a systematic review of disability awareness interventions for children and youth

623

Disability & Rehabilitation, 2013; 35(8): 623–646© 2013 Informa UK, Ltd.ISSN 0963-8288 print/ISSN 1464-5165 onlineDOI: 10.3109/09638288.2012.702850

Purpose: Children’s lack of knowledge about disability can adversely impact their attitudes toward people with disabilities. The purpose of this study is to review the common elements of effective disability awareness interventions. Methods: A systematic review of disability awareness interventions for children and youth was conducted to assess the effective components of these interventions. Electronic searches were conducted using OVID, CENTRAL, PsychInfo, ERIC, Social Science Citation Index, GreyNET Scopus and Google Scholar. The inclusion criteria included (i) an intervention raising awareness about disability, (ii) school-age children with the average age between 5–19 years old, (iii) at least one measurable outcome focusing on knowledge about disability or attitudes towards and/or acceptance of people with a disability and (iv) published article or grey literature. Results: Of the 1031 articles that were identified in the search, 42 met the criteria to be included in the review. We classified the disability awareness interventions into 5 broad types including (i) social contact, (ii) simulation, (iii) curriculum, (iv) multi-media curriculum and (v) multiple components. Thirty-four studies showed an improvement in attitudes towards and/or acceptance of peers with disabilities. Eight of these studies also demonstrated an improvement in knowledge of people with disabilities. Five of the interventions found no support for improving knowledge about, or acceptance of people with disabilities. Conclusion: Disability awareness interventions can successfully improve children’s knowledge about and attitudes towards peers with a disability; they should include several different components over multiple sessions. Relevance: These findings are being used to further develop disability awareness interventions to help improve the social inclusion and participation of children with disabilities within mainstream classrooms.

Keywords: Children, disability awareness, intervention, review, school-age, youth

Introduction

Improving inclusive environments within classrooms is especially critical for children with disabilities because of the increased prevalence of inclusive education (i.e. children who spend most or all of their time being schooled with their typically developing peers). Evidence consistently shows that being placed in an integrated classroom does not guarantee that children with disabilities will be accepted, valued and included [1–3]. For instance, nearly fifty percent of children with disabilities feel that they do not belong within their class, feel lonely, isolated and unsafe [4,5]. This is concerning because there are over 200,000 Canadian children and youth

Review

A systematic review of disability awareness interventions for children and youth

Sally Lindsay1 & Ashley edwards2

1Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada and 2Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada

Correspondence: Sally Lindsay, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada. E-mail: [email protected]

Disability & Rehabilitation

2013

35

8

623

646

© 2013 Informa UK, Ltd.

10.3109/09638288.2012.702850

0963-8288

1464-5165

Review of disability awareness interventions

11June2012

• Well-designed disability awareness interventions for children and youth can help improve knowledge about disability, attitudes towards people with a dis-ability and acceptance of peers with a disability.

• Rehabilitation health care providers and educators should be trained to recognize when children with disabilities are being socially excluded and be pre-pared to provide or recommend appropriate resources and interventions on how to address this issue.

• Clinicians, educators and children with disabilities should all be involved in the development of disability awareness programs.

• Educators should carefully choose an appropriate intervention to meet the needs of the children in their class while considering age appropriateness and diver-sity of the students. It is also important for educators to be cognizant of the broader societal influences that impact attitudes towards disability.

Implications for Rehabilitation

(Accepted June 2012)

S. Lindsay & A. Edwards

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624 S. Lindsay & A. Edwards


living with a disability [6], the majority of whom attend integrated classrooms and are at an increased risk for social exclusion and bullying [4,7,8].

Children’s adverse attitudes toward peers with disabilities have been widely documented in preschool, elementary and secondary school settings [1,9]. Research demonstrates that children often only interact with peers who have a disability in structured settings where they are encouraged to do so [3,4]. Favazza et al. [10] found that without supportive programs children often have low acceptance of peers with disabilities. For example, a meta-analysis of 20 studies found that children aged 3–12 years old preferred being in proximity to typically developing peers compared to children with disabilities [11].

Children’s attitudes towards their peers with disabilities are often strongly influenced by their degree of knowledge about disability, which stems from their social environments [3,7,12,13]. Adverse attitudes and social exclusion are often the result of children’s lack of knowledge about disabilities [2,3]. Given that perceptions of disability often shape attitudes and behaviours, it is vital to improve children’s understand-ing of people with disabilities [13,14]. One key mechanism of improving attitudes is through disability awareness interventions.

Importance of disability awareness and social inclusion at school

The social inclusion of all children is critical. According to the UN Convention on Rights of the Child [15] all children “should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community.” Thus, most integrated schools place emphasis on belonging, acceptance and sup-portive peer relationships [16]. The provision of inclusive and accepting social climates within schools is necessary to decrease the likelihood that children will be socially excluded from their peers [16]. This is particularly important because children who are victims of social exclusion often experience adverse physical, mental and social consequences such as depression, anxiety and low self-esteem [8,17,18]. It is criti-cal therefore, to help improve the social inclusion of children with disabilities because acceptance and a sense of belonging are essential to a child’s social and academic development and overall quality of life [3,4,19,20]. For integrated classrooms to be successful, children need opportunities to learn more about social inclusion and people with disabilities through ongoing learning opportunities in a co-operative environ-ment [4]. One key mechanism of improving inclusive envi-ronments is through social inclusion and disability awareness interventions, which can help children to develop respectful attitudes toward individual differences [21].

Disability awareness interventions

Interventions aimed at increasing children’s disability aware-ness within mainstream classrooms can help improve knowl-edge, attitudes and acceptance of people with disabilities [21–23]. There have been a wide variety of formats of disability

awareness interventions including providing information about disabilities [23,24], videos [25], drama [26], theatre and puppet shows [20,26–28], discussions [26], stories [29], simu-lations [30,31], structured interactions [10] and classroom activities [32,33] among others [34,35]. The outcomes of such disability awareness interventions are mixed. For example, some researchers [24,34] have found a positive change in attitudes toward people with disabilities following a disability awareness intervention, while others [23] have reported that there was no change.

Despite the growing literature on the inclusion of chil-dren with disabilities in mainstream classrooms and the subsequent increase in disability awareness interventions, the common elements of the effective components have not been synthesized and remain largely unknown. Indeed, little atten-tion has been paid to effective strategies to promote positive attitudes towards their peers with disabilities [36]. It is critical that disability awareness interventions are effective so that they can provide typically developing children with opportu-nities to learn and develop positive attitudes about differences in a respectful context [37,38]. Helping children nurture such attitudes at school can contribute to the creation of a positive social climate among children and youth [4,37]. Addressing attitudes towards people with disabilities in childhood is important because at this age their attitudes are still evolving and early interventions may be especially beneficial [27,34]. This review aims to synthesize the common characteristics of effective disability awareness interventions for children and to make recommendations for their further development.

Method

The objective of this systematic review is to critically appraise the evidence of disability awareness and social inclusion interventions for children and youth.

Research questions(1) What are the common elements of effective disability awareness interventions for children and youth? and (2) What recommendations can be made for further development of disability awareness programs?

Search strategyThe following databases were searched for relevant articles in English published from 1980–September 2011: CINAHL, MEDLINE(OVID), Healthstar (OVID) PubMed, EMBASE, Web of Science, Cochrane Databases for Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), ERIC, PsychInfo, Social Science Citation Index, Scopus, GreyNet, Conference Proceedings, and Google Scholar. The search strategy involved using the following subject headings and search terms: “disab* awareness”, and/or “social inclu-sion” were combined with “attitude” and/or “outcome.” The “similar article” function and manual cross-referencing from identified studies were used to enhance the search.

The inclusion criteria involved (i) an intervention to raise awareness about disability or to enhance social inclusion for people with disabilities; (ii) school-age children and youth

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Review of disability awareness interventions 625


with the majority of the sample or average age between 5–19 years old; (iii) at least one measurable outcome focusing on knowledge about disabilities, or attitudes towards people with disabilities; and (iv) published or grey literature from 1980–September 2011. These criteria were chosen because child-hood is an ideal time to help develop positive attitudes towards people with disabilities. This date range was chosen because research on this topic has dated back to the early 1980s when inclusive education policies started being implemented.

Through this search process 1031 articles were identified and two people reviewed the titles and abstracts of these arti-cles. Nine hundred and forty-seven articles were eliminated based on their title or abstract not being related to the current search. After removing duplicates and applying the inclusion criteria 42 articles remained in the final analysis. Full articles were then retrieved and evaluated for relevance.

Data abstraction and classification processData from the included studies were extracted and compiled by one author and independently verified by another investi-gator using a structured abstraction form that was based on previously completed systematic reviews [38]. Each article that met the inclusion criteria was read in its entirety by both authors before summarizing the key attributes. The first author kept a journal of decisions as part of an audit trail to ensure the study’s conformability. These journal entries were used to formulate discussion points for meetings between the authors.

Articles were summarized and coded by the second author and then checked by the first author and a research assistant. A list of all the key themes was developed and a constant com-parison method was used to facilitate the distinction of pat-terns, variations and relationships [39]. Data elements were compared and critiqued and the commonalities were sum-marized and evaluated. After the initial analysis was complete both authors reviewed the key themes identified and minor adjustments were made until consensus was reached. This review method is compatible with the use of varied data from diverse methodologies [40].

The articles were classified into a hierarchy of evidence based on the rigour of their methodology. We used the American Academy of Neurology’s classification of evidence for therapeutic intervention [41]. A summary of this classifica-tion system involves the following: (class I) randomized con-trolled trials meeting rigorous; (class II) matched prospective cohort studies or RCT in a representative population lacking on of the criteria in class one; (class III) all other controlled trials; (class IV) all other studies that did not meet the criteria for class I to III [41]. Recommendations for the effectiveness of the interventions to improve knowledge and attitudes were based on the strength of evidence of all articles [41].

Results

A total of 42 studies were included in the review. Table I pro-vides an overview of the study characteristics including sam-ple, purpose, design, components of the disability awareness interventions, results and limitations of the studies. In terms

of the focus on the intervention, 11 focused on disability in general, followed by physical disabilities (10), mental illness (7), several disabilities (6), autism (2), intellectual disability (2) and 1 article focusing on each one of the following condi-tions: schizophrenia, Tourette Syndrome, cerebral palsy and visual impairments. Sample sizes ranged from 3 to 2081. The average ages of the children involved in these studies ranged from 5 to 19 years old. Many of the studies did not contain detailed demographic information about their sample so it is difficult to make comparisons between the articles in this respect. Of the studies that gave details about the gender com-position of the sample, they were roughly equal in terms of males and females in most studies.

A wide variety of standardized measures were used to evalu-ate the effectiveness of the interventions (refer to Table I). The majority of the studies focused on measuring attitudes towards people with disabilities (e.g. Chedoke-McMaster Attitudes Toward Children with Handicaps (CATCH), Peer Acceptance Scale, Peers Attitudes Toward Handicapped (PATH), Acceptance Scales for Kindergartners (ASK), Children’s Attitudes Toward Integrated Physical Education-Revised (CAIPE-R)), accep-tance of people with disabilities (e.g. Children’s Social Distance from Handicapped) and behaviour (Personal Contact with Disabilities Scale) followed by knowledge of disability (e.g. Children’s Knowledge About Handicapped Scale). Several other non-standardized measures were also used.

The majority of the studies (32) did not have a theoretical framework to inform their intervention. Of the studies that did have a theoretical framework they included such theories as behaviour change theory [42], theory of planned behaviour [24,43,44], social learning theory [24,43], social contact the-ory [16,34], social model of disability [22], social desirability and attribution theory [23], theory of mere exposure effect [3], theory of persuasive communication and social cognitive theory [3,16], cognitive behavioural theory [7,16], models of attitude change [45], and interpersonal relations theory [45].

First, we provide an overview of the overall effectiveness of the interventions by the type of outcome measured. Next, we outline common components of the effective interventions. Finally, we highlight key lessons learned and make recom-mendations for the further development of disability aware-ness interventions.

Effectiveness of the interventionsThere were two broad outcomes that these interventions measured: (i) knowledge of people with disabilities and (ii) attitudes towards and acceptance of peers with disabilities. Overall, the majority of the studies (34) showed significant improvements in attitudes towards children with a disability as well as improvements in knowledge about people with disabilities (8 studies) (refer to Table II). Five studies did not demonstrate a significant improvement in knowledge or attitudes following the intervention.

Attitudes towards and acceptance of people with disabilitiesA key outcome among the studies we reviewed involved attitudes towards and acceptance of people with a disability.

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Tabl

e I.

Stud

y ch

arac

teris

tics.

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dySo

cial

con

tact

Arm

stro

ng

et a

l., 1

987

(Can

ada)

(n/a

) 87

9–13

yea

rs

old

(pub

lic

scho

ol,

segr

egat

ed

clas

ses)

Phys

ical

d

isabi

litie

sRa

ndom

ized

co

ntro

l tria

l (46

bu

ddie

s, 45

co

ntro

ls)

Che

doke

-McM

aste

r At

titud

es T

owar

d C

hild

ren

with

H

andi

caps

(C

ATC

H);

Perc

eive

d

Com

pete

nce

Scal

e;

Pare

ntal

Atti

tude

s To

war

d C

hild

ren

with

Han

dica

ps

(PAT

CH

)

N/a

To e

valu

ate

the

eff

ectiv

enes

s of a

“b

uddy

” pro

gram

de

signe

d to

impr

ove

at

titud

es o

f no

n-di

sabl

ed ch

ildre

n

tow

ards

phy

sical

ly d

is-ab

led

child

ren

•Assignedabu

ddy

of

the

sam

e ge

nder

(w

ith a

disa

bilit

y)•Meetw

eeklyfor3

m

onth

s, op

port

unity

fo

r soc

ial i

nter

actio

n,

no a

cade

mic

elem

ents

•Sign

ificantly

impr

oved

attit

udes

to

war

ds

child

ren

with

di

sabi

litie

s (C

lass

II)

•Ea

chsc

hool

deve

lope

d th

eir

own

prog

ram

(not

st

anda

rdiz

ed a

cros

s sc

hool

s)•Littlekn

ownabou

tlo

ng te

rm im

pact

•Mostb

uddieswere

fem

ale

Mar

mon

et a

l.,

2007

(Isr

ael)

170

(n/a

)M

ean

age

1 0.

5 ye

ars

Disa

bilit

y (g

ener

al)

Qua

si

expe

rimen

tal

desig

n

(non

-equ

ival

ent

cont

rol g

roup

)

Attit

udes

tow

ards

ch

ildre

n w

ith d

is-ab

ilitie

s (ba

sed

on

Sille

r et a

l.’s (1

967)

m

easu

re; C

hild

ren’s

Se

lf-Effi

cacy

Sca

le

(Ban

dura

198

9)

Con

tact

th

eory

(A

llpor

t 19

54)

To a

sses

s to

wha

t ext

ent

a di

rect

cont

act p

rogr

am

(Par

tner

s to

Incl

usio

n)

chan

ged

the

gene

ral

educ

atio

n st

uden

ts’

attit

udes

tow

ards

ch

ildre

n w

ith

disa

bilit

ies

•1-yearprogram

pr

ovid

ed d

irect

co

ntac

t with

stud

ents

w

ith d

isabi

litie

s th

roug

h w

eekl

y or

bi

-wee

kly

join

t ac

tiviti

es la

stin

g 30

–90 m

in•

mean#ofdire

ct

cont

act m

eetin

gs w

as

16.7

5

•Sign

ificantly

impr

oved

di

sabi

lity-

rela

ted

attit

udes

and

spec

ific

self-

effica

cy im

prov

ed

over

tim

e (C

lass

III)

•Participantsweren’t

rand

omly

ass

igne

d•Con

troland

ex

perim

enta

l gro

ups

wer

e no

t sy

stem

atic

ally

m

atch

ed

New

berr

y an

d Pa

rish,

198

7 (U

S)45

6 (4

9%

fem

ale)

8–11

yea

rs

old

Men

tal,

phys

ical

an

d in

telle

ctua

l di

sabi

litie

s, he

arin

g

Pre-

and

post

-tes

ts;

rand

omly

ass

igne

d en

viro

nmen

tal a

nd

cont

rol g

roup

s

Pers

onal

Attr

ibut

e

Inve

ntor

y fo

r C

hild

ren

N/a

To e

xplo

re so

cial

in

tera

ctio

n ou

tsid

e th

e cl

assr

oom

; to

asse

ss if

th

ere

wer

e at

titud

inal

be

nefit

s for

child

ren

with

an

d w

ithou

t di

sabi

litie

s to

inte

ract

at

a w

eekl

y sc

out

mee

ting

•6weeks×1hper

wee

k•10group

s,5includ

ed

1 m

embe

r with

a

disa

bilit

y

•Dire

ctso

cialco

ntact

can

fost

er in

crea

sed

acce

ptan

ce a

nd m

ore

posit

ive

attit

udes

(C

lass

III)

•Labelling

ofthe

disa

bled

child

•Onlyon

echild

in

each

scou

t tro

op h

ad

a di

sabi

lity

Pier

cy e

t al.,

200

2 (N

ew Z

eala

nd)

51 (4

3%

fem

ale)

5–7

year

s old

(6

boys

from

seg-

rega

ted

clas

s;

rem

aind

er fr

om

mai

nstr

eam

cl

ass)

Inte

llect

ual

disa

bilit

ies

Rand

omly

ass

igne

d to

one

of 3

gro

ups

(co-

oper

ativ

e

lear

ning

gro

up,

soci

al co

ntac

t gr

oup,

cont

rol);

pr

e-po

st te

st

Peer

-Acc

epta

nce

Scal

e, Po

pula

rity

In

dex,

Soc

ial-D

is-ta

nce

Scal

e,

Beha

viou

r O

bser

vatio

ns

N/a

To u

nder

stan

d th

e

impa

ct o

f a

coop

erat

ive-

lear

ning

pr

ogra

m o

n th

e so

cial

ac

cept

ance

of c

hild

ren

with

mod

erat

e to

seve

re

lear

ning

disa

bilit

ies

•10weekprogram

•Coo

perativ

elearning

gr

oup,

soci

al-c

onta

ct

grou

p

•Sign

ificantly

incr

ease

d po

sitiv

e in

tera

ctio

ns b

etw

een

child

ren

with

and

w

ithou

t int

elle

ctua

l di

sabi

litie

s (C

lass

III)

•Unk

nownwhether

coop

erat

ive-

lear

ning

is

bette

r em

brac

ed b

y yo

unge

r chi

ldre

n

(Con

tinue

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Soci

al c

onta

ct

Fred

eric

kson

and

Tu

rner

, 200

3 (U

K)20

(5%

fe

mal

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12 y

ears

ol

d (in

tegr

ated

cl

asse

s)

Emot

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l and

be

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on/

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; ra

ndom

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Soci

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ldre

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ale

of C

hild

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Act

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ehav

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; M

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lass

In

vent

ory

N/a

To e

valu

ate

two

smal

l in

terv

entio

ns, a

nd

obse

rve

the

impa

ct o

f C

ircle

of F

riend

s on

va

rious

asp

ects

of a

ch

ild’s

soci

al

com

pete

nce

•Ph

ase1:Circ

leof

Frie

nds f

or 6

wee

ks•Ph

ase2:ju

ststud

ents

who

had

not

par

-tic

ipat

ed in

Circ

le

of F

riend

s; 6

wee

kly

mee

tings

(firs

t by

ed. p

sych

olog

ist, r

est

by sc

hool

), w

ithin

-su

bjec

ts d

esig

n

•Sign

ificantlyim

proved

perc

eptio

ns a

bout

di

sabl

ed ch

ild•Interventio

nhad

posit

ive

effec

ts o

n so

cial

acc

epta

nce

by

clas

smat

es (C

lass

III)

•Po

tentialfornega-

tive

labe

lling

for t

he

disa

bled

child

•Sm

allsizeofstud

ygr

oup

Barr

ett a

nd R

an-

dall,

200

4 (U

K)

6 (3

3%

fem

ale)

Gra

des 3

/4

(incl

usiv

e sc

hool

)

Disa

bilit

ies

(gen

eral

)Pr

e-te

st, p

ost-

test

qu

estio

nnai

reSo

ciom

etric

qu

estio

nnai

reN

/aTo

inve

stig

ate

an

adap

ted

vers

ion

of th

e C

ircle

of F

riend

s pr

ogra

m

•6weeks(1

×weekfor

30 m

in) c

o-le

d by

an

Educ

atio

nal P

sych

olo-

gist

and

teac

her

•Structure:warmup

activ

ity, m

ain

activ

ity,

rela

xatio

n ex

erci

se•Mod

el1:circ

leof

frie

nds a

roun

d th

e ch

ild (c

hild

not

pr

esen

t in

clas

s di

scus

sion)

; Mod

el 2

: ch

ild w

ith d

isabi

lity

is in

clude

d in

clas

s di

scus

sion

whe

n

circ

le o

f frie

nds i

s in

trodu

ced;

Mod

el 3

: ci

rcle

of f

riend

s is s

et

up ar

ound

mor

e tha

n on

e chi

ld in

the c

lass

.

•Im

provedch

ildren’s

perc

eptio

ns (i

n th

e w

hole

clas

s con

tact

gr

oup)

(Cla

ss IV

)

•Shorttermin

terven

-tio

n •Who

leclassc

ontext

not a

ddre

ssed

Whi

take

r et a

l.,

1998

(UK

)(n

/a)

5210

–14

year

s ol

d

(mai

nstr

eam

sc

hool

)

Autis

mIn

terv

iew

s and

qu

estio

nnai

reno

t giv

enN

/aTo

faci

litat

e in

tera

ctio

ns

for t

he id

entifi

ed ch

ild

with

oth

er ch

ildre

n; to

re

duce

the

perc

eive

d im

pairm

ent f

or th

e

iden

tified

child

; re

cogn

ize

the

im

pairm

ent o

f soc

ial

skill

s for

child

ren

with

di

sabi

litie

s; an

d to

ad

dres

s spe

cific

in

divi

dual

pro

blem

s

•circleoffrie

nds

appr

oach

•4mainsteps:

es

tabl

ishin

g

prer

equi

sites

, di

scus

sion

with

the

clas

s, es

tabl

ish a

ci

rcle

, wee

kly

m

eetin

gs o

f the

circ

le•Meetin

g1:ledby

Autis

m O

utre

ach

Team

, tea

cher

sele

cts

6–8

circ

le m

embe

rs

•Sign

ificant

impr

ovem

ents

in

inte

ract

ions

with

ch

ildre

n w

ith

disa

bilit

ies

(Cla

ss IV

)

•Somechild

ren

beca

me

upse

t or

dist

ress

ed w

hen

the

iden

tified

child

re

acte

d un

expe

cted

ly

or in

tens

ely

•Nocontrolgroup

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Sim

ulat

ion

Pivi

k et

al.,

200

2 (C

anad

a)(n

/a)

609–

11 y

ears

ol

dPh

ysic

al

disa

bilit

yC

ontr

olle

d

pre-

test

, pos

t-te

st

desig

n; ra

ndom

The

Kno

wle

dge

Que

stio

nnai

re;

Chi

ldre

n’s S

ocia

l D

istan

ce fr

om

Han

dica

pped

Pe

rson

s Sca

le

N/a

To a

sses

s the

eff

ectiv

enes

s of a

vi

rtua

l rea

lity

co

mpu

ter g

ame

to

educ

ate

child

ren

abou

t ac

cess

ibili

ty a

nd

attit

udin

al b

arrie

rs

•30min,desktop

vir-

tual

real

ity p

rogr

am;

child

ren

view

ed g

ame

as if

they

wer

e sit

ting

in a

whe

elch

air

(exp

erie

nced

ob

stac

les,

stai

rs,

narr

ow d

oors

, ob

ject

s too

hig

h to

re

ach,

etc

)

•Programwas

effec

tive

for

incr

easin

g

child

ren’s

kno

wle

dge

of a

cces

sible

bar

riers

•Grades5

–6sh

owed

grea

test

chan

ge; n

o ge

nder

diff

eren

ces i

n kn

owle

dge

of

barr

iers

but

mal

es

had

high

er p

ost t

est

attit

ude

scor

e

(Cla

ss II

)

•Accessib

lesc

hooland

m

ay h

ave

alre

ady

had

posit

ive

attit

udes

Hut

zler

et a

l.,

2007

a (I

srae

l)75

(41%

fe

mal

e)7–

10 y

ears

ol

dPh

ysic

al

disa

bilit

yQ

uest

ionn

aire

Attit

udes

Tow

ards

Pe

ers w

ith

Disa

bilit

y;

Chi

ldre

n’s

Attit

udes

Tow

ards

Pe

ers w

ith

Disa

bilit

y Sc

ales

Theo

ry

of

plan

ned

beha

v-io

ur;

soci

al

lear

ning

th

eory

To d

eter

min

e th

e eff

ect

of th

e C

hild

ren’s

A

ttitu

des T

owar

ds P

eers

w

ith D

isab

ility

Sca

les

and

an e

lite

whe

elch

air

bask

etba

ll ga

me

on

alte

ring

chi

ldre

n’s

attit

udes

tow

ard

thei

r pe

ers w

ith d

isab

ilitie

s

•1h

simulatedm

ove-

men

t act

iviti

es

follo

wed

by

a

disc

ussio

n•Childrenwere

as

signe

d a

sim

ulat

ed d

isabi

lity

•Im

provedattitud

es

tow

ards

incl

udin

g ch

ildre

n w

ith d

isabi

li-tie

s (C

lass

IV)

•Nocontrolgroup

Hut

zler

et a

l.,

2007

b (I

srae

l)(n

/a)

121

Gra

des

10–1

1Ph

ysic

al

disa

bilit

yQ

uest

ionn

aire

Attit

udes

Tow

ards

Pe

ers w

ith

Disa

bilit

y

Theo

ry o

f pl

anne

d be

hav-

iour

; so

cial

le

arni

ng

theo

ry

To d

eter

min

e th

e eff

ect

of th

e C

hild

ren’s

At

titud

es T

owar

ds P

eers

w

ith D

isabi

lity

Scal

es

and

an el

ite w

heel

chai

r ba

sket

ball

gam

e on

al

terin

g ch

ildre

n’s

attit

udes

tow

ard

thei

r pe

ers w

ith d

isabi

litie

s

•3×

3demon

stratio

nfr

om e

lite

w

heel

chai

r ba

sket

ball

play

ers

vers

us th

e sc

hool

te

am w

ho

sat o

n ex

tra

w

heel

chai

rs•Athletesthen

in

trod

uced

th

emse

lves

and

to

ld th

e cr

owd

ab

out t

hem

selv

es

as w

ell a

s th

eir

te

am

•Im

provedattitud

es

for b

oth

gend

ers,

an

d on

ly g

irls

beha

viou

rally

(C

lass

IV)

•Nocontrolgroup

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Sim

ulat

ion

Loov

is an

d

Loov

is, 1

997

(US)

430

(51%

fe

mal

es)G

rade

s 2–6

Disa

bilit

y

(gen

eral

)Pr

e-po

st d

esig

n

(no

cont

rol

grou

p)

CAT

CH

N/a

To m

easu

re th

e effi

cacy

of

sim

ulat

ed

expe

rienc

es w

ith a

va

riety

of d

isabi

litie

s on

the

attit

udes

of

elem

enta

ry sc

hool

st

uden

ts

•Inphysic

al

educ

atio

n, sm

all

grou

ps o

f stu

dent

s sp

ent 5

min

each

in

: fing

er sp

ellin

g an

d sig

n la

ngua

ge

exer

cise

s, or

ient

atio

n an

d fil

ling

a kna

psac

k w

hile

usin

g ki

tche

n to

ngs,

man

oeuv

rabi

lity

thro

ugh

an o

bsta

cle

cour

se in

a w

heelc

hair,

w

ord

scra

bble

and

sent

ence

reco

gniti

on

and

writ

ing

with

a pe

ncil

and

pick

ing

up

coin

s wea

ring

glov

es

with

tiss

ue st

uffed

in

the fi

nger

s.

•Girlsa

ttitudes

tow

ards

pee

rs w

ith

disa

bilit

ies c

hang

ed

signi

fican

tly

(Cla

ss IV

)

•Nocontrolgroup

Cur

ricu

lum

God

eau

et a

l.,

2010

(Fra

nce)

784

(58%

fe

mal

e)

12–1

3 ye

ars

old

(mos

tly

high

so

cio-

econ

omic

st

atus

)

Disa

bilit

y

(gen

eral

)Ra

ndom

ized

, con

-tr

ol g

roup

CAT

CH

Que

stio

n-na

ire; H

BSC

Fa

mily

Affl

uenc

e Sc

ale;

KID

-SC

REEN

-52;

M

ultin

atio

nal

Stud

y of

Atti

tude

s To

war

d In

divi

dual

s w

ith In

telle

ctua

l D

isabi

litie

s

N/a

To a

sses

s the

eff

ectiv

enes

s of a

n

inte

rven

tion

on th

e at

titud

e of

7th

gra

de

stud

ents

tow

ard

thei

r pe

ers w

ith a

disa

bilit

y an

d id

entif

y pe

rson

al o

r en

viro

nmen

tal f

acto

rs

asso

ciat

ed w

ith at

titud

es

held

by

stud

ents

and

m

etho

d to

impr

ovin

g at

titud

es

•Teachersand

staff

atte

nded

a fi

lm o

n in

clus

ive

educ

atio

n an

d th

en p

artic

ipat

ed

in a

deb

ate

med

iate

d by

the

rese

arch

team

•Teacherswerethen

aske

d to

org

anize

se

vera

l les

sons

that

in

clude

d th

e edu

ca-

tiona

l mat

eria

l pro

-vi

ded

by th

e res

earc

h-er

s (fil

m, e

xerc

ises,

inclu

sive e

duca

tion

polic

y, ro

le pl

ays a

nd a

bibl

iogr

aphy

)

•Afte

redu

catio

nal

prog

ram

no

sig

nific

ant c

hang

e in

at

titud

es to

war

d

disa

bilit

y (C

lass

I)

•Childrenwho

re

spon

ded

in p

re a

nd

post

test

wer

e m

ore

com

mon

ly a

ssoc

iate

d w

ith sp

ecifi

c so

cio-

econ

omic

fa

ctor

s

Rahm

an e

t al.,

19

98 (P

akist

an)

100

(50%

fe

mal

e)

12–1

6 ye

ars

old

Men

tal

heal

thC

ontr

olle

d de

sign;

pr

e-te

st, p

ost t

est

ques

tionn

aire

19 q

uest

ion

qu

estio

nnai

re

writ

ten

in U

rdu;

ba

sed

on

unst

ruct

ured

in

terv

iew

s with

lo

cals

N/a

To a

sses

s a sc

hool

bas

ed

inte

rven

tion

to d

evel

op

men

tal-h

ealth

aw

aren

ess f

or sc

hool

ch

ildre

n, th

eir p

aren

ts,

frie

nds a

nd n

eigh

bour

s

•Participatory

educ

atio

nal m

etho

ds;

awar

enes

s act

iviti

es

inco

rpor

ated

to d

aily

ac

tiviti

es in

clud

ing

essa

ys, p

lays

, ann

ual

spee

ch co

ntes

ts

•Sign

ificantch

ange

for s

tude

nts

awar

enes

s of m

enta

l he

alth

issu

es

(Cla

ss II

)

•Fewergirlsthenbo

ys

atte

nd sc

hool (C

ontin

ued)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Cur

ricu

lum

Batta

glia

et a

l.,

1990

(US)

1380

(6

0%

fem

ale)

Gra

des 6

–12

(inte

grat

ed

clas

ses)

Men

tal

illne

ssPo

st-t

est

ques

tionn

aire

an

d co

ntro

l gr

oup

Nor

thum

berla

nd

Cou

ntry

Cou

ncil

Pupi

l Que

stio

nnai

re

N/a

To e

valu

ate

the

use

of a

m

enta

l illn

ess a

war

enes

s w

eek

prog

ram

•45minpresentation

give

n by

20

resid

ents

fr

om a

uni

vers

ity

psyc

hiat

ry p

rogr

am

•Attitud

esto

ward

ps

ychi

atris

ts w

ere

mor

e po

sitiv

e fo

r yo

uth

who

had

at

tend

ed th

e

pres

enta

tion

and

m

ore

likel

y to

seek

he

lp fr

om p

sych

iatr

ist

(Cla

ss II

I)

•Unsureifpresentatio

nch

ange

d he

lp se

ekin

g be

havi

our

•Nofollo

w-up

Hol

tz, 2

007

(US)

179

(49%

fe

mal

e)

Age

d 7–

15

year

s old

(m

ean

age

9.5

year

s); (

4 pu

blic

, 2

priv

ate

scho

ols)

–

65%

Cau

ca-

sian,

8%

A

fric

an

Am

eric

an,

5% A

sian,

9%

H

ispan

ic, 1

3%

Oth

er

ethn

icity

Tour

ette

’s

Synd

rom

ePr

e- a

nd

post

-tes

t;

rand

omiz

ed

cont

rolle

d tr

ial

Kno

wle

dge

Q

uest

ionn

aire

; C

hedo

ke-M

cMas

ter

Attit

udes

Tow

ard

Chi

ldre

n w

ith

Han

dica

ps

ques

tionn

aire

Beha

v-io

ur

chan

ge

theo

ry

(Ajz

en)

To d

eter

min

e th

e im

pact

of

an

educ

atio

nal v

ideo

on

Tou

rette

’s Sy

ndro

me

on th

e at

titud

es a

nd

know

ledg

e of

child

ren

•Video“Y

ou’ve

Gota

Frie

nd”

•Stud

entsin

the

co

ntro

l gro

up

wat

ched

a v

ideo

ca

lled

“Bra

inst

orm

: Th

e Tr

uth

Abo

ut

YourBrainon

D

rugs

” an

unre

late

d in

form

ativ

e vi

deo

•Sign

ificantch

angein

kn

owle

dge,

attit

udes

, be

havi

oura

l in

tent

ions

and

soci

al

acce

ptan

ce (C

lass

III)

•Didnotm

easurebe-

havi

our s

peci

fical

ly•Unsureifthechanges

rem

aine

d ov

ertim

e;

Mar

tinez

, 200

7 (U

S)(n

/a)

78G

rade

s 3–4

(L

atin

o; u

rban

; lo

w S

ES)

Disa

bilit

y

(var

iety

)Ra

ndom

as

signm

ent;

ex

perim

enta

l and

co

ntro

l co

nditi

ons;

pr

e-an

d

post

-tes

t

Acc

epta

nce

Scal

e:

Elem

enta

ry L

evel

; A

bout

Me

D

emog

raph

ic;

Wha

t I Th

ough

t A

bout

the

Book

Q

uest

ionn

aire

N/a

To a

ddre

ss th

e at

titud

es

of ch

ild b

efor

e an

d aft

er

they

had

par

ticip

ated

in

a di

sabi

lity

awar

enes

s pr

ogra

m

•6sessions(5

week

peri

od);

led

by a

sc

hool

psy

chol

ogis

t•boo

kdiscussing

ba

sic

fact

s abo

ut th

e di

sabi

lity

(Cla

ss I)

•Disc

ussio

ninclu

ded:

plot

/con

tent

, ex

plan

atio

n of

dis-

abili

ty, s

imila

ritie

s be

twee

n ch

ildre

n w

ith

and

with

out d

isabi

litie

s (5

boo

ks: b

lindn

ess,

autis

m, p

hysic

al

disa

bilit

y, in

telle

ctua

l di

sabi

lity

and

AD

HD

; 2

book

s gen

eral

di

sabi

lity)

•Sign

ificanceinflu

ence

on ch

ildre

n’s at

titud

es

tow

ard

peer

s with

sp

ecia

l nee

ds•Girlsw

eremore

ac

cept

ing

of p

eers

w

ith sp

ecia

l nee

ds

(Cla

ss II

I)

•6weeksm

aynothave

been

a lo

ng e

noug

h pe

riod

for

inte

rven

tion

•Diffi

culttom

easure

whe

ther

attit

ude

chan

ge tr

ansla

ted

to b

ehav

iour

al a

nd

inte

ntio

nal c

hang

e

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Cur

ricu

lum

Pitr

e et

al.,

200

7 (C

anad

a)14

4 (5

5%

fem

ale)

Gra

des 3

–6M

enta

l hea

lthPr

e-an

d po

st- t

est;

expe

rimen

tal a

nd

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rol g

roup

s (r

ando

miz

ed)

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ified

O

pini

ons A

bout

M

enta

l Illn

ess S

cale

(O

MI)

N/a

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lter t

he at

titud

es o

f ch

ildre

n in

rega

rd to

m

enta

l hea

lth st

igm

ati-

zatio

n

•3×

45-m

inplays

whe

re p

uppe

ts p

or-

tray

ed p

ople

with

a

men

tal i

llnes

s (sc

hizo

-ph

reni

a, d

emen

tia

and

depr

essio

n/an

xiet

y)

•Sign

ificantlyim

proved

attit

udes

tow

ards

men

-ta

l illn

ess (

Cla

ss II

I)

•Sm

allerthanintend

ed

stud

y•Oneed

ucationalsem

i-na

r unl

ikely

to h

ave

long

lasti

ng im

pact

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mm

ende

d•Im

portantthatcom

-m

unity

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mm

itted

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ener

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w

ith a

com

paris

on

grou

p

Mod

ified

ver

sion

of

Haz

zard

’s (1

983)

sc

ales

to a

sses

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ildre

n’s k

now

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e ab

out p

eopl

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ith

disa

bilit

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al

mod

el o

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sabi

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psyc

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educ

a-tio

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sses

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eff

ectiv

enes

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pr

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m to

sens

itize

el

emen

tary

scho

ol

stud

ents

to is

sues

re

late

d to

disa

bilit

y

•10weeks×1h/w

eek

(act

iviti

es in

clud

ed:

lear

ning

abo

ut

disa

bilit

y, ba

rrie

rs

expe

rienc

ed, b

reak

ing

dow

n st

ereo

type

s)

•Stud

entsweresen-

sitiz

ed to

disa

bilit

y iss

ues a

nd re

port

ed

mor

e po

sitiv

e at

titud

es

tow

ard

thei

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pe

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nd h

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of e

xpos

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cont

act

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corr

ect i

nfor

mat

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abou

t disa

bled

peo

ple

and

thei

r cap

abili

ties

(Cla

ss II

I)

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ndom

ized

Bink

ard

1985

(U

S)(n

/a)

1989

Gra

des 4

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iety

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dize

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easu

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ws

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bilit

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e

effec

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ess o

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bilit

y aw

aren

ess

prog

ram

•60-m

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pet

show

pre

sent

atio

n (~

10 m

in sc

ripts

for

each

pup

pet t

hat h

as a

di

sabi

lity)

•88%ofchildrensaid

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met

hing

new

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isabi

litie

s;

94%

like

d th

e pup

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show

; 92%

felt

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r ab

out c

hild

ren

with

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sabi

litie

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lass

IV)

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;no

sign

ifica

nce

test

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stan

dard

ized

m

easu

res

Essle

r et a

l.,

2006

(UK

)(n

/a)

104

13–1

4 ye

ars

old

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grat

ed

clas

ses)

Men

tal h

ealth

Non

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trol

led

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rven

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and

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dout

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atre

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dge

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ive

attit

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eena

gers

to

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ds m

enta

l hea

lth

•Fi

rst p

hase

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z, dr

ama,

gam

es w

hich

fo

cuse

d on

men

tal

heal

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lass

IV)

•Se

cond

pha

se: b

uild

se

lf es

teem

and

aw

aren

ess o

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n at

titud

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igns

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pany

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wledge

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enta

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lass

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)

•Canno

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vidu

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turn

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ere

an

onym

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ttitu

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e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

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Sam

ple

ch

arac

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bilit

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udy

desig

nM

easu

reTh

eory

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ectiv

eTy

pe o

f int

erve

ntio

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y fin

ding

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vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Cur

ricu

lum

Kim

, 200

9

(Kor

ea)

(n/a

) 20

81G

rade

s 5–6

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clus

ive

cl

assr

oom

s)

Disa

bilit

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eral

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, in

terv

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tand

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mea

sure

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essin

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titud

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war

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child

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with

di

sabi

litie

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perc

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f the

in

terv

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n

N/a

To a

sses

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wed

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pos

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orks

hop

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iscus

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•Com

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real

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ower

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nce

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plic

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Mic

ou, 2

003

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S)16

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Gra

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Revi

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)

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vest

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perc

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f AD

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•Participantswere

read

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•Childrenwerethen

aske

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asse

ssin

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e

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divi

dual

•Interventio

n

prov

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ectiv

enes

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pee

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pro

gram

for

alte

ring

attit

udes

of

child

ren

tow

ards

th

eir p

eers

tow

ards

ch

ildre

n w

ith A

DH

D

(Cla

ss IV

)

•Morethanju

st

asso

ciat

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is

need

ed to

impr

ove

a

child

’s so

cial

st

atus

Nab

ors a

nd

Lehm

kuhl

, 20

05 (U

S)

180

(50%

fe

mal

e)

16–3

1 ye

ars

old

(mea

n ag

e =

19);

(Cau

casia

n (1

53),

Afr

ican

A

mer

ican

(14)

, H

ispan

ic (3

), A

sian

(9),

did

not s

peci

fy (1

)

Cer

ebra

l pa

lsyG

ende

r blo

cked

, th

en ra

ndom

ly

assig

ned

to

vign

ette

s

Ana

logu

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sign;

D

emog

raph

ic

Que

stio

nnai

re;

ROC

Q S

cale

;

N/a

To e

xam

ine

fact

ors

influ

enci

ng y

oung

ad

ults’

per

cept

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of

child

ren

with

cere

bral

pa

lsy

•20–30m

invignette

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tion

of ch

ildre

n w

ith ce

rebr

al p

alsy

co

mpa

red

to h

ealth

y ch

ildre

n•Femaleshadm

ore

posit

ive

perc

eptio

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of a

ll ch

ildre

n th

an

mal

es (C

lass

IV)

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nlim

its th

e “r

eal w

orld

” pr

esen

tatio

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mat

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use

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ideo

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limita

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rt, 2

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ada)

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113

–18

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alth

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t-te

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desig

n;Su

rvey

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om se

vera

l pr

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n th

e W

orld

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chia

tric

A

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glob

al

anti

stig

ma

prog

ram

N/a

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valu

ate

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eff

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sing

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deo-

base

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m to

ad

dres

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kno

wle

dge

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attit

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igh

scho

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uden

ts in

re

gard

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sc

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phre

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sson

#1: s

tude

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hare

th

eir cu

rrent

know

ledge

ab

out s

chizo

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re w

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min

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sson

#2:

role

pl

ayin

g, th

e le

sson

m

ater

ial i

s acc

ompa

-ni

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y di

scus

sion

•Stud

entswere

signi

fican

tly m

ore

know

ledg

eabl

e an

d le

ss so

cial

dist

anci

ng

tow

ards

disa

bled

pe

ers (

Cla

ss IV

)

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pact (C

ontin

ued)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

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(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

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y fin

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vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Cur

ricu

lum

Swai

m, 2

001

(U

S)23

3 (5

0%

fem

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Gra

des 3

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(m

iddl

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Am

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Adj

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Che

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RF)

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desir

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at-

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To e

xam

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tow

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and

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, Au

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(n =

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and

Autis

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Info

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= 7

8)•Afte

rabrief

intr

oduc

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vi

deo

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show

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to e

ach

grou

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port

raye

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all

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the

vide

os: i

n th

e

first

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inte

ract

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soci

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ac

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the

seco

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spla

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autis

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tism

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fem

ales

, gav

e lo

wer

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tivity

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gs to

the

child

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autis

m a

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pose

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thei

r ty

pica

lly d

evel

opin

g pe

ers

•Providing

in

form

atio

n fo

r ch

ildre

n ha

d no

im

pact

on

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r at

titud

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ehav

iour

s (C

lass

IV)

•Be

haviou

rsofchild

acto

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cu-

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nvey

ed sp

ectr

um o

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tistic

beh

avio

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Mul

ti-m

edia

cu

rric

ulum

Adi

bser

eshk

i et

al.,

201

0

(Teh

ran)

221

(52%

fe

mal

e)

Gra

de 3

–5 (i

n-cl

usiv

e cl

asse

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ysic

al

disa

bilit

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t-te

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omiz

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ntro

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oup

Acc

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Scal

e (V

oeltz

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he p

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am in

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st

uden

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abou

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ivid

ual

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renc

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on 2

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ovie

ab

out k

ids w

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bilit

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Sessi

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pro

mot

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acce

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essio

n 4—

defin

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phys

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ssion

5•To

olsa

ndequ

ipment

used

by

peop

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es-

sion

6—di

sabi

lity

and

rela

ted

activ

ities

; Ses

-sio

n 7—

com

mun

ica-

tion

prob

lem

s; Se

ssio

n 8—

how

to h

elp

peop

le

with

disa

bilit

ies.

•Increasedacceptance

of st

uden

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ith

phys

ical

disa

bilit

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•Girlsh

adhigher

acce

ptan

ce th

an

boys

•5thgradersh

ad

high

er a

ccep

tanc

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mpa

red

to

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ger g

rade

s (C

lass

II)

•Onesc

ale

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eoretic

ally

info

rmed

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Mul

ti-m

edia

cu

rric

ulum

Wat

son,

200

4 (U

S)15

66

(52%

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mal

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Gra

des 6

–8

(1.9

% A

sian

Am

eric

an, 2

.6%

A

fric

an-A

mer

-ic

an, 1

6.3%

H

ispan

ic, 1

.2%

N

ativ

e A

mer

i-ca

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Pac

ific

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nder

, 69.

8%

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casia

n, 7

.8%

m

ixed

eth

nici

ty)M

enta

l illn

ess

Pre-

and

post

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nTh

e K

now

ledg

e

Test

(cur

ricul

um

eval

uatio

n) a

nd

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Q (s

hort

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At

trib

utio

n

Que

stio

nnai

re)

N/a

To e

valu

ate

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ct

part

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atin

g in

a

curr

icul

um b

ased

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entio

n ab

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nce

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enta

l on

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titud

es to

war

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vidu

als w

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men

tal i

llnes

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ses p

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eb

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d ac

tiviti

es to

fa

cilit

ate

lear

ning

, th

roug

h sim

ulat

ions

, an

imat

ions

and

vi

deos

•Sm

allbutsign

ificant

impr

ovem

ents

in

attit

udes

(Cla

ss II

)

•Nocontrolgroup

or

follo

w u

p to

see

if th

e ch

ange

was

m

aint

aine

d•Hardtodetermine

whe

ther

inte

rven

tion

had

an im

pact

on

thei

r act

ual b

ehav

iour

Haz

zard

and

Ba

ker,

1982

(US)

(n/a

) 32

5G

rade

s 3–6

(6

0%

Cau

casia

n,

40%

min

ority

)

Disa

bilit

y

(gen

eral

)Ra

ndom

ly

assig

ned;

pre

an

d po

st te

sts

Chi

ldre

n’s

Kno

wle

dge

Abo

ut

Han

dica

pped

Pe

rson

’s Sc

ale;

C

hild

ren’s

Soc

ial

Dist

ance

from

H

andi

capp

ed P

eers

Sc

ale;

The

Pe

rcep

tion

of a

H

andi

capp

ed

Pers

on M

easu

re

N/a

To e

valu

ate

the

impa

ct

of th

e m

ulti-

med

ia

prog

ram

in

chan

ging

/impr

ovin

g

the

attit

udes

of

child

ren

tow

ards

th

eir p

eers

with

di

sabi

litie

s; to

faci

litat

e m

ains

trea

min

g in

sc

hool

s

•6×

45-m

in

sess

ions

(m

ultim

edia

pr

ogra

m)

•Ea

chse

ssion

in

clud

ed 1

5 min

film

, di

scus

sion,

cl

assr

oom

ac

tivity

, boo

k le

ft in

th

e cl

assr

oom

to b

e re

ad in

free

tim

e•2trainersledthe

se

ssio

ns, b

ut

clas

sroo

m te

ache

rs

wer

e en

cour

aged

to

part

icip

ate

•Sign

ificantin

crease

in d

isabi

lity

kn

owle

dge

•greatera

warenesso

fap

prop

riate

beh

av-

iour

al re

spon

ses t

o di

sabl

ed p

eers

•girlsm

orepo

sitive

then

boy

s in

term

s of

soci

al d

istan

ce,

beha

viou

r and

inte

nt

to in

tera

ct (C

lass

III)

•Goo

dfirststep,sug

-ge

sted

to u

se in

con-

junc

tion

with

ano

ther

in

terv

entio

n•Onlyfemaletrainers

(sug

gest

one

mal

e, on

e fe

mal

e)

Pinf

old

et a

l.,

2003

(UK

)(n

/a)

472

Gra

des 9

–12

Men

tal h

ealth

Pre-

and

post

st

udy

desig

n (6

m

onth

pos

t tes

t)

Pret

est P

ilot

Que

stio

nnai

reN

/aTo

ass

ess t

he

effec

tiven

ess o

f an

in

terv

entio

n w

ith

youn

g pe

ople

aim

ed at

in

crea

sing

men

tal

heal

th li

tera

cy a

nd

chal

leng

ing

nega

tive

st

ereo

type

s ass

ocia

ted

with

seve

re m

enta

l ill

ness

•Worksho

psdelivered

by a

trai

ned

faci

lita-

tor;

Sess

ion

1:

1-h

men

tal h

ealth

(v

ideo

); Se

ssio

n 2:

pr

omot

ing

w

ell-b

eing

and

chal

-le

ngin

g us

e of

de

roga

tory

term

s an

d la

bels;

em

phas

is pl

aced

on

rem

ovin

g di

stan

ce b

etw

een

us

and

them

; gro

up

exer

cise

s and

in

form

atio

n le

aflet

s

•Greatestchanges

occu

rred

for f

emal

es

attr

ibut

ed to

cont

act

with

peo

ple

who

hav

e m

enta

l illn

ess

•Mentalh

ealth

ed

ucat

iona

l ses

-sio

ns a

re a

succ

essf

ul

man

ner t

o ch

alle

nge

ster

eoty

pica

l atti

tude

s to

war

d pe

ople

with

m

enta

l hea

lth is

sues

(C

lass

III)

•Nocontrolgroup

for

pre

and

post

stud

y•So

cialdesira

bilitybias

in at

titud

e as

sess

-m

ents

•Writtenview

sand

ex

pres

sed

attit

udes

m

ay n

ot re

flect

any

be

havi

oura

l cha

nge

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Mul

ti-m

edia

cu

rric

ulum

Tava

res,

2011

(C

anad

a)(n

/a)

5112

–13

year

s ol

dPh

ysic

al

disa

bilit

yQ

uasi-

expe

rimen

tal

grou

p; p

re- a

nd

post

- tes

t; fo

llow

up

1 m

onth

afte

r po

st-t

est

Che

doke

-McM

aste

r At

titud

es T

owar

d C

hild

ren

with

H

andi

caps

Sca

le

(CAT

CH

); So

cial

In

tera

ctio

n

Que

stio

nnai

res

N/a

To e

valu

ate

the

influ

ence

of

a p

rese

ntat

ion

on th

e at

titud

es o

f chi

ldre

n to

war

ds th

eir p

eers

with

ph

ysic

al d

isabi

litie

s

•45minpresentation

•Kno

wledgeis

co

rrec

ted

or a

dded

to

•Disc

usssim

ilarities

betw

een

the

able

bo

died

and

disa

bled

; vi

deo

“Kid

s Jus

t W

ant t

o H

ave

Fun”

•Presentersask

spec

ific q

uest

ions

ab

out t

he ch

ild’s

disa

bilit

y an

d th

e ch

ildre

n an

swer

th

e qu

estio

ns•Ro

leplaying

•Morepo

sitive

at

titud

es a

nd g

reat

er

unde

rsta

ndin

g of

di

sabi

lity

•Shorttermpositive

impa

ct o

n at

titud

es

and

pote

ntia

l on

the

soci

al in

clus

ion

of th

e no

n-in

clud

ed ch

ild

(Cla

ss II

I)

•Re

sultsnotcon

sistent

acro

ss a

ll sc

hool

s•To

osm

allofsam

ple

size

to g

ener

aliz

e•Interventio

nmayhave

nega

tivel

y im

pact

ed

targ

et ch

ild (f

elt o

ver-

whe

lmed

or i

sola

ted)

•Identifi

catio

nofch

ild

with

di

sabi

lity

– ta

ken

ou

t of t

he cl

assr

oom

•Un

sureab

outlo

ngterm

im

pact

Mul

tiple

com

pone

nts

Clu

nie-

Ross

and

O

’Mea

ra, 1

989

(Aus

tral

ia)

(n/a

) 60

Gra

de 4

(in

tegr

ated

an

d

non-

inte

grat

ed

scho

ols)

Inte

llect

ual

disa

bilit

ies

and

disa

bilit

y in

ge

nera

l

Pre-

test

, pos

t tes

t (e

xper

imen

tal

grou

p (3

0) a

nd

cont

rol g

roup

(3

0)

Peer

Atti

tude

s To

war

d th

e H

andi

capp

ed S

cale

(P

ATH

S): 3

su

b-sc

ales

(p

hysic

al,

lear

ning

, be

havi

oura

l)

and

a to

tal s

core

N/a

To e

valu

ate

the

effec

tive-

ness

of a

pro

gram

to

chan

ge th

e at

titud

es o

f pr

imar

y sc

hool

stud

ents

to

war

ds ch

ildre

n w

ith

disa

bilit

ies i

n bo

th in

clu-

sive

and

non-

incl

usiv

e cl

assr

oom

s

Mul

ti-m

edia

cu

rric

ulum

, sim

ulat

ion

and

soci

al co

ntac

t•4×

90minse

ssions

(ove

r 2 w

eeks

)•Se

ssion

1: m

ovie,

str

uctu

red

abou

t ba

rrie

rs•Se

ssio

n 2:

exp

erie

nces

in

whe

el ch

air

•Sign

ificantlym

ore

posit

ive

attit

ude

tow

ard

peer

s with

di

sabi

litie

s by

ch

ildre

n in

the

ex

perim

enta

l gro

up

•Eff

ectiv

einattitud

eto

war

d di

sabl

ed

•Se

ssio

n 3:

stor

y an

d vi

deo

abou

t di

ffer

ence

s an

d si

mila

ritie

s•Se

ssio

n 4:

soci

al

cont

act –

10

stud

ents

w

ith in

telle

ctua

l di

sabi

litie

s wen

t ro

ller s

katin

g w

ith

the

grad

e 4

clas

ses

•Th

roug

houtall

ph

ases

the

in

tegr

ated

had

mor

e po

sitiv

e at

titud

es

(Cla

ss II

)

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Mul

tiple

com

pone

nts

Flor

ian

and

Ke

hat,

1987

(I

srae

l)

(n/a

) 11

4G

rade

s 10–

11

(het

erog

eneo

us

cultu

ral a

nd

soci

oeco

nom

ic

back

grou

nds;

urba

n ce

ntre

)

Phys

ical

di

sabi

lity

Rand

om

assig

nmen

t; 3

ex

perim

enta

l gr

oups

, 1 co

ntro

l gr

oup

Jord

an a

nd

Ces

sna’s

qu

estio

nnai

re

(sho

rten

ed

vers

ion)

N/a

To e

xam

ine

the

impa

cts

of d

iffer

ently

stru

ctur

ed

educ

atio

nal p

rogr

ams

on h

igh

scho

ol st

uden

ts’

attit

udes

tow

ard

in

divi

dual

s with

ph

ysic

al d

isabi

litie

s;

addr

essin

g ho

w to

ch

ange

spec

ific

com

pone

nts o

f at

titud

es

Curr

icul

um, s

imul

atio

n an

d so

cial

cont

act

•G

roup

1: (

n =

28),

one m

eetin

g pe

r wee

k (le

ctur

e and

disc

us-

sion,

role

sim

ulat

ion;

fie

ld tr

ip)

•G

roup

2: (

n =

26),

(lect

ure,

disc

ussio

n,

role

sim

ulat

ion

in th

e co

mm

unity

)•G

roup

3: (

n =

31),

(lect

ure,

disc

ussio

n,

role

sim

ulat

ion

with

in

the c

lass

room

, soc

ial

cont

act)

•G

roup

4: (

n =

29)

cont

rol g

roup

•Group

2sign

ificant

chan

ge in

attit

udes

•Group

3:change

oc

curr

ed b

ut n

ot st

a-tis

tical

ly si

gnifi

cant

•Meetin

gwith

in

divi

dual

s with

di

sabi

litie

s did

not

im

pact

attit

ude

•Im

portanttorely

on v

ario

us m

etho

ds

and

met

hodo

logi

cal

com

bina

tions

•Differencebetween6

and

9 w

eek

prog

ram

ha

d no

effe

ct

(Cla

ss II

)

•Psycho

metric

m

easu

re w

as n

ot

sens

itive

eno

ugh

to

eval

uate

val

id

impa

cts o

f the

pr

ogra

m’s

impl

emen

tatio

n•Technicald

ifficul-

ties w

ith o

ne g

roup

le

avin

g th

e sc

hool

to

com

plet

e th

eir t

asks

Rein

a et

al.

2011

(S

pain

)34

4 (4

7%

fem

ale)

10–1

5 ye

ars

old

(mea

n ag

e 13

.3)

Visu

al

impa

irmen

tQ

uasi

ex

perim

enta

l de

sign

Attit

udes

Tow

ard

Disa

bilit

y

Que

stio

nnai

re

(ATD

Q)

N/a

To e

xplo

re th

e eff

ect o

f tw

o aw

aren

ess p

rogr

ams

(6-d

ay v

ersu

s 1-d

ay

prog

ram

s) o

n ch

ildre

n’s

attit

udes

tow

ard

peer

s w

ith a

visu

al im

pairm

entM

ulti-

med

ia c

urric

ulum

an

d sim

ulat

ion

•6-dayprogram

incl

uded

: lec

ture

an

d vi

deo

on v

isual

im

pairm

ents

, a g

ame,

simul

ated

act

iviti

es,

trai

ning

and

com

peti-

tive

socc

er u

sing

blin

d fo

lded

gog

gles

and

a

spor

t sho

w•1-dayprogram

incl

uded

onl

y th

e le

ctur

e an

d vi

deo

•Sign

ificanteffectsin

the

cogn

itive

, em

otio

nal a

nd

beha

viou

ral s

cale

s•Sign

ificantlym

ore

fem

ales

show

ed

favo

urab

le re

sults

th

an m

ales

•Th

e6-daydyadic

inte

rven

tion

was

m

ore

effec

tive

than

th

e 1-

day

awar

enes

s un

it (C

lass

II)

•Th

isstud

ydidno

tta

ke in

to a

ccou

nt th

e im

pact

of p

revi

ous

cont

act o

n kn

owle

dge

of p

eopl

e w

ith a

dis-

abili

ty

Rose

nbau

m e

t al.,

19

86 (C

anad

a)66

(45%

fe

mal

e)G

rade

s 4–7

(9

–13

year

s ol

d)

Disa

bilit

y

(gen

eral

)Q

uasi

ex

perim

enta

l (p

re-t

est,

post

test

w

ith a

cont

rol

grou

p)

Ched

oke-

McM

aste

r At

titud

es to

war

d

Child

ren

with

H

andi

caps

(CAT

CH):

Perc

eived

Co

mpe

tenc

e Sca

le,

Pare

ntal

Attit

udes

to

war

d Ch

ildre

n w

ith

Han

dica

ps (P

ATCH

), Kn

owled

ge o

f D

isabl

ed P

eopl

e

N/a

To e

xplo

re th

e

effec

tiven

ess o

f tw

o

inte

rven

tions

for

impr

ovin

g at

titud

es

tow

ard

disa

bilit

y an

d m

ore

spec

ifica

lly

child

ren

with

di

sabi

litie

s - lo

ok at

eff

ectiv

enes

s of

prog

ram

s ind

ivid

ually

an

d co

llabo

rativ

ely

Curr

icul

um a

nd so

cial

co

ntac

t•Bu

ddyprogram:3

mon

ths

•KidsO

ntheBlock:

10weeks×45m

in,

4 pu

ppet

show

s and

di

scus

sions

•Com

binedKidsO

nth

e Bl

ock

& B

uddy

Pr

ogra

m: b

oth

pro-

gram

s con

curr

ently

•KO

Bandbu

ddy

gr

oup

attit

udes

wer

e sig

nific

antly

low

er

than

the

budd

y on

ly

grou

p•KO

B-Bu

ddyg

roupwas

poor

er th

en th

e con

trol

and

KOB

alone

•Bu

ddyon

lygroup

kn

ew m

ore

child

ren

with

disa

bilit

ies

(Cla

ss II

I)

•Natureofbud

dy

prog

ram

diff

ered

f ro

m sc

hool

to sc

hool

•Needtodefine

rela

tions

hip

betw

een

attit

ude

and

be

havi

oura

l (Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Mul

tiple

com

pone

nts

Rillo

tta a

nd

Net

telb

eck,

20

07 (A

ustr

alia

)

259

(55%

fe

mal

e)

Gra

de 9

–12

(priv

ate

scho

ol)

Inte

llect

ual

disa

bilit

yQ

uasi

expe

rimen

tal;

age

mat

ched

co

ntro

l gro

ups

Attit

udes

Tow

ard

Pers

ons w

ith a

n

Inte

llect

ual

Disa

bilit

y

Que

stio

nnai

re;

Theo

ry

of m

ere

expo

sure

eff

ect;

theo

ry o

f pe

r-su

asiv

e co

mm

u-ni

catio

n

To u

nder

stan

d th

e

impa

ct o

f lon

g-la

stin

g po

sitiv

e at

titud

es

rega

rdin

g ed

ucat

iona

l an

d so

cial

incl

usio

n fo

r pe

ople

with

an

in

telle

ctua

l disa

bilit

y, th

roug

h a

soci

al a

nd

educ

atio

nal i

nteg

rate

d se

tting

alo

ng w

ith a

pr

ogra

m th

at p

rovi

ded

trai

ning

in d

isabi

lity

awar

enes

s

Mul

ti-m

edia

cur

ricul

um

and

soci

al co

ntac

t•Grade6

Stu

dent

s: 3×

45minsessionsof

disa

bilit

y aw

aren

ess

prog

ram

s (in

clude

d:

getti

ng to

kno

w

stude

nts w

ith an

inte

l-le

ctua

l disa

bilit

y, to

ur-

ing

thei

r cla

ssro

om,

play

ing

spor

ts/co

okin

g to

geth

er, g

uest

spea

ker

disc

ussin

g in

clusio

n)•G

rade

8 st

uden

ts:

8×45

minaw

areness

of d

isabi

lity

prog

ram

ra

n by

teac

hers

(pre

-se

ntat

ions

, disc

ussio

n,

vide

o, g

uest

spea

kers

, ke

y ele

men

t was

non

-di

sabl

ed an

d di

sabl

ed

stude

nt in

tera

ctin

g by

pl

anni

ng an

d un

der

taki

ng an

activ

ity)

•G

rade

8 st

uden

ts:

com

plet

ed a

10 se

ssio

n pr

ogra

m (s

imila

r to

othe

r gro

up b

ut 2

ad-

ditio

nal s

essio

ns w

ith

mor

e dire

ct co

ntac

t an

d tw

o vi

deos

)

•Stud

entswho

com

-pl

eted

an

8-se

ssio

n aw

aren

ess p

rogr

am

repo

rted

mor

e po

si-tiv

e at

titud

es to

war

d pe

ople

with

disa

bilit

ies

than

thos

e w

ho at

-te

nded

onl

y 3

sess

ions

•Similarp

ositivityin

at

titud

es in

child

ren

who

had

just

com

-pl

eted

the

sess

ions

and

th

ose

who

had

8 y

ears

pr

evio

usly

•Mostp

romising

for

fem

ales

(Cla

ss II

I)

•Scho

olsd

ifferedin

pr

esen

tatio

n,

com

mitm

ent a

nd

unde

rsta

ndin

g

Schu

lze

et a

l.,

2003

(Ger

man

y)(n

/a)

150

14–1

8 ye

ars

old

Schi

zoph

reni

aPr

e-te

st, p

ost t

est

with

a co

ntro

l gr

oup

Que

stio

nnai

re

(des

igne

d fo

r thi

s st

udy:

ster

eoty

pic

view

s of

schi

zoph

reni

a an

d so

cial

dist

ance

N/a

To re

duce

stig

ma

and

disc

rimin

atio

n to

war

ds

indi

vidu

als w

ith

schi

zoph

reni

a w

ithin

a

scho

ol e

nviro

nmen

t

Mul

ti-m

edia

curr

icul

um

and

soci

al co

ntac

t•Usedartworkand

gam

es to

pro

mot

e em

otio

nal w

ellbe

ing

and

men

tal h

ealth

•Followe

dbydiscussio

nwa

ys to

cope

with

ill

ness

or w

hen

they

fee

l “do

wn”

; a yo

ung

pers

on w

ith

schi

zoph

reni

a disc

usse

d th

eir ow

n sto

ries

•Re

sultedinsig-

nific

ant r

educ

tion

of

ster

eoty

pes (

impr

oved

at

titud

es) (

Cla

ss II

I)

•Attitud

esarenot

the

only

fact

or to

be

havi

our (C

ontin

ued)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(C

ount

ry)

N (%

fe

mal

e)Sa

mpl

e

char

acte

ristic

sTy

pe o

f disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Mul

tiple

com

pone

nts

Kra

he a

nd

Altw

asse

r, 20

06

(Ger

man

y)

70 (6

3%

fem

ale)

Gra

de 9

(m

ean

age

14.8

)Phys

ical

di

sabi

lity

Expe

rimen

tal;

rand

omiz

ed

cont

rol g

roup

, 3

mon

th fo

llow

up

Mod

ified

qu

estio

nnai

re

Abo

ut

Attit

udes

Tow

ards

th

e Ph

ysic

ally

D

isabl

ed; P

erso

nal

Con

tact

with

D

isabi

lity

Scal

e D

evel

oped

; soc

ial

desir

abili

ty m

easu

re

(Sto

ber)

Cog

nitiv

e be

hav-

iour

al;

mod

els o

f at

titud

e ch

ange

To co

mpa

re co

ntro

lled

inte

rven

tions

for

alte

ring

attit

udes

to

war

ds in

divi

dual

s w

ith d

isabi

litie

s

Mul

ti-m

edia

cu

rric

ulum

, sim

ulat

ion

and

soci

al co

ntac

t•2×

90minse

ssions;

cogn

itive

inte

rven

tion:

pe

rson

al e

xper

ienc

es

with

disa

bilit

y, de

fin-

ing

phys

ical

disa

bilit

y, ta

xono

my,

labe

lling

(v

ideo

of P

aral

ympi

c G

ames

), hi

stor

ical

ov

ervi

ew, i

nter

actin

g w

ith a

per

son

with

a

disa

bilit

y, di

spel

ling

ster

eoty

pes

•Be

havi

oura

l int

erve

n-tio

n: 9

phy

sical

ly

disa

bled

athl

etes

cam

e, ta

ught

and

orga

nize

d sp

orts

in th

e gym

(g

oal-b

all,

whe

elcha

ir,

bask

etb

all a

nd si

tting

vo

lleyb

all)

•Com

binedcogn

itive-

beha

viou

ral i

nter

ven-

tion

had

a m

ore

signi

fican

t effe

ct in

im

prov

ing

attit

udes

th

an th

e co

gniti

ve

inte

rven

tion

•Meetin

gindividu

-al

s with

a d

isabi

lity

was

key

in d

ispel

ling

ster

eoty

pes/

myt

hs

(Cla

ss II

I)

•Unclearwhetherit

was

com

bina

tion

of

cogn

itive

-beh

avio

ural

or

just

beh

avio

ural

th

at h

ad a

n im

pact

Pana

giot

ou e

t al.,

20

08 (G

reec

e)17

8 (5

1%

fem

ales

)Gra

des 5

and

6

mea

n

age

= 11

.5

Phys

ical

di

sabi

litie

sEx

perim

enta

l de

sign

Chi

ldre

n’s A

ttitu

des

tow

ard

Inte

grat

ed

Phys

ical

Ed

ucat

ion—

Revi

sed

(CA

IPE-

R)

Con

tact

th

eory

; pe

r-su

asiv

e co

mm

u-ni

catio

n th

eory

, so

cial

-co

gniti

ve

To e

xam

ine

the

effec

t of

the

Para

loym

pic s

choo

l da

y pr

ogra

m o

n th

e

attit

udes

of 5

th a

nd 6

th

grad

e st

uden

ts w

ithou

t di

sabi

litie

s and

the

effe

ct

of g

ende

r diff

eren

ces o

n th

e in

clus

ion

of ch

ildre

n

with

disa

bilit

ies i

n

phys

ical

edu

catio

n cl

asse

s.

Cur

ricu

lum

and

sim

ulat

ions

•Paraloym

picschool

day (

1-da

y) th

at

inclu

ded

10 ac

tiviti

es

(15 m

in ea

ch):

hum

an

right

s, Pa

raly

mpi

c ga

mes

, boc

cia,

cla

ssifi

catio

n, si

tting

vo

lleyb

all, g

oal-b

all,

acce

ssib

ility

gam

es,

pain

ting,

whe

elcha

ir ba

sket

ball

and

athl

etics

.th

eory

an

d in

ter-

pers

onal

re

latio

ns

theo

ry

•Studentsw

eresepa

-ra

ted

into

10

grou

ps

(18–

20 st

uden

ts in

ea

ch g

roup

and

then

ro

tate

d am

ong

the

activ

ities

)

•Sign

ificantdifference

in g

ener

al at

titud

es

tow

ard

peer

s with

ph

ysic

al d

isabi

litie

s bu

t not

spor

t-sp

ecifi

c at

titud

es•Nogend

erdifferences

(Cla

ss II

I)

•Th

eorie

swere

men

tione

d bu

t not

in

corp

orat

ed in

to th

e an

alys

is

(Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Xaf

opou

lous

et

al.,

200

9

(Cze

ch R

epub

lic)

71 (4

0%

fem

ale)

Aver

age

age

= 11

.3Ph

ysic

al

disa

bilit

yPr

e-po

st d

esig

nC

hild

ren’s

Atti

tude

To

war

d In

tegr

ated

Ph

ysic

al

Educ

atio

n-Re

vise

d (C

AIP

E-R)

Theo

ry

of

plan

ned

beha

vi-

our

To in

vest

igat

e th

e eff

ect

of P

arao

lym

pic d

ay

on ch

ildre

n’s at

titud

es

tow

ards

pee

rs w

ith a

di

sabi

lity

in g

ener

al

phys

ical

edu

catio

n cl

ass

Mul

tiple

com

pone

nts

Soci

al co

ntac

t and

sim

ulat

ions

•6grou

ps(1

2stud

ents

each

) rot

ated

into

6

activ

ities

(40 m

in

each

): (1

) Par

alym

pic

spor

ts (v

ideo

and

di

scus

sion)

, (2

) sle

dge

hock

ey

(ada

pted

equ

ip-

men

t and

pra

ctic

al

exer

cise

),

(3) w

heel

chai

r m

obili

ty

(exp

erie

nced

bei

ng

diffe

rent

and

mov

ing

in a

diff

eren

t way

) (4

) whe

elch

air b

as-

ketb

all,

(5

) mee

t an

athl

ete

with

a d

isabi

lity,

(6

) boc

cia

(the

pro

-gr

am e

mph

asiz

ed

resp

ect a

nd a

ccep

-ta

nce

of in

divi

dual

di

ffere

nces

, ath

letic

ac

hiev

emen

ts a

nd

right

s of d

isabl

ed

peop

le to

take

par

t in

spor

ts

•Th

eon

e-day

inte

rven

tion

po

sitiv

ely

influ

ence

d th

e ge

nera

l atti

tude

s of

girl

s but

not

thei

r sp

ort s

peci

fic

attit

udes

(Cla

ss IV

)

•Nocontrolgroup

Fava

zza

and

Odo

m, 1

997

(U

S)

46 (5

0%

fem

ale)

5–6

year

s old

(8

5% C

auca

sian,

15

% A

fric

an

Am

eric

an;

low

SES

) –

inte

grat

ed

clas

ses

Disa

bilit

y

(gen

eral

)Ra

ndom

ized

co

ntro

l gro

up

(pre

test

and

pos

t te

st)

Acc

epta

nce

Scal

e fo

r Kin

derg

arte

ners

(A

SK),

Inve

ntor

y of

D

isabi

lity

Re

pres

enta

tion

(ID

R), O

pini

ons

Rela

tive

to M

ain-

stre

amin

g (O

RM)

N/a

To e

xam

ine

the

effec

ts

of le

vel o

f con

tact

, bo

oks a

nd d

iscus

sions

on

the

attit

udes

of

kind

erga

rten

-age

ch

ildre

n to

war

d pe

ople

w

ith d

isabi

litie

s

Curr

icul

um a

nd so

cial

co

ntac

t•9weekprogramdivid

-ed

into

3 g

roup

s (no

, lo

w an

d hi

g co

ntac

t)•Eq

uipm

entavailable

for c

hild

ren

to e

xplo

re•3storiesreadeach

wee

k in

the

high

co

ntac

t•15minofstructured

play

with

child

ren

with

disabilities3

×/week

•So

cialco

ntactand

us

e of

child

ren’s

bo

oks a

re e

ffect

ive

mea

ns to

alte

r the

at

titud

es o

f chi

ldre

n (C

lass

IV)

•Differencesincontact

grou

ps co

uld

be

rela

ted

to sc

hool

se

tting

s•Infoabo

utch

ild’s

unde

rsta

ndin

g or

pe

rcep

tion

of a

per

son

with

a d

isabi

lity

was

no

t ass

esse

d•Cou

ldhavebeen

stre

ngth

ened

by

usin

g be

havi

oura

l ob

serv

atio

n (Con

tinue

d)

Tabl

e I.

(Con

tinue

d).

Firs

t aut

hor,

year

(Cou

ntry

)N

(%

fem

ale)

Sam

ple

ch

arac

teris

tics

Type

of

disa

bilit

ySt

udy

desig

nM

easu

reTh

eory

Obj

ectiv

eTy

pe o

f int

erve

ntio

nKe

y fin

ding

s (le

vel o

f ev

iden

ce)

Lim

itatio

ns o

f stu

dy

Dis

abil

Reh

abil

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Nat

iona

l Uni

vers

ity o

f Si

ngap

ore

on 0

6/06

/14

For

pers

onal

use

onl

y.



Mul

tiple

com

pone

nts

Curr

icul

um a

nd so

cial

co

ntac

tFa

vazz

a et

al.,

20

00 (U

S)(n

/a)

575–

6 ye

ars o

ld

(2%

Cau

casia

n;

98%

Afr

ican

A

mer

ican

; lo

w S

ES)

Disa

bilit

y

(gen

eral

)Ra

ndom

ized

co

ntro

l gro

up

(pre

test

and

pos

t te

st)

Teac

her I

mpr

essio

n Sc

ale;

Acc

epta

nce

Scal

e fo

r K

inde

rgar

tene

rs

(ASK

);

Inve

ntor

y of

D

isabi

lity

Re

pres

enta

tion

(I

DR)

N/a

To e

xam

ine

the

eff

ectiv

enes

s of a

n

inte

rven

tion

to

prom

ote

acce

ptan

ce o

f yo

ung

child

ren

with

di

sabi

litie

s

•W

hole

Inte

rven

tion:

st

ory

time,

disc

us-

sions

in cl

assr

oom

, st

ruct

ured

pla

y w

ith

child

ren

with

di

sabi

litie

s, st

ory

time

and

disc

ussio

ns at

ho

me

•St

ory

Gro

up:

part

icip

ated

in st

ory

tim

e pa

rt o

f in

terv

entio

n at

hom

e an

d sc

hool

•Pl

ay G

roup

: pa

rtic

ipat

ed o

nly

in th

e str

uctu

red

play

aspe

ct

of th

e int

erve

ntio

n;

story

tim

e and

disc

us-

sions

cent

red

arou

nd

disa

bilit

y

•Childrenexpo

sedto

indi

vidu

al

com

pone

nts o

f the

in

terv

entio

n ha

d sh

ort-

term

gai

ns in

ac

cept

ance

of

indi

vidu

als w

ith

disa

bilit

y w

hile

ch

ildre

n ex

pose

d to

th

e w

hole

inte

rven

-tio

n ha

d sh

ort a

nd

long

-ter

m g

ains

in

acce

ptan

ce•sig

nificantgainsin

le

vels

of ac

cept

ance

fo

und

only

in th

e “hi

gh

leve

l of c

onta

ct” g

roup

s (le

ss ex

posu

re to

peo

ple

with

disa

bilit

ies w

as

linke

d w

ith lo

wer

ac

cept

ance

(Cla

ss IV

)

•Childreninth

eco

ntro

l gro

up w

ere

at

a di

ffere

nt sc

hool

than

th

e ot

her 3

gro

ups

•Lo

wre

liabilityofASK

(d

ue to

self-

repo

rts)

•Classwasra

ndom

ly

assig

ned,

not

the

indi

vidu

al st

uden

ts

Ison

et a

l., 2

010

(Aus

tral

ia)

147

(32%

fe

mal

e)

9–11

yea

rs o

ld

(priv

ate

scho

ols;

2 A

nglic

an, 1

C

atho

lic

scho

ol; 1

Boy

s sc

hool

, 2

Co-

ed)

Disa

bilit

y (g

ener

al)

Pre-

post

test

an

d fo

cus g

roup

Base

line

qu

estio

nnai

re fo

r th

is st

udy

(Lik

ert

Scal

e, Tr

ue/F

alse

, O

pen

Ende

d

rela

ting

to

pres

enta

tion)

Cog

nitiv

e be

hav-

iour

al

To e

valu

ate

the

eff

ectiv

enes

s of a

shor

t di

sabi

lity

awar

enes

s pa

ckag

e fo

r stu

dent

s in

5th

grad

e, to

add

ress

ga

ps in

kno

wle

dge,

ac

cept

ance

and

at

titud

es to

war

d

peop

le w

ith d

isabi

litie

s

Curr

icul

um, s

imul

atio

n an

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Thirty-four of the interventions we reviewed showed statis-tically significant improvements in attitudes toward and/or acceptance of people with disabilities (refer to Table II). In terms of the rigour of these studies six the interventions had class II level evidence [46–51], 17 studies with class III level evidence [1,3,4,16,22,27,34,42,45,52–57] and 15 studies with class IV evidence [7,10,20,23,24,35,36,43,44,58–63] (refer to Table II). The successful components of these interventions are discussed further in the ‘components’ section below.

Knowledge about disabilityA second key outcome addressed by some studies was knowl-edge about people with disabilities. Upon examining the stud-ies by level of rigour, one class II [30], four class III studies [22,33,43,64] and three class IV studies [7,60,62] found statis-tically significant improvements in knowledge about people with disabilities (refer to Table II). Within the class II study Pivik [30] used a simulation-based intervention involving a 30-min desktop virtual reality program where children had an opportunity to experience the world as if they were sitting in a wheelchair. Other interventions [64] involved six 45-min ses-sions (multi-media program) led by two trained people which involved films, discussion, activities and books to improve children’s knowledge about disability.

Trilva et al.’s [22] intervention involved several curricu-lum-based activities, which took place for 1 h/week over 10 weeks. Rahman’s [33] 4-month curriculum approach used participatory education methods and awareness activities to help improve children’s knowledge about disabilities. Holtz’s study [42] showed a video to raise awareness about disabili-ties. Overall, the evidence is a level C (refer to Table II), which means that these interventions are possibly effective at improv-ing knowledge about disability. None of the studies that we examined showed a lack of improvement in knowledge about people with disabilities so we are unable to compare success-ful and unsuccessful components of interventions.

Three studies we reviewed had mixed results [28,35,64] which may be due to the studies comparing several different formats or interventions, in addition to having several different

outcome measures. An additional three studies in our review found that their intervention did not have a significant impact on improving attitudes or acceptance of people with disabili-ties [9,23,32]. Godeau et al. [32] suggest that this lack of effect may have been a result of improved attitudes in both the con-trol and experimental group, thus, showing no overall effect. They contend that the introduction of any disability awareness intervention or questionnaire could lead students to reflect on their own personal interactions with a child with a disability [32]. With regards to the Nabors [9] study, their intervention was one of the only studies that compared the views of chil-dren with disabilities to typically developing children. Their sample also had a much older average age compared to the other studies in this review. In Swaim’s study [23], they used three different conditions and also had multiple outcome mea-sures, which could have accounted for their findings.

Effectiveness of interventions by gender and ageNotable gender differences were found in several studies where girls consistently had better attitudes towards peers with disabilities than males [1,3,9,24,32,44,51,57,59,64]. It is important to note, however, that the studies reporting gender differences were at a class III or IV level of evidence so the findings should be interpreted with caution (see Table II).

Some of the interventions found a difference in impact by age [23,30,49]. For example, one study found a difference in attitudes based on age of the children where those in grade 6 gave lower ratings to children with a disability (autism) com-pared to children in grade 3 [23]. In contrast, another study found that fifth graders had higher acceptance of peers with a disability compared to those in younger grades [49].

Components of the interventionsA main objective of our review was to explore the com-mon components of disability awareness interventions. The number and type of components involved in the inter-ventions varied greatly. They included such things as pre-sentations [55], academic/curriculum based [9,32,33,60], stories [1,61], video [23] multi-media (i.e. more than one: stories, movies, art, games, role playing, discussions etc [3,4,7,42,45,49–51,56,60,62,64].), contact with a person with a disability [3,10,16,28,34–36,45,48,52–54,58], simulations [24,30,43,59] classroom activities [35,36,48], plays/puppet shows [20,27,28]. Many of the interventions combined several of these approaches.

We classified the various types of interventions into the following categories based on the mode of their delivery: (i) social contact; (ii) simulation; (iii) curriculum; (iv) multi-media curriculum and (v) multiple components.

Social contactSeven of the interventions used a “social contact” approach where children were exposed to a person with a disability. One class II study [48], 4 class III studies [34,52–54] and two class IV studies [35,58] demonstrated significantly improved attitudes and/or acceptance of peers with a disability follow-ing a social contact intervention. Therefore, there is pos-sible evidence (level C) to support the use of social contact

Table II. Overview of effective disability awareness interventions by outcome.Level of evidence

Knowledge about people with disabilities

Attitudes towards/acceptance of people with disabilities

Class I N/a N/aClass II • Simulations • Social contact interventions

• Multi-media interventions

• Multi-media interventions• Multi-component interventions

Class III • Curriculum interventions

• Social contact interventions• Curriculum interventions• Multi-component interventions

Class IV • Curriculum interventions

• Social contact

• Multi- component interventions

• Simulation• Curriculum• Multi-component interventions

Legend of intervention effectiveness [41].Unshaded: Probably effective (B); Light shaded: Possibly effective (C); Dark shaded: Data inadequate.

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interventions to improve children’s attitudes towards peers with a disability (see Table II). Social contact interventions were often based on social contact theory, which suggests that interaction between groups may change attitudes toward out-groups and may reduce stereotyping and prejudice. Interventions in this category varied in length from 6 weeks to 1 year. Three of the studies used a “Circle of Friends” approach [35,54,58] to enhance social inclusion in a mainstream set-ting. This works by mobilizing peers to provide support to a child with a disability. Others, such as Armstrong [48], used a “buddy system” where children with disabilities were paired up with a typically developing peer of the same gender and met regularly at school to engage in social activities. Newberry and Parish [52] had a similar principle behind their interven-tion; however, they focused on social interaction outside of the classroom. Further, Piercy’s [53] study brought children with disabilities and typically developing children together through co-operative learning groups, which were more aca-demic based than the other interventions. We were unable to compare the successful and unsuccessful components of social contact disability awareness interventions because all of these studies showed positive outcomes.

Simulation-based interventionsFour of the interventions included in our analysis used simu-lations to raise awareness about disabilities among children [24,30,43,59]. One class II study [30] and three class IV stud-ies [24,43,59] showed improvements in children’s knowledge about disability (refer to Table II). For example, Pivik’s [30] simulation-based study engaged students in a 30-min virtual reality program to gain a better understanding of what it is like to move around in a wheelchair and the obstacles that are experienced. There is possible evidence (level C) to sup-port the use of simulation interventions to improve children’s knowledge about people with disabilities. Three class IV studies [24,43,59] showed improvements in attitudes towards children with disabilities; however, the data are inadequate to make a recommendation on the effectiveness of this type of intervention.

Curriculum-based interventionsFourteen of the interventions included in our search were curriculum-based and focused on a wide range of disabilities including disability in general (6), mental illness (5), Tourette Syndrome, autism, cerebral palsy, and attention deficit hyperactivity disorder. There was a great range in the type of curriculum-based intervention including presentations [45], games [41], classroom exercises [4,32,33], videos [23,42,62], plays and puppet shows [20,27,63] and stories [1,9,61].

In regards to using curriculum-based interventions to improve knowledge about disabilities, one class II study [33], two class III studies [22,42] and three class IV studies [60,62,63] reported a significant change in knowledge about disability. This evidence is at a level C indicating that these interventions are possibly effective at improving knowledge about disabilities. Among the studies with a higher level of evidence, Rahman [33] used participatory educational

methods and awareness activities in the classroom to improve knowledge about mental health. Holtz’s [42] intervention involved a video about children with a disability. Meanwhile, Trilvia’s [22] intervention involved classroom-based activities that occurred 1 h/week over 10 weeks.

The findings from curriculum-based interventions regard-ing improving attitudes towards children with disabilities are mixed. For example, one class I study [32] found no significant change in attitudes towards disability following their intervention (refer to Table II). As we mentioned earlier this may have been due to both the intervention and control group having improved attitudes. Meanwhile, four class III [1,22,27,42,55] and three IV studies [20,61,62] also showed significant improvements in attitudes using curriculum-based interventions. These interventions included one-off presenta-tions or class activities [20,42,55,61] to multiple sessions over a longer period of time [1,22,27]. As a result of the interven-tions showing conflicting results we are unable to make a recommendation of best practices using a curriculum-based intervention to influence attitudes towards children with disabilities.

Multi-media based curriculum interventionsFive of the interventions used multi-media curriculum based interventions to improve attitudes towards children with disabilities. This included two class II studies [49,50] and three class III studies [4,57,64]. The interventions ranged in length from one 45-min session (i.e. simulations and class activities) to eight 45-min sessions involving presentations, movies and class activities. The type of disability that inter-ventions focused on also varied from disability in general for the younger grades to more specific conditions (i.e. mental health, visual impairments) for high school students. This evidence (level C) from these multi-media interventions indi-cates that these interventions are possibly effective at improv-ing attitudes towards children with disabilities.

Only one multi-media based curriculum intervention [64] examined improvements in knowledge about disability, thus, the evidence is insufficient to make a recommendation about best practices.

Multi-component interventionsTwelve of the interventions included in our analysis used multiple components (i.e. several of the approaches men-tioned above). Two class II studies [46,47], five class III studies [3,16,45,51,56] and four class IV studies [7,10,36,44] dem-onstrated an improved attitude towards peers following the intervention. Thus, these interventions (level C evidence) are possibly effective at improving attitudes towards children with disability. For example, three interventions used a combined approach involving curriculum activities and social contact with a person with a disability [10,28,36]. Two other studies similarly used multi-media curriculum activities combined with social contact [3,56]. Four interventions included a vari-ety of curriculum activities, simulation exercises and social contact with a person with a disability [7,45–47]. Ison et al.’s [7] participants reported that using interactive activities along

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with social contact (i.e. having a presenter with a disability) was the key to the success of their intervention. Children reported that social contact/exposure to someone with a dis-ability is critical to improving behaviours [7,52,57]. Meanwhile Panagantiou [16] and Xafpoulous [44] used curriculum activi-ties and simulation exercises to influence children’s attitudes through a range of Paralympics activities. The programs varied in length from a one-day session of Paralympic activities [16] to four 90-min sessions over 2 weeks [46] to a 6-day program involving multi-media curriculum activities and simulation exercises [51].

One of the advantages of a multiple components interven-tion was that several authors compared the effectiveness of different components within their intervention. For example, Krahe [45] found that social contact was essential to improv-ing attitudes towards people with disabilities. They also reported that a combined cognitive-behavioural intervention had a statistically significant effect in improving attitudes towards people with disabilities than cognitive intervention. Meanwhile, Favazza [10] found that those exposed to the whole intervention as opposed to individual components had both short and long-term gains in terms of social acceptance of peers with disabilities. They found that statistically signifi-cant gains in acceptance were made in the group that had a high level of contact with peers with a disability. In contrast, Florian and Kehat [47] found that social contact did not influ-ence attitudes.

Rosenbaum’s [28] study had mixed findings where they compared different interventions for improving attitudes. One involved a buddy program lasting 3 months, one involved a series of 4 (45 min puppet shows) over 10 weeks and the final intervention combined the puppet show and the buddy pro-gram concurrently. They found that the children in the inter-vention that combined the puppet show and buddy program did not have improved attitudes compared to the children in the buddy-only group. They suggest that this may have been a result of the dissonance between what children experienced and what they were led to expect in the educational puppet program [28].

In sum, there were five key types of interventions based on their mode of delivery (i.e. social contact; simulation; cur-riculum; multi-media curriculum, and multiple components) which influenced knowledge of disability, attitudes and accep-tance of peers with disabilities.

Length of the interventionsThe length of the disability awareness interventions varied greatly from a one-off 20-min session to a 1-year program with bi-weekly activities lasting 30–90 min each session. With a few exceptions, most studies that had positive outcomes involved more than one session and had multiple components such as books, videos, discussions, simulations, practical exer-cises, and/or interaction with people with disabilities. Some researchers also recommended that several approaches and methods be used for disability awareness interventions [47].

Only two studies examined the impact of different lengths/types of programs on the attitudes toward children with

disabilities. Reina et al. [51] found that their 6-day interven-tion was more effective than the 1-day awareness unit. In Rillota and Nettlebeck’s [3] study, students who completed an 8-session awareness program reported more positive atti-tudes toward children with a disability compared to those who attended the 3-session awareness program. Meanwhile, Florian [47] found no difference between a 6-week and 9-week program in altering attitudes in a multi-component interven-tion. Pitre [27] argued that a one-off session is unlikely to have a long-lasting impact on attitudes and behaviour. This suggests that there may be a threshold when the program can maintain its impact. The first two studies compared shorter duration (6-day versus 1-day; and 8 weeks versus 3 weeks) while the study that found no difference in outcomes was 6 versus 9 weeks (considerably longer than the comparisons in the first two studies). The discrepancy in findings by length of programs could also have been due to the heterogeneous culturally and socio-economically diverse sample.

Discussion

This review provides evidence for how to achieve optimal outcomes for improving attitudes towards and acceptance of people with a disability. Uncovering the effective components of disability awareness interventions is especially important as schools, educators and health professionals increasingly invest in the development of disability awareness interven-tions to further enhance social inclusion [38]. Although some interventions in this review have more recently implemented inclusive education policies compared to others, the authors of these interventions consistently argue that there are diffi-culties with achieving social inclusion of children with dis-abilities and that this cannot be achieved through inclusive polices alone [20].

Our review shows that several different types of disability awareness interventions can be used to positively influence knowledge about people with disability. Common elements of successful interventions included breaking down stereotypes and creating awareness of the barriers that with people with disabilities encounter. Such interventions were done in a vari-ety of different formats including simulations, multi-media and curriculum-based interventions which varied greatly in length and target audience.

Our findings also highlight that several successful strate-gies can be used to influence attitudes towards children with disabilities. Common components of successful interven-tions included social contact with a person with a disability over a period of time, multi-media and multi-component approaches involving stories, class activities and discus-sions. The social contact approach was used more often with younger children over longer periods of time from 6 weeks to 1-year programs to allow time to develop understanding of disability and possible friendships. A few of the other types of interventions were one-off sessions while many others ran over a longer period of time.

Improving knowledge about disability is important because children’s attitudes are often strongly influenced by their degree

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of knowledge [7,65]. A lack of understanding can perpetuate stigma and social exclusion [2,60]. Indeed, unfavourable peer attitudes are a major barrier to the full social inclusion of chil-dren with disabilities in integrated schools [32].

Many of the disability awareness interventions we reviewed reported a consistent gender and age-based pattern influencing attitudes whereby females often had more posi-tive attitudes towards peers with disabilities than males. Past evidence also shows that girls often have more favourable attitudes towards children with a disability compared to boys [1] and that some interventions may appeal differently to boys and girls [38]. Similarly, an age based pattern emerged where children from older grades were more accepting than younger children. This is consistent with similar research on bullying interventions suggesting that younger children may benefit less than older children [8]. Our review also highlighted that interventions used most often with younger children focused on disability in general while some successful interventions with older students were more disability specific.

Our recommendations for the further development of disability awareness programs include having multiple com-ponents, interactive activities, social contact with people who have a disability, several sessions over a longer period of time rather than a brief one-off session and having standardized measures and a rigorous methodological design. Interventions should also be context specific taking educational policies and societal customs into account.

What is lacking in the disability awareness interventions we reviewed is that they tended to target one class at a time. It would be worthwhile to explore a whole-school based inter-vention, which has been shown to be effective in the bully-ing literature [8]. An intervention that is only based on one level (e.g. classroom) may not have a lasting impact. Failing to address the systemic issues and the social environment related to social exclusion can undermine the success of the interven-tion [8]. Thus, a multi-level and multi-component approach is needed involving school boards, community, teachers, par-ents and children to improve attitudes towards people with disabilities.

An important element for future programs to consider is the influence of the socio-contextual environment of how children with disabilities are perceived and treated [2]. This is particularly critical when choosing an intervention that it is not only age appropriate but also that it is culturally sensitive as well in recognizing different views of disability. Consistent evidence shows that attitudes towards people with disability vary by cultural context [66]. The studies examined in our review were from a wide range of countries where views of disability may vary considerably.

Conclusion

Our review focused on disability awareness interventions for school aged children. This study addressed several gaps in the literature by synthesizing the common components of effec-tive disability awareness interventions. Developing a better understanding of the effective components is critical to help

improve the social inclusion of children with disabilities [38]. A focus on children is important because their attitudes are still evolving and early interventions can be especially ben-eficial. Successful interventions can provide children with opportunities to develop positive attitudes about differences in respectful contexts [38].

Overall, the studies reviewed suggest that there is possible evidence that disability awareness interventions are effective at influencing knowledge about and attitudes toward people with disabilities. Commonalities of successful interventions included having multiple components over a period of time and often included social contact with a person who has a disability.

Several limitations to this review need to be considered. First, some studies had heterogeneous samples and relatively small sample sizes. Second, the use of variable outcome mea-sures may limit the ability to accurately measure the effects of the interventions. Finally, the studies were conducted over a broad range spanning over 30 years and across different cultures. Thus, attitudes towards people with disabilities may differ across time and context [66].

There are several directions for future research. First, more rigorous designs are needed (e.g. RCTs) to evaluate the effectiveness of interventions on attitudes towards children with disabilities and over longer periods of time to assess any changes. Second, more research is needed to explore compari-sons of different lengths, formats and types of schools (e.g. public, private), setting (e.g. class versus whole-school based) and geographic locations. Specifically, comparisons of effec-tive components within interventions should be evaluated individually to examine what works best for whom and in what context. Third, further work should explore who ben-efits most from the interventions by paying close attention to the socio-demographic characteristics of the sample (i.e. gen-der, social class, ethno-cultural status, geographic location). Fourth, more exploration is needed around simulation and curriculum-based interventions which showed mixed results in our review. Further, despite the wide variety of approaches used to enhance disability awareness, we did not find any studies meeting our inclusion criteria that used a computer game. Further research could explore this as a mechanism of influencing attitudes towards people with disabilities. Finally, very little is known about the impact of these interventions on children with disabilities (e.g. their perceptions of how peers are treating them) and how interventions make them feel. It would also be worthwhile to seek their involvement in the future development of disability awareness interventions.

Implications for Rehabilitation

This review can help rehabilitation professionals, educators and policy makers to better understand what types of inter-ventions work best for school age children to enable more youth with disabilities to feel socially included at school. First, rehabilitation health care providers should help children with disabilities to be knowledgeable about their condition and how and when it is best to disclose to their peers. This can help

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to facilitate knowledge about their specific needs at school. Clinicians and educators should be aware of the challenges that children with disabilities face such as social exclusion at school and be prepared to provide children with resources and interventions on how to cope. Second, clinicians, educa-tors and children with disabilities should both contribute to the development of age appropriate disability awareness interventions. Very few of the interventions were developed or implemented by clinicians knowledgeable about pediatric dis-ability. Involving such professionals at the outset of developing a program may enhance disability awareness interventions. Researchers, clinicians and educators need to work together to further develop and test interventions that can facilitate dis-ability awareness among school-age children to reduce some of the negative consequences children such as social exclusion. Third, educators should choose an appropriate intervention to meet the needs of the children in their classroom (i.e. age, disability type, cultural background) while also considering the broader societal influences on attitudes towards disability. Finally, at a community level, disability advocacy should target schools, teachers and increased government funding for dis-ability awareness programs for school-age children.

Declaration of Interest: The authors report no conflicts of interest. This study was funded by Bloorview Research Institute Institutional start-up grant and a Ward Family summer student program.

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a systematic review of disability awareness interventions for children and youth

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