horner johnson et al-2002-journal of intellectual disability research

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Abstract

Background The purpose of the present study wasto gain insight into the structure and organizationof the attitudes of Japanese students toward peoplewith intellectual disability (ID). The study alsoexamined how these attitudes are related to individ-ual characteristics, such as experience with peoplewith ID, major field of study and career interests.Methods The participants completed a series ofmeasures developed in the USA: three measures ofattitudes toward people with ID, a demographicquestionnaire and a social desirability scale.Students completed the measures anonymously.Results The factor structures of all three attitudescales replicated the structures found in the USA.Attitudes toward the community inclusion ofpeople with ID were negatively correlated with anendorsement of eugenics. Students in social workand psychology had more positive attitudes thanother students. Participants who expressed an interest in a career working with people with ID

Correspondence: Willi Horner-Johnson, Oregon Office on Disabil-ity and Health, CDRC PO Box , Portland, OR , USA(e-mail: [email protected]).

had more positive attitudes than students with nointerest in such a career.Conclusions Attitude measures developed in theUSA can be used in Japan, and can provide usefulinformation as well as an opportunity for cross-cultural comparisons. For a more complete under-standing of the attitudes of Japanese people towardpeople with ID, these attitudes should also bestudied using measures based in Japanese culturewhich have specifically developed to measure atti-tudes in Japan.

Keywords attitudes, cross-cultural research, Japan,students

Introduction

The literature on attitudes toward people with intellectual disability (ID) and on living conditionsfor those with ID is primarily focused on developedWestern societies. Less is known about attitudestoward people with ID world-wide, or about thelives of people with ID in Asia, Africa and LatinAmerica. One country in which attitudes towardpeople with ID are beginning to receive morepublic attention is Japan. There is a sense that theJapanese public at large has little knowledge of theexistence of facilities for people with ID, or of

Journal of Intellectual Disability Research

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Blackwell Science Ltd

Attitudes of Japanese students toward people with intellectual disability

W. Horner-Johnson,1 C. Keys,1 D. Henry,1 K. Yamaki,1 F. Oi,2 K. Watanabe,3 H. Shimada3 & I. Fugjimura4

1 University of Illinois at Chicago, Chicago, Illinois, USA2 Hirosaki Gakuin University, Aomori Prefecture, Japan3 Institute for Developmental Research, Aichi Human Service Centre, Aichi Prefecture, Japan4 Higashiyamata Residence,Yokohama, Kanagawa Prefecture, Japan

people who live and work in them (Ito & Tagawa; JLMR ). In an effort to change this situation, parents, professionals and self-advocatesare advocating for community inclusion and disabil-ity rights (JLMR ; CIA ). These groupsare working to change the tradition of segregationand isolation that, as in many other countries,people with disabilities have traditionally experi-enced in Japan.

The current interest in attitudes toward peoplewith ID in Japan makes the present study particu-larly relevant. The purpose of the study is to gainan insight into the structure and organization ofJapanese attitudes toward people with ID. A seriesof paper-and-pencil scales was used to measure atti-tudes toward community inclusion of people withID among university students in Japan. This studyalso examines how these attitudes are related toindividual characteristics, such as experience withpeople with ID, major field of study and careerinterests.

Importance of attitudes toward people with intellectual disability

A key reason for studying attitudes lies in the assertion by Ajzen & Fishbein ) that attitudesare the best predictors of behavioural intentions.In support of the attitudebehaviour relationship,Kraus () performed a meta-analysis and foundthat attitudes significantly predict behaviour. As amarginalized group, people with ID are often sub-jected to discrimination and exclusion. Such nega-tive attitudes and the concomitant behaviours cangreatly limit their choices, both in human-servicesettings and in the larger community. Knowledge ofattitudes in specific settings would identify areas inwhich people with ID are most likely to encounterresistance. Knowledge of negative attitudes can alsohighlight concerns which need to be addressed ineducating the public, such as public willingness to use eugenics measures, including involuntarysterilization.

Measuring attitudes toward people with intellectual disability

Most efforts to measure attitudes have portrayedpeople with ID as relatively passive objects of

others attitudes. It is only in the past decade thatdimensions of empowerment and self-advocacy of people with ID have been considered (Henryet al. ). Recent measures such as the MentalRetardation Attitude Inventory (MRAI; Antonak &Harth ) have addressed some issues of com-munity living philosophy. However, for the mostpart, attitude measures have done little to addressthe issues deemed important by people with IDthemselves (Keys et al. ).

In an effort to provide a measure that adequatelycaptures attitudes relating to the community in-clusion and empowerment of people with ID,Henry et al. () created the Community Living Attitudes Scale Mental Retardation Form(CLAS-MR). This scale was developed with theinput of people with ID to tap into beliefs abouttheir empowerment and self-advocacy, as well asattitudes regarding their exclusion and sheltering.The scale also measures the extent to which peoplewith ID are viewed as similar to oneself and others.

The present study used both the CLAS-MR andthe MRAI to measure attitudes toward people withID in Japan. This study also measured attitudestoward the use of eugenics in relation to ID. Theway in which members of a culture view peoplewith ID is likely to be related to their willingness toemploy eugenic measures such as involuntary steri-lization. An indicated willingness to use eugenicsmeasures with people with ID implies that peoplewith ID are not highly valued and are seen asdefective. These views are likely to be influenced by larger societal values, such as conformity andproductivity.

Because the views of people with ID in Japanappear to be in a transitional state, it is difficult toknow how people with ID may be received inJapanese society as they move toward communityinclusion. On the one hand, people with ID havetraditionally been kept in seclusion. On the other,there are currently enthusiastic advocates workingfor increased inclusion of people with ID. Thus,it seems quite likely that attitudes may vary con-siderably depending on exposure to and interest in issues surrounding ID. An understanding of attitudes toward people with ID is particularlyimportant during this transitional phase. Universitystudents are a singularly useful group to study toascertain whether diverse trends exist because the


W. Horner-Johnson et al. Attitudes of Japanese students366

Blackwell Science Ltd, Journal of Intellectual Disability Research ,

student population is itself in flux. Students areboth reflectors of tradition and carriers of change.Thus, student attitudes may be a harbinger offuture social attitudes.

Research questions

Given the utility of studying the attitudes of Japanese students toward people with ID, thepresent investigation addressed the following questions: How do Japanese students organize their ideasabout people with ID? How well do attitude mea-sures developed in the USA work in Japan? Are thefactor structures of the measures similar? How do attitudes toward community inclusion ofpeople with ID relate to attitudes toward eugenicsand ID? Are these constructs related? Do demographic characteristics such as sex, pastexperience with people with disabilities, presentacademic major field of study and future careerinterest affect responses on measures of attitudestoward people with ID, and if so, how?

The similarity of attitude factor structures inJapan to structures found in the USA has not beenstudied previously, nor have attitudes toward com-munity inclusion and empowerment been systemat-ically studied in Japan. To the present authorsknowledge, this study is also the first to examinerelationships among attitudes toward inclusion,empowerment and eugenics in Japan, and to studyrelationships between all of these attitudes and thedemographic variables mentioned above.

Subjects and methods

Participants

The research participants were students atMeisei University in Tokyo, Tokai University inIsehara City, and Aichi Technical School of Nursingin Aichi Prefecture, Japan. The survey was anoptional class activity conducted by collaboratingresearchers in Japan during classes which they wereteaching. Eleven out of the participants weredropped from the sample because of multiplemissing responses. The vast majority of the remain-ing participants were Japanese, were betweenthe ages of and years, had never married,

were attending a -year college and had no dis-abilities. Four participants did not indicate theirsex; out of the remainder, .% were female and.% male. Their major fields of study, and experi-ence with and interest in disabilities are shown inTable .

Measures

The participants completed three measures of attitudes toward people with ID and a social desirability scale. The three attitude measures areLikert-type scales with positive and negative state-ments about people with ID, and five response




Table 1 Major field of study, and experience of and interest in dis-ability: (ID) intellectual disability

Variable Frequency Percentage

Major field of studyEducation 67 24.4Psychology 44 16.0Economics 27 9.8Electrical Engineering 25 9.1Mechanical Engineering 15 5.5Literature 14 5.1Social Work 13 4.7Civil Engineering 11 4.0Chemistry 11 4.0Nursing 10 3.6Physics 9 3.3Missing 29 10.5

Do you have a disability?No 264 96.0Yes 7 2.5Missing 4 1.5

Do you have a close friend or relative with a disability?No 199 72.4Yes 72 26.2Missing 4 1.5

Have you ever been employed to work with people with ID?No 211 76.7Yes 54 19.6Missing 10 3.6

Are you interested a career working with people with ID?No 113 41.1Not sure 106 38.5Yes 47 17.1Missing 9 3.3

options: () disagree strongly, () disagree moder-ately, () neutral, () agree moderately and ()agree strongly.

Community Living Attitudes Scale Mental Retardation Form

The CLAS-MR (Henry et al. ) is a -itemmeasure consisting of four subscales: Empower-ment, Exclusion, Sheltering and Similarity. TheEmpowerment subscale ( items) taps into atti-tudes toward the self-advocacy and empowermentof people with ID. The Exclusion subscale (eightitems) measures the tendency to exclude peoplewith ID from community life. The Sheltering sub-scale (seven items) measures the extent to whichpeople with ID are seen as needing sheltering andprotection. The Similarity subscale ( items) cap-tures the perceived similarity of people with ID to people without ID. The CLAS-MR subscaleshave demonstrated acceptable internal consistency(a = ..), retest reliability (.. at onemonth), construct validity in correlations with otherattitude scales and no significant relationship withsocial desirability (Henry et al. ).

Mental Retardation Attitude Inventory

The MRAI (Antonak & Harth ) is a -itemscale measuring attitudes toward people with ID on four subscales: IntegrationSegregation, SocialDistance, Private Rights and Subtle DerogatoryBeliefs. IntegrationSegregation (seven items) refersto beliefs about including or excluding people withID in various aspects of community life. Social Distance (eight items) involves willingness or reluc-tance to be associated with someone with ID. ThePrivate Rights subscale (seven items) concerns therights of individuals who wish to exclude peoplewith ID. The Subtle Derogatory Beliefs subscale(seven items) refers to degrading views of the abil-ities and character of people with ID. Antonak &Harth () reported internal consistencies of thesubscales ranging from . to . (Cronbachsalpha) and a split half reliability of ... Sub-scale scores were significantly related to familiaritywith individuals who have ID and were shown to beindependent of social desirability response bias(Antonak & Harth ).

Scale of Attitudes Toward Mental Retardation and Eugenics

The Scale of Attitudes toward Mental Retardationand Eugenics (AMRE; Antonak et al. ) is a -item measure tapping beliefs about the repro-ductive rights of people with ID. For example,People with ID should be permanently sterilizedbefore they are allowed to marry. This measureyields a single scale score. Antonak et al. ()found that the scale had a coefficient alpha internalconsistencyhomogeneity index of . and thatscale scores did not differ significantly by socialdesirability score.

MarloweCrowne Social Desirability Scale Short Form

The -item version of the MarloweCrowne SocialDesirability Scale (MCSDS-SF; Strahan & Gerbasi) has a correlation of . with the original -item scale and an internal consistency alpha of .(Fischer & Fick ). This scale measures the par-ticipants tendency to select a socially acceptableresponse, even though it may not be true. Thisinformation is important because participants maybe inclined to indicate positive attitudes towardpeople with ID because they think they should,rather than because these responses represent theirown attitudes.

The participants also completed a demographicquestionnaire. In addition to information such assex, age and major field of study, students wereasked to indicate whether they had friends or rela-tives with disabilities, whether they had ever workedwith people with ID, and whether they were inter-ested in a career working with people with ID.

Procedures

Translation of the measures was conducted accord-ing to the method used by Liang & Bogat () toestablish cultural equivalence. Content equivalencewas established by having four bilingual Japanesenationals read all of the items in English, and indi-cate whether each item was relevant to Japaneseculture, questionably relevant or irrelevant. Itemsmarked irrelevant by one or more people were elim-inated. Items marked questionably relevant by atleast two people were reworded or eliminated. This




process resulted in one item being eliminated fromeach of the three attitude measures.

Semantic equivalence was established throughtranslation and back-translation of the measures.Collaborating researchers in Japan were responsiblefor the translation of the measures into Japanese.The translated measures were then translated backinto English by a professional translation service inChicago, IL, USA. The two English versions (i.e.the original and the back translation) were thencompared. Items were rated by four knowledgeableresearchers of attitudes toward people with ID ashaving the same meaning in both versions, almostthe same meaning in both versions or differentmeanings in the two versions. Items which did not have the same meaning were examined by abilingual Japanese national to determine whetherthe change in meaning occurred in the translationinto Japanese and/or in the back translation intoEnglish. Items in which the translation into Japanese was judged to be true to the original wereleft unchanged. Items in which the translation intoJapanese differed in meaning from the original werere-translated. Five items were reworded because ofdifficulties with translating the original items.

Researchers in Japan administered the translatedmeasures to students in classes which they wereteaching. Students were informed that completingthe measures was optional and was not related to class grades. They completed the measuresanonymously.

Results

Scale scoring

Mean scores on the AMRE and each subscale ofthe CLAS-MR and MRAI were calculated bysumming the scores on individual questions anddividing the total score by the number of questions.Thus, the mean scores are on a scale of . TheEmpowerment and Similarity subscales of theCLAS-MR were scored so that higher scores indi-cate more positive attitudes (i.e. more likely toendorse empowerment of people with ID and morelikely to see individuals with ID as similar tooneself). For the Exclusion and Sheltering sub-scales of the CLAS-MR, higher scores indicate lesspositive attitudes (i.e. more likely to favour exclu-

sion of people with ID and more likely to endorseunnecessary protectiveness of people with ID). Allsubscales of the MRAI were scored so that higherscores indicated more positive attitudes towardpeople with ID. The AMRE is also scored this way,meaning that higher scores indicate less endorse-ment of eugenics in relation to ID.

Confirmatory factor analysis

To address the question of whether Japanese atti-tudes toward people with ID follow the same factorstructure as that found in the USA, confirmatoryfactor analyses of the CLAS-MR and the MRAIwere conducted. A model was tested, using theAMOS . computer program, in which each item was allowed to load only on its own factor(Arbuckle ); the factors were allowed to correlate.

The overall chi-square value for the CLAS-MRwas significant [c2(639) = ., P < .]. This isnot surprising since complex models often result in large chi-square values. The root mean square(RMS) residual and the probability of a close fit(Pclose) are more appropriate indices of model fit.The RMS residual is an indicator of the averageamount of error around each estimated parameter.Any RMS values below . are considered accept-able and those below . are excellent (Steiger, cited in Henry et al. ). The RMS residualfor this model was .. The Pclose is the probabilitythat the RMS is really below .. A value of . orhigher is an indication that the model is in fact agood fit. For the present model, Pclose was .. TheRMS residual and the probability of a close fit indi-cate that the four-factor structure of the CLAS-MRwas a very good fit to the Japanese student data.The four factors are Empowerment, Exclusion,Similarity and Sheltering. Factor loadings are listedin Table . Out of the items, (%) hadfactor loadings of . or higher in the appropriatedirection on their subscales.

The same type of confirmatory factor analysiswas conducted with the MRAI items. The overallchi-square value was significant [c2(339) = .,P < .]. Again, this value is inflated because ofthe complexity of the model and merely indicatesthat the fit is not ideal. The RMS residual was . and the Pclose was .. These values indicate







Table 2 Community Living Attitudes Scale: confirmatory factor loadings: (ID) intellectual disability

FactorSubscale/item loading

Empowerment2. People with ID should not be allowed to marry and have children* 0.323. A person would be foolish to marry a person with ID* 0.477. People with ID should not hold public office* 0.53

12. People with ID should not be allowed to drive* 0.4115. I would trust a person with ID to be a baby-sitter for one of my children 0.6021. People with ID should be encouraged to lobby legislators on their own 0.3222. People with ID are the best people to give advice and counsel to others who wish to move into community living 0.3023. The opinion of a person with ID should carry more weight than those of family members and professionals in

decisions affecting that person 0.5024. People with ID can plan meetings and conferences without assistance from others 0.5525. People with ID can be trusted to handle money responsibly 0.5032. The rights of people with ID are more important than professional concerns about their problems 0.5033. Agencies which serve people with ID should have them on their boards 0.3838. Professionals should not make decisions for people with ID unless absolutely necessary 0.19

Exclusion18. I would not want to live next door to people with ID 0.6526. Residents have nothing to fear from people with ID living and working in their neighbourhoods* 0.3929. The best care for people with ID is to be part of normal life in the community* 0.4934. The best way to handle people with ID is to keep them in institutions 0.6735. Homes and services for people with ID should be kept out of residential neighbourhoods 0.6436. Increased spending on programmes for people with ID is a waste of tax dollars 0.5137. Homes and services for people with ID downgrade the neighbourhoods they are in 0.6639. People with ID are a burden on society 0.60

Similarity 0.274. People with ID should be guaranteed the same rights in society as other people 0.275. People with ID do not want to work* 0.318. People with ID should not be given any responsibility* 0.549. People with ID can organize and speak for themselves 0.39

10. People with ID do not care about advancement in their jobs* 0.4911. People with ID do not need to make choices about the things they will do each day* 0.4813. People with ID can be productive members of society 0.4814. People with ID have goals for their lives like other people 0.4516. People with ID cannot exercise control over their lives like other people* 0.4517. People with ID can have close personal relationships just like everyone else 0.4619. People with ID are usually too limited to be sensitive to the needs and feelings of others* 0.55

Sheltering1. People with ID are happier when they live and work with others like them 0.016. People with ID need someone to plan their activities for them 0.33

20. People with ID should live in sheltered facilities because of the dangers of living in the community 0.5927. People with ID usually should live in residential facilities where they can have the help and support of staff 0.4628. Sheltered workshops for people with ID are essential 0.2330. Most people with ID prefer to work in a sheltered setting that is more sensitive to their needs 0.2031. Without some form of control and supervision, people with ID could get in real trouble out in the community 0.37

*Reverse scored item.

that the four-factor structure of the MRAI was also a very good fit to the data gathered fromJapanese students. The four factors of the MRAIare IntegrationSegregation, Social Distance,Private Rights and Subtle Derogatory Beliefs. Outof the items, (%) loaded at . or higherin the appropriate direction on their subscales.Factor loadings are listed in Table .

Antonak et al. () found a single-factor struc-ture for the AMRE. An exploratory factor analysiswas conducted to determine whether the Japanesedata also indicated a unidimensional structure.Although seven factors with eigenvalues over .emerged, the first factor is considerably larger thanthe others. The first factor had an eigenvalue of. and accounted for .% of the variance. The




Table 3 Mental Retardation Attitude Inventory: confirmatory factor loadings: (ID) intellectual disability

FactorSubscale/item loading

IntegrationSegregation1. School officials should not place children with ID and children without ID in the same classes* 0.612. We should integrate people with ID and people without ID in the same neighbourhoods 0.637. It is a good idea to have separate after-school programmes for children with ID and children without ID* 0.39

12. Integrating children with ID and children without ID into the same pre-school classes should not be attempted because of the turmoil it would cause* 0.70

16. Having people with ID and people without ID work at the same job sites will be beneficial to both 0.6022. High school students with ID should be assigned to the same classes as high school students without ID 0.5728. The child with ID should be integrated into regular classes at school 0.61

Social Distance3. I would allow my child to accept an invitation to a birthday party given for a child with ID 0.565. I am willing for my child to have children with ID as close personal friends 0.71

11. I have no objection to attending the movies or a play in the company of people with ID 0.6714. I would rather not rather not have people with ID as dinner guests with my friends without ID* 0.7717. I would rather not have a person with ID swim in the same pool that I swim in* 0.6718. I would be willing to introduce a person with ID to friends and neighbours in my home town 0.6523. I would be willing to go to a competent barber or hairdresser with ID 0.5726. I would rather not have people with ID live in the same apartment building I live in* 0.71

Private Rights6. If I were a landlord, I would want to pick my tenants, even if this meant only renting to people without ID* 0.098. Regardless of her or his own views, a private nursery school director should be required to admit children with ID 0.60

13. Real estate agents should be required to show homes to families with children with ID regardless of the desires of the homeowners 0.29

19. Campground and amusement park owners have the right to refuse to serve anyone they please, even if it means refusing people with ID* 0.27

21. If I were a barber or a beauty shop owner, I would not resent it if I were told that I had to serve people with ID 0.7527. A person should not be permitted to run a day-care centre if she or he will not serve children with ID 0.20

Subtle Derogatory Beliefs4. People with ID are not yet ready to practice the self-control that goes with social equality for people without ID* 0.649. Even though children with ID are in public school, it is doubtful whether they will gain much from it* 0.62

10. Although social mixing of people with ID and people without ID may be all right, it is impractical until people with ID learn to accept limits in their relationships with the opposite sex* 0.48

15. Children with ID waste time playing in class instead of trying to do better* 0.4620. The problem of prejudice toward people with ID has been exaggerated* 0.0424. In the same social situations, people with ID do not do as well as people without ID* 0.4925. Even though people with ID may be treated unfairly, they could get what they want if they were more patient* 0.15

*Reverse scored item.

second factor had an eigenvalue of . andaccounted for only .% of the variance. Subse-quent factors with eigenvalues greater than .accounted for amounts of variance close to thataccounted for by the second factor. These sec-ondary factors did not add conceptual clarity to thesolution; thus, a single-factor solution was accepted.

Construct validity

The correlations between the subscales of theCLAS-MR and the MRAI were examined for con-vergent validity. All four CLAS-MR subscales weresignificantly correlated with all four subscales of theMRAI in the appropriate direction, with the excep-tion of the correlation between the Sheltering sub-scale of the CLAS-MR and the Private Rightssubscale of the MRAI. When a Bonferroni correc-tion was applied, only this last correlation was nolonger significant. Each of these two subscales alsohad significant correlations with the remaining sub-scales (see Table ).

Correlations between community inclusion andeugenics attitudes

Correlations between each of the CLAS-MR andMRAI subscales, and the AMRE were significantand relatively strong with the Bonferroni correctionapplied (see Table ). Students with high scores on

the Empowerment and Similarity subscales on theCLAS-MR and on the MRAI subscales also scoredhigh (indicating positive attitudes toward peoplewith ID) on the AMRE. The students who scored high on the Exclusion and Sheltering scales of the CLAS-MR scored lower on the AMRE, indicat-ing that they were more likely to approve of usingeugenics in relation to ID. These correlations are in the appropriate direction to indicate that theCLAS-MR, the MRAI, and the AMRE are measuring related constructs.

Discriminant validity

Correlations between the MCSDS-SF on the onehand, and the CLAS-MR subscales, the MRAI sub-scales and the AMRE on the other were computedin hopes of establishing discriminant validity. Non-significant correlations with social desirability wouldindicate that responses to the attitude measureswere not unduly influenced by a tendency toprovide socially desirable responses. None of thecorrelations were significant when a Bonferroni cor-rection for the number of correlations in the matrixwas applied (see Table ).

Demographic variables and attitudes

Overall, the respondents in the present studyexpressed moderately positive attitudes. Five of the




Table 4 Correlations between scales

Emp Excl Sim Shelt INSE SDIS PRRT SUDB AMRE SDes

Empowerment (Emp) Exclusion (Excl) -0.58* Similarity (Sim) 0.57* -0.68* Sheltering (Shelt) -0.31* 0.36* -0.27* Integration-Segregation (INSE) 0.52* -0.63* 0.56* -0.36* Social Distance (SDIS) 0.58* -0.66* 0.55* -0.35* 0.62* Private Rights (PRRT) 0.33* -0.50* 0.39* -0.14 0.40* 0.54* Subtle Derogatory Beliefs (SUDB) 0.47* -0.50* 0.46* -0.33* 0.56* 0.57* 0.31* Reproductive Rights (AMRE ) 0.64* -0.69* 0.63* -0.44* 0.62* 0.68* 0.49* 0.61* Social Desirability (SDes) 0.13 -0.15 0.16 -0.12 0.20 0.17 0.08 0.12 0.16

*P < . (Bonferroni corrected probabilities).Higher scores indicate more negative attitudes on the Exclusion and Sheltering subscales of the Community Living Attitudes Scale, but morepositive attitudes on all other scales: (AMRE) Scale of Attitudes Toward Mental Retardation and Eugenics.

demographic variables had sufficient variability forperforming further analyses: () sex; () having arelative or close friend with a disability; () havingbeen employed in the field of ID; () major field of study; and () interest in a career working withpeople with ID. The three dichotomous demo-graphic variables (i.e. sex, whether or not studentshad a friend or relative with a disability, andwhether or not they had ever been employed in the field of ID) were correlated with all of the attitude measures. When a Bonferroni correctionwas applied, the only significant correlation wasbetween the Private Rights subscale of the MRAI,and having a relative or friend with a disability(r = .). Those with a relative or close friend witha disability were more likely to endorse the rights ofpeople with ID.

There were different majors, which were collapsed into four categories which roughlyapproximate a continuum from quantitative physi-cal sciences to helping professions and follow thegeneral pattern of their attitude scores. The PhysicalScience & Economics category included physics,chemistry and economics. The Engineering cate-gory consisted of electrical, mechanical and civilengineering majors. Students majoring in educa-

tion, literature and nursing made up the Mixed category. Psychology and social work majors comprised the Mental Health category.

A multivariate analysis of variance (MANOVA) wasused to determine the relationship of major field ofstudy to the CLAS-MR subscales and the MRAIsubscales. Major field of study had a significanteffect on the combined CLAS-MR subscales [F(12, 800) = ., P < .]. With a Bonferroni cor-rection applied to the probabilities, Mental Health(i.e. social work and psychology students) was con-trasted with the other three groups on each of thesubscales. There were no significant differencesbetween groups on the Empowerment subscale.The Mental Health group scored significantly loweron the Exclusion subscale (indicating more positiveattitudes) than Physical Science & Economics andEngineering, as well as students who did not indi-cate a major. On the Sheltering and Similarity sub-scales, Mental Health scores were significantly morepositive than those students who had declared nomajor. Means and standard deviations are listed inTable .

Major field of study also had a significant effecton the combined MRAI subscales [F(12, 800) = .,P < .]. There were no significant differences on




Table 5 Scale means and standard deviations (SDs) by major field of study: (AMRE) Scale of Attitudes Toward Mental Retardation andEugenics

Major field of study

PhysicalScience No declared

Mental Health Mixed Engineering & Economics major

Scale Mean SD Mean SD Mean SD Mean SD Mean SD

Empowerment 3.48 0.36 3.45 0.46 3.37 0.54 3.38 0.54 3.27 0.47Exclusion 1.62 0.38* 1.92 0.61 2.00 0.61 2.23 0.85 2.28 0.74Similarity 4.18 0.41 4.01 0.51 3.96 0.48 3.92 0.68 3.78 0.63Sheltering 3.03 0.47 3.13 0.52 3.18 0.52 3.26 0.48 3.38 0.44IntegrationSegregation 3.63 0.46* 3.47 0.52 3.29 0.48 3.21 0.68 3.18 0.63Social Distance 3.99 0.65* 3.68 0.76 3.46 0.74 3.33 0.86 3.28 0.82Private Rights 3.13 0.44 3.11 0.43 2.99 0.41 2.88 0.55 2.92 0.62Subtle Derogatory Beliefs 3.50 0.40* 3.35 0.47 3.09 0.58 3.22 0.57 3.07 0.59Eugenics (AMRE) 3.71 0.38* 3.51 0.40 3.41 0.42 3.38 0.50 3.23 0.49

* Significantly different from Engineering, Physical Science & Economics and no declared major. Significantly different from no declared major.

the Private Rights subscale. For the three othersubscales, the Mental Health group had signifi-cantly more positive attitudes than Physical Science& Economics, Engineering and the no declaredmajor group (for means and standard deviations,see Table ). A univariate ANOVA was conducted tomeasure the effects of major on AMRE scores.There was a significant effect [F(3, 274) = .,P < .]. Post hoc comparisons indicated that thesignificant group differences were that both MentalHealth and Mixed differed significantly from nodeclared major. The Mental Health category alsoresponded significantly more positively than theEngineering group and the Physical Science & Economics category (for means and standard deviations, see Table ).

MANOVAs were also performed with career inter-est as the independent variable. The effect of careerinterest on the combined subscales of the CLAS-MR was significant [F(8, 518) = ., P < .]. Foreach of the subscales, three groups were contrasted:students who answered yes to the question ofwhether they were interested in a career in ID,those who responded no and those who were notsure. A Bonferroni correction was used to controlfor the inflation of type I error with multiple tests.On all four subscales, the interested and not suregroups expressed significantly more positive atti-tudes than the not interested group, but did not

differ significantly from each other. The means andstandard deviations are shown in Table .

There was a significant effect of career intereston the combined subscales of the MRAI [F(8,518)= ., P < .]. As with the CLAS-MR, theinterested and not sure groups were not signifi-cantly different from each other, but both indicatedsignificantly more positive attitudes than the notinterested group. Table lists the means and stand-ard deviations. A univariate ANOVA was conductedto measure the effects of career interest on AMREscores. There was a significant effect [F(2, 265) =., P < .]. Post hoc comparisons (Bonferronicorrected) indicated that both the interested groupand the not sure group were significantly morepositive than the not interested group, but did notsignificantly differ from each other (for means andstandard deviations, see Table ).

Correlations between demographic variables andthe MCSDS-SF yielded no significant results whenthe Bonferroni correction was applied.

Discussion

The first research question that the present studysought to answer was: How are Japanese attitudestoward people with ID conceptually organized? Itwas not known whether Japanese attitudes would beinterpretable along the same dimensions which




Table 6 Scale means and standard deviations (SDs) by career interest: (ID) intellectual disability: (AMRE) Scale of Attitudes Toward MentalRetardation and Eugenics

Interested in a career in ID

Yes Not sure No

Scale Mean SD Mean SD Mean SD

Empowerment 3.59 0.34* 3.52 0.45* 3.25 0.50Exclusion 1.75 0.52* 1.80 0.55* 2.17 0.74Similarity 4.13 0.48* 4.11 0.49* 3.84 0.56Sheltering 3.05 0.54* 3.04 0.47* 3.30 0.48IntegrationSegregation 3.62 0.53* 3.49 0.47* 3.24 0.59Social Distance 4.06 0.60* 3.80 0.68* 3.26 0.78Private Rights 3.21 0.39* 3.09 0.44* 2.92 0.53Subtle Derogatory Beliefs 3.40 0.47* 3.47 0.49* 3.08 0.48Eugenics (AMRE) 3.70 0.38* 3.60 0.38* 3.31 0.42

* Significantly different from the not interested group at the P < . level. No other significant differences were found.

had been found for attitude scales designed in theUSA. The confirmatory factor analyses of the datafrom this sample of Japanese students indicate thatthe same dimensions and factor structures areapplicable to this population. The CLAS-MR andthe MRAI, both intended by US researchers tomeasure similar constructs, were significantly corre-lated, indicating that the Japanese respondents alsoperceived these constructs as related to each other.

The AMRE was correlated with the other twoattitude measures to address the second researchquestion of whether people who responded nega-tively on the CLAS-MR and the MRAI would alsoendorse the more dehumanizing views contained inthe AMRE. The AMRE includes items which aremore strongly worded than the statements on theCLAS-MR and the MRAI. For example, it is onething to say that one would not wish to live nextdoor to a person with ID. It may require a moredeeply seated negative attitude to be willing to saythat one believes people with ID should be involun-tarily sterilized. On the other hand, a tendency toexclude people with ID and view them as dissimilarto oneself is likely to reflect a lack of valuation ofpeople with ID. As Wolfensberger () argued, itis this failure to value the lives of people with IDthat leads to a willingness to end or prevent thoselives through the use of eugenics. The data from thepresent sample indicate that attitudes toward com-munity inclusion and toward eugenics are stronglyrelated. Those who support the empowerment andinclusion of people with ID are less likely toapprove of eugenic measures to control ID. Thosewith less inclusive and affirming views are morelikely to endorse eugenics.

It should be noted that correlations of the Sheltering subscale of the CLAS-MR with theother attitude scales, while significant, were moder-ate relative to the other correlations among scales.Unlike the other scales, Sheltering includes itemswhich do not necessarily indicate either a negativeor a positive attitude toward people with ID.Rather, this subscale assesses protective attitudes.These attitudes could be considered negative in thesense that people with ID are not perceived as ableto take care of themselves, make their own deci-sions and live independently in the community.However, protective attitudes may sometimes berealistic, and they may indicate that people with ID

are at least valued enough to be worthy of care andconcern.

Thirdly, the present study examined the relation-ship between various demographic variables andattitudes toward people with ID. Students with arelative or friend with a disability showed moresupport for the rights of people with ID than theothers. There was a tendency toward more positiveattitudes on the part of students who had beenemployed working with people with ID, but thesecorrelations were not significant when the numberof correlations (and the probability of type I error)was taken into account. Nevertheless, these resultsprovide some support for findings from otherresearch in the USA that experience with peoplewith disabilities is associated with more positiveattitudes toward members of that group (Levy et al.; Kregel & Tomiyasu ; Hernandez et al.). Indications that experience with people withID may lead to more positive attitudes should beencouraging to advocates of increased inclusion in Japanese schools. Recent efforts to develop afeeling of comradeship (MESC , p. )between children with and without ID throughinclusive activities may be helping more peoplewithout ID to grow up with positive attitudestoward inclusion of people with ID. However,as Allport () discussed in research on race relations, increased contact does not automaticallylead to more positive attitudes. He listed a numberof variables affecting the degree and direction ofattitude change, including frequency and durationof contact, whether equal status contact occurs,whether the interaction is positive or negative,and whether it is seen as representative or as anexception to the rule. Eberhardt & Mayberry ()have studied equal status contact and attitudestoward people with disabilities among occupationaltherapists. They found that attitudes were relatednot only to contact, but also to the therapistseducation programmes and the holistic philosophyof the profession. Additional research is needed toelucidate the conditions under which contact withpeople with ID leads to more positive attitudes andthe amount of contact needed to have positiveeffects.

Students in mental health majors and studentsinterested in a career in the field of ID respondedmore positively on all of the attitude measures. The




students now in such fields as social work and psy-chology, and those expressing a desire to work withpeople with ID are the people most likely to inter-act with people with ID in the future and to have adirect impact on their lives. It is encouraging thatthese are the students displaying the most positiveattitudes.

Also encouraging is that, overall, attitudes towardpeople with ID expressed by the students in thepresent sample were clearly on the positive side ofneutral. Whether these results indicate increasinginclusivity in Japanese culture as a whole is a ques-tion for further research. The students who partici-pated in this study were drawn from conveniencesamples, rather than being randomly selected, andmay not be representative of Japanese universitystudents as a whole. Furthermore, young universitystudents may be more indicative of future societaltrends than they are of current attitudes of thegreater Japanese public. More representative com-munity samples are needed to develop a fullerunderstanding of Japanese attitudes toward peoplewith ID. In addition to research on general commu-nity views of people with ID, attitudes of staff currently working with people with ID should beinvestigated because their attitudes directly affectpeople with ID.

Implications for theory, research and practice

The factor structures and inter-scale correlationspreviously found for the measures used were upheldin the present sample from Japan. These similaritiesindicate that there are some cross-cultural compo-nents of attitudes toward people with ID which can be compared. A next step will be to comparethe data gathered from Japanese students to datafrom students in the USA to determine how similaror different Japanese and US attitudes may be.However, the fact that the data from Japanese students could be fitted into a US model does notnecessarily mean that this is the best model fordescribing Japanese attitudes. There may well beaspects of Japanese attitudes toward people with IDwhich are not apparent in this study because themeasures used did not contain questions to elicitthem. For a more complete understanding of Japanese attitudes toward people with ID, theseattitudes should also be studied using measures

based in Japanese culture and specifically developedto measure attitudes in Japan.

The measures used in the present study couldprovide a starting point for developing more cultur-ally anchored measures. For example, the itemswith low factor loadings on the CLAS-MR and theMRAI may be tapping aspects of Japanese attitudestoward people with ID which were not representedin the four-factor structure used in the USA. Addi-tional items reflecting specifically Japanese valuesand cultural influences (e.g. importance of socialstructure, urban/rural cultural differences and reli-gious beliefs) would need to be considered as pos-sible additions. A measure of social desirability inthe context of Japanese society may also be neededsince the items of the MCSDS-SF may not fullyreflect socially desirable behaviour in Japan.

In addition to a need for more culturally basedtheoretical research, additional research is neededto determine the significance of the attitudesexpressed on paper-and-pencil measures. Therespondents in the present study expressed moder-ately positive attitudes toward people with ID andthese attitudes were consistent across measures.Thus, the next issues to examine are to what extentand in what ways, if any, do these attitudes manifestthemselves in behaviours toward people with ID.Without additional research on how attitudestoward people with ID are expressed in Japanesesociety, few firm conclusions can be drawn regard-ing the implications of these attitudes for commu-nity inclusion and empowerment of Japanese peoplewith ID.

A first step in establishing a relationship betweenthese attitudes and behaviour would be to use atti-tude measures in conjunction with other measuresof readiness to begin work with people with ID andperformance reviews of those already in the field. Ifa strong connection is apparent, attitude measurescould then be used as a tool to identify those whomight need additional training for working withpeople with ID as well as those who are likely to beadvocates for the rights of people with ID.

A similar process was successful in developing aselection instrument for counsellors at a US campfor people with developmental disabilities (Keyset al. ). Current camp staff were asked to identify key values and attitudes which counsellorsshould endorse. Based on this information, consul-




tants developed an interview to identify applicantswhose views were most consistent with the corevalues of the camp. The counsellors selected bymeans of this interview were later evaluated onbehaviourally anchored rating scales. As a result of the use of this interview and related humanresource strategies in recruitment, training andsupervision, the quality of counsellor performanceincreased and the turnover of counsellors decreasedfrom % to %. This type of process enables thestudy of relationships between responses to ascreening interview or questionnaire on attitudesand actual performance. The success of the camp inquestion in hiring quality staff through the use ofthe screening interview holds promise for the use of measures of attitudes toward people with ID inimproving direct-care services for people with ID.

Distinctive contributions of the study

The present study sheds light on the conceptualorganization of Japanese attitudes toward peoplewith ID. The data were an acceptable fit to factorstructures found in the USA, establishing the exis-tence of comparable attitude structures in the twocountries. This research opens the door for cross-cultural comparison studies, enabling advocates toshare information about attitudes toward peoplewith ID on a larger scale.

In addition, studying attitudes toward peoplewith ID in other countries leads to a more com-plete understanding of the place of people with IDin different cultures of the world. It may also leadto a clearer understanding of the effects of culturalvalues on attitudes toward people with ID. Further-more, it is hoped that conducting such studies willengender interest in continued attitude researchwithin each country. Future research in Japan maycapture additional dimensions of Japanese attitudes.In the future, item-by-item analysis may also yieldadditional useful information on Japanese perspec-tives regarding specific issues.

To the present authors knowledge, this is thefirst study to systematically examine attitudestoward the empowerment and inclusion of peoplewith ID in Japan. It is particularly salient toconduct this research at a time when advocates andpeople with ID are seeking increased rights andcommunity inclusion. Studying attitudes toward

community inclusion for people with ID mayprovide advocates with useful information to guidetheir efforts to educate the public, thus enrichingthe lives of people with and without disabilities.The present authors hope that this study will alsoserve as a first step in continued collaboration and development of culturally anchored attitudemeasures.

Acknowledgements

This article is based on the first authors MastersThesis, conducted under the direction of thesecond and third authors, and Fabricio Balcazar.The authors would like to thank ToshiakiTachibana, Institute for Developmental Research,Aichi Human Service Centre, Japan, for his feed-back on an earlier draft of this paper.

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