1. Introduction

1.1. The role of the NDA in monitoring attitudes to disability

The National Disability Authority (NDA) was established in 2000. One of the 4 priorities outlined in its first Strategic Plan (2001-2003) was to influence attitudes in Irish society: "The Authority will identify and develop public awareness of disability issues and attitudes towards people with disabilities and mobilise support within Irish society for inclusive policies and practices." (A Matter of Rights: Strategic Plan 2001-3, 2001, p.22).

The National Disability Authority's 2007-2009 Strategic Plan states, "the Authority will periodically undertake research to benchmark attitudes in relation to disability" (p.32).

In 2001, the NDA conducted the first national survey on public attitudes to disability in the Republic of Ireland. This study examined attitudes to equality, education, employment, state benefits and public services for people with disabilities.

Given the legislative and other initiatives implemented in Ireland since the 2001 attitude to disability survey, 2006 was considered an opportune time to reassess attitudes to disability. Developments that took place in the 5-year period between the 2 surveys included the implementation of the National Disability Authority Act 1999; the Equal Status Act 2000; the European Year for People with Disabilities (EYPD) in 2003 during which Ireland's hosted the World Special Olympics; the Special Education Needs Act 2004 and, more recently, the National Disability Strategy. Also, given that 2007 was to be the European Year of Equal Opportunities for All in the European Union, it was considered appropriate that the results of the 2006 National Attitudes Survey would be made available in that year and could inform targeted action in 2007 and beyond. In November and December 2006, therefore, the NDA conducted the second national survey on public attitudes to disability in the Republic of Ireland to identify any attitude changes since 2001 and to benchmark attitudes for future national/ international monitoring. Insight Statistical Consulting was contracted to carry out this work.

The 2006 report Public Attitudes to Disability, produced by Insight Statistical for the NDA, and this literature review by the NDA are presented together - two reports in one pack. The public attitudes to disability report contains the results of the Public Attitudes Survey while this literature review report places key findings of the report in the context of the national and international literature. The literature review also compares and contrasts the 2006 findings with those of the 2001 national survey on public attitudes to disability in the Republic of Ireland.

In addition to the two NDA national surveys on public attitudes to disability in Ireland, other research carried out in the Republic of Ireland on attitudes to disability includes McGreil's research on prejudice (1980,1996), the 2001 Euro-barometer study which polled more than 16,000 EU citizens including Irish citizens and research in 2003 on options for influencing public attitudes towards people with disabilities (NDA, 2004). In the 2001 Eurobarometer survey 80% of respondents said they were at ease in the presence of people with disabilities. On a scale of 1 to 4, levels of ease varied with type of disability. The highest feelings of ease were recorded in Ireland, the UK, the Netherlands, Sweden, Spain and Denmark (on average at least 3.5) compared to 3.01 for West Germany, 2.97 for East Germany and 2.65 for Greece. In McGreil's work on prejudice in Ireland, where attitudes to disability is a minor element of his research, respondents were generally found to be more accepting of people with physical disabilities than they were regarding people belonging to other minority groups.

In Northern Ireland a number of surveys on public attitudes to disability have been carried out. These include the 2001 survey on Public Attitudes to Disability in Northern Ireland (Equality Commission for Northern Ireland) and a Northern Ireland Life and Times survey in 2003 (Office of the First Minister and Deputy First Minister, Northern Ireland) on public attitudes to disability. In the Northern Ireland survey on Public attitudes to disability in 2001, public opinion was generally positive about disability issues. Positive attitudes were mostly the same between different subgroups and, notably, between people with and without disabilities. Older people were more likely to be negative in their opinion, which is interesting, given that they were more likely to have a disability and to have friends with disabilities. More details from these surveys are referred to in later sections and compared and contrasted to the findings in the Republic of Ireland.

1.2. The need to investigate attitudes

At the 2006 NDA Research Conference in Dublin, Bert Massie, Chairperson of the UK Disability Rights Commission, said:" Attitudes to disability are the major barrier to disabled peoples' full participation...From pity, awkwardness and fear, to low expectations about what disabled people can contribute, stereotypical and negative attitudes hold people back" (Massie, 2006)."People with disabilities regularly identify societal attitudes as the most potent and negative stressor in their lives..."(Voh, 1993).

As long as negative attitudes persist, the full rightful acceptance of people with disabilities is unlikely (Nowicki, 2006 citing Antonak et al, 2000). Recognizing that persons with disabilities are still exposed to and oppressed by prejudice and discrimination may be the first step in reducing prejudice (Genesi 2007 citing Marks, 1997).

In 'Everybody Belongs' Shapiro (2000) discusses how negative myths and stereotypes continue to create ingrained prejudices toward people with disabilities. These prejudices are reflected in negative attitudes and behaviour, which can impede the participation of people with disabilities in social, educational and vocational contexts (White et al, 2006 citing Rao, 2004; Rubin et al 1995; Rusch et al, 1995). Swain et al (1993) review the extensive range of barriers faced by people with disabilities.

Rosenthal et al (2006) cite studies including Brodwin et al (2002), Cook et al (1998), Livenh et al (1997) and Smart (2002) that demonstrate how negative social attitudes block the integration of people with disabilities into society. In addition to the above studies, Chen (2002) cites others that also demonstrate the constrictive effects of negative societal attitudes in preventing individuals with disabilities from "mainstreaming into society". These include Arokiasamy et al (2001), De Loach (1994), Moore et al (1999), Orange (2002) and Yuker (1994,1995). Deal (2006)also cites studies that demonstrate that attitudes towards people with disabilities are predominantly negative including DuBrow (1965), English et al (1971), Florian et al (1987), Gething (1991), Lee and Rodda (1994), Fries (1997), Stiker (1997) and Christie et al (2000).

Negative attitudes are linked to behaviours such as social rejection and maintenance of higher levels of social distance toward persons with disabilities (Olkin et al, 1994; Wright 1983; and White et al, 2006 citing Davis, 1961; Evans, 1976 and Link et al, 1999).

Negative attitudes resulting in discrimination in the workplace continues to be a significant problem for people with disabilities (Brostrand, 2006 citing Antonak et al, 2000; Lebed, 1985; Scope, 2003; and Shapiro, 1994). In spite of the 1990 ADA legislation in the USA, discrimination at work, rooted in negative attitudes, continues to adversely affect employment outcomes (Brostrand, 2006 citing Kennedy et al, 2001).

Societal attitudes influence social policy and legislation and there is support for the societal attitudes theory that public attitudes dictate, to a considerable extent social policy (Hewes et al, 1998 citing Hahn, 1985 and others). Negative public attitudes can be a formidable barrier to the success of particular policies because the public significantly influences how much importance is given to an issue. This situation is not helped by the fact that "disabled people are under-represented in the public sector, particularly in strategic and management positions. They are under-represented where decisions about policy and service provision are taken" (Massie, 2006).

While many researchers highlight the fact that negative attitudes to disability persist including Antonak et al (2000), Brostrand (2006), Byrd et al (1988) Link et al (1999), White et al (2006), Livenh (1991) and Longoria et al (2006), as well as those mentioned earlier, there is also evidence that attitudes to disability are improving.

The 2006 NDA Survey of Attitudes to Disability in Ireland suggests that attitudes to disability are improving in Ireland. These findings are discussed throughout this literature review in the context of national and international research findings.

In England, Deal (2006) in his doctoral research found that people with and without disabilities had similar attitudes to disability. These attitudes fell within the positive threshold of the scale, reflecting a positive attitude towards disability. More negative attitudes were found in both groups when a subtle prejudice subscale was used. People with disabilities who voluntarily met with other people with disabilities collectively held the most positive attitudes of all towards disability.

In the 2004 Canadian Attitudes Survey (Office of Disability Issues, Canada) there was broad agreement among people with and without disabilities that progress had been made towards including people with disabilities in Canadian society. However, respondents considered that people with disabilities still faced numerous barriers, first and foremost negative attitudes and prejudices of other people and society.

In the UK 2002 Attitudes Towards Disability Study, Disabled for Life (Grewal et al, 2002), commissioned by the Department for Work and Pensions (DPG), the majority of the 2064 respondents, of whom 47% had a disability, thought that the position of people with disabilities had improved in the prior two decades but that strong attitudinal and structural barriers remained. The study showed a continuum of attitudes towards disability from inclusive attitudes, characterised by a positive view of the lives of people with disabilities and a broad definition of disability to exclusionary attitudes that focused on differences negatively.

Diversity in Disability (Molloy et al, 2003), a follow-on qualitative study from the 2002 UK Survey, Disabled for Life, also commissioned by the DPG, involved 103 people with disabilities. Participants in the study believed that progress had been made in society and that opportunities for people with disabilities had substantially increased. They described a range of life experiences and attitudes. They considered that negative attitudes to disability can lead to low self esteem, restricted opportunities for people with disabilities to fully participate in key areas of life and ongoing adverse effects on the physical and mental health of people with disabilities.

1.3. Defining and understanding attitudes

There is no universally accepted and agreed definition of what attitudes are.

Definitions of attitudes include the following:

  • "Attitudes are relatively stable mental positions held toward ideas, objects or people" (Gleitman 1991 cited by Eby et al, 1998)
  • "Attitudes are a combination of beliefs and feelings that predispose a person to behave a certain way" (Noe, 2002, p 108 cited by Brostrand, 2006)
  • "Attitude is an idea charged with emotion which predisposes a class of actions in particular class of social situations" (Antonak, 1988, p.109)
  • An attitude is a mental or neural state of readiness, organised through experience, exerting a directive or dynamic influence on the individual's response to all objects and situations to which it is related (Allport, 1935)
  • "An attitude is an idea (cognitive component) charged with emotion (affective component) which predisposes a class of actions (behavioural component) to a particular class of social situations" (Triandis et al, 1984,p.21).

As can be seen in the above definitions, attitudes are often defined in terms of mood, thought processes, behavioural tendencies and evaluation (Hernandez et al, 2000). Cognitive, affective and behavioural evaluations are central to the notion of attitudes. Cognitive evaluations refer to thoughts people have about the attitude object. Affective evaluations refer to feelings or emotions people have in relation to the attitude object. Behavioural evaluations refer to people's actions with respect to the attitude object. The attitude object in this literature review and in the Surveys of Attitudes to Disability in Ireland is mainly the notion of disability but also includes people with disabilities and disability issues.

While attitudes can be thought of as internal individual processes, they link each person to a social world of other people, activities and issues, including people who are actively engaged in helping form or change attitudes (Eby et al 1998 citing Zimbardo, 1985). Thus, attitudes are part of a framework by which we interpret our social environment.

Attitudes represent relatively stable attributes and, at the same time, they appear to be learned rather than innate (Zimbardo et al, 1969 cited by Eby et al, 1998). Social learning theory highlights the process of acquisition of knowledge and attitudes from important others, such as parents, teachers, peers, and media figures (Bandura, 1977).

Current thinking favours a relationship between attitudes and behaviour and researchers no longer question if attitudes predict behaviours but under which circumstances do attitudes predict behaviours (Bentler et al, 1981; Cialdini et al, 1981 cited by Eby et al, 1998).

Behaviour is related to attitudes in complex ways. A number of studies have found that differences in the extent to which attitudes guide behaviour result from differences in how easily or quickly a person retrieves the attitude from memory (Olson et al, 1993; Sherman et al, 1989). Other factors that mediate the relationship between attitudes and behaviour include habit or past behaviour (e.g., Triandis, 1977), stability of attitudes over time (Schwartz, 1978), volitional control of behaviour (Davidson et al, 1979), and the degree of direct experience with the attitude object (e.g., Regan et al, 1977; Zimbardo, 1985).

Gender, age and a range of factors can influence attitudes. Gender differences in attitudes may be because of gender based response biases rather than because of disability biases. Research on children for example has shown that children prefer to associate with their own gender (Sippola, 1997). Rosenthal et al (2006) in the USA examined rehabilitation students' attitudes towards persons with disabilities in high- and low-stake social contexts. They found that attitude was significantly affected by client characteristics unrelated to disability including age and race or ethnicity and factors influencing attitude formation differed across the two social contexts. Age and disability type were most involved in the decision making process in the low-stakes group while performance related variables were most important in the high-stakes context.

Attitude formation and its link with behaviour are further addressed in section 4 of this review.

1.4. Social desirability/appropriateness and measuring attitudes

It may be becoming more socially appropriate for the public and for employers, teachers etc., to espouse positive global attitudes towards disability. However, specific attitudes, if investigated, may be found to be more negative (e.g. Hernandez et al, 2000). Genesi (2007) citing Scruggs et al (1996) refers to evidence in the educational field that, while on a philosophical level teachers agreed with inclusion programs for children with disabilities, when it came down to their practical use in the classroom they expressed reservations. This may be part of the social desirability phenomenon or effect.

In the 2006 Public Attitudes to Disability survey, to reduce the social desirability effect, the interviewers stressed confidentiality, anonymity and appealed to the respondents to provide honest answers. The respondents did not know that the National Disability Authority had commissioned the survey or was associated with the survey. In 2001 the same methodology was used and so the social desirability effect is probably similar in the two surveys.

The fact that the social desirability of responding in particular ways to disability issues may be on the increase must be borne in mind when designing surveys and when interpreting results. To date attitudes to disability have most commonly been investigated through direct means and typically involving self-report surveys. Instruments widely used to examine attitudes towards persons with disabilities as a group include the Attitudes towards Disabled Persons Scale (ATDP) developed by Yuker et al (1960) and the Scale of Attitudes toward Disabled Persons (SADP) developed by Antonak (1982). These assess attitudes from a social perspective as opposed to a personal one with questions centring on how persons are, or should be, treated at the societal level (White et al, 2006 citing Gething et al, 1994). All these measures are subject to concerns about the influence of socially desirable responses and false positive scores.

The social desirability phenomenon where it becomes more appropriate socially to express particular sentiments and attitudes may account for some of the differences in response found when comparing the results of the 2001 and 2006 public attitudes to disability surveys in Ireland. Socially appropriate responses may not necessarily be reflected in behaviour and such considerations need to be borne in mind when planning and designing future research and monitoring tools. Due consideration should be given to the use of more subtle or indirect methods of assessing attitudes.

In England Deal (2006) examined attitudes of people with and without disabilities towards other people with disabilities and to different impairment groups. The results were similar and attitudes of both groups fell within the positive threshold of the scale indicating positive attitudes to disability. However, when measured by a subtle prejudice sub-scale of the instrument used, people with and without disabilities produced more negative attitudes. This suggests that people may often hold subtle forms of prejudice towards disability that may not be detected when using more direct methods that allow respondents to respond in ways they consider more socially appropriate.