Stigma research in the field of intellectual disabilities: a scoping review on the perspective of care providers

"All I know is that a disabled person is someone who is crippled": Using narratives of parents to unmask the misconceptions of Mild intellectual disabilities concept as a learning support hindrance

Background: Learning-support provision by parents is key to children's scholastic success. However, when children are diagnosed with mild intellectual disabilities and in need of additional support, learning support provision is hindered. Aim: The study sought to investigate parents' experiences when providing learning support to children diagnosed with Mild intellectual disabilities. Setting: Using a phenomenological design and an interpretive paradigm, anchored in a qualitative research approach, data were gathered from parents whose children were diagnosed with Mild intellectual disabilities across three inclusive schools from disadvantaged backgrounds in the Gauteng province, in South Africa. Methods: Twenty-three (23) parents were purposefully selected to participate in the study by sharing their lived experiences. Data was collected using semi-structured interviews and thematic content data analysis methods. Bronfenbrenner's bio-ecological systems theory underpinned the study. Results: The findings revealed that the parents' misconception of the mild intellectual disability concept is one of the learning support hindrances. Conclusion: Parental empowerment through psycho-education was highlighted as a need for policy and practice adaptation.

Informal Network Members' Perspectives and Experiences on Work for People with Intellectual Disabilities: A Thematic Synthesis

PURPOSE

The level of participation of people with intellectual disabilities (ID) in various forms of work, including daytime activities, appears to be suboptimal. Informal networks of people with ID constitute crucial forms of support, as they can significantly influence occupational choices and opportunities. This review aims to synthesize existing research for the purpose of examining how informal network members perceive the meaning of employment or daytime activities for their relatives with ID.

METHODS

Following the PRISMA guideline, a systematic search of scientific literature published between 1990 and July 2022 was conducted. The qualitative results from twenty-seven studies (qualitative and mixed-method) were analyzed using thematic synthesis.

RESULTS

Four overarching themes and several subthemes were identified: (I) Ensuring customized work for my relative; (II) The ongoing need to collaborate and share care responsibilities with professionals; (III) The meaning of work for both my relative and myself; and (IV) Achieving full work participation for my relative is neither straightforward nor self-evident.

CONCLUSIONS

Informal networks place great value upon customized and sustainable work opportunities for their relatives with ID, particularly community-based work. While network members play an important role in creating these opportunities, they encounter obstacles resulting from both collaboration difficulties with professionals and employers and public and structural forms of stigma. Researchers, professionals, policy makers, and employers are encouraged to collaborate with individuals with ID as well as their networks to increase the meaningful work opportunities available to them.

Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability

BACKGROUND

The establishment of a valuable and meaningful working alliance between people with mild intellectual disabilities (IDs) and healthcare professionals is critically important for improving both the quality of life and impact of therapy for people with mild IDs. Measuring the working alliance as a treatment or support component is therefore of utmost relevance. In light of the increased use of eHealth tools, it is also essential to measure the alliance using these tools, which is referred to as technical alliance. There was a lack of validation of these two measurements for healthcare professionals working with people with mild IDs, which this study sought to address.

METHOD

Both the validated Working Alliance Inventory - Short Form - MID (WAI-SF-MID) and Technical Alliance Inventory - Short Form - MID (TAI-SF-MID) for general patient populations were adapted for healthcare professionals working with people with mild IDs. A two-step approach was conducted to systematically adapt both measurements with an expert group of healthcare professionals. Confirmatory factor analysis was conducted to test a three-factor structure for both the WAI-SF-MID (N = 199) and the TAI-SF-MID (N = 139), and internal consistency was determined for both scales.

RESULTS

An acceptable-to-good model fit was found for both the WAI-SF-MID and the TAI-SF-MID; confirmatory factor analysis confirmed a three-factor model for both measurements. Cronbach's alpha and McDonald's omega were excellent for both total scales (≥0.90) and acceptable to good for sub-scales of both versions.

CONCLUSION

Both the WAI-SF-MID and the TAI-SF-MID are promising measurements for determining healthcare professionals' perspective on the (digital) working alliance with people with mild IDs.

The relationship between direct care providers' physical activity behaviour and perceived physical activity needs for people with intellectual disabilities

BACKGROUND

The promotion of physical activity and the decrease of inactivity and sedentary behaviour are crucial for a healthy lifestyle and positive quality of life. People with intellectual disabilities are at increased risk of inactivity and sedentary behaviour. Therefore, it is important to increase their physical activity by implementing physical activity guidelines in their daily life. Professional direct care providers can play a decisive role in supporting people with intellectual disabilities to participate in physical activity, but the engagement of direct care providers with this role may be reflective of their own attitudes and beliefs towards physical activity. Therefore, the link between the implementation of current physical activity guidelines for people with intellectual disabilities and direct care providers' own beliefs and behaviour with regard to physical activity is investigated.

METHOD

A total of 104 direct care providers completed self-reported questionnaires about their own physical activity behaviour (IPAQ-SF), recommendations for people with intellectual disabilities (adaption of EMIQ-HP) and questions regarding global physical activity guidelines. They were also asked about potential barriers and facilitators for the recommendation of physical activity in open-ended questions.

RESULTS

Personal physical activity behaviour is related to the recommended physical activity for people with intellectual disabilities (moderate-to-vigorous physical activity: r_s  = 0.408, P = 0.005). However, recommended physical activity behaviour for people with intellectual disabilities is significantly lower than direct care providers' own physical activity behaviour (P < 0.001). 47.1% of the respondents recommended people with intellectual disabilities to participate in less than the 150 min of moderate intensity physical activity per week for that is recommended in global physical activity guidelines.

CONCLUSION

Direct care providers may hold stereotypical views and insecurities about the potential harms associated with people with intellectual disabilities participating in physical activity. Therefore, the dissemination of physical activity recommendations for people with intellectual disabilities should be a major target for health professionals, social workers and scientists to address direct care providers' concerns. Furthermore, we need to emphasise the benefits of regular physical activity to professional direct care providers and directly to people with intellectual disabilities.

Setting up a new team of support staff for people with mild intellectual disability or borderline intellectual functioning and severe challenging behaviour: A concept mapping study

BACKGROUND

Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors).

METHOD

Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results.

RESULTS

Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home.

CONCLUSIONS

Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start.

"They treat you like a person, they ask you what you want": a grounded theory study of quality paid disability support for adults with acquired neurological disability

PURPOSE

Adults with acquired neurological disability often require paid disability support to live an ordinary life. However, little is known about what facilitates quality support. This study aims to explore the lived experience of people with acquired neurological disability to develop an understanding of the factors that influence the quality of support.

METHODS

Guided by constructivist grounded theory, in-depth qualitative interviews were conducted with 12 adults with acquired neurological disability. Data analysis followed an iterative process to develop themes and subthemes and explore relations between themes to build a model of quality support.

RESULTS

Nine key factors emerged in the dyadic space, with the support worker recognising the person as an individual as foundational to quality support. Beyond the dyadic space, three broader contextual factors were identified as influential on the quality of support by mechanism of facilitating or constraining the person with disability's choice. Finally, the provision of quality support was characterised by the person feeling in control.

CONCLUSIONS

Findings support the rights of people with disability to quality, individualised support, and a need for interventions to better prepare the disability workforce to deliver support in line with the needs and preferences of people with acquired neurological disability. IMPLICATIONS FOR REHABILITATIONTo provide quality support, disability support workers need to recognise the person with disability as an individual and the expert in their support needs and preferences.The quality of paid disability support is primarily determined by the way the person with disability and support worker work together in the dyadic space.Ensuring people with acquired neurological disability have authentic choice over their support arrangements and daily living is critical to facilitate quality support, and in turn help the person with disability to feel in control.

Experiences of parents of adolescents with intellectual disabilities regarding the transition to sexual development: A transitions theory-based qualitative study

BACKGROUND

To describe of the experiences of parents regarding the transition to sexual development of their adolescents with intellectual disabilities who are 15-19 years old.

METHODS

This study employs a descriptive interpretative approach and uses Meleis's transitions theory as its theoretical frame of reference. This study uses purposive sampling methods for recruitment. We collected data through individual semi-structured interviews (n = 11) and researcher observations between February 2021 and April 2021 and employed an inductive content analysis approach.

RESULTS

Three main themes emerged from the data: parental factors driving the transition process, parents' needs regarding the transition process, and outcomes of the transition process. In addition, most parents struggled to remodel their identities following the transition due to concerns over their adolescent's ability to cope with the challenges of adulthood.

CONCLUSION

Considered in the context of middle-range transitions theory, we suggest that parental experiences regarding adolescents' transition to sexual development stem from varying levels of uncertainty and depend on the situation, preferences, and family needs of each individual parent. It is useful to utilise Meleis's transitions theory to understand deeply and explore the impact of the sexual development of adolescents with intellectual disabilities on parents.

Sexuality, Education and Support for People with Intellectual Disabilities: A Systematic Review of the Attitudes of Support Staff and Relatives

Support staff and relatives are uncertain about multiple aspects of the sexuality of people with intellectual disabilities. Given that their attitudes embody positive and negative views, they can respectively support and restrict free sexual expression among people with intellectual disabilities and their potential for (intimate) relationships. A qualitative systematic literature review was conducted on the attitudes of support staff and relatives toward the sexuality of people with intellectual disabilities. A systematic search strategy was deployed across seven databases. The identified articles were screened on predetermined inclusion and exclusion criteria, and assessed on quality, which resulted in 31 included studies. A metasynthesis of these studies resulted in two major themes emerging, namely (a) attitudes toward the sexuality of people with intellectual disabilities, and (b) attitudes toward the sex education and support. Themes represented both positive and restrictive attitudes among support staff and relatives. The findings suggest that despite a general acceptance of the sexual rights of people with intellectual disabilities, certain forms of sexuality were approached more cautiously. Moreover, the sexual needs of some subgroups of people with intellectual disabilities received scarce attention. Those support staff and relatives holding rather restrictive attitudes appear to emphasize sexual risks. Finally, support staff and relatives stressed the importance of providing sex education and support for people with intellectual disabilities, while, simultaneously, expressing insecurity over the subject. The findings can help to improve the support provided to support staff and relatives to promote sexual health among people with intellectual disabilities.

Development and psychometric assessment of a psychological well-being instrument for adults with mild intellectual disability or borderline intellectual functioning

BACKGROUND

Measuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being.

AIMS

The current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF.

METHODS AND PROCEDURES

The instrument (SPWB-ID) was adapted from Ryff's scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF.

OUTCOMES AND RESULTS

The trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores.

CONCLUSIONS AND IMPLICATIONS

The SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

Social educator students' readiness to address sexual health in their future profession

BACKGROUND

Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues.

PURPOSE

To investigate social educator students' readiness to address sexual health in their future profession.

METHODS

In 2019, 213 social educator students (response rate 34%) responded to the Students' Attitudes towards addressing Sexual Health Extended online questionnaire.

RESULTS

Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities.

CONCLUSION

Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.