CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

People with disabilities are among the most marginalised groups in society, largely because societies have failed to include them and to accommodate their individual differences. The World Health Organization (WHO) estimates that about 1.3 billion people, or 16% of the global population, live with a significant disability. It reports that they die earlier, have poorer health and face more limitations in everyday functioning than people without disabilities, mainly because of unfair conditions in many areas of life, including the health system itself (WHO, 2022). In 2021 the World Health Assembly adopted resolution WHA74.8, which calls on member states to ensure that persons with disabilities receive effective health services as part of universal health coverage (WHO, 2022). Health systems therefore have a clear obligation to remove the barriers that prevent persons with disabilities from obtaining care.

Attitudes of health workers are one of those barriers. Persons with disabilities report bias, stigma and discrimination from health care providers, and negative attitudes of health workers can affect the quality of care that patients receive (Ajuwon et al., 2023; Olalekan & Jimoh, 2021). In Nigeria, for example, studies of hospital services point to the attitudes of providers, alongside systemic barriers, as factors that limit access to and the quality of care for patients with disabilities (Olalekan & Jimoh, 2021). Health workers who lack disability-specific knowledge, feel uncomfortable around people with disabilities or hold stigmatising views are less able to treat them as whole persons. Health professionals therefore need to be educated about the causes, consequences and treatment of disabling conditions, and about the stigma that people with disabilities endure, so that attitudes shift towards a more holistic outlook.

There is no universally accepted way of describing and discussing disability, which complicates how disability is studied and reported and makes it harder to understand disability and to design interventions. Disability may be present from birth or acquired through injury or chronic illness. It may be visible or invisible, temporary or long-term, severe or minor, static or progressive. A broad definition that combines medical and social perspectives is most useful, because it recognises the role of social, attitudinal and physical environments and personal attributes in shaping participation. Health professionals often view disability through a medical lens that overlooks the social aspects of a person’s life, whereas a bio-psychosocial view draws attention to its many dimensions and is a useful conceptual framework for nursing education, practice and research.

Improving disability education has been repeatedly called for, and such education has to take account of negative attitudes as a contributing factor to barriers in health care (WHO, 2022). Nurse educators are responsible for preparing students to uphold the core values of the profession, which includes planning and providing care and advocating for people with disabilities. Students enter nursing programmes with established attitudes, which change as they gain knowledge, relationships and experience, and educators have a strong influence on how those attitudes develop. The attitudes and values that student nurses carry into the clinical area are therefore shaped in part by their educators.

Researchers have studied the attitudes of nursing students to disability in several countries. Studies have identified student characteristics and experiences, such as age, level of study and contact with disabled people, as factors associated with attitudes (Munsuri Rosado & Pinazo Hernandis, 2015). Most of this work was done outside Nigeria, and there is comparatively little evidence on nursing students in Nigeria.

1.2 Statement of the Problem

People with intellectual, physical or emotional disabilities form a substantial part of the world’s population. WHO’s current estimate is that one in six people live with significant disability (WHO, 2022). As the number of people living with disabilities grows, partly because of population growth, ageing and medical advances that prolong life, so does the demand for competent and sensitive health services (Ajuwon et al., 2023). Nurses are the largest group of health professionals and are involved in most care, so they are central to meeting this demand.

Yet many people with disabilities report negative experiences when dealing with health care providers from all professions. Reported problems include poor communication and relationships with health professionals, delays in detecting and treating conditions, insufficient information and support, and inadequate holistic care (WHO, 2022; Olalekan & Jimoh, 2021). Where providers hold negative attitudes, patients with disabilities may avoid or delay seeking care, and providers themselves may avoid this area of practice. Studies of nursing students in other countries also report mixed findings, with some groups showing relatively positive attitudes and others showing negative attitudes or discomfort (Munsuri Rosado & Pinazo Hernandis, 2015).

More knowledge is therefore needed about the current attitudes of future nurses towards people with disabilities and about the factors that shape those attitudes. The present study examines the attitudes of student nurses and the factors that most influence them. The results will inform educators, health professionals, counsellors and employers who design programmes to improve students’ attitudes.

1.3 Research Objectives

The purpose of this study is to determine the attitudes of student nurses toward people with disabilities and to evaluate the factors that influence the attitudes of future nurses. The specific objectives are to:

1. analyse the attitude of student nurses toward people with disabilities;
2. determine which demographic variables (age, gender, level of education, amount of contact with people with disabilities and cultural background) most influence this attitude; and
3. determine how the attitude of student nurses toward people with disabilities can be improved.

1.4 Research Questions

The following research questions, based on the objectives, guided the study:

1. What is the attitude of student nurses toward people with disabilities?
2. Which demographic variables (age, gender, level of education, amount of contact with people with disabilities and cultural background) most influence this attitude?
3. How can the attitude of student nurses toward people with disabilities be improved?

1.5 Significance of the Study

Disability is common, negative attitudes toward it are widely perceived, and the evidence points to a need for better disability education. Negative attitudes are recognised as a barrier to care (WHO, 2022; Olalekan & Jimoh, 2021), so nursing students need to reflect on how they define disability, how they feel about and relate to people with disabilities, and how disability-related content is taught and assessed. Greater attention to these matters can improve instruction, reduce disparities in the care of people with disabilities and encourage a holistic view of all patients.

Studies of health workers in Nigeria recommend improved pre-service and in-service training, together with the development of positive attitudes, to make health care more inclusive (Ajuwon et al., 2023; Olalekan & Jimoh, 2021). Evidence on how student nurses currently think, and on the factors behind their attitudes, can guide curriculum development that integrates the care of people with disabilities into nursing education at all levels. Further evaluation of such a curriculum would then show how it affects the quality of care.

The study will help to identify factors that should be addressed in the training of health care students and the attitudes of future health professionals that may hinder the integration and delivery of services for people with disabilities. It will also give educators, health professionals, counsellors and employers a basis for improving students’ attitudes.

References

Ajuwon, P., et al. (2023). The status of inclusive healthcare services in Nigeria. Journal of Health and Rehabilitation Sciences, 2(2), 56–65. https://doi.org/10.33700/jhrs.2.2.89

Munsuri Rosado, J., & Pinazo Hernandis, S. (2015). Actitudes de los estudiantes de Enfermería hacia las personas con discapacidad [The attitude of nursing students towards persons with disability]. Metas de Enfermería, 18(6), 22–26.

Olalekan, A. A., & Jimoh, R. A. (2021). Barriers in accessing healthcare services by patients with disabilities in Nigerian hospitals. https://gijmss.com.ng/index.php/gijmss/article/view/27

World Health Organization. (2022). Global report on health equity for persons with disabilities. World Health Organization. https://www.who.int/publications/i/item/9789240063600