Attitudes towards people with intellectual disability in the UK and Libya: A cross-cultural comparison
Introduction
Every cultural group has its own way of thinking and feeling, and consequently acting and reacting. The study of how culture differs among groups, communities and societies typically necessitates a position of cultural relativism. Judging a society and how it acts towards specific events should be preceded by establishing evidence about the nature of cultural differences of that society and about the roots of those differences and their consequences.
Attitudes towards people with intellectual disability (ID) are a key factor both for education and for society, in that these attitudes lead to important consequences for the approaches taken politically, together with the consequent outcomes. Attitudes are influenced by a number of factors – physical, intellectual, social and emotional – and the experiences of the individual or the group. Positive attitudes can lead to decisions such as social and psychological acceptance of the person who has a disability (Tervo et al., 2002, Werner et al., 2015), improving programmes for people who have a disability – educational (Tindall, MacDonald, Carroll, & Moody, 2015); social (Kam and Wong, 2008, Keith et al., 2015); medical (Boyle et al., 2010, Ryan and Scior, 2014); and occupational (Tsang et al., 2004, Uysal et al., 2014). By contrast, negative attitudes can lead to decisions such as rejection (Daruwalla and Darcy, 2005, de Boer and Munde, 2014, Hassanein, 2015), segregation (Keith et al., 2015, Keller and Siegrist, 2010), and degradation (Panek & Jungers, 2008). The importance of knowing the attitudes of individuals towards people who have a disability can be summarised as: contributing to making programmes for individuals with disabilities more successful; attempting to make the attitudes of the individuals towards disability more positive; and the education and enlightenment of the public to adjust any incorrect concepts and to try to make the attitudes more positive (Eberhardt and Mayberry, 1995, Golding and Rose, 2014, Werner et al., 2012). Raven and Rubin (1983) have pointed out that attitudes are not inherited but acquired and learned, with the individual acquiring them from the prevailing societal culture through socialisation.
Culture refers to the joint collection of characteristics that is passed between generations and which distinguishes one society from another (Dickson et al., 2000, Tindall et al., 2015). Several researchers have tried to determine the influences cultures exert on attitudes (similarities and differences) by assessing their effect(s) on individuals’ behaviour (El-Keshky and Emam, 2015, Fatimilehin and Nadirshaw, 1994, Florian, 1982, Gaad, 2004, Kagawa-Singer, 2004, Scior et al., 2010). Some of these studies have shown that there were more positive attitudes towards people with ID in the developed countries than in the developing ones, other studies tend to find more positive attitudes towards people with ID in western countries than in eastern ones (Florian, 1982). Several studies have identified a tendency to find more positive attitudes towards people with ID in societies characterised by values of individualism rather than in societies characterised by values of collectivism (Bi, 2010, Black et al., 2003, Rao et al., 2010).
The existing (mostly Western) literature has found that attitudes to people with ID are affected by the predominant culture, formal education (Gasteiger-Klicpera et al., 2013, Schwartz and Armony-Sivan, 2001, Symons et al., 2014), previous personal contact with people with disabilities (Li and Wang, 2013, Scior et al., 2013) and by gender (Maha, 2013, Panek and Jungers, 2008, Scior et al., 2013). The most used assessment tool for these studies has been the Community Living Attitudes Scale for Mental Retardation (CLAS-MR) (Henry et al., 1996, Henry et al., 1999). Originally developed in the United States, the CLAS-MR scales have been validated on the initial US sample for their reliability and validity and have been used by many researchers in several countries including the USA, the UK, Israel, Japan, Pakistan and China. The CLAS-MR scale is widely used and shown to be valid, reliable and relevant. The scale is a questionnaire with 42 items, each in 6-point Likert format ranging from 1 = strongly Disagree to 6 = strongly Agree. The scale contains four subscales. The 15 item Empowerment subscale items relates to the policies and decisions that affect the lives of people with ID reflect the idea that they should be enabled to make their own opinions. The 7 item Exclusion subscale assesses desire to exclude people with ID from community life. The 6 item Sheltering sub-scale assesses the extent to which the daily lives of people with ID must be supervised by others and/or to protect them from community life's dangers. The 14-item Similarity sub-scale assesses the respondent's view on how similar people with ID are to typically-achieving people in the community. Scores are averaged for each sub-scale. Each sub-scale therefore has a minimum score of 1 and a maximum score of 6. For the Empowerment, Sheltering and Similarity sub-scales, a higher score represents more empowering, more supportive, more similar attitudes respectively, whereas for the Exclusion subscale a higher score indicates a less inclusive attitude.
Table 1 summarises the cross-cultural findings to date. It may be seen that there is considerable heterogeneity between the different countries and the different populations sampled within each country. Of particular interest is the study by Patka, Keys, Henry, and McDonald (2013) of attitudes in Pakistan, where it is evident that attitudes were very much less positive than in the other countries sampled.
It is also evident from Table 1 that there is a dearth of information about attitudes to people with ID in Arab countries. Several researchers recommend the need for research in this field in developing countries and specifically in the Arab countries (Alborno and Gaad, 2012, Haimour, 2012, Keller and Al-hendawi, 2014). The current study contributes to this literature by measuring and comparing attitudes towards ID in the UK and in Libya.
Libya is a north-African country situated on the southern coast of the Mediterranean Sea bordered by Egypt to the east, the Sudan to the southeast, Chad and Niger to the south Algeria to the west and Tunisia to the north-west. The population of Libya is 6.5 million, with the majority being Sunni Muslims.
Four distinctive aspects of Libyan culture are salient for attitudes to people with ID in Libya. First, Arab cultures value individual honour and family respect extremely highly and consequently any individual stigma is keenly felt at the individual level. Second, Libya is a highly collectivist society – scoring 80 on Hofstadter's collectivism index (Abubaker, 2008, Aharoni, 1992), as opposed to 35 for the more individualistic UK society (Obeidat, Shannak, Masa’deh, & Al-Jarrah, 2012) – the family and group are of great significance and an essential wellspring of an individual's personality. Consequently an individual's stigma strongly affects the extended family group. Third, as a custom-based society, the effects of any stigma are long-lasting, maybe even into future generations. Fourth, Libya is a Muslim society. The Quran makes little explicit mention of disability (Bazna and Hatab, 2005), but as Hasnain, Shaikh, and Shanawani (2008) note “Many Muslims see disability in the context of qadar/kismat, or fate, a cornerstone of Muslim belief. This concept is often expressed as the belief in preordination that what was meant to be will be, and what was not meant to happen does not occur.” This tendency may be more marked for a congenital disability, such as some cases of ID, rather than to a disability attributable to a physical injury or other non-congenital causes. These four factors highlight the likely discrepancies between attitudes to people with ID in Libya as opposed to Western countries, and further justify the need for research on the issue.
In Libya, the Gaddafi government gave considerable attention to people with a disability: laws were issued, institutions were established to provide care, special committees were formed for each kind of disability and social security laws were issued. Unfortunately, issuing laws without proper mechanisms for implementing them does not guarantee change in individual behaviour (Li and Wang, 2013, Martz et al., 2009). Benomir (2004) have claimed that, despite the seminars, discussions and conferences organised concerning care for people with a disability together with laws and regulations affirming their rights in society, care for people with ID in Libya is still not sufficient and remains practised in the same manner which prevailed a hundred years ago in developed countries; namely a segregated system merely providing care in separate institutions.
This analysis provides the rationale for assessing the attitudes to people with ID in Libya. Indeed, given the revolution that took place within a year after this survey, it may provide unique data that can no longer be replicated. It is also important to recognise the differences between different categories of people within a country. It is again evident from Table 1 that the attitudes of staff working with people with ID were markedly different from those of the general population. Consequently we determined to investigate the attitudes both of staff working with ID and of students, on the grounds that students, especially psychology students, are the population sector most likely to help shape opinion regarding approaches to people with ID in the future. In fact, studies have also established that a student's discipline can affect their attitude towards people with IDs. For example Rasker et al. (2008) and Brown et al. (2009) established that the attitudes of the fourth-year students of Occupational Therapy were more positive than those of the first-years of the same specialisation. The attitude of psychology students may have significant influence on the standard and quality of development of the services provided for people with ID which could be related to the fact that those students are expected to work (after graduation) with this sector. Unfortunately, to our knowledge there have been no studies internationally that compare the attitudes of psychology students with those of students from other disciplines.
Consequently, the study was designed to assess attitudes to people with ID in two countries (the UK and Libya), and within each country to assess the attitudes of professional staff working with people with ID and those of students; and to compare the attitudes of Psychology students with those from a different science discipline, namely mathematics.
Section snippets
Hypotheses
The above considerations allow us to develop a series of hypotheses regarding the study outcomes. In general, negative attitudes are more likely to be found in collectivistic cultures, as previous research indicates (Rao et al., 2010, Shao et al., 2011). However, based on the availability of the four sub-scales of the CLAS, and the four differential factors noted earlier, it is possible to derive more detailed predictions. Hypothesis 1 Empowerment. We predict that, overall, Libyan respondents will give
Participants
Participants comprised University students and professional staff at schools for children with ID, with the students being recruited from Psychology and Mathematics departments. This allowed an explicit examination of role, and an implicit examination of familiarity with ID, together with some analysis of the effects of different types of formal education. In Libya questionnaires were distributed to staff at a school for children with ID and at two Universities (Sebha and Tripoli Universities).
Results
Data were screened for normality and for outliers. There was no significant skewness for any of the four CLAS-MR subscales. The internal consistency for the CLAS-MR for Libya and the UK was acceptable to good with the overall Cronbach alpha coefficient 0.7 for Libya and 0.7 for the UK. The means and standard deviations of the ratings are provided in Table 2.
Four separate analyses of variance were then undertaken, one for each of the CLAS-MR sub-classes as dependent variables. There were three
Discussion
In terms of main effects, we established that there were clear, significant differences in attitude to people with ID between the Libyan and the British participants. Hypothesis 1, Hypothesis 2, Hypothesis 3, Hypothesis 4 were supported. The British participants gave significantly higher ratings towards people with ID on Empowerment (Hypothesis 1), significantly lower ratings for Exclusion (Hypothesis 2), and significantly higher ratings for Similarity (Hypothesis 4). They also gave higher, but
Funding
The Libyan research received a specific small grant from Sebha University in Libya.
Acknowledgments
We gratefully acknowledge the support of staff and/or students in Sebha University, Tripoli University and Janzoor Special School in Libya and the University of Sheffield and Woolley Wood School in the UK.
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