Exploring the attitudes and knowledge of support workers towards individuals with intellectual disabilities Natalie S Golding

Journal of Intellectual Disabilities 2015, Vol. 19(2) 116–129 ª The Author(s) 2014 Reprints and permission: DOI: 10.1177/1744629514563777

The University of Birmingham, UK

John Rose The University of Birmingham, UK Date accepted: 14 November 2014

Abstract Background: The aim of this study is to explore support workers’ attitudes and knowledge towards individuals with intellectual disabilities (IDs) to see whether a new attitude scale needs to be developed. Method: Support workers from a charitable organization located in the West Midlands in the United Kingdom participated in one of four focus groups conducted in late 2013. Thematic analysis was then conducted which identified the emergent themes from the focus groups. Results: Five themes emerged from the analysis, namely, discrimination of people with IDs, attitude change, impacts of integration, their role as a carer and the impact of training. Only one theme, ‘the impacts of integration’, is clearly represented in current attitude scales; ‘their role as a carer’ and ‘discrimination of people with IDs’ are partially represented. Conclusion: These results suggest that current attitude scales do not accurately measure the attitudes of support workers; therefore, a modified attitude scale could be developed to incorporate findings from this study. Keywords attitudes, intellectual disability, knowledge, learning disability, support workers

An intellectual disability (ID) has been defined as a having three core components, namely, ‘significant impairment of intellectual and social functioning, acquired before adulthood’ (p. 4) (British Psychological Society, 2000). The lives of people with IDs and their families have always

Corresponding author: John Rose, School of Psychology, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. Email: [email protected]

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been affected by the way they are perceived and treated by the communities in which they live (Cummins and Lau, 2003). From a historical perspective, public and private attitudes towards individuals with ID have been one of intolerance and a lack of understanding. Brodwin and Orange (2002) have demonstrated how negative social attitudes block the integration of people with ID into society which can negatively impact upon on their education, employment, housing and health. Valuing People (Department of Health, 2001) and Valuing People Now (Department of Health, 2009) have promoted the right of individuals with IDs to live as equal citizens in the community. As a result of a recent investigation into abuse in a hospital setting in the United Kingdom, there has been a renewed impetus for people with IDs to live in the community (Department of Health, 2012). This has led to greater integration into the community which has subsequently increased awareness and improved understanding of individuals with IDs in society. Research has shown that improved understanding has encouraged more positive attitudes (Deal, 2006; Scior, 2011). Pre-existing literature investigating attitudes towards individuals with ID has focused on healthcare professionals such as general practitioners (GPs), nurses and also students (Gill et al., 2002; Klooster et al., 2009). Howells (1986) suggested that negative GP attitudes towards patients with ID can impede the health care that they receive. In light of this, Gill et al. (2002) investigated GPs’ attitudes when working with patients with ID. They found that whilst GPs held positive attitudes to working with patients with ID, they were less willing to adapt services to meet the specific needs of individuals with ID. This may be explained by Day and Jancar (1994) who describe a possible reluctance by doctors to provide medical treatments to those with ID because their behaviour is perceived as too difficult to control. Gill et al.’s (2002) findings may also be attributed to a lack of knowledge and understanding from health-care professionals. It is possible that this could explain the increased number of deaths of people with ID reported in general hospitals highlighted by MENCAP (2012). That research highlights the importance and necessity of investigating attitudes to ensure patients with ID have access to the same health-care services as the general population. Whilst research into the attitudes of support workers is somewhat limited, Bigby et al. (2009) explored the attitudes of support workers towards the application of current policies to individuals with severe IDs. They combined data from an action research study (participant observation) and a questionnaire to conclude that although support workers accept the goals of inclusion, active participation and choice within current policies, some staff felt that it was not achievable in people with more severe IDs. The reasons staff gave to support their views ranged from negative attitudes from the community towards the individuals with IDs to characteristics of the residents such as age and their mental capacity. The Mental Retardation Attitude Inventory (MRAI; Antonak and Harth, 1994) is an established attitude scale used to measure attitudes towards people with IDs. The four aspects included in the scale are the degree to which those with IDs should be integrated into the community, the degree to which people with and without IDs should associate with each other, the degree to which the rights of people with IDs should be upheld and lastly the beliefs about the social behaviour of people with IDs. McManus et al. (2011) used the MRAI scale to determine whether contact and knowledge are predictors of students’ attitudes towards individuals with IDs and which variable has the greatest influence. Based on Allport’s (1954) contact hypothesis, it could be predicted that students will have more positive attitudes towards individuals with IDs if they have more contact with that social group and greater knowledge. However, McManus et al. (2011) highlight that mere contact with individuals with IDs may not always have a positive outcome and therefore distinguish between

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quality and quantity of contact, suggesting that the quality of contact may be a more significant predictor of attitudes. Quality of contact is operationalized as the positivity or negativity of the experiences that one has with people with IDs, therefore, if a person has negative experiences with individuals with IDs, their attitudes are more likely to be negative. On the contrary, if a person has positive experiences with individuals with IDs, their attitudes are more likely to be positive. Their claim was supported as they found that only quality of contact was important in predicting attitudes with findings indicating that the more positive the experience, the more positive the students’ attitudes were. McManus et al. (2011) do, however, acknowledge an interaction between quality and quantity of contact; the probability of someone experiencing a positive interaction will be reduced the less they interact with an intellectually disabled person or if most of the interactions are negative. Like the MRAI-R, the Community Living Attitudes Scale–Mental Retardation form (CLASMR; Henry et al., 1996) also measures attitudes towards ID in four subscales, namely, empowerment, exclusion, sheltering and similarity. Empowerment reflects the view that people with IDs should actively make decisions, whilst exclusion suggests people with IDs should be socially excluded. Sheltering suggests protection from the risks of community life and similarity measures the extent to which a respondent views someone with IDs as similar to themselves. The CLAS-MR has distinct advantages over previous measures in that it still assesses attitudes closely in agreement with values found in current policies such as the White Paper Valuing People (2001) and its reliability and validity has been confirmed in a number of studies (Henry et al., 1996; Yazbeck et al., 2004). Klooster et al. (2009) used the CLAS-MR to assess nursing students’ attitudes towards people with IDs and compared it with the attitudes held by their non-nursing peers. They found that nursing students were more likely to support similarity and reject exclusion of people with IDs and they attributed this to the positive interactions between the nursing staff and people with IDs. Flatt-Fultz and Phillips (2012) proposed that training can improve attitudes towards the empowerment of individuals with IDs and found that support workers who viewed a brief video about individuals with IDs in empowering roles had more favourable attitudes towards the empowerment of individuals with IDs than those who did not view the video. Yazbeck et al. (2004) used the CLAS-MR and the MRAI to investigate attitudes towards people with IDs among students, disability service professionals (DSPs) and the general population. They found that compared to the general population, DSP and students deemphasized the necessity to shelter individuals with IDs, supported similarity, rejected the exclusion of people with IDs from society and acknowledged the importance of empowering individuals. Similarly, DSP and students reported more support for integration and the rights of individuals with IDs and held significantly less derogatory opinions about individuals with IDs. Ouellette-Kuntz et al. (2010) report similar findings using the Social Distance subscale of the Multidimensional Attitude Scale on Mental Retardation (Harth, 1971). Social distance refers to a willingness to recognize, live near or be associated with a certain individual or group (Harth, 1971). They found that older participants were more likely than younger participants to support a higher social distance between themselves and individuals with ID; whilst less educated participants desired social distance compared with highly educated participants. They concluded that whilst several participant characteristics remained relevant in today’s society when predicting social distance attitudes, the scale lacks sensitivity as the nature of the items prevents accurate discrimination of social distance attitudes in the current context of political correctness. It is important to acknowledge that the attitude scales discussed have been available for almost 20 years, and whilst it has been argued that societal attitudes have remained stable over time

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(McCaughey and Strohmer, 2005), recent research suggests that existing questionnaires are not reflecting the attitudes of student populations (Patel and Rose, 2014). Since support workers are an important group who are responsible for promoting independence as well as empowering and integrating individuals with IDs into the community, it would be beneficial to investigate their attitudes to see whether current attitude scales accurately reflect the attitudes of a group who have extensive contact with individuals with IDs.

The aim The aim of this study is to explore support workers’ attitudes and knowledge towards individuals with IDs. By running focus groups, support workers’ attitudes can be explored and compared with the items measured in current attitude scales to see whether a new attitude scale needs to be developed which directly measures attitudes of support workers.

Method Participants The participants were support workers sometimes known as residential care workers in the United Kingdom. The charitable organization they worked for characterized the role of the support worker as an employee whose role was to enable each person to exercise as much control as possible over their lives to be as independent as possible and to enjoy a wide range of rewarding and varied experiences. All the workers interviewed in this study worked in small residential homes which had between five and seven residents. A total of 20 support workers volunteered to participate in the study, of which 10 were females. The age of participants ranged from 21 to 61 years (Mage ¼ 38.5 years). The number of years working for the organization ranged from 2 months to 25 years (Myears ¼ 9.1 years). Seventeen participants described themselves as White British, one Chinese, one Afro-Caribbean and one of mixed race. The sample was made up of staff from four different care homes within the same organization. None of the group had a professional qualification but all participants had received mandatory training which included deaf blind awareness, Mental Capacity Act, equality and diversity, sexuality and relationships, non-crisis intervention and communication training. Participants were recruited using posters placed in four residential care homes.

Developing the focus group Focus groups were chosen as the method of data collection because of the exploratory nature of the study. The support staff also represented an existing group with a common interest, and it has been shown to be useful to work with pre-existing groups, especially those who work together on a regular basis as was the case for the individuals who worked in the same house (Kitzinger, 1994). An advantage of this method is that it will yield rich, in-depth qualitative data regarding the attitudes of support workers (Braun and Clark, 2006). In preparation for developing the questions for the focus groups, every effort was made to minimize the bias on participant answers by examining past literature on attitudes towards ID along with current attitude scales to identify areas of interest which were then transformed into open questions (Table 1).

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Table 1. Structure of questions. Basic structure of questions 1. 2. 3. 4. 5. 6. 7. 8. 9.

In general, how do you view individuals with an intellectual disability? What impact can integrating an individual with an intellectual disability into the community have on the person and society? To what extent do you believe an individual with an intellectual disability can be independent? To what extent do you believe individuals with intellectual disabilities are similar to yourself Is it possible to offer individuals choices in everyday life and when making life-changing decisions? Have your attitudes and behaviours towards individuals with intellectual disabilities changed since working with them? Do you think that the training you have received has changed the way you view individuals with an intellectual disability? Do you think individuals with intellectual disabilities still experience negative stigma from the general public? Do you think it is possible to change the way in which the public perceive individuals with intellectual disabilities?

Setting Four focus groups took place in a meeting room within one of the care homes. One of the researchers led the focus groups and acted as the facilitator. Each focus group had between four and six participants and discussions lasted between 45 min and 50 min.

Procedure Before the focus groups commenced, participants sat around a table and were given an information sheet outlining the study and their rights. They then signed a consent form and completed a demographic questionnaire. Each discussion was recorded. During the sessions, a standardized set of questions was used to ensure consistency between each group. The questions started with a general overview of how staff viewed individuals with IDs progressing onto more specific questions through the use of probes.

Data analysis The recordings from each focus group were downloaded onto a computer and transcribed verbatim. Thematic analysis was carried out, as it allows the researcher to identify broad themes within a qualitative data set and exploration of the data in a flexible way (Braun and Clark, 2006). Thematic analysis was also chosen, as it allows the researcher to focus on patterned meanings across a larger data set. The approach used was based on Braun and Clark’s (2006) six-step method. The first step in the analysis was to transcribe the data into written form and then read through the transcripts six times to become familiar with the breadth and depth of the data. After this, the data were organized into meaningful groups, and initial codes were produced by adopting an inductive, data-driven approach. Phrases were highlighted, which reflected the beliefs held by support workers. Themes were then created based on codes that had been grouped together with shared similar meanings. After the initial themes had been produced, they were reviewed under investigator triangulation.

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Figure 1. The five main attitude themes and sub-themes.

Investigator triangulation involves another researcher checking the validity of the interpretations drawn from the data regarding the formation of the themes. During this process, some subthemes were excluded due to a lack of supporting evidence, whilst other sub-themes were combined to produce more coherent themes. These changes resulted in a broader agreement between researchers which increased the validity of the themes. The themes were then labelled with names that summarized the essence of what the themes were about. Ethical approval was obtained from the University Ethics Committee and then permission was granted by the organization to interview their employees for the study.

Results The themes were grouped into a diagram displaying the five emergent themes and their sub-themes (Figure 1) and a table which showed the frequency of quotes which related to each theme (Table 2).

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Table 2. The frequency of quotes relating to each theme and sub-themes. Themes and sub-themes

Frequency of quotes for each theme

Discrimination of people with ID Negative Positive Attitude change Attitude change in society With age Personal attitude change Impacts of integration Positive impacts for the individual Negative impacts for the individual Positive impacts for the society Negative impacts for the society Their role as a carer To promote independence/empowerment To protect The impact of training

51 40 11 36 13 12 11 34 15 5 10 4 23 16 7 15

Note: ID ¼ intellectual disability.

Themes This study aimed to explore support workers’ attitudes towards individuals with IDs, and by applying thematic analysis, five attitudes themes have emerged. They are discrimination of people with ID, attitude change, impacts of integration, their role as a carer and the impact of training. Each emergent theme shall now be discussed and example quotations will be provided to support the findings. Theme 1: Discrimination of people with ID. It was evident from each focus group that support workers still felt that individuals with IDs were discriminated against by society. The majority of comments made were negative and referred to the members of society either being verbally discriminative, such as making comments, or discriminating in terms of their actions, such as staring and making obvious attempts to move away. The general consensus was that support workers felt that members of the public see individuals with IDs as nuisances with (nothing going on in their brains) (Table 3). Support workers attributed this negative discrimination to society’s lack of knowledge and understanding and in some cases, ignorance on the part of society. There were, however, examples of when positive discrimination had taken place, such as when staff at leisure centres were more polite towards the individual with the ID than the support worker assisting that individual. In addition, one support worker spoke of jobs that are created specifically for individuals with IDs under the ‘access to work scheme’. Theme 2: Attitude change. When analyzing the transcripts, it seemed that there were three variables that influenced attitude change, namely, experience, time and age. Most staff agreed that working with individuals with IDs and gaining experience had made their attitudes more positive. For example, staff reported that prior to working with such individuals, they believed individuals with

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Table 3. Quotes representing discrimination towards individuals with an ID. Negative discrimination

Positive discrimination

‘People presume that there is nothing going on in ‘I find that the staff are more polite towards them than they are towards us and the public, we went the brain’ (T1-K). somewhere the other day and the staff there were ‘There’s loads of incidents, people have left the really good with our residents but I know when I’ve swimming pool when we’ve got in and you know been in there they haven’t been that nice to me’ it’s deliberate’ (T3-G). (T4-F). ‘Or in restaurants, people deliberately move tables just to get away’ (T3-L). Note: T# ¼ transcript number; capitalized letter: participant.

Table 4. Quotes representing attitude change. Personal attitude change

Attitude change in society

‘Well in all honesty before, I saw them ‘But you know in the 20 years I’ve worked here, I’ve seen a change in as vegetables, in all honesty, they both the individuals we work with would be sitting there dribbling, and and the people that perceive them, it wasn’t until my first day through things have definitely improved the doors, meeting the guys, and I (T2-R). was just like Jesus! It just opened my eyes’ (T2-N). ‘I was scared to speak to them. I wouldn’t of approached them cos I didn’t know how to. The more I work with people the more I understand them, their thinking and understanding’ (T1-C).

Attitude change with age ‘The kids are usually more understanding than the parents’ (T3-B). ‘With kids, it’s easier to change their mind’ (T3-L).

IDs did not have the ability to be independent and were like ‘vegetables’ (Table 4). Staff also admitted that they had also been too scared to speak to such people within the community before working with them due to a lack of knowledge. Beliefs about attitude change in society yielded mixed beliefs. Whilst some staff felt that things have improved within the past 20 years for people with ID, others felt that attitudes have not changed and that society is still judgemental. Support workers also discussed the differences in attitudes between children and adults. Whilst staff acknowledged that children can be quite cruel, laughing at individuals with IDs, they also expressed how, compared with adults, children are more understanding and inquisitive. Staff felt that adults, on the other hand, are less understanding and more judging. Theme 3: Impacts of integration. Support workers’ attitudes towards integration were generally positive and it was believed by most that both the individual with IDs and society would gain from integration. Some of the positive impacts on the individuals that were discussed included empowering the individual and promoting their independence. This could be achieved by generating more opportunities to do things and creating new experiences. Staff also suggested it would

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Table 5. Quotes representing beliefs about the impacts of integration. Positive impacts

Negative impacts

For the individual: For the individual: ‘Yeah people do tend to label or they get stared at ‘It empowers them’ (T1-L) which can make, if they are aware that they are ‘and promotes their independence’ (T1-K) being stared at, can, erm, make them feel ‘More opportunities to do things’ (T2-N) uncomfortable and as a result they then play up’ ‘Yeah of course. New experiences’ (T2-F) (T1-K) ‘He has built up a good relationship with the people in the church and the staff have and when he goes there, nobody treats him any different because of who he is, he just treated as one of the congregation and he’s involved as much as possible’ (T4-M) For society: For society: ‘Yeah because if you release some of these people ‘I think it would increase their knowledge through onto the street without proper medication and positive experiences, meeting people, getting to support they could do harm to society, like one know them as individuals’ (T2-L) of the girls who got killed in Birmingham’ (T3-C)

help individuals with IDs to feel part of society and not left out. This belief was reinforced by an example of one individual being treated as part of the congregation at their local church, after making regular visits (Table 5). Staff also felt society would benefit by increasing their awareness of individuals with IDs, which in turn would increase their knowledge. Staff referred to discrimination as being the main negative impact from integration experienced by the individual. When directly asked, support workers discussed the potential harms to society by integrating individuals with IDs into the community, which were physical harm if an individual was not properly supported or on the right medication and the public feeling intimidated or frightened. Theme 4: Their role as a carer. Despite not being asked specifically about their role as a support worker, many participants spoke of what they perceived their role to be to promote independence/ empowerment and to protect. It is not surprising that staff identified with a caring role similar to that of many family carers. Some staff felt that it was their job to give individuals with IDs the opportunity to be independent and enhance their skills so that they would be able to achieve things. Generally, staff believed it was possible to offer individuals with IDs choices in everyday life, as long as the individual had the capacity to make an informed choice. This, in turn, would empower the individual, respecting their rights to choice and living their life to their full capacity. However, some support workers felt that promoting empowerment and independence did need to be balanced by protection. For example, one staff member said that support workers have to give the people they support as much choice as possible without putting them at risk (Table 6). Staff also admitted that they do become over protective of the people they support, trying to ensure they remain safe and believe that this is due to their vulnerability. Theme 5: Impacts of training. All the support workers who had participated in the study spoke very positively of the training that they had received, claiming that it was very informative. The training

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Table 6. Quotes representing the support workers’ perception of their role as a carer. To promote independence/empowerment

To protect

‘Giving them as much choice as possible without ‘I try to improve and enhance their skills and putting them in any risk’ (T1-K) knowledge to the best of their abilities and ‘I think you become very protective over them as well understanding’ (T4–F) because they are vulnerable. You do stick up for ‘Yeah I think it’s important to give the people, the guys them and don’t want people to say bad things about we support, the opportunity to be as independent them’ (T3-B) as they can possibly be, so, it gives them that opportunity cos that develops their skills’ (T4-G)

Table 7. Quotes representing attitudes towards training. Impacts of training ‘It teaches you how to support them and deal with ‘And how to develop, encourage independence and bring out the best in people and how to support behaviours and how to communicate effectively individual disabilities’ (T2-L) and helps you understand why they behave the way they do and recognising signs of anxiety’ (T1–S)

that the support workers had received provided knowledge of policies and procedures, which they felt had made them more professional by improving their work practice. Staff also agreed that training provides you with an in-depth understanding of why individuals with IDs behave the way they do and how best to develop, support and bring out the best in the people (Table 7). The support workers also felt training reveals the importance of being consistent in your work practice and provides the opportunity to share experiences, which staff felt was very beneficial.

Discussion This study explored the attitudes and knowledge of support workers towards individuals with intellectual disabilities which led to the emergence of five attitude themes. After comparing these themes with the items in current attitude scales such as the CLAS-MR (Henry et al., 1996) and the MRAI (Antonak and Harth, 1994), it seems that only one theme, ‘the impacts of integration’, is sufficiently represented. The themes ‘their role as a carer’ and ‘discrimination of people with ID’ are only partially represented, which suggests a modified attitude scale needs to be developed that accurately measures the attitudes of support workers. The attitude theme impacts of integration is most adequately represented in both the CLAS-MR and the MRAI. The subscales that correspond to this theme are exclusion in the CLAS-MR and integration in the MRAI. An example item from the CLAS-MR that reflects support workers’ attitudes towards integration is ‘Without some control and supervision, people with mental retardation could get in real trouble out in the community’. This item measures the belief found in this study that support workers feel that potential harms to society, as a result of integration, may occur if individuals with IDs are not supported properly. The MRAI also contains items referring to integration, in particular, the item ‘Having people who have IDs and who do not have IDs work at the same jobsites will be beneficial to both’ reinforces the belief of support workers that individuals

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with IDs have ‘a lot to offer to society, a lot of values and qualities’ (T2-L). Whilst the attitude scales measure attitudes towards integration, evidence has shown that support workers may act as barrier to social inclusion if they do not allow the individual the opportunity to go out into the community (Abbott and McConkey, 2006). Therefore, attitude scales may need modifying to assess the reasons for this so that solutions for this perceived barrier can be developed. The theme ‘their role as a carer’ is only represented in the CLAS-MR. An item that demonstrates a support worker’s role is ‘The rights of people with mental retardation are more important than professional concerns about their problems’. This item reflects the finding that support workers feel their role is to promote empowerment by upholding the rights of individuals with ID whilst also protecting them from risks, such as to their health. This supports Yazbeck et al. (2004) who found that disability workers acknowledged the importance of empowering individuals and upholding their rights and Kroese et al. (2013) who discovered that support workers emphasize the importance of allowing service users to gain independence by placing them central to all decisionmaking. Thus, from the evidence, it seems that support workers hold positive attitudes towards individuals with IDs. It is important that support workers’ attitudes towards their role as a carer are measured as it has been shown that staffs’ attitudes affect the people with intellectual disabilities’ quality of life (Kroese et al., 2013). By including items in an attitude scale that measure attitudes towards their role, it can be seen whether any guidance or training is needed to enhance support workers’ delivery of services, which promote empowerment and independence. Both the CLAS-MR and MRAI make reference to discrimination. Within the MRAI, the item ‘I would rather not have a person who has ID swim in the same pool that I swim in’ reflects one support worker’s claim that members of the public leave the pool if individuals with IDs go swimming. Support workers also felt that members of the public see individuals with ID as nuisances. This view is measured by the CLAS-MR in the item ‘People with mental retardation are a burden on society’. Since discrimination still appears to be prevalent in society, developing items to assess support workers’ beliefs about discrimination may be vital when developing solutions to overcome discrimination as this information can be used to educate society about IDs. Although training emerged as a theme, there is no reference to this within the attitude scales. Support workers felt that the training they had received was very informative, providing them with knowledge and understanding on how to support individuals with IDs, which in turn promoted positive attitudes. This supports Wong and Wong (2008) who claim that training increases staffs’ knowledge and enhances their skills and attitude. Due to the importance of training for support workers and the impact it has on individuals with IDs, it would seem valuable to modify attitude scales so that they measure the impact of training. In this way, service providers can determine whether current training programmes encourage staff to adopt positive attitudes by increasing their knowledge and understanding. Similarly, the process of attitude change is not measured in any of the current attitude scales. This theme would benefit from inclusion in attitude scales so that agencies such as the government and service providers are able to see what factors influence attitude change. For example, support workers believe that experience is important in changing attitudes as it increases people’s knowledge and understanding. Therefore, by assessing these factors in an attitude scale, the government or organizations, such as schools, may be able to develop policies or educational schemes in an attempt to improve societal attitudes towards individuals with IDs. Whilst analysing the data, it became apparent that there were certain links between the themes (Figure 2). It is worth noting that whilst these links are interesting, they are tentative and further research is required. The data obtained from this study could be used to design an experimental

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Figure 2. A diagram representing how the main attitude themes are linked together.

study looking into these connections. For example, a study that compares the attitudes of support workers before and after training would be able to determine whether training was an important factor in attitude change or whether attitudes are consistent and training simple enhances knowledge. Whilst studies of this type have been reported previously (e.g. Rose et al., 2014), attitude change is often recorded however subsequent behaviour change (if any) is rarely assessed and needs more attention in future research. There are limitations to the study which may have impacted upon the findings. Unfortunately, some participants who had volunteered were later unable to participate which resulted in a smaller sample size being obtained, thus limiting the generalizability of the data and questioning the external validity. In addition, all participants were from the same organization and, consequently, will have been taught to have certain views to promote the organization’s ethos. Therefore, a recommendation for future research would be to increase the sample size by using participants from a variety of different service providers to improve the validity of the results. Whilst focus groups allow participants to refine what they say by hearing other people’s perspectives (Kitzinger, 1994), it became evident during the discussions that one member tended to dominate the group and this often resulted in some participants becoming shy and not speaking. This means that some participants may not have put their point across for fear of being interrupted by their colleagues. To overcome this problem, supplementary techniques such as questionnaires may be used in future to ensure each participant is given a voice and to respect any sensitive views. Whilst thematic analysis has many advantages, one limitation of using this method is that analysis is carried out by one researcher, thus making interpretations subjective and susceptible to researcher bias. However, investigator triangulation was carried out when reviewing the themes so that a broader agreement was established to increase the validity of the themes. As this is a preliminary qualitative research, the results could be used to develop a more experimental study to investigate the role of certain factors, such as training and experience, in the development and maintenance of support workers’ attitudes and knowledge towards individuals with IDs. The findings may also help in developing a new attitude scale which accurately reflects the attitudes of support workers. Based on the results from the study, it seems that discrimination

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still remains within society, therefore policies and strategies need to be developed which aim to bring together those with and without ID under positive circumstances so that we can move towards an accepting society. Funding This research received no specific grant from any funding agency in the public, commercial or not-for profit sectors.

References Abbott S and McConkey R (2006) The barriers to social inclusion as perceived by people with intellectual disabilities. Journal of intellectual disabilities 10(3): 275–287. Allport GW (1954) The Nature of Prejudice. Reading, MA: Addison-Wesley, p. 537. Antonak RF and Harth R (1994) Psychometric analysis and revision of the Mental Retardation Attitude Inventory. Mental Retardation 32: 272–280. Bigby C, Clement T, Mansell J, et al. (2009) ‘It’s pretty hard with our ones, they can’t talk, the more able bodied can participate’: staff attitudes about the applicability of disability policies to people with severe and profound intellectual disabilities. Journal of Intellectual Disability Research 54(4): 363–376. Braun V and Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3: 77–101. British Psychological Society (2000) Learning Disability: Definitions and Contexts. Leicester: Professional Affairs Board (BPS). Brodwin MG and Orange LM (2002) Attitudes toward disability. In: Andrew JD and Faubion CW (eds) Rehabilitation Services: An Introduction for the Human Services Professional. Osage Beach: Aspen Professional Services, pp. 174–197. Cummins A and Lau A (2003) Community integration or community exposure? A review and discussion in relation to people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities 16: 145–157. Day K and Jancar J (1994) Mental and physical health and ageing in mental handicap: a review. Journal of Intellectual Disability Research 38: 241–256. Deal M (2006) Attitudes of disabled people towards other disabled people and impairment groups. Doctoral Thesis, City University London (Health Care Resarch Unity, School of Nursing and Midwifery). Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century (CM5086). Wetherby: NHS Executive. Department of Health (2009) Valuing People Now: A Three Year Strategy for People with Learning Disability (290565e). London: Department of Health. Department of Health (2012) Transforming Care: A National Response to Winterbourne View Hospital Department of Health Review: Final Report. London: Department of Health. Flatt-Fultz E and Phillip LA (2012) Empowerment training and direct support professionals’ attitudes about individuals with intellectual disabilities. Journal of Intellectual Disabilities 16: 119–125. Gill F, Kroese BS and Rose J (2002) General practitioners’ attitudes to patients who have learning disabilities. Psychological Medicine 32: 1445–1455. Harth R (1971) Attitudes towards minority groups as a construct in assessing attitudes towards the mentally retarded. Education and Training of the Mentally Retarded 64(4): 142–147. Henry D, Keys C, Balcazar F, et al. (1996) Attitudes of community-living staff members toward persons with mental retardation, mental illness, and dual diagnosis. Mental Retardation 34: 367–379. Howells G (1986) Are the medical needs of mentally handicapped adults being met? Journal of the Royal College of General Practitioners 36: 449–453. Kitzinger J (1994) The methodology of focus groups: the importance of interaction between research participants. Sociology of Health and Illness 16(1): 103–121.

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Golding and Rose


Klooster PM, Dannenberg JW, Taal E, et al. (2009) Attitudes towards people with physical or intellectual disabilities: nursing students and non-nursing peers. Journal of Advanced Nursing 65: 2562–2573. Kroese BS, Rose J, Heer K, et al. (2013) Mental health services for adults with intellectual disabilities– what do service users and staff think of them? Journal of Applied Research in Intellectual Disabilities 26(1): 3–13. McCaughey TJ and Strohmer DC (2005) Prototypes as an indirect measure of attitudes toward disability groups. Rehabilitation Counseling Bulletin 48: 89–99. McManus JL, Feyes KJ and Saucier DA (2011) Knowledge and contact as predictors of attitudes toward individuals with intellectual disabilities. Journal of Social and Personal Relationships 28: 579–590. MENCAP (2012) Death by Indifference: 74 Deaths and Counting: A Progress Report 5 Years on MENCAP. London: MENCAP. Ouellette-Kuntz H, Burge P, Brown H, et al. (2010) Public attitudes toward individuals with intellectual disabilities as measured by the concept of social distance. Journal of Applied Research in Intellectual Disabilities 23: 132–142. Patel M and Rose J (2014) Students’ attitudes towards individuals with an intellectual disability. Journal of Intellectual Disabilities 18(1): 90–103. Rose J, Galivan A Blake J, et al. (2014) An evaluation of short training course in positive behaviouaral support. International Journal of Developmental Disabilities 60(1): 35–42. Scior K (2011) Public awareness, attitudes and beliefs regarding intellectual disability: a systematic review. Research in Developmental Disabilities 32(6): 2164–2182. Wong PKS and Wong DFK (2008) Enhancing staff attitudes, knowledge and skills in supporting the selfdetermination of adults with intellectual disability in residential settings in Hong Kong: a pretest–posttest comparison group design. Journal of Intellectual Disability Research 52(3): 230–243. Yazbeck M, McVilly K and Parmenter TR (2004) Attitudes toward people with intellectual disabilities: an Australian perspective. Journal of Disability Policy Studies 15: 97–111.

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Exploring the attitudes and knowledge of support workers towards individuals with intellectual disabilities.

The aim of this study is to explore support workers' attitudes and knowledge towards individuals with intellectual disabilities (IDs) to see whether a...
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