Coauthored by Scott Frankowski, PhD, Nazanin Heydarian, PhD, and Kathleen Bogart, PhD
The National Institutes of Health recently noted that people with disabilities experience significant health disparities. A key barrier to quality care is inaccessible, uninformed, or biased healthcare. This is a pressing issue, as one in five people in the United States has a disability, and most people will experience disability at some point in their lives or will care for someone who does. In our recently published study, we sought to understand factors that contribute to ableist attitudes among mental and physical healthcare providers. Ableism refers to stereotypes, prejudice, and discrimination toward people with disabilities (Bogart & Dunn, 2019). Provider ableism can impair clinical decision making, resulting in poorer quality care. Also, disabled people pick up on ableist attitudes which can negatively impact their engagement in their own healthcare.
We updated an old but widely used questionnaire, now named the Revised Attitudes Toward People with Disabilities Scale to measure ableism. Using this scale, we surveyed healthcare and mental healthcare professionals, and students of these professions, to determine what characteristics predict higher levels of ableist attitudes toward disabled people. Fortunately, most people did not have high ableism scores. However, certain characteristics did predict more ableist views than average.
First, men were more likely than women and those who identified as non-binary to hold ableist views. Second, quality but not quantity of contact with disabled people was associated with lower ableism. Age, education level, and the provider’s own disability status were not associated with attitudes toward people with disabilities.
In 1954, social psychologist Gordon Allport wrote that people who are prejudiced toward one group tend to be prejudiced toward many different groups. This idea of a generalized prejudice has held up well to scientific scrutiny. Contemporary researchers continued working on Allport’s ideas with a focus on determining the attitudes and deeply held beliefs of people who are racist, sexist, homophobic, and in the case of our own research, who hold ableist attitudes.
People who hold authoritarian attitudes and those high in social dominance orientation consistently hold the most prejudiced attitudes toward just about any marginalized group. Authoritarians are quick to submit to authority figures and can become aggressive when those authority figures or their ideals are challenged. People high in social dominance orientation tend to view society as having groups that are “winners” and “losers” and believe that inequality is the natural order of the world. We found that these general components of prejudice extended to ableist attitudes.
However, beliefs specific to disability can also influence ableism. The study also examined the impact of disability models—sets of beliefs about the cause, nature, and responsibility of disability. The medical model of disability views disability as a solely medical problem that needs to be fixed by the healthcare profession. This orientation can ignore the individual, their needs, and structural barriers to access in their lives. Conversely, a social model orientation toward disability views disability as a social issue, and focuses on removing barriers and empowering people with disabilities. In our research, we found that greater endorsement of the medical model was associated with more ableist attitudes. This relationship between medical model orientation and ableism was moderately strong even when controlling for all other predictors, including the strong predictors of authoritarian attitudes, social dominance orientation, and quality of contact with disabled people. Similarly, when healthcare providers lacked a social model orientation toward disability, they held more ableist attitudes compared to those who endorsed a social model orientation – again, controlling for all other predictors.
When considering how we can make the interactions that disabled people have with their healthcare and mental health providers more positive, our research distinguished between some avenues for intervention as well as avenues that would likely not improve attitudes among healthcare providers. We cannot change people’s demographics nor their lived experiences with disability and disabled people in their lives. Authoritarian and social dominance beliefs are deeply held belief systems that impact how people think about and interact in their social worlds. Thus, these components that predict ableism would be difficult avenues for instilling a change in attitudes.
Focusing on promoting a social model orientation toward disability, however, does seem like a promising intervention strategy. By training healthcare providers to understand disability as a social issue, they can better meet the needs of people with disabilities. This shift in perspective could also encourage collaboration with psychologists, city planners, and social workers to better understand the needs of individuals within their environments. Of course, this type of structural change is multifaceted and takes time.
More immediately, brief interventions with healthcare providers to promote behaviors that are consistent with a social model orientation may change mindsets and have practical applications. For example, including alt text for blind patients to succinctly describe medical charts, images, or informational brochures and fliers, can make these materials more accessible. A brief training on including captions on Zoom calls or PowerPoint presentations is a way to make this practice salient, is easy to do, and benefits Deaf people. Our future research is focusing on these types of brief interventions with the hope of increasing social model orientation among healthcare providers. Our goal is to create a feedback loop that promotes social model orientation, leading to less ableist views of disability among healthcare professionals.
Scott Frankowski, PhD is an assistant professor in the Department of Psychological Science at the University of Texas Rio Grande Valley. His social psychology research focuses on prejudice, stereotypes, and social inequities.
Nazanin Heydarian, PhD is an assistant professor in the School of Social Work at the University of Texas Rio Grande Valley. As a health psychologist, her research examines the social and structural factors influencing healthcare access and barriers to care for people with disabilities, with an emphasis on improving health equity.