General practitioners' attitudes to patients who have learning disabilities

"Is it my job?" An exploratory qualitative analysis of medical specialists' adaptation strategies when addressing the health needs of people with intellectual disabilities

Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.

What do specialist mental health professionals think of the mental health services for people with intellectual disabilities in Singapore?

BACKGROUND

This research aimed to investigate the views and experiences of specialist mental health professionals working with adults with intellectual disabilities and mental health problems in Singapore in order to gain insight into the functioning of the local specialist intellectual disability mental health service and how it may be improved.

METHODS

Eight staff members from specialist service were interviewed. The transcriptions of the interviews were analysed using thematic analysis.

RESULTS

Analysis revealed four themes (1) Identifying their roles; (2) Ensuring continuity of care; (3) Disempowerment of service users and (4) Improving clinical practice.

CONCLUSIONS

Participants identified the challenges they faced working with this population. They highlighted the importance of building therapeutic relationships during the treatment process and discussed the stigma that people with intellectual disabilities face in the community. Recommendations and implications are discussed in relation to service provision, improving staff knowledge and recruiting more staff to work in this field.

Primary care providers' attitudes towards individuals with intellectual disability: Associations with experience and demographics

Primary care providers are the main point of contact with the healthcare system for individuals with intellectual disability, and they may have pre-existing attitudes towards this group that impacts care. We examined whether participants' gender, age, professional status and experience with individuals with intellectual disability were associated with attitudes by surveying 95 family physicians, family medicine trainees and advanced practice nursing students across a Canadian province. Younger participants were more likely to feel that those with intellectual disability are similar to themselves and that individuals with intellectual disability should be empowered to take control of their lives. Older participants were more likely to believe that individuals with intellectual disability are vulnerable. These findings suggest there may be a generational difference in attitudes, and educational interventions may be needed to ameliorate attitudes among older primary care providers to reduce the impact of pre-existing attitudes on the provision of care.

Nurses' attitudes, beliefs, and emotions toward caring for adults with intellectual disabilities: An integrative review

BACKGROUND

Negative health-care provider attitudes are a contributing factor to the myriad health disparities faced by people with intellectual disabilities (ID). Nursing comprises the nation's largest health-care profession, yet no integrative review on this topic is found.

PURPOSE

To organize findings of studies exploring nurses' attitudes, beliefs, and emotions about caring for adults with ID, to identify areas for future research, and to discuss recommendations for nursing practice.

METHODS

Whittemore and Knafl's integrative review method guided this study.

RESULTS

Twenty studies were conducted across eight countries, dichotomized according to mainstream or ID nursing specialty, and were mostly setting-specific. Common themes included: "knowing the person," "paternalism/infantilization," "communication challenges," "organizational support," "time," and "ID-specific knowledge and experience." Mainstream nurses' emotions were primarily negative, whereas ID nurses experienced conflicting positive and negative emotions. Antecedents and effects of nurse attitudes and emotions on the quality of care of adults with ID were identified.

CONCLUSIONS/IMPLICATIONS

Despite recent increased research on this topic across multiple countries, further research is needed. The findings of this study will aid the development of strategies to address negative nurse attitudes toward caring for adults with ID and act as a foundation for future research beyond the descriptive stage.

Nurses' attitudes and emotions toward caring for adults with intellectual disabilities: Results of a cross-sectional, correlational-predictive research study

BACKGROUND

Negative healthcare provider attitudes may contribute to healthcare disparities in adults with intellectual disabilities. This study identified predictors of nurses' attitudes and emotions toward caring for adults with intellectual disabilities in the United States.

METHOD

A convenience sample of 248 nurses was used to collect nurses' attitudes and emotions toward caring for adults with intellectual disabilities (Adapted Caring for Adults with Disabilities Questionnaire) and quality of life beliefs (Prognostic Beliefs Scale).

RESULTS

Overall, nurses held less positive attitudes toward caring for an adult with intellectual disability versus a physical disability. Intellectual disability nurses held more positive attitudes and emotions and less negative emotions than non-intellectual disability nurses. Quality of life beliefs predicted nurse attitude, positive emotions and negative emotions. The number of adults with intellectual disabilities cared for during the nurse's career predicted negative emotions.

CONCLUSIONS

Future interventions should focus on improving nurses' understanding of the quality of life of adults with intellectual disabilities.

General Practitioners' Perceptions on Clinical Management and Training Needs regarding the Healthcare of Community-Dwelling People with Intellectual Disability: A Preliminary Survey in Singapore

Background

Studies worldwide indicate that people with intellectual disability have high risks of physical and mental morbidities, and poor quality of health care. This study was aimed at determining general practitioners' perceptions on barriers in clinical assessment and training needs with regard to the healthcare of community-dwelling people with intellectual disability.

Methods

A survey questionnaire was developed specifically for the study through focus group discussions and a literature review. The study was conducted as a cross-sectional anonymous survey of private general practitioners practicing in Singapore. The survey contained questions on their experience and training needs in assessing and treating patients with intellectual disability.

Results

Forty-nine of the 272 questionnaires sent out were returned. The respondents were predominantly male general practitioners working in “solo” practices. For most general practitioners, the proportion of patients with intellectual disability ranged from 1% to 5%. Nearly 90% of general practitioners identified problems in communicating with such patients as an important barrier that affected the quality of assessment of their health conditions. Other barriers identified were behavioral issues and sensory impairments. Only one-third of the general practitioners were confident that they had sufficient knowledge of physical and mental health conditions related to patients with intellectual disability. Three-fourths of the general practitioners believed that further training in this area would be beneficial.

Conclusion

Appropriate interventions to address barriers in assessment and management of patients with intellectual disability with further training for general practitioners may improve the standard of healthcare provided to this population group.

Priority-setting and feasibility of health information exchange for primary care patients with intellectual disabilities: A modified Delphi study

OBJECTIVE

Accurate health information exchange (HIE) is fragile in healthcare for patients with intellectual disabilities (ID), threatening the health outcomes for this patient group. In conjunction with a group of experts, we aimed to identify the principal actions and organisational factors facilitating HIE for primary care patients with ID and to assess their perceived feasibility in daily practice.

METHODS

We conducted a two-round modified Delphi study with Dutch GPs (n=22), support workers (n=18) and ID physicians (n=20). In an extensive set of 61 items covering actions and organisational factors, experts ranked items in order of importance and rated their feasibility.

RESULTS

Agreement was reached on the importance of 22 actions and eight organisational factors, of which 82% were deemed (very) feasible in daily practice. Experts stressed the importance of listed actions and factors being implemented simultaneously and remarked that further priority should be based on contextual demands.

CONCLUSION AND PRACTICE IMPLICATIONS

This study indicates the principal actions and organisational factors for HIE regarding primary care patients with ID. The set can be used as a practical guide to optimise inter-professional cooperation and arrange the distribution of HIE roles and responsibilities in relation to this patient group.

Principles of effective communication with patients who have intellectual disability among primary care physicians

OBJECTIVE

Examine physicians' implementation of effective communication principles with patients with intellectual disabilities (ID) and its predictors.

METHODS

Focus groups helped construct a quantitative questionnaire. The questionnaire (completed by 440 physicians) examined utilization of effective communication principles, attitudes toward individuals with ID, subjective knowledge and number of patients with ID.

RESULTS

Subjective knowledge of ID and more patients with ID increased utilization of effective communication principles. Provision of knowledge that allows patients to make their own medical decisions was predicted by more patients with ID, lower attitudes that treatment of this population group is not desirable, less negative affect and greater perception that treatment of this group is part of the physician's role. Effective preparation of patients with ID for treatment was predicted by higher perception of treatment of this group as part of the physician's role, lower perception of this field as undesirable and higher perception of these individuals as unable to make their own choice. Simplification of information was predicted by a greater perception of treatment of this group as part of the physician's role and more negative affect.

CONCLUSION

Greater familiarity may enhance care for these patients.

PRACTICE IMPLICATIONS

Increase exposure to patients with ID within training.

Mainstream health professionals' stigmatising attitudes towards people with intellectual disabilities: a systematic review

BACKGROUND

Equal access to mainstream healthcare services for people with intellectual disabilities (ID) still requires attention. Although recent studies suggest that health professionals hold positive attitudes towards people with ID, stigmatising attitudes may influence their efforts to serve people with ID in community healthcare practice. To stimulate inclusion in mainstream healthcare services, this systematic review focussed on barriers in attitudes of mainstream health professionals towards people with ID.

METHOD

Five electronic databases were systematically searched and references in full text articles were checked for studies published in the English language between January 1994 and January 2016. A social-psychological triad of cognitive, affective and behavioural dimensions of stigmatising attitudes is used to structure and discuss the results.

RESULTS

The literature search generated 2190 records with 30 studies that passed our exclusion criteria. Studies were mostly cross-sectional and of moderate quality. With respect to stigma, a lack of familiarity with and knowledge about people with ID was found. ID was considered as a stable condition not under personal control. Moreover, mainstream health professionals had either low or high expectations of the capabilities of people with ID. Professionals reported stress, lack of confidence, fear and anxiety, a tendency to treat people with ID differently and a lack of supporting autonomy.

CONCLUSIONS

Stigmatising attitudes towards people with ID appeared to be present among mainstream health professionals. This might affect the ongoing challenges regarding inclusion in mainstream healthcare services. To facilitate inclusion in mainstream healthcare services, it is recommended to include contact and collaboration with experts-by-experience in education programs of health professionals. Future research should progress beyond descriptive accounts of stigma towards exploring relationships between cognitive, affective and behavioural dimensions as pointers for intervention. Finally, inclusion would benefit from an understanding of 'equal' treatment that means reasonable adjustments instead of undifferentiated treatment.

Midwives׳ experiences of caring for women with learning disabilities - A qualitative study

BACKGROUND AND OBJECTIVE

people with learning disabilities (LD) are increasingly likely to become parents and are entitled to have access to the right support to be able to be suitable parents. However, access to such support is affected by limited resources, attitudes towards people with LD becoming parents, and lack of training regarding caring for parents with learning disabilities for midwives. A learning disability (LD) is defined as a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), reduced skills to cope independently with everyday life, has an impact on most areas of a person's life and the difficulties started in early childhood. Little research has explored health professionals' experiences of their support of people with LD during their journey to become parents. Midwives are often the first professionals pregnant women come into contact with and therefore are key professionals in the support system for parents with LD. The principle objective of the current research is to develop an understanding of midwives' experiences of caring for women with a LD.

DESIGN

the study explored midwives׳ experiences of caring for women with LD using an Interpretative Phenomenological Approach (IPA).

PARTICIPANTS

nine qualified midwives employed by a single NHS trust participated in the study.

MEASUREMENTS AND FINDINGS

a semi-structured interview schedule was utilised during one-to-one interviews with the midwives. The interview transcripts were analysed using IPA stages. Four superordinate themes were identified.

KEY CONCLUSIONS

The midwives reported receiving a lack of LD training and faced significant time constraints, which left them feeling that they could not spend the necessary time with the women to meet their pregnancy needs. The midwives felt unsupported in their attempts to deliver adequate midwifery care, speaking about a lack of accessible support for pregnant women with LD. They were left feeling responsible to fill the gaps in service provision. The midwives were dedicated in delivering adequate care to help give women with LD a positive experience of childbearing. They felt a safeguarding process (child protection) was an inevitable part of women with LD's pregnancy experience yet were aware that the right support at the right time could improve parenting capacity.

IMPLICATIONS FOR PRACTICE

it is recommended that training on working with and providing services for people with LD is made available to qualified and student midwives as well as accessible resources, professional support and supervision.

Implicit Attitudes towards People with Intellectual Disabilities: Their Relationship with Explicit Attitudes, Social Distance, Emotions and Contact

Implicit attitude research has expanded rapidly over the last decade and is seen as very promising as it counters biases present in much attitude research such as social desirability. However, most research in the area of intellectual disabilities has focused on explicit attitudes alone. This study examined implicit attitudes to this population and also examined their association with emotional reactions and contact, which have previously been found to have a significant influence on attitudes and stigma. A web based survey consisting of a single target Implicit Association Test, measures of explicit attitudes, social distance, and emotional reactions towards and contact with individuals with intellectual disabilities was completed by 326 adult UK residents. Implicit attitudes were not significantly associated with explicit attitudes, social distance or emotional reactions. Instead there were small to moderate associations between emotional reactions and explicit attitudes and social distance. Implicit attitudes did not vary according to participants’ level of contact with individuals with intellectual disabilities, type of the contact relationship (voluntary versus involuntary), gender or educational attainment. In contrast, these participant characteristics did affect explicit attitudes and social distance. Implicit attitudes towards individuals with intellectual disabilities were somewhat negative and, unlike explicit attitudes and stigma, did not vary according to participant demographics or contact. As they may have a negative impact on the lives of people with intellectual disabilities, implicit attitudes merit increased attention in research and interventions in the intellectual disabilities field.

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

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.

Training on intellectual disability in health sciences: the European perspective

BACKGROUND

Intellectual disability (ID) has consequences at all stages of life, requires high service provision and leads to high health and societal costs. However, ID is largely disregarded as a health issue by national and international organisations, as are training in ID and in the health aspects of ID at every level of the education system.

SPECIFIC AIM

This paper aims to (1) update the current information about availability of training and education in ID and related health issues in Europe with a particular focus in mental health; and (2) to identify opportunities arising from the initial process of educational harmonization in Europe to include ID contents in health sciences curricula and professional training.

METHOD

We carried out a systematic search of scientific databases and websites, as well as policy and research reports from the European Commission, European Council and WHO. Furthermore, we contacted key international organisations related to health education and/or ID in Europe, as well as other regional institutions.

RESULTS

ID modules and contents are minimal in the revised health sciences curricula and publications on ID training in Europe are equally scarce. European countries report few undergraduate and graduate training modules in ID, even in key specialties such as paediatrics. Within the health sector, ID programmes focus mainly on psychiatry and psychology.

CONCLUSION

The poor availability of ID training in health sciences is a matter of concern. However, the current European policy on training provides an opportunity to promote ID in the curricula of programmes at all levels. This strategy should address all professionals working in ID and it should increase the focus on ID relative to other developmental disorders at all stages of life.

Students' attitudes towards individuals with an intellectual disability

The aim of the study was to investigate attitudes held by a British student population towards individuals with an intellectual disability. Students participated in focus groups addressing their attitudes, behaviours and perceptions of individuals with an intellectual disability. Thematic analysis was the method used to identify emergent themes. Results identified five main themes in relation to intellectual disabilities. The themes suggest that attitude scales fail to effectively measure the multidimensional nature of British student's attitudes towards intellectual disabilities. One out of the five emergent attitude themes from the current study is sufficiently represented in measures of attitudes towards intellectual disability. These results suggest a need to modify current attitude scales or develop new ones to measure the British population's attitudes towards intellectual disabilities. A lack of knowledge about intellectual disabilities was also identified. Participants recognized exposure through the media as a tool to increase knowledge.

Intellectual disability and mental health problems: a qualitative study of general practitioners' views

OBJECTIVES

To investigate general practitioners' (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP).

DESIGN

Qualitative study using in-depth interviews.

SETTING

General practice in Hedmark county, Norway.

PARTICIPANTS

10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation.

RESULTS

The participants' knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits.

CONCLUSIONS

GPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field.

Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health

OBJECTIVES

Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision.

DESIGN

A cross-sectional design was used.

METHODS

A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services.

RESULTS

Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services.

CONCLUSIONS

The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.

Stigma and intellectual disability: a review of related measures and future directions

The theoretical construct of stigma has received much attention in psychiatric disability research, leading to the development of widely used measures. Such measures have had real world impact in that they allow for the assessment of stigma change efforts. The study of stigma has not received the same level of attention for persons with intellectual disabilities. In this manuscript we evaluate existing measures of intellectual disability stigma through a systematic review of the literature. Twenty-four scales were reviewed and evaluated. Findings indicate a paucity of stigma measures based on theoretical conceptualizations pointing to a need for further development of measures to pursue the study of public, self, and family stigma as related to intellectual disability.

Health of people with intellectual disabilities: A review of factors influencing access to health care

The rights and needs of people with intellectual disabilities are being acknowledged within Department of Health policies. In spite of this, however, it is frequently cited that people with intellectual disabilities are vulnerable to many health problems but have poor access to health-related services. There are many factors that can act as barriers to people with intellectual disabilities enjoying good health and accessing services. These include: (a) a lack of clarity regarding responsibilities for ensuring that health policies are operationalized; (b) social and residential aspects of life being emphasized within the quality of life framework for evaluating services for people with intellectual disabilities, with health as an under-represented domain; (c) a lack of reliable and valid measures that can be used with carers and people with intellectual disabilities to explore health, particularly in comparison to literature on the general population; (d) potential communication difficulties (between the person with intellectual disabilities, their carers and health staff) that can impact on decision-making processes from early identification of health problems through to the stage of gaining appropriate treatment. These areas are discussed giving rise to questions and challenges for policy makers, researchers and clinicians.

Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study

BACKGROUND

There is a long history of certain medical conditions being associated with stigma, stereotypes, and negative attitudes. Research has shown that such attitudes can have a detrimental effect on patients presenting with stigmatised medical conditions and can even flow on to impact their family. The objective of this study was to measure the attitudes of undergraduate students enrolled in six different health-related courses at Monash University toward patients with intellectual disability, substance abuse, and acute mental illness.

METHODS

A convenience sample of undergraduate students enrolled in six health-related courses in first, second and third years at Monash University were surveyed. The Medical Condition Regard Scale--a valid and reliable, self-report measure of attitudes--was administered to students along with a brief demographic form. Mean scores, t-tests, and ANOVA were used to analyse student attitudes. Ethics approval was granted.

RESULTS

548 students participated. Statistically significant differences were found between the courses (p = 0.05), year of the course (p = 0.09), and gender (p = 0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions.

CONCLUSION

The findings suggest that students in undergraduate health-related courses, as a group, have a strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems.

The Attitudes to Disability Scale (ADS): development and psychometric properties

BACKGROUND

This paper describes the development of an Attitudes to Disability Scale for use with adults with physical or intellectual disabilities (ID). The aim of the research was to design a scale that could be used to assess the personal attitudes of individuals with either physical or ID.

METHOD

The measure was derived following standard WHOQOL methodology as part of an international trial. In the pilot phase of the study, 12 centres from around the world carried out focus groups with people with physical disabilities, people with ID, with their carers, and with relevant professionals in order to identify themes relevant for attitudes to disability. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centres worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods.

RESULTS

The outcome of the second round of data collection and analysis is a 16-item scale that can be used for assessment of attitudes to disability in physically or intellectually disabled people and in healthy respondents.

CONCLUSIONS

The Attitudes to Disability Scale is a new psychometrically sound scale that can be used to assess attitudes in both physically and intellectually disabled groups. The scale is also available in both personal and general forms and in a number of different language versions.

The Interaction with Disabled Persons scale: revisiting its internal consistency and factor structure, and examining item-level properties

The Interaction with Disabled Persons scale (IDP) has been used in research into baseline attitudes and to evaluate whether a shift in attitudes towards people with developmental disabilities has occurred following some form of intervention. This research has been conducted on the assumption that the IDP measures attitudes as a multidimensional construct and has good internal consistency. Such assumptions about the IDP appear flawed, particularly in light of failures to replicate its underlying factor structure. The aim of this study was to evaluate the construct validity and dimensionality of the IDP. This study used a prospective survey approach. Participants were recruited from first and second year undergraduate university students enrolled in health sciences, occupational therapy, physiotherapy, community and emergency health, nursing, and combined degrees of nursing and midwifery, and health sciences and social work at a large Australian university (n=373). Students completed the IDP, a 20-item self-report scale of attitudes towards people with disabilities. The IDP data were analysed using a combination of factor analysis (Classical Test Theory approach) and Rasch analysis (Item Response Theory approach). The results indicated that the original IDP 6-factor solution was not supported. Instead, one factor consisting of five IDP items (9, 11, 12, 17, and 18) labelled Discomfort met the four criteria for empirical validation of test quality: interval level scaling (scalability), unidimensionality, lacked of DIF across the two participant groups and data collection occasions, and hierarchical ordering. Researchers should consider using the Discomfort subscale of the IDP in future attitude research since it exhibits sound measurement properties.

People with developmental disabilities teaching medical students--does it make a difference?

BACKGROUND

Negative attitudes towards people with developmental disabilities, including intellectual disabilities (ID), have the potential to contribute to the poor healthcare received by this group. The aim of this study was to evaluate changes in the attitudes of fourth year undergraduate medical students towards interacting with people with developmental disabilities after taking part in a communication skills training session.

METHOD

Students (N = 128) completed an attitude scale at the beginning and end of a 3-hour communication skills session, and provided evaluative comments. The session comprised a lecture on developmental disabilities and communication, followed by direct contact with tutors with disabilities, and finally, a communication exercise. All tutors had ID, and some also had physical and/or sensory disabilities.

RESULTS

A significant change in attitudes was evident, with the students feeling more comfortable interacting with people with disabilities after the session than before. Students reported that they had gained a greater understanding and insight into the communication issues faced by this group, as well as valuing them more as individuals.

CONCLUSIONS

Even a brief information session, combined with the opportunity to interact with people with disabilities, can have an impact on medical students' attitudes. Further research is needed to determine how such experiences may influence their future practice.

Student and professional attitudes and interests in working with people with complex communication needs

Speech-language pathology interest in working with people with complex communication needs was investigated in this study. Participants were third year speech-language pathology undergraduates and recent graduates who had participated in a unit on AAC. Undergraduates (n = 85) completed an Interaction with Disabled Persons attitudinal scale and a questionnaire about interest in various client groups before and after the unit. Some undergraduates (n = 34) repeated the attitudinal scale and completed another questionnaire 2 years after graduation. Recent graduates (n = 56) completed a questionnaire about working with people with complex communication needs and factors influencing work choices; 10 also participated in interviews or focus groups. We found a small but positive attitudinal shift for the undergraduates, but, along with previous disability experience, this was a weak predictor of working with this group. Working in developmental disability ranked low amongst undergraduate preferences. Most graduates were influenced in their job choices by a desire to work on a particular team and previous clinical placements. Questionnaires and interview/focus group data indicated the strong influence of clinical placements on later work choices. Participants who worked in disability appeared passionate about the work involved and offered suggestions for engaging more professionals with this group. Implications for speech-language pathology services in disability are discussed.

Effect of training on attitudes and expertise of optometrists towards people with intellectual disabilities

PURPOSE

To determine whether participation in an educational programme, which comprised both lectures and supervised patient contacts, did more to improve the attitudes, expertise, knowledge and confidence of optometrists and student optometrists towards people with intellectual disabilities (ID) compared with receiving didactic lectures only.

METHODS

Optometrists and student optometrists were invited to take part in vision screening. A series of lectures were provided followed by supervised practice for a minimum of 2 days. A questionnaire was administered before the commencement of the training, and afterwards, in order to assess the impact of the training. The results were compared with a group of control subjects who received similar lectures without the clinical experience.

RESULTS

For both groups there were statistically significant improvements in self-reported knowledge of ophthalmic complications of ID, confidence in working with people with ID, and there was a significantly reduced perceived need for further training after the courses. There was a significantly better result for the group experiencing patient contact particularly in respect of self-reported attitudes towards people with ID. Confidence in dealing with people with ID was related to the number of such patients seen over the last year.

CONCLUSIONS

Training incorporating clinical experience, and using real patients, is particularly effective, although there is still benefit in providing lecture type courses. It is recommended that, whenever possible, courses are provided that offer hands-on experience with real patients. There is a need for further research using validated attitudinal scales to investigate the attitudes of optometrists to people with ID.