Katrina Scior

Public awareness, attitudes and beliefs regarding intellectual disability: a systematic review.

The general publics responses to people with intellectual disabilities influence the likely success or failure of policies aimed at increasing their social inclusion. The present paper provides a review of general population based research into awareness, attitudes and beliefs regarding intellectual disability published in English between 1990 and mid-2011. An electronic search using PsycINFO and Web of Science plus a hand search of the literature was completed. Most of the 75 studies identified consisted of descriptive surveys of attitudes. They tend to conclude that age, educational attainment and prior contact with someone with an intellectual disability predict attitudes, while the effect of gender is inconsistent. Eight studies examined lay knowledge about intellectual disability and beliefs about its causation in a range of cultural contexts. The impact of interventions designed to improve attitudes or awareness was examined by 12 studies. The evidence is limited by the fact that it is mostly based on relatively small unrepresentative samples and cross-sectional designs. It is concluded that overall, high quality research into general population attitudes to intellectual disability is limited. Public knowledge of intellectual disability and causal beliefs are particularly under-researched areas. There is a notable absence of well designed evaluations of efforts to reduce misconceptions about intellectual disability and tackle negative attitudes. Areas for future research are noted, including the need for well designed studies that consider awareness, attitudes and beliefs in relation to stigma theory.

Using discourse analysis to study the experiences of women with learning disabilities

There has been a steady rise in interest in qualitative research methods in the area of learning disability over recent years. Discourse analysis has found relatively little use though, particularly in studying the experiences of people with learning disabilities directly, rather than the accounts of non-disabled informants. The present study used a discourse analytic approach in examining the accounts of women with learning disabilities, in order to arrive at an understanding how they position themselves in relation to gender and disability. The results indicate that, while the learning disability literature and services are largely ‘gender blind’, for women with learning disabilities gender and disability cannot be separated. Instead, they may be faced with marked contradictions and dilemmas when they position themselves within dominant discourses of gender, while also subject to powerful discourses of disability.

Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers

Background People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. Method and Main Findings Twenty nine participants (14 patient and carer dyads, and one carer) took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. Conclusion Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability.

Public Attitudes Toward People With Intellectual Disabilities: A Cross-Cultural Study

This study investigated attitudes toward people with intellectual disabilities among the general Hong Kong Chinese population and compared these to a White British sample, using the Community Living Attitudes Scale-Mental Retardation form (CLAS-MR; D. Henry, C. Keys, F. Balcazar, & D. Jopp, 1996 ). As predicted, attitudes among the Hong Kong Chinese public (n = 149) were less favorable than the British sample (n = 135). The former were less opposed to the exclusion of people with intellectual disabilities, less likely to view them as similar to themselves and more in favor of sheltering such individuals. Of all demographic variables examined, ethnicity was the strongest predictor of attitudes, although it only accounted for a small part of the variance in attitudes. The results are discussed in terms of policy implementation and additional research.

Bipolar disorder and stigma: a systematic review of the literature.

AIM The degree to which bipolar disorder is stigmatised by the public and the extent of internalised stigma for people with this disorder, their families, and carers has been a relatively neglected area of research. This review aimed to determine what is currently known about stigma and bipolar disorder. METHOD A systematic search of the literature was conducted to identify publications which investigated public attitudes and/or beliefs about bipolar disorder or explored internalised stigma in bipolar disorder. The electronic databases PsychINFO, Medline, Embase, and Web of Science were searched for articles published between 1992 and 2012. RESULTS Twenty five articles met the reviews inclusion criteria. There are inconsistent findings regarding public stigma, although there is some evidence that bipolar disorder is viewed more positively than schizophrenia and less positively than depression. There is a moderate to high degree of internalised stigma in bipolar disorder, although the literature raises questions regarding its ubiquity in this population. LIMITATIONS Limiting the search by year of publication and excluding studies where stigma was not the main focus could mean stigma has wider implications than were identified. CONCLUSIONS This review is the first systematic synthesis of research relating to stigma and bipolar disorder. In comparison to research on other mental health problems, there is a dearth of literature exploring stigma in bipolar disorder. The literature is largely inconclusive. Future research is needed to replicate tentative findings and address methodological limitations before the field can move on to the development of anti-stigma interventions.

Stigma, public awareness about intellectual disability and attitudes to inclusion among different ethnic groups.

BACKGROUND Attitudes to the inclusion of people with intellectual disabilities (IDs) have been studied extensively, yet evidence on public awareness about ID and stigma is limited. The relationship between attitudes, knowledge and stigma associated with ID is poorly understood. The present study examined these factors and the relationships between them in the context of a multicultural society. METHOD UK residents of working age (n = 1002) were presented with a diagnostically unlabelled vignette of someone with a mild ID. They were asked to label the difficulties presented and to complete measures of social distance and attitudes to the inclusion of people with IDs. RESULTS While attitudes to the inclusion of people with IDs were relatively positive overall, social contact was viewed with ambivalence. Inclusion attitudes and social distance were only moderately correlated. Across the whole sample 28% recognised typical symptoms of mild ID. Recognition of ID was associated with lower stigma and more positive attitudes than attribution of the difficulties presented to other causes. White Westerners showed increased knowledge, lower stigma and favoured inclusion more than participants from ethnic minorities. Among the latter group, Asians showed lower stigma and attitudes more in line with inclusion policies than participants of Black African/Caribbean backgrounds. Once a host of contextual factors were considered jointly, only contact was consistently associated with the variables measured. CONCLUSIONS Stigma associated with ID is of concern across all ethnic groups, although it appears to be increased among the public from ethnic minorities. Given that contact and awareness are associated with reduced stigma, they should be considered as prime foci for efforts to tackle ID stigma. The current findings serve as baseline for attempts to increase public awareness and tackle stigma.

People with profound and multiple learning disabilities : a collaborative approach to meeting complex needs

Introduction - collaborative working with people with profound and multiple learning disabilities personal - personal needs and independence, medical aspects, physical management, sensory needs social - relationships, communication, sexuality, challenging behaviour learning and development - foundations of learning and development, teaching and learning, learning environments, person-centred planning community - working with families, advocacy and empowerment, integration and ordinary lifestyles, cultural issues, leisure and the arts, community-based rehabilitation in the developing world.

Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity

Introduction Loneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England. Method An inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed. Results Participants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity. Discussion It is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples’ beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided.

Interventions aimed at increasing knowledge and improving attitudes towards people with intellectual disabilities among lay people.

Despite policies aimed at ensuring equal rights and maximising respect and social inclusion for people with intellectual disabilities, in their daily lives many continue to face negative attitudes and discrimination within society. Misconceptions about what it means to have an intellectual disability and about the capabilities of people with intellectual disabilities appear widespread, and may contribute to prejudice and discrimination. This review provides a summary and evaluation of empirical interventions aimed at increasing knowledge and targeting negative attitudes towards this population among lay people of working age. An electronic search using PsycINFO, Web of Science and PubMed identified 22 English language studies published between 1990 and early 2014 that reported a specific intervention with a lay population sample. The majority of studies reported promising outcomes, particularly those aimed at increasing knowledge of intellectual disability through education. Support for the positive influence of contact with people with intellectual disabilities was demonstrated across several interventions. Interventions delivered at least partly by individuals with intellectual disabilities, and educational interventions appear to hold the most promise. The evidence is limited though by the weaknesses of measurement tools employed.

Tackling stigma associated with intellectual disability among the general public: a study of two indirect contact interventions.

Although evidence abounds that people with intellectual disabilities are exposed to stigma and discrimination, few interventions have attempted to tackle stigma among the general public. This study set out to assess the impact of two brief indirect contact interventions on lay peoples inclusion attitudes, social distance and positive behavioral intentions, and to explore emotional reactions towards the two interventions. 925 participants completed the first online survey. Participants were randomized to watch either a 10 min film based on intergroup contact theory, or a film based on a protest message. In total, 403 participants completed the follow-up survey at one month. Both interventions were effective at changing inclusion attitudes and social distance in the short term and these effects were partially maintained at one month. The protest based intervention had a greater effect compared to the contact one on aspects of inclusion attitudes and evoked stronger emotional reactions. Despite small effect sizes, brief indirect contact interventions may have a potential role in tackling public stigma associated with intellectual disability but their effects on behavioral intentions are questionable.