scale can be used in the assessment of gross and fine motor skills of children with mild and moderate intellectual disabilities for clinical and research purposes.

The Impact of Community-Based Rehabilitation in a Post-Conflict Environment of Sri Lanka

HIGASHIDA, Masateru
2017

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Purpose: Conflict and disability are closely associated; it is therefore significant to examine strategies at the grassroots-level for restoring the human rights of people with disabilities living in post-conflict societies. The aim of this study is to reveal the impact of and issues with community-based rehabilitation (CBR) in the Northern Province of Sri Lanka that was ravaged by civil war from 1983 to 2009.

 

Methods: The research was implemented in October 2016, in collaboration with a local NGO in the Mullaitivu district. A mixed-methods approach was followed, which included quantitative analysis of the NGO’s registration database of people with disabilities in the area (n=964), group interviews with 9 community rehabilitation committees (CRCs) of people with disabilities and their family members (n=118), and semi-structured interviews with clients of the CBR programme (n=5). Thematic analysis was applied to the narrative data.

 

Results: The quantitative analysis on clients of the NGO revealed that 60.9% of disabilities were related to war. Livelihood assistance was the most common type of self-reported need (44.6%). The qualitative analysis revealed that in communities with inadequate local resources, CRCs that had access to livelihood assistance made a positive impact on the socioeconomic conditions of people with disabilities and their family members. Potential issues were observed, such as the expectation of and dependence on the financial aid without self-help. Some people with disabilities would not attend CRCs if there were no financial benefits. As most of the participants had war-related disabilities, it is also possible that participation of people with intellectual and psychiatric disabilities unrelated to war may not have been promoted in some CRCs.

 

Conclusions: The CBR programme has had positive impacts on the living conditions of participants, albeit with some potential issues such as financial expectations and aid dependency. The authors argue that empowerment of people with disabilities and addressing socioeconomic inequality should be considered simultaneously.

Gendered experiences of physical restraint on locked wards for women

FISH, Rebecca
HATTON, Chris
2017

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Physical restraint is used in inpatient services for people with intellectual disabilities as a way of holding a person to avoid injury. This article uses data from an ethnographic study in a locked unit in the north of England to explore women’s experiences of physical restraint using a feminist disability studies analysis. Data consists of field notes as well as interviews with 16 of the women who had experienced restraint, and 10 staff who worked with them. The women gave insights into the gendered phenomenon of restraint in light of their past experiences of violence. The authors argue that restraint is used with women to encourage passivity at times when more relational and therapeutic methods could be used. The article offers recommendations for alternative strategies that services can encourage.

Preparation of students with disabilities to graduate into professions in the South African context of higher learning: Obstacles and opportunities

NDLOVU, Sibonokuhle
WALTON, Elizabeth
2016

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Background: Persons with disabilities continue to be excluded from professions in South Africa despite legislation on non-discrimination and equity. Objectives: We sought to identify both the opportunities and obstacles that students with disabilities face in professional degrees.

 

Method: Selected texts from the South African and international literature were analysed and synthesised.

 

Results: Students with disabilities are afforded opportunities to graduate into professions through the current climate of transformation, inclusion and disability policies, various support structures and funding. These opportunities are mitigated by obstacles at both the higher education site and at the workplace. At university, they may experience difficulties in accessing the curriculum, disability units may be limited in the support they can offer, policies may not be implemented, funding is found to be inadequate and the built environment may be inaccessible. Fieldwork poses additional obstacles in terms of public transport which is not accessible to students with disabilities; a lack of higher education support extended to the field sites, and buildings not designed for access by people with disabilities. At both sites, students are impacted by negative attitudes and continued assumptions that disability results from individual deficit, rather than exclusionary practices and pressures.

 

Conclusion: It is in the uniqueness of professional preparation, with its high demands of both theory and practice that poses particular obstacles for students with disabilities. We argue for the development of self-advocacy for students with disabilities, ongoing institutional and societal transformation and further research into the experiences of students with disabilities studying for professional degrees.

Discourses of service user involvement in meeting places in Norwegian community mental health care: a discourse analysis of staff accounts

YNNESDAL HAUGEN, Lill Susann
ENVY, Andreas
BORG, Marit
EKELAND, Tor-Johan
ANDERSSEN, Norman
2016

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In previous research, meeting places have been favourably addressed by service users, but they have also been contested as exclusionary. In this participatory explorative study, we sought to perform a contextual analysis of meeting places in Norway based on a discourse analysis of three focus group discussions with 15 staff members. We asked the following question: how do meeting-place employees discuss their concrete and abstract encounters with service users and their experiences? We focused on service user involvement, which was largely analysed as neoliberal consultation and responsibilisation. Service users were positioned as resisting responsibility trickling down and defending staffed meeting places. Social democratic discourse was identified in the gaps of neoliberal discourse, which is noteworthy given that Norway is a social democracy. This relates to global concerns about displacements of democracy. We suggest that meeting places appear to hold the potential for staff and service users to collaborate more democratically.

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