mainstream-health-professionals-stigmatizing-attitudes-towards-people-with-intellectual-disabilities-a-social-barrier-to-effective-capabilities

Pelleboer, Hannah A. (1,2); van Oorsouw, Wietske M. W. J. (1); van Weeghel, Jaap (1,3,4); Embregts, Petri J. C. M. (1,2) (2017). 'Mainstream health professional’s stigmatizing attitudes towards people with intellectual disabilities: a social barrier to effective capabilities' Paper presented at the annual conference of the HDCA, Cape Town 2017.


Abstract


The importance of equal access to mainstream healthcare services for people with intellectual disabilities (ID) is stressed by the UN’s Convention on the Rights of Persons with Disabilities (2006). Bodily health is essential to human development and is inherently linked to concerns of social justice. Unlike many low-income countries, Western high-income countries have relatively accessible and high quality healthcare systems. However, also within high-income countries, people with ID experience poorer health than the general population. Moreover, difficulties using healthcare services, avoidable harm and even premature, avoidable death have been reported for people with ID (e.g., MENCAP; 2012).


Health professionals are key persons in the access to and quality of mainstream healthcare services for people with ID (e.g., see, Article 25 of UNCRPD). Attitudes of health professionals towards people with ID may influence their effort to support good quality healthcare in mainstream services. For example, ward culture, staff attitudes and staff knowledge are found to be crucial in ensuring accessible hospital services for patients with ID (Tuffrey-Wijne, 2014). 


However, people with ID and their carers have reported discrimination and stigmatizing attitudes within healthcare. Preliminary evidence affirms that stigmatizing attitudes amongst health professionals towards people with ID are a possible barrier for people with ID in accessing high quality, mainstream healthcare services. Yet, little is known about the existence and nature of stigmatizing attitudes amongst health professionals towards people with ID. Therefore, we have conducted a systematic literature review to summarize the available evidence about mainstream healthcare professionals’ stigmatizing attitudes towards people with ID. The social-cognitive triad of cognitive (i.e., lack of knowledge, perceptions), affective (i.e., emotional reactions), and behavioral intentional (i.e., discriminatory behavior) dimensions of stigma is used as a guideline to structure and discuss the results.


Thirty studies were included in the analysis. Even though positive attitudes towards inclusion of people with ID in mainstream services were found, the studies revealed stigmatizing attitudes. For example, a lack of familiarity with and knowledge about people with ID was found. Moreover, mainstream health professionals held unrealistic high or low expectations of the capacities of people with ID. Professionals experienced stress, a lack of confidence, fear and anxiety when treating people with ID. Also, professionals demonstrated a tendency to treat people with ID differently and a lack of supporting the autonomy of people with ID.


In terms of the capability approach public stigma as a social conversion factor as well as self-stigma as a personal conversion factor, play a profound role in the conversion from characteristics of goods (e.g., the right and resources to make use of healthcare services) to individual functionings (e.g., achieving bodily health) (Robeyns, 2005). Experienced stigma of people with ID may limit the capability of access to healthcare. Knowledge about people with ID’s experienced stigma will provide information about the actual functionings people with ID can achieve.


It is recommended to use de-stigmatization interventions to help them overcome these limitations. Regarding mainstream healthcare services, it is recommended to include contact with people with ID as well as participatory methods like co-education or co-researching in education programs of health professionals. Finally, according to the capability approach, inclusion would benefit from an understanding of healthcare professionals that ‘equal’ treatment means reasonable adjustments to support equality of people’s capability set instead of undifferentiated treatment (resource equality) (Tuffrey-Wijne, 2014; Nussbaum, 2006).


The process of conducting a systematic literature review and forthcoming results will be presented on a poster and discussed within the context of the capability approach. 


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