Transcript Personal value preferences and attitudes toward people with

Personal value preferences and
attitudes toward people with
disabilities
Evgeny Tartakovsky, Ph.D.,
Tel-Aviv University, the School of
Social Work
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The studies
1. Nurses and physicians working in HIV
Centers in Kazakhstan
2. Staff members of community services for
people with intellectual disability and
severe mental illness in Israel
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Background on HIV/AIDS
• 34 million people are living with HIV in the
world
• 8 million are receiving medical treatment
• In Russia, Ukraine, and Central Asia
Republics of the FSU the HIV epidemic
continues, differently from other countries
in the world
• Differently from what most people think,
HIV is not a fatal disease
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Reactions to PLWHA
• Negative reactions in the general population are
widespread
• They include:
– fear of catching the disease
– dislike of being in contact with terminally ill people
– unwillingness to be in contact with “immoral” populations (e.g.,
intravenous drug users, homosexuals, prostitutes)
– concern over being stigmatized
• Negative reactions of medics to PLWHA may result in
poor patient management, denial or postponement of
their required treatment, care, and support, and
compromised quality of care
• Socio-demographic characteristics explain a very small
proportion of variance in attitudes
• Education, special training, and length of practice
(consistent with Contact Hypothesis)
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The specifics of Kazakhstan
• Between 2005-2007, 139 children, 13 of their mothers,
and two of their fathers were diagnosed as HIV positive
in the Chimkent Region in Southern Kazakhstan
• Before this children’s HIV epidemic, most registered HIVpositive people in Southern Kazakhstan were drug users
• 21 doctors and nurses were charged for professional
negligence and for receiving payment for unnecessary
blood transfusions. Most of them were convicted to
several years in prison. Several of the high-ranking
officials at the Regional Health Department were fired
• Normality of HIV. Stigmatization. Money. Guilt and Anger
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Values and attitudes
• Human cognitive structures are organized
according to a hierarchy
• Values constitute the most general and abstract
part of this hierarchy; they reflect the individuals’
preferences across a wide range of situations
and have a motivational property
• Attitudes are defined as the disposition to
evaluate an attitudinal object with some degree
of favor or disfavor; they represent the
individuals’ preferences in specific conditions
• One of the prominent functions of attitudes is to
assert personal values
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Values according to Schwartz
Values
Definitions
Benevolence
Caring for the welfare of the others with whom one is in
frequent social contact
Universalism Understanding, appreciation, tolerance, and protection of the
welfare of all people and of nature
Tradition
Respect, commitment, and acceptance of the costumes and
ideas provided by the traditional culture or religion
Conformity
Limiting actions and urges that might violate social
expectations and norms
Security
The need for protection of safety, harmony, and stability of the
social structure and of the self
Power
Aspiration for social status through gaining control and
dominance over other people and resources
Achievement Acquiring personal success through demonstrating competence
according to social standards
Hedonism
Pursuit of pleasure and sensual satisfaction
Stimulation
Valuing variety, aspiration for change, challenge, and
excitement
Self-direction Importance of independent thought and action
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Relations among the values
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Hypotheses: Values and attitudes
towards PLWHA
• Self-enhancement values (especially power)
may be associated with negative attitudes
towards out-groups, while self-transcendence
values (especially universalism) may be
associated with positive attitudes towards outgroups.
• Conservation values may be associated with
negative attitudes towards out-groups, while
openness to change values may be associated
with positive attitudes towards out-groups
• These assumptions have been supported for
attitudes towards immigrants, ethnic minorities,
and homosexuals
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Participants and procedure
• 87 physicians and 38 nurses working in
HIV/AIDS Centers in Kazakhstan
• Experience in medicine: M(SD)=18.6(9.86)
• Experience with HIV: M(SD)=3.22(3.41)
• The research questionnaires were
distributed at training seminars
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Instruments: Attitudes towards
PLWHA
• The AIDS Attitude Scale, AAS (Bliwise et al., 1991). This
15-item questionnaire combines items measuring three
aspects of negative attitudes towards PLWHA (a 5-point
scale):
– Fear of contagion (e.g., “Despite all I know about how HIV/AIDS
is transmitted, I am still afraid of catching it”),
– Negative emotions (e.g., “I sometimes find it hard to be
sympathetic towards patients with HIV/AIDS”),
– Professional resistance (e.g., “Given a choice, I would prefer not
to work with patients with HIV/AIDS”).
α=.91
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Value priorities
• The Schwartz Value Survey, SVS (Schwartz,
1992)
• Participants are asked to rate the degree to
which each value serves as a guiding principle
in their lives
• 57 items; 9-point scale
• α = .60 - .81
• Item examples:
– Equality (equal opportunity for all)
– Inner harmony (at peace with myself)
– Social power (control over others, dominance)
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Pearson correlation coefficients between
socio-democratic characteristics and
negative attitudes towards PLWHA
Variables
Age
Gender (1 – male; 2 – female)
Education (1 – BA; 2 – MA)
Negative attitudes towards
PLWHA
-.08
-.07
-.04
Family status (1 – married or
cohabitating; 2 – single)
.04
Religiosity (1 – not religious; 2 –
somewhat religious; 3 – very religious)
.05
Occupation (1 – doctors; 2 – nurses)
Years working in medicine
Years working with HIV/AIDS
-.05
-.02
-.44***
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Pearson correlation coefficients between
personal value preferences and negative
attitudes towards PLWHA
Variables
Negative attitudes towards PLWHA
Security
Conservation
Tradition
Benevolence
-.04
.07
.21*
-.23*
Universalism
Self-direction
Stimulation
-.08
-.02
.09
Hedonism
Achievement
Power
-.02
.13
.31**
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A multiple regression analysis
• 4 predicting variables: years of working with
HIV/AIDS + the values of tradition, benevolence,
and power.
• F(4,120)=11.6; p<.001
– R² = .28
– Adjusted R² = .25
• Three regression coefficients were significant:
– years working with HIV/AIDS (β = -.33)
– tradition (β = .24)
– power (β = .22)
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Discussion
• For those high on benevolence, being empathic and
caring for their patients provides a pleasant sense of
satisfaction derived from their contribution to the welfare
of “close others”
• General humanism (as expressed in the universalism
values) was not important. The reason is not clear
• Care for PLWHA is inconsistent with the power values: a
low-status population and low salary -> a not prestigious
area of specialization
• Care for PLWHA is inconsistent with the tradition values:
a “sinful” population. However, no connection with the
degree of religiosity was found
• Seniority: self-selection and attrition
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Background on the community services for
people with Intellectual Disability and Severe
Mental Illness in Israel
• The philosophy of supported community living for people
with ID/SMI:
–
–
–
–
independent living
social integration
working in real jobs
clients’ participation in decision-making regarding their lives
• Community services:
–
–
–
–
•
•
•
•
supported residence
workshops
clubs
outpatient clinics (drugs and psychotherapies)
People with ID/SMI in community services in Israel:
SMI: 15,000
ID: 25,000
About 60% have both SMI and ID
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Sampling
(more or less representative)
•
•
•
•
•
126 worked in services for people with ID
96 worked in services for people with SMI
The mean age: 35
¾ females
10% managers, 24% social workers, 65%
support workers
• 80% worked in hostels and supported
community living residences
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Instruments: Attitudes of the staff
• The Community Living Attitudes Scale, CLAS (Henry et
al., 1996a). This is a 40-item questionnaire consisting of
four subscales (a 6-point scale; α=0.76-0.83):
– The Empowerment scale (13 items) measures the degree to
which respondents believe that people with ID/SMI should be
allowed to make their own decisions (e.g., “People with ID/SMI
are the best people to give advice and counsel to others who
wish to move into community living”).
– The Exclusion scale (8 items) measures the respondents’ desire
to exclude people with ID/SMI from community life (e.g., “The
best way to handle people with ID/SMI is to keep them in
institutions”).
– The Sheltering scale (7 items) measures the extent to which the
respondents believe that people with ID/SMI require protection
from harm (e.g., “People with ID/SMI need someone to plan their
activities for them”).
– The Similarity scale (12 items) measures the degree to which
respondents believe people with ID/SMI share a common
humanity with others (e.g., “People with ID/SMI can have close
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personal relationships just like everyone else”).
Instruments: Value preferences
• The latest version of the Portrait Values
Questionnaire (Schwartz et al., 2012)
• 57 items describing a person
• A 6-point scale; α=0.72-0.87
• Item examples:
– It is important to him to form his own opinions
and have original ideas (self-direction)
– Being very successful is important to him
(achievement)
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Pearson correlation coefficients between the
socio-demographic variables and attitudes
SocioEmpowerment Similarity Exclusion Sheltering
demographic
characteristics
-.42**
-.27**
.17*
.40**
Gender(1-male)
.01
.06
.00
-.03
Age
-.04
-.08
.06
.03
Origin (1-Isr.)
.02
-.12
.10
.07
Education
.30**
.29**
-.19**
-.33**
Religiosity
.03
.00
-.01
.02
Seniority
.01
.01
-.05
-.03
Position (1-SW)
-.20**
-.26**
.31**
.28**
Place (1-hostel)
-.01
.07
-.05
-.07
Group (1-SMI)
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Pearson correlation coefficients between
value preferences and attitudes
Values
Empowerment Similarity Exclusion Sheltering
Self-direction
.22**
.26**
-.19**
-.12
Stimulation
-.02
-.04
.02
-.00
Hedonism
.09
-.02
-.06
-.04
Achievement
-.05
.05
.05
-.06
-.26**
-.34**
.36**
.13
Security
-.05
-.09
.00
.05
Conformity
-.02
-.10
.05
.05
Tradition
-.02
.01
-.06
.09
Benevolence
.15*
.34**
-.23**
-.16*
Universalism
.15*
.20**
-.20**
-.07
Power
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A multiple regression analysis
• Socio-demographic values R²:
–
–
–
–
Empowerment: 26%
Similarity: 18%
Exclusion: 14%
Sheltering: 29%
• Values’ addition ΔR²:
–
–
–
–
Empowerment: 5%
Similarity: 12%
Exclusion: 12%
Sheltering: 0%
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Discussion: A positive effect of the
self-transcendence values
• Different mechanisms:
– Benevolence: satisfaction and pleasure in
caring for others who belong to the in-group
– Universalism: general humanist approach,
appreciation of equal rights for all, and
willingness to accept people unlike yourselves
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Discussion: A positive effect of the
self-direction values
• Support for the philosophy of community
living requires a certain degree of
independent thought, reliance upon one's
own judgment, and comfort with diversity
– society’s resistance to community living for
people with ID/SMI
• No connection between the conservation
values and community living attitudes
– A tradition of community care for people with
ID/SMI in collectivistic cultures
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Discussion: A negative effect of the
power values
• Community living contradicts the goals of
achieving control and dominance over
people and resources
– The philosophy of community living assumes
transferring control to the people with ID/SIM
– A low social status and prestige of working in
community services
– A sense of helplessness and hopelessness
vis-à-vis people with ID/SIM
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Discussion: The effect of sociodemographic characteristics
• SMI (a more positive attitude) vs. ID:
– A more educated staff ->better knowledge
– More established services (a longer history of
services and a stronger state support)
• Managers and SW have a more positive
attitudes than community support workers
– A higher education -> more knowledge and less fear
– A less intensive contact with the clients
– Managers stronger adhere to the organizational
norms and values than the frontline workers
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Practical considerations
• Selection of the professionals: a higher preference for
the self-direction, universalism, and benevolence values;
a lower preference for the power and (for some areas)
tradition values
• Self-awareness regarding one’s own value preferences:
the imagined values vs. the real ones –> value
confrontation
• Value-change focused trainings (especially in the
beginning of the career)
– Proclamation of the organizational values
– Analysis of the staff’s values; increasing salience of the desired
values and decreasing salience of the undesired values
– Analysis of the connections between values, attitudes, and
behavior
– More information about the nature of the clients’ problem may
change the motivational meaning of working with them (fighting
helplessness and hopelessness)
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– Raising the status of people working with people with disabilities
Thank you!
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