Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability

Medication management issues perceived by pharmacists and disability caregivers while supporting people with disability

Background

Australia has a notable gap in guidance for pharmacists, caregivers and disability service providers in: (i) supporting people with disabilities (PWD) within the medication management cycle, (ii) understanding their obligations for providing high quality care, and (iii) preventing medication-related harm.

Objective

The objective of this study was to identify medication management issues for PWD from the perspective of disability caregivers and pharmacists when supporting PWD with their medication.

Methods

A qualitative study design using semi-structured interviews of pharmacists and disability caregivers was undertaken across six different states or territories in Australia.

Results

Interviews were conducted with registered pharmacist participants (n=10), and disability workers (n=10). Seven themes emerged for both pharmacists and caregivers, with most sub-themes and codes concordant between the two cohorts. Clinical issues, particularly related to polypharmacy and psychotropic use; confidence in providing medicines and medication information accurately to PWD; practical and behavioural issues caregivers experienced when administering medication; challenges in providing individualised and person-centred care to PWD; inadequate communication and transfer of information between healthcare professionals, caregivers, and PWD; insufficient disability awareness training for pharmacists and medication training for caregivers; and challenges working with provider organisations within the current practice environment were described.

Conclusions

This study highlighted seven areas where issues were perceived to arise in medication management for PWD. By understanding the issues perceived by those directly providing care, it may be possible to improve medication management. Further research is needed to understand the perceived role of pharmacists in supporting medication management for PWD and their caregivers, and how enabling pharmacists scope might reduce medication-related risks and support QUM in this sector.

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

LAY ABSTRACT

Children, adolescents, and adults with autism spectrum disorder and intellectual disability experience high rates of co-occurring psychiatric conditions throughout their lifetime. However, there is a shortage of psychiatrists to treat these populations. We evaluated how much education psychiatrists-in-training receive on how to care for individuals with autism spectrum disorder/intellectual disability. We found that in many psychiatry programs, residents receive limited training experiences in autism spectrum disorder/intellectual disability involving lectures and patient contact and that psychiatry program directors would benefit from more resources to strengthen education in autism spectrum disorder/intellectual disability.

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.

Experiences With the Mental Health Service System of Family Caregivers of Individuals With an Intellectual/Developmental Disability Referred to START

People with intellectual and developmental disabilities (IDD) frequently have behavioral or mental health needs, but experience obstacles to treatment. Family caregivers are often responsible for coordinating the care of individuals with IDD. This study examined family caregiver experiences using intake data from a national tertiary crisis intervention model designed for people with IDD and mental health needs. Caregivers (n = 488) completed the Family Experiences Interview Schedule. Less than half of families reported satisfaction with the mental health services received. Notable gaps were in crisis, night and weekend services, choice of services and providers, communication and coordination between providers, and specialized training. Experiences were worse for caregiving fathers and individuals with IDD with co-occurring chronic medical conditions.

Best Practice Principles When Working With Individuals With Intellectual Disability and Comorbid Mental Health Concerns

Working with individuals with dual disabilities can be a complex process in the presence of limited evidence base to guide clinical practice. The aims of this qualitative study were to investigate perceptions of best practices of Australian psychologists who work with this specialist population. Thirty-eight Australian psychologists working in the intellectual disability field participated in eight semistructured focus groups. Perceptions of evidence-based practice for individuals with intellectual disabilities and in relation to mental health assessment were explored. Psychologists demonstrated resourcefulness in adapting to limits in available evidence-based practice and in modifying mainstream practice to suit the needs of individuals with dual disabilities. Findings suggest the necessity of practice-based evidence in contributing to the evidence base, and person-centered approaches in relation to best practice for people with intellectual disabilities. Implications for strengthening psychologists' clinical competency and bridging the research and practice gap are discussed.

A RANZCP trainee's experience of working with patients with an intellectual disability: a case series

OBJECTIVES

This study aimed to highlight the interplay of intellectual disability and psychiatric presentation using a case series.

METHODS

A brief review of the current literature and an illustrative case series of five intellectually disabled patients with psychiatric patients whose diagnosis were clarified over time who presented with a psychiatric illness are provided.

RESULTS

The presence of intellectual disability often compounds the difficulty of establishment of mental-health diagnosis.

CONCLUSIONS

More focus is required on training and skills development across mental-health services regarding the assessment of psychiatric disorders in people with an intellectual disability.

Attitudes of health care professionals toward people with intellectual disability: a comparison with the general population

BACKGROUND

Few studies have examined attitudes that may promote the social inclusion of persons with an intellectual disability (ID) among health care providers (HCPs). Yet these attitudes could impact the accessibility and quality of services provided to this population, as well as the general attitudes of HCPs. The objectives of this study were to (1) examine HCPs' pro-inclusion attitudes toward people with ID, (2) compare these to the general population's attitudes and (3) examine how HCPs' attitudes vary as a function of their socio-demographic characteristics.

METHOD

The Attitudes Toward Intellectual Disability Questionnaire was administered to 367 HCPs and a representative sample of the Québec population (N = 1605).

RESULTS

Results indicated that at least half of HCPs displayed positive attitudes, that is, attitudes that are compatible with notions of social inclusion and equal rights, toward individuals with ID. Positive attitudes were less frequently observed for the Interaction and the Sensitivity or tenderness factors measured by the Attitudes Toward Intellectual Disability Questionnaire. In comparison with the general population, HCPs exhibited more positive attitudes on the Knowledge of causes and Sensitivity or tenderness factors and less positive attitudes on the Interaction factor. HCPs who regarded themselves as more knowledgeable about ID and those who reported higher quality contacts or interactions with persons with ID expressed attitudes that were more favourable toward social inclusion.

CONCLUSIONS

In addition to providing general knowledge about ID and the specific health care needs of individuals with ID, training programmes should also promote interactions with this population. Further studies are needed to document HCPs' pro-inclusion attitudes toward people with ID and to assess the impact of interventions on these attitudes.

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.

Cohort profile: a data linkage cohort to examine health service profiles of people with intellectual disability in New South Wales, Australia

PURPOSE

People with intellectual disability are a minority group who experience poorer physical and mental health than the general population and have difficulty accessing healthcare services. There is lack of knowledge about healthcare service needs and gaps experienced by people with intellectual disability. This study aims to interrogate a large linked administrative data set containing hospital admissions, presentations to emergency departments (ED) and mortality data to provide evidence to inform the development of improved health and mental health services for this population.

PARTICIPANTS

A retrospective cohort of people with intellectual disability (n=51 452) from New South Wales (NSW), Australia, to explore health and mental health profiles, mortality, pattern of health service use and associated costs between 2005 and 2013. The cohort is drawn from: the Disability Services Minimum Data Set; Admitted Patients Data Collection; Emergency Department Data Collection, Australian Bureau of Statistics Death Registry and Registry of Births, Deaths and Marriages. Mental health service usage among those with intellectual disability will be compared to a cohort of people who used mental health services (n=1 073 139) and service usage other than for mental health will be compared with published data from the general population.

FINDINGS TO DATE

The median age of the cohort was 24 at the time of the last hospital admission and 21 at the last ED presentation. The cohort has a higher proportion of men than women and accounts for 0.6% of the NSW population in 2011. Over 70% had up to 5 ED presentations and hospitalisations between 2005 and 2012. A high proportion of people with intellectual disability live in the most disadvantaged neighbourhoods.

FUTURE PLANS

Results will be used to inform the development of more responsive healthcare, including improved interactions between health, social and disability supports. More generally, the results will assist the development of more inclusive policy frameworks for people with intellectual disability.

Using 'candidacy' as a framework for understanding access to mainstream psychological treatment for people with intellectual disabilities and common mental health problems within the English Improving Access to Psychological Therapies service

BACKGROUND

The Improving Access to Psychological Therapies (IAPT) service was established to address common mental health problems among the English population in a timely manner in order to counter the social and economic disadvantage accompanying such difficulties. Using the concept of candidacy, we examined how the legitimacy of claims by people with intellectual disabilities to use this service is facilitated or impeded.

METHOD

We used a sequential mixed methods design. We completed 21 interviews with a range of stakeholders, including people with intellectual disabilities and their carers. Themes from the interviews were used to design an online survey questionnaire that was returned by 452 staff from IAPT and specialist intellectual disability services.

RESULTS

Using the candidacy framework, we noted that eligibility and access to IAPT were achieved through dynamic and iterative processes of negotiation involving people with intellectual disabilities and their supporters on one side and IAPT staff and service structures on the other. Barriers and facilitators were apparent throughout the seven dimensions of candidacy (identification, navigation, permeability of services, appearances, adjudications, offers and resistance and operating conditions) and were linked to discourses relating to the character and purpose of IAPT and specialist intellectual disability services.

CONCLUSIONS

Opportunities exist for some people with intellectual disabilities to assert their candidacy for IAPT input, although there are barriers at individual, professional, organisational and structural levels. More attention needs to be paid to how principles of inclusiveness are operationalised within IAPT teams and to the mental health facilitation role of specialist intellectual disability staff.

Ambulatory mental health data demonstrates the high needs of people with an intellectual disability: results from the New South Wales intellectual disability and mental health data linkage project

OBJECTIVE

To investigate the ambulatory mental health service profile of persons with intellectual disability (ID) in a representative sample of New South Wales (NSW).

METHODS

A statistical linkage key was used to link the Disability Services Minimum Data Set (DS-MDS) and a community mental health services dataset (MH-COM) for a representative area of NSW for the period 2005-2010. Linkage was undertaken in four NSW local health districts (LHDs), covering 36.7% of the NSW population. The mental health profiles and service use characteristics of people with an ID were compared to mental health service users without an ID.

RESULTS

Of the 89,262 people in the MH-COM over this 6-year period, 1,459 people (1.6 %) were identified as having an ID. Compared to those without an ID, people with an ID were more likely to have psychotic disorders, developmental disorders and personality disorders, and more than twice as likely to have an 'unknown' diagnosis. Compared to those without an ID, people with an ID were less likely to have depressive disorders, adjustment disorders and other disorders. Service use profiles revealed that people with an ID had 1.6 times more face-to-face contacts, and a total face-to-face contact time which was 2.5 times longer than people without an ID.

CONCLUSIONS

Ambulatory mental health data from NSW indicates that people with an ID receive care for a distinct range of mental disorders, and experience uncertainty regarding their diagnosis. People with an ID have higher service needs which require recognition and the allocation of specific resources. Such data provide a suitable baseline for future evaluation of the impact of ambulatory mental health reforms for people with an ID.

Predictors of specialized inpatient admissions for adults with intellectual disability

Individuals with intellectual disability (ID) have complex mental health needs and may seek specialized ID psychiatric services. This study reports on predictors of specialized inpatient admissions for 234 individuals with ID who received outpatient services at a psychiatric hospital. Overall, from 2007-2012, 55 of the 234 outpatients were triaged into the specialized inpatient unit. Aggression towards others and psychotropic polypharmacy significantly predicted these admissions. Unlike previous research, schizophrenia and level of ID did not predict admissions, suggesting that these factors may have a differential impact in specialized versus mainstream inpatient services. Findings are discussed in relation to how specialized inpatient units can be most responsive to these vulnerable patients and the factors that may impact clinical decision making.

Attitudes toward Adults with Intellectual Disability: A Survey of Ontario Occupational and Physical Therapy Students

PURPOSE

To examine attitudes of students in Ontario master's degree programmes in occupational therapy (MScOT) and physical therapy (MScPT) toward adults with intellectual disability (ID).

METHODS

A quantitative cross-sectional survey study was conducted. An electronic questionnaire was distributed to 1,255 MScOT/PT students at five Ontario universities via email, using a modified Dillman approach. Descriptive statistics were used to describe experiences, attitudes, willingness, and preparedness.

RESULTS

Overall response rate was 17.9%. A total of 96.0% of respondents felt "quite" or "very willing" to deliver rehabilitation to adults with ID; however, 50.7% of respondents felt "not at all prepared" or "a little prepared" to interact with this population in a clinical setting. Of those who felt unprepared, 75.4% reported it to be due to inadequate knowledge. In addition, Ontario MScOT/PT students have neutral attitudes toward adults with ID.

CONCLUSIONS

While many MScOT/PT students are willing to deliver rehabilitation to adults with ID, a large proportion do not feel adequately prepared to interact with this population in a clinical setting. These findings could inform future research and curricular reform in the rehabilitation professions so that future clinicians are better prepared to provide support for this population.

Psychiatrists' knowledge, training and attitudes regarding the care of individuals with intellectual disability

BACKGROUND

Psychiatrists are responsible for providing proper care for people with intellectual disability who have psychiatric disorders. This study examined psychiatrists' perceptions of their own training, knowledge and therapeutic skills, as well as their attitudes towards this population.

METHODS

Questionnaires were distributed to 679 psychiatrists working within the public sector in Israel.

RESULTS

Completed questionnaires were returned from 256 psychiatrists (38% response rate). Most (90%) participants reported having had limited training in the diagnosis and treatment of people with intellectual disabilities, while between 34% and 72% reported having inadequate knowledge in specific areas.

CONCLUSION

The findings of limited training and self-perceived inadequate knowledge are at least partially explained by the service model, wherein people with intellectual disabilities are cared for by general mental health services. The identified inadequacies could be overcome through the implementation of a model in which specially trained psychiatrists are deployed within generic services.

Service development for intellectual disability mental health: a human rights approach

BACKGROUND

People with intellectual disability (ID) experience higher rates of major mental disorders than their non-ID peers, but in many countries have difficulty accessing appropriate mental health services. The aim of this paper is to review the current state of mental health services for people with ID using Australia as a case example, and critically appraise whether such services currently meet the standards set by the Convention on the Rights of Persons with Disabilities.

METHODS

The literature regarding the current state of mental health services for people with ID was reviewed, with a particular focus on Australia.

RESULTS

The review highlighted a number of issues to be addressed to meet the mental health needs of people with ID to ensure that their human rights are upheld like those of all other citizens. Many of the barriers to service provision encountered in Australia are likely also to be relevant to other nations, including the culture of division between disability and mental health services, the inadequate training of both disability and mental health workers in ID mental health, and the lack of relevant epidemiological data. None of these barriers are insurmountable.

CONCLUSIONS

Recommendations are made for adopting a human rights-based approach towards the development and provision of mental health services for people with ID. These include improved policy with measurable outcomes, improved service access via clear referral pathways and the sharing of resources across disability and mental health services, and improved service delivery through training and education initiatives for both the mental health and disability workforce.

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.

Mental health: knowledge, attitudes and training of professionals on dual diagnosis of intellectual disability and psychiatric disorder

BACKGROUND

Dual diagnosis (DD) refers to the coexistence of intellectual disability and psychiatric disorder. In order to provide individuals with DD with adequate care, it is essential for mental health workers to have adequate knowledge and positive attitudes. These may be achieved through proper training.

AIMS

To summarise the available literature examining the knowledge, attitudes and training of psychiatrists and other professional caregivers in regard to serving people with DD.

METHODS

A search strategy was developed to find manuscripts published in English since 1995.

RESULTS

Twenty-seven studies on knowledge, attitudes and training in the field of DD were identified and reviewed in this paper.

CONCLUSION

The findings of this review stress the need to improve the knowledge, competence and attitudes of practitioners within the DD field via training and practice opportunities. In light of this review, recommendations for improving training opportunities and for conducting future research are made.

Carer reports of the efficacy of cognitive behavioral interventions for anger

Anger resulting in Aggression can be a significant problem for some people with Intellectual Disabilities. Carers were asked to complete a provocation inventory and an attribution scale before and after a group cognitive behavioral intervention aimed for anger and at similar points in time for a waiting list control. When compared using an analysis of variance results suggest that staff perceive a significant reduction in aggressive responses for participants who took part in the intervention. A regression analysis of factors that may influence the amount of change observed suggests that greater change was achieved if participants were accompanied by carers and had been attributed by carers as having an emotional cause for their behavior.

Annotation: New research into general psychiatric services for adults with intellectual disability and mental illness

BACKGROUND

There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either model with research being often of a poor quality, lacking replication, and outcome measures were often inappropriate or varied between studies. This review aims assess differences in outcome for patients with ID and mental disorders treated in general or specialised ID mental health services.

METHOD

A literature review was conducted using electronic databases and websites of ID and mental health organisations to locate all references where people with ID receive mental health care in general psychiatric services from 2003. No meta-analysis was attempted because of the divergent nature of the studies.

RESULTS

People with ID (especially severe ID) have reduced access to general psychiatric services. General psychiatric inpatient care is unpopular especially with carers but can be improved by providing specially trained staff and in-reach from community ID teams. Opportunities may exist to enhance the care of people with borderline intellectual functioning within general psychiatric services.

CONCLUSIONS

Although no new randomised controlled trials have been published, the weight of research is accumulating to suggest that provision of general psychiatric services without extra help is not sufficient to meet the needs of people with ID.

Emergency psychiatric services for individuals with intellectual disabilities: perspectives of hospital staff

Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities, from the perspective of hospital staff. Focus groups were conducted with emergency psychiatry staff from 6 hospitals in Toronto, Canada. Hospital staff reported a lack of knowledge regarding intellectual disabilities and a shortage of available community resources. Hospital staff argued that caregivers need more community and respite support to feel better equipped to deal with the crisis before it escalates to the ER and that hospital staff feel ill prepared to provide the necessary care when the ER is the last resort. Input from hospital staff pointed to deficiencies in the system that lead caregivers to use the ER when other options have been exhausted. Both staff and caregivers need support and access to appropriate services if the system is to become more effective at serving the psychiatric needs of this complex population.

Depression in people with intellectual disability: an evaluation of a staff-administered treatment program

The prevalence of co-morbid depression in people with intellectual disability (ID) provides a strong rationale for the early identification and treatment of individuals at risk. The aim of this study was to evaluate a staff-administered group CBT program for the treatment of depression in people with mild ID. A sample of 13 staff employed at two community-based disability agencies were trained to deliver the program to 47 individuals with mild ID and symptoms of depression. A wait list control group comprised of 27 individuals subsequently completed the program. Compared to the control group, individuals who had participated in the treatment program showed lower depression scores, and fewer automatic negative thoughts. Furthermore, these changes were maintained at a 3-month follow-up. The results indicate that staff can be trained to deliver a CBT program within community settings that is effective in the reduction of depression symptomatology in people with mild ID.

Psychiatric care of adults with intellectual disabilities: changing perceptions over a decade

OBJECTIVE

In light of developments in training and service provision, the aim of the present study was to compare two state-wide surveys, undertaken in 1994 and in 2004, of psychiatrists about their perceptions of their training and psychiatric treatment of adults with intellectual disabilities who also have mental health needs.

METHODS

A 50-item self-administered questionnaire was developed for the 2004 survey, based on the 1994 study. This was sent to all 624 Fellows of the Royal Australian and New Zealand College of Psychiatry registered in Victoria at the time. A series of questions was asked based on workload, training, the role of psychiatry in intellectual disabilities, opinions on assessment and management, improving services, and the demographics of participant psychiatrists. Results of the 2004 survey are compared with the 1994 study.

RESULTS

There has been some change in psychiatrists' opinions about acute admission wards, believing strongly that they do not meet the needs of the adults with severe intellectual disabilities, leaving them vulnerable to exploitation. There has been some improvement in their ability to adequately manage adults with intellectual disabilities who have mental health needs and/or problem behaviours.

CONCLUSIONS

Mainstream mental health services fail to meet the needs of adults with intellectual disabilities. Improved specialist clinical services and more clinical training opportunities are required.

Aggressive challenging behaviour and intellectual disability

PURPOSE OF REVIEW

The aim of this article is to review reports of aggressive challenging behaviour in individuals with intellectual disability from September 2006 to March 2008.

RECENT FINDINGS

Studies continued to demonstrate the prevalence and significance of aggressive challenging behaviour in persons with intellectual disability. Over half of the population engages in some form of aggression, but only a small number is responsible for frequent or severe acts. A publication that identified aggression profiles offered a promising new approach. Aggressive behaviour in adults often has multiple functions. The most frequently studied interventions were either behavioural or somatic. Parents learned skills to effectively intervene with their aggressive preschool child. Reviews of medication efficacy studies concluded that there was insufficient evidence to recommend a single medication. Psychiatrists agreed that medication should not be the first treatment option. In one study, a class of medication was found to reduce aggression, but not aggression with self-injury, or self-injury alone.

SUMMARY

Research on aggressive challenging behaviour requires assessment instruments that address the topography and severity of aggression. Identifying aggression types may clarify mixed results of previous research and improve treatment effectiveness. Greater access to effective, nonmedication treatments is needed.

Psychometric properties of the Mental Retardation Attitude Inventory-Revised in Chinese college students

BACKGROUND

This study examines the psychometric properties of the Mental Retardation Attitude Inventory-Revised (MRAI-R; Antonak & Harth) in Chinese college students. The research questions included: (1) Is the MRAI-R a reliable measure for Chinese college student? (2) Is the MRAI-R related to familiarity with people with intellectual disabilities (PWID) and professional training? and (3) Does the four-factor model of the MRAI-R fit the Chinese college student data?

METHOD

Five hundred and thirty-four college students from China participated in the study. Descriptive, Pearson product-moment correlation, Cronbach alpha reliability coefficient and factor analyses were used to examine the reliability and validity of the MRAI-R in this Chinese college student sample.

RESULTS

The alpha coefficient reliability of the total scale of the MRAI-R was 0.78. The alpha coefficient reliabilities for the integration-segregation (INSE) subscale, the social distance (SDIS) subscale, the private rights (PRRT) subscale and the subtle derogatory beliefs (SUDB) subscale were 0.50 (INSE), 0.78 (SDIS), 0.50 (PRRT) and 0.21 (SUDB) respectively. Correlation analyses indicated that familiarity with PWID and professional training had a weak correlation with attitudes towards PWID. A confirmatory factor analysis revealed that the standardized factor loadings and goodness-of-fit indices were inadequate (the chi-square/degrees of freedom ratio = 3.24; the goodness-of-fit index = 0.85; the comparative fit index = 0.69; the RMSEA* = 0.07). A principal axis factoring analysis (PAF) with oblique rotation identified three factors with 25% of the variance accounted for the sample. However, the results of this PAF were factorial complex and not interpretable in that many items of the scale had double loadings on more than one factor.

CONCLUSIONS

The factor structure of the MRAI-R in this sample of Chinese college students did not replicate the structure found in American adults. Although the SDIS subscale of the MRAI-R appeared to be a reliable instrument among the four subscales of the MRAI-R, the reliabilities of the INSE, PRRT and SUDB subscales were low. Continuing investigations of the utility of the MRAI-R in Chinese culture is needed. Attitude instruments based on Chinese culture may be developed.