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Personal value preferences and attitudes toward people with

disabilitiesEvgeny 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 HIV-positive 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 SchwartzValues 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 out-groups.

• 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 Negative attitudes towards PLWHA

Age -.08Gender (1 – male; 2 – female) -.07Education (1 – BA; 2 – MA) -.04Family status (1 – married or cohabitating; 2 – single)

.04

Religiosity (1 – not religious; 2 – somewhat religious; 3 – very religious)

.05

Occupation (1 – doctors; 2 – nurses) -.05Years working in medicine -.02Years working with HIV/AIDS -.44***

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Pearson correlation coefficients between personal value preferences and negative

attitudes towards PLWHA Variables Negative attitudes towards PLWHA

Security -.04

Conservation .07

Tradition .21*

Benevolence -.23*

Universalism -.08

Self-direction -.02

Stimulation .09

Hedonism -.02

Achievement .13

Power .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 personal relationships just like everyone else”).

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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

Socio-demographic

characteristics

Empowerment Similarity Exclusion Sheltering

Group (1-SMI) -.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

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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

Power -.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

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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 socio-demographic 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)

– Raising the status of people working with people with disabilities

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Thank you!