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AN INVESTIGATION OF THE RELATIONS BETWEEN STUDENT KNOWLEDGE, PERSONAL CONTACT, AND ATTITUDES TOWARD INDIVIDUALS WITH SCHIZOPHRENIA a
Shaun M. Eack & Christina E. Newhill
a
a
University of Pittsburgh Published online: 16 Mar 2013.
To cite this article: Shaun M. Eack & Christina E. Newhill (2008) AN INVESTIGATION OF THE RELATIONS BETWEEN STUDENT KNOWLEDGE, PERSONAL CONTACT, AND ATTITUDES TOWARD INDIVIDUALS WITH SCHIZOPHRENIA, Journal of Social Work Education, 44:3, 77-96 To link to this article: http://dx.doi.org/10.5175/JSWE.2008.200700009
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AN INVESTIGATION OF THE RELATIONS BETWEEN STUDENT KNOWLEDGE, PERSONAL CONTACT, AND ATTITUDES TOWARD INDIVIDUALS WITH SCHIZOPHRENIA
Shaun M. Eack University of Pittsburgh
Christina E. Newhill
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University of Pittsburgh
A survey of 118 MSW students was conducted to examine the relationship between social work students’ knowledge about, contact with, and attitudes toward persons with schizophrenia. Hierarchical regression analyses indicated that students’ knowledge about and contact with persons with schizophrenia were significantly related to better attitudes toward this population. Moderated multiple regression analyses revealed a significant interaction between knowledge about and contact with persons with schizophrenia, such that knowledge was only related to positive attitudes among students who had more personal contact with individuals with the illness. Implications for social work training in severe mental illness are discussed.
are the primary providers of
ing with persons with schizophrenia may neg-
psychosocial treatment to individuals with
atively influence their attitudes toward this
schizophrenia (Substance Abuse and Mental
population (Eack & Newhill, in press). Such
Health Services Administration, 2001), a com-
attitudes are of particular importance, as
plex and disabling mental disorder that poses
they have been consistently linked with nega-
unique treatment challenges to mental health
tive outcomes among persons with schizo-
professionals. Recent evidence has suggested
phrenia (e.g., Moore & Kuipers, 1992; Snyder
that although social workers have remained
et al., 1996). Unfortunately, the mechanisms
committed to serving this population, they
by which negative attitudes develop among
often feel inadequately prepared for this chal-
social workers are not well known.
SOCIAL WORKERS
lenging work (Newhill & Korr, 2004), and that
Social psychological theories of attitude
the challenges they face in the course of work-
and stereotype development suggest that
Journal of Social Work Education, Vol. 44, No. 3 (Fall 2008). Copyright © 2008, Council on Social Work Education, Inc. All rights reserved.
77
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JOURNAL OF SOCIAL WORK EDUCATION
inadequate knowledge about a group of peo-
toward this population. Social work educators
ple may lead to negative attitudes toward that
have long recognized this, and for the past sev-
group (Allport, 1954; Weber & Crocker, 1983).
eral decades mandated the exploration of atti-
Given that many social workers feel inade-
tudes, values, and ethics in social work educa-
quately prepared for working with persons
tion (CSWE, 2008; Garcia & Van Soest, 1997;
with schizophrenia (Newhill & Korr, 2004), a
Van Soest, 1994). Stigma may be defined as a
lack of requisite knowledge about this popu-
mark of shame or disgrace that is viewed as not
lation may be a primary mechanism by which
normal and “is manifested by bias, distrust,
negative attitudes develop. However, to date,
stereotyping, fear, embarrassment, anger
no study has examined how social workers’
and/or avoidance” (U.S. Department of Health
knowledge about schizophrenia is related to
and Human Services, 1999). Such stigma is
their attitudes toward this population. One of
often operationalized through the develop-
the primary functions of social work educa-
ment of negative stereotypes and attitudes
tion is to ensure that successive generations of
toward a group of people that are based on
social workers continue to “practice without
either a lack of knowledge or inaccurate know-
discrimination and with respect, knowledge,
ledge about some aspect of that group (All-
and skills related to clients’ age, class, color,
port, 1954; Sherman, 1996; Weber & Crocker,
culture, disability [italics added], ethnicity, fam-
1983). For example, certain stereotypes about
ily structure, gender, marital status, national
individuals with mental illness have derived
origin, race, religion, sex, and sexual orienta-
from ill-formed notions about the dangerous-
tion” (Council on Social Work Education
ness of such persons (e.g., Corrigan, Marko-
[CSWE], 2001, Educational Policy and Accred-
witz, Watson, Rowan, & Kubiak, 2003).
itation Standards, Educational Policy 1.2). An
Cognitive models of stereotype develop-
investigation of the relationship between
ment support the link between knowledge
knowledge and attitudes about schizophrenia
and attitudes by conceptualizing stereotypes
is of particular importance to social work edu-
as simplified collections of categorized infor-
cators, as it can provide key insights about
mation, which are often based on inaccurate
how negative attitudes develop among social
or incomplete information (Hilton & von Hip-
workers, and serve to guide the development
pel, 1996). Perhaps the most prominent of
of professional training curricula that focuses
these models suggests that stereotypes are
on facilitating more positive attitudes toward
formed from illusory connections made be-
working with individuals with schizophrenia.
tween salient, but often incomplete, knowledge about dissimilar individuals and the per-
Knowledge, Stigma, and Attitude Development
ceived social group to which they belong (Hamilton, Dugan, & Trolier, 1985; Hamilton
Although clinical social workers are trained in
& Gifford, 1976; Hamilton & Rose, 1980). For
diagnosing and treating severe mental illness,
example, in the illustration provided previ-
they are not immune to the continuing social
ously about individuals with mental illness,
stigma that surrounds society’s attitudes
salient information (i.e., a violent act) is inap-
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ATTITUDES AND KNOWLEDGE ABOUT SCHIZOPHRENIA
79
propriately connected with members of an
tional and awareness campaigns to remediate
outgroup (i.e., individuals with mental ill-
negative attitudes toward different groups
ness), because of the shared distinctiveness of
(e.g., Hill & Augoustinos, 2001), and has been
violence and mental illness.
widely applied to the understanding of stereo-
Implicit in cognitive models of stereotype
types about minority populations (e.g.,
formation is the assumption that stereotypes
Henderson-King & Nisbett, 1996; Rosenfield,
are not necessarily malevolent, but are usually
Greenberg, Folger, & Borys, 1982).
incorrect (Ryan, 2002). However, because neg-
Research supporting cognitive models of
ative information is frequently the most salient
stereotypes, which suggest that stereotypes
(Mullen & Johnson, 1990) and there exists a
stem from information-processing biases, have
substantial information-processing bias (i.e.,
extended beyond looking at traditional minor-
in-group/out-group bias) that favors one’s
ity populations, and have begun focusing on
own group over another (Hewstone, Rubin, &
individuals with mental illness. Broadly, this
Willis, 2002), stereotyped information is often
literature has indicated that widespread mis-
anything but benign. Consequently, because
conceptions about the association between
the information that comprises stereotypes is
violence and mental illness has significantly
usually incomplete and unduly negative, lack
influenced society’s attitudes toward this pop-
of knowledge constitutes a primary mecha-
ulation (Corrigan et al., 2003; Corrigan et al.,
nism by which negative attitudes and stereo-
2005; Haghighat, 2001), and that correcting
types develop and are maintained. Within the
this misconception has some benefit in im-
field of mental health and social work educa-
proving people’s attitudes toward the severely
tion, numerous studies have supported this
mentally ill (Corrigan, Watson, Warpinski, &
premise, arguing for the importance of provid-
Gracia, 2004). Findings specific to schizophre-
ing social workers and related professionals
nia have suggested that stigmatizing attitudes
with appropriate and accurate information
are internationally ubiquitous (Lee, 2002), are
about mental illness, as a method of ameliorat-
related to misconceptions about dangerous-
ing negative attitudes and stereotypes. For
ness and other factors presumed to be associ-
example, Corrigan and colleagues (2002)
ated with the illness (Angermeyer & Mat-
found that misconceptions about the danger-
schinger, 2005; Penn, Kohlmaier, & Corrigan,
ousness of persons with mental illness had a
2000), and may to some degree be ameliorated
significant impact on the fearful attitudes of
by public information campaigns (Anger-
community college students toward such indi-
meyer & Matschinger, 2005; Penn, Chamber-
viduals. Another study of social work students
lin, & Mueser, 2003). One particularly inform-
found knowledge about psychotropic medica-
ative study by Link, Phelan, Bresnahan,
tion to be related to social work students’ atti-
Stueve, and Pescosolido (1999), which used a
tudes
medications
nationally representative sample of persons in
(Bentley, Farmer, & Phillips, 1991). Indeed, this
the United States (N=1,444), found that 61%
knowledge–stereotype connection has been
believed that persons with schizophrenia were
the underlying assumption of many educa-
likely to be violent. This is in stark contrast
toward
taking
such
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JOURNAL OF SOCIAL WORK EDUCATION
with available evidence (Swanson et al., 2006).
tact serves to lessen social distance, blur inter-
Furthermore, studies have expanded these
group boundaries (Miller, Brewer, & Edwards,
findings beyond the lay public, and docu-
1985), and reduce intergroup anxieties (Hew-
mented the presence of these misconceptions
stone, 2003). Furthermore, the contact hypothe-
among some health-care student populations
sis may be a useful paradigm to guide the
(Llerena, Caceres, & Penas-Lledo, 2002), in-
development of approaches aimed at im-
cluding social work students (Schwartz, 2004).
proving attitudes toward different social
Such findings point to the importance of
groups (Allport, 1954), particularly those who
knowledge about schizophrenia in both atti-
are disadvantaged, stigmatized, or marginal-
tude formation and modification, and the
ized by the majority culture. Indeed, many
promising role of social work education in
have found success in applying the contact hy-
addressing negative attitude development.
pothesis to reducing negative attitudes toward minority (e.g., Wittig & Grant-Thompson,
Intergroup Contact and Attitude Development
1998) and other stigmatized populations (e.g., Bowen & Bourgeois, 2001). Social work educa-
Although substantial research has indicated
tors have also applied these findings to address
that there is a relationship between the amount
attitudes and values development among their
of information one has about a group and one’s
students. For example, Shor and Sykes (2002)
attitudes toward that group, the development
found that the integration of individuals with
and modification of attitudes is not so straight-
mental illness in the social work classroom set-
forward. Although knowledge about a particu-
ting was effective at reducing students’ stereo-
lar group can have a substantial impact on atti-
types toward this population. Moreover, some
tudes, at least one other important factor con-
have suggested that the effects of intergroup
tributes to attitude development: personal con-
contact may moderate the effects of knowledge
tact. Theories of intergroup relations have put
on attitude development and change, such that
forth this “contact hypothesis,” which suggests
individuals who have had more contact with a
that, not only does information about a specif-
stigmatized population may be more influ-
ic group influence attitudes, but so does actual
enced by new stereotype-incongruent informa-
exposure to and direct contact with that group
tion (Pettigrew, 1998; Weber & Crocker, 1983).
(Allport, 1954; Messick & Mackie, 1989). Of
Unfortunately, how contact and knowledge
course, knowledge and contact are closely
interact to influence attitudes is not well under-
related, because at least some of the informa-
stood, particularly with regard to the attitudes
tion a person learns about another group stems
of social work students toward individuals
from direct contact with members of that group
with severe mental illness.
(Pettigrew, 1998). However, research has indi-
Although the contact hypothesis has been
cated that contact with members of dissimilar
explored primarily with minority populations,
groups influences attitude development be-
some research has indicated that contact with
yond the information-gathering qualities as-
individuals with mental illness also influences
sociated with this process, as intergroup con-
attitudes toward this population. For example,
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ATTITUDES AND KNOWLEDGE ABOUT SCHIZOPHRENIA
81
Link and Cullen (1986) found that the amount
dents, who will eventually provide the majority
of voluntary and involuntary contact Mid-
of psychosocial treatment for this population. To
western U.S. community residents had with
date, the only known study to examine how
individuals with mental illness was negatively
both knowledge and contact with individuals
related to perceptions of dangerousness, even
with mental illness influences attitudes has lent
among residents who had primarily involun-
some support to the contact hypothesis. Holmes,
tary contact with such individuals. Angermey-
Corrigan, Williams, Canar, and Kubiak (1999)
er and Matschinger (1997) found in a national
reported that undergraduate students who took
German sample that personal experiences with
a general psychology course or a class on severe
mental illness were associated with lower rat-
mental illness and who had more direct contact
ings of social distance from individuals with
with individuals with mental illness, exhibited
mental illness. Such findings highlight the
greater improvements in positive attitudes
importance of personal contact with individu-
toward such individuals. However, this research
als with mental illness to attitude development
was limited to an examination of attitudes
and modification. Recently, research on contact
toward individuals with mental illness in gener-
with individuals with mental illness has been
al, which may not be generalizable to attitudes
extended more specifically to individuals with
toward individuals with specific and highly
schizophrenia, suggesting that individuals who
stigmatized mental illnesses, such as schizo-
have had less contact with persons with schizo-
phrenia. Further research on how knowledge
phrenia maintain greater social distance from
and contact interact to influence attitudes
such individuals and perceive them to be more
toward this population is clearly needed.
dangerous (Penn, Guynan, Daily, & Spaulding,
This research sought to examine the rela-
1994). Furthermore, experimentally manipulat-
tionship between social work students’ atti-
ed increases in contact with individuals with
tudes toward and knowledge about schizo-
schizophrenia have generally been shown to
phrenia, and the degree to which this relation-
improve attitudes toward this group (Corrigan
ship is moderated by personal contact.
et al., 2001, 2002; Reinke, Corrigan, Leonhard,
Drawing on early social psychological theo-
Lundin, & Kubiak, 2004; but see Penn & Link,
ries of stereotype and attitude development,
2002).
we examined the following hypotheses.
Although contact with individuals with schizophrenia is an important factor in the
•
H1: There is a significant positive relation-
development of attitudes toward this group,
ship between social work students’ know-
other factors such as knowledge, may also be
ledge about schizophrenia and their atti-
important to understanding the process of atti-
tudes toward this population.
tude development, maintenance, and modifica-
•
H2: There is a significant positive relation-
tion. There has been surprisingly little research
ship between the amount of contact stu-
on how knowledge about and contact with per-
dents have with individuals with schizo-
sons with schizophrenia interact to influence
phrenia and their attitudes toward this
attitudes, particularly among social work stu-
population.
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JOURNAL OF SOCIAL WORK EDUCATION
H3: The relationship between students’
classroom session, and were asked to complete
attitudes toward and knowledge about
a questionnaire assessing their knowledge
schizophrenia is moderated by the amount
about, attitudes toward, and exposure to indi-
of contact they have with this population,
viduals with schizophrenia during the final 15
such that the relationship between knowl-
minutes of class. The instructor informed stu-
edge and attitudes is stronger for students
dents that their participation in this research
who have more frequent and closer con-
was completely voluntary and would not affect
tact with this population.
their grade or standing in the class or with the
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school in any way. During the survey the Method
instructor was required to leave the room, while students returned the unsigned surveys, com-
Participants
pleted or not, to a blank envelope located at the
A convenience sample of 1st- and 2nd-year
front of the classroom. The authors then
graduate-level social work students (N=118)
retrieved the envelopes containing the surveys
was surveyed. Participants were predomi-
from each instructor. For those choosing to par-
nantly female (n=89), with ages ranging from
ticipate, the survey took no longer than 15 min-
22 to 62 years (M=32.30; SD=9.91). The major-
utes to complete. This research was approved
ity of the participants were Caucasian (n=98),
by the university’s Institutional Review Board.
13 were African American, 1 was Hispanic, 1 was Asian, and 5 did not report their racial
Measures
background or reported it as other. Students’
Knowledge about schizophrenia. Participants’
educational backgrounds were primarily
knowledge about schizophrenia was assessed
social science disciplines (n=80), and their
using the Knowledge About Schizophrenia
master’s specialization was educationally
Questionnaire, or KASQ (Ascher-Svanum,
diverse with regard to the four specializations
1999), a 25-item multiple choice questionnaire
offered by the participating institution, with
covering knowledge about the symptoms (e.g.,
57 specializing in mental health, 38 in child
“A person with schizophrenia nearly always
welfare, 11 in health care, and 7 in community
has [the following symptoms]”), etiology (e.g.,
organization. Five individuals did not report
“Which of the following is a possible cause of
on their master’s specialization.
schizophrenia?”), and treatment of schizophrenia (e.g., “Common side-effects of antipsychot-
Procedures
ic drugs are. . . .”). The KASQ was developed in
Participants were recruited from three sections
a series of four studies with inpatients with
of Human Behavior and the Social Environ-
schizophrenia, and demonstrated adequate
ment I and one section of Human Behavior and
internal consistency (all α >.80) and high
the Social Environment II by their instructors to
test–retest reliability (r=.83; Ascher-Svanum,
participate in a study of their perceptions and
1999). Test difficulty averaged a 75% correct
knowledge about schizophrenia. Students were
response rate. Throughout the course of these
surveyed during their regularly scheduled
studies, the construct validity of the KASQ was
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ATTITUDES AND KNOWLEDGE ABOUT SCHIZOPHRENIA
83
also established by showing that the KASQ
press). Principal components analysis support-
was sensitive to changes in knowledge after
ed the two-factor (general attitudes and atti-
exposure to an educational program. In this
tudes about working with individuals with
sample of social work students, six items on the
schizophrenia) structure of this instrument.
KASQ concerning the prevalence, prognosis,
Subscale scores reflecting positive attitudes
and diagnosis of schizophrenia, common side-
were computed by averaging items within
effects of antipsychotic medications, and symp-
each subscale. We found the internal consisten-
toms of the illness that do not respond to treat-
cy of both the general attitudes and attitudes
ment, were removed from the scale because of
about working with individuals with schizo-
low reliability or variability. We found the
phrenia subscales to be within acceptable
internal consistency of this revised 19-item
ranges (α =.75 and .82, respectively).
measure to be acceptable (α =.75).
Contact with individuals with schizophrenia.
Attitudes toward individuals with schizophre-
Participants’ contact with individuals with
nia. Participants’ attitudes toward individuals
schizophrenia was assessed with regard to
with schizophrenia were measured using a
both degree and frequency. Degree of contact
novel 12-item self-report questionnaire de-
was assessed using a 9-item checklist asking
signed by the first author to assess social work
participants to indicate the various levels of
students’ general attitudes about individuals
exposure they have had to schizophrenia. De-
with schizophrenia, (e.g., “Individuals with
gree ranged from exposure to observational/
schizophrenia are dangerous,” “Individuals
medial depictions of schizophrenia (e.g., “I
with schizophrenia can lead full and satisfying
have watched a television program/movie or
lives,” “I would not want to live next door to an
read a newspaper/magazine article about a
individual who has schizophrenia”), as well as
person with schizophrenia”) to exposure to
their attitudes about working with individuals
individuals with schizophrenia living in the
with this illness (e.g., “I would find little satis-
respondent’s household (“There are members
faction in working with individuals with schiz-
in my household who have schizophrenia”).
ophrenia”). The instrument contained both
Items were weighted based on their social dis-
items related to positive and negative attitudes.
tance from persons with schizophrenia (e.g.,
Items were rated using a Likert scale ranging
medial depictions representing greater social
from 1 (strongly disagree) to 6 (strongly agree)
distance than living with a person with
and recoded such that higher scores represent
schizophrenia), with lower scores indicating
more positive attitudes. This instrument was
greater social distance. Total degree of contact
developed based on the Opinions About Men-
was computed by summing the number of
tal Illness scale (Cohen & Struening, 1962) and
areas of exposure to schizophrenia each par-
Community Attitudes Toward the Mentally Ill
ticipant endorsed. Frequency of contact was
scale (Taylor & Dear, 1981), as well as previous
assessed using a single-item 5-point graphic
work assessing social workers’ attitudes
scale asking participants to rate, from never to
toward individuals with severe mental illness
daily, the frequency with which they have
(Newhill & Korr, 2004; Eack & Newhill, in
contact with persons with schizophrenia.
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JOURNAL OF SOCIAL WORK EDUCATION
students to both information about schizo-
Results
phrenia and direct practice experience with Do Knowledge and Contact Relate To
individuals who have this illness.
Social Work Students’ Attitudes
After finding that students’ attitudes about
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About Schizophrenia?
schizophrenia were significantly related to both
We began our examination of the relation-
their knowledge about and contact with indi-
ships among social work students’ attitudes
viduals with the illness, a series of hierarchical
toward, knowledge about, and contact with
regression analyses was conducted to examine
individuals with schizophrenia by computing
the independent relationship between each of
zero-order correlations among these con-
these factors and students’ attitudes. As can be
structs. As can be seen in Table 1, social work
seen in Table 2, results from these analyses indi-
students who knew more about schizophrenia
cated that although knowledge about schizo-
were significantly more likely to exhibit posi-
phrenia did explain a significant amount of the
tive general attitudes toward this population,
variance in students’ attitudes toward working
and were also more likely to have positive
with this population, both degree and frequen-
attitudes toward working with individuals
cy of contact with individuals with schizophre-
with schizophrenia. In addition, both frequen-
nia continued to explain a significant amount of
cy and degree of contact with individuals
variance in students’ attitudes, above and
with schizophrenia were also significantly
beyond their knowledge about the illness.
positively associated with students’ general
However, because of the substantial shared
attitudes toward this population, as well as
variance between our measures of contact, nei-
their attitudes toward working with individu-
ther degree nor frequency of contact with indi-
als with schizophrenia. Such findings would
viduals with schizophrenia provided an indi-
seem to indicate the importance of exposing
vidual significant contribution to students’ atti-
TABLE 1. Relationships Among Social Work Students' Knowledge About, Contact With, and Attitudes Toward Individuals With Schizophrenia
Measure
1
2
General attitudes
—
Attitudes toward working
.58**
—
Knowledge
.31**
.36**
3
4
5
—
Frequency of contact
.21**
.27**
.16*
Degree of contact
.25**
.29**
.31**
— .59**
—
M
4.45
4.47
.82
1.30
4.43
SD
.73
1.00
.15
1.27
2.61
Note. Because of missing data, N ranges from 114 to 118 depending on the analysis. *pE= 3FBECPPLFYDFSQUTBUXXXDVQDPMVNCJBFEV
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Journal of Social Work Education Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uswe20
AN INVESTIGATION OF THE RELATIONS BETWEEN STUDENT KNOWLEDGE, PERSONAL CONTACT, AND ATTITUDES TOWARD INDIVIDUALS WITH SCHIZOPHRENIA a
Shaun M. Eack & Christina E. Newhill
a
a
University of Pittsburgh Published online: 16 Mar 2013.
To cite this article: Shaun M. Eack & Christina E. Newhill (2008) AN INVESTIGATION OF THE RELATIONS BETWEEN STUDENT KNOWLEDGE, PERSONAL CONTACT, AND ATTITUDES TOWARD INDIVIDUALS WITH SCHIZOPHRENIA, Journal of Social Work Education, 44:3, 77-96 To link to this article: http://dx.doi.org/10.5175/JSWE.2008.200700009
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AN INVESTIGATION OF THE RELATIONS BETWEEN STUDENT KNOWLEDGE, PERSONAL CONTACT, AND ATTITUDES TOWARD INDIVIDUALS WITH SCHIZOPHRENIA
Shaun M. Eack University of Pittsburgh
Christina E. Newhill
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University of Pittsburgh
A survey of 118 MSW students was conducted to examine the relationship between social work students’ knowledge about, contact with, and attitudes toward persons with schizophrenia. Hierarchical regression analyses indicated that students’ knowledge about and contact with persons with schizophrenia were significantly related to better attitudes toward this population. Moderated multiple regression analyses revealed a significant interaction between knowledge about and contact with persons with schizophrenia, such that knowledge was only related to positive attitudes among students who had more personal contact with individuals with the illness. Implications for social work training in severe mental illness are discussed.
are the primary providers of
ing with persons with schizophrenia may neg-
psychosocial treatment to individuals with
atively influence their attitudes toward this
schizophrenia (Substance Abuse and Mental
population (Eack & Newhill, in press). Such
Health Services Administration, 2001), a com-
attitudes are of particular importance, as
plex and disabling mental disorder that poses
they have been consistently linked with nega-
unique treatment challenges to mental health
tive outcomes among persons with schizo-
professionals. Recent evidence has suggested
phrenia (e.g., Moore & Kuipers, 1992; Snyder
that although social workers have remained
et al., 1996). Unfortunately, the mechanisms
committed to serving this population, they
by which negative attitudes develop among
often feel inadequately prepared for this chal-
social workers are not well known.
SOCIAL WORKERS
lenging work (Newhill & Korr, 2004), and that
Social psychological theories of attitude
the challenges they face in the course of work-
and stereotype development suggest that
Journal of Social Work Education, Vol. 44, No. 3 (Fall 2008). Copyright © 2008, Council on Social Work Education, Inc. All rights reserved.
77
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JOURNAL OF SOCIAL WORK EDUCATION
inadequate knowledge about a group of peo-
toward this population. Social work educators
ple may lead to negative attitudes toward that
have long recognized this, and for the past sev-
group (Allport, 1954; Weber & Crocker, 1983).
eral decades mandated the exploration of atti-
Given that many social workers feel inade-
tudes, values, and ethics in social work educa-
quately prepared for working with persons
tion (CSWE, 2008; Garcia & Van Soest, 1997;
with schizophrenia (Newhill & Korr, 2004), a
Van Soest, 1994). Stigma may be defined as a
lack of requisite knowledge about this popu-
mark of shame or disgrace that is viewed as not
lation may be a primary mechanism by which
normal and “is manifested by bias, distrust,
negative attitudes develop. However, to date,
stereotyping, fear, embarrassment, anger
no study has examined how social workers’
and/or avoidance” (U.S. Department of Health
knowledge about schizophrenia is related to
and Human Services, 1999). Such stigma is
their attitudes toward this population. One of
often operationalized through the develop-
the primary functions of social work educa-
ment of negative stereotypes and attitudes
tion is to ensure that successive generations of
toward a group of people that are based on
social workers continue to “practice without
either a lack of knowledge or inaccurate know-
discrimination and with respect, knowledge,
ledge about some aspect of that group (All-
and skills related to clients’ age, class, color,
port, 1954; Sherman, 1996; Weber & Crocker,
culture, disability [italics added], ethnicity, fam-
1983). For example, certain stereotypes about
ily structure, gender, marital status, national
individuals with mental illness have derived
origin, race, religion, sex, and sexual orienta-
from ill-formed notions about the dangerous-
tion” (Council on Social Work Education
ness of such persons (e.g., Corrigan, Marko-
[CSWE], 2001, Educational Policy and Accred-
witz, Watson, Rowan, & Kubiak, 2003).
itation Standards, Educational Policy 1.2). An
Cognitive models of stereotype develop-
investigation of the relationship between
ment support the link between knowledge
knowledge and attitudes about schizophrenia
and attitudes by conceptualizing stereotypes
is of particular importance to social work edu-
as simplified collections of categorized infor-
cators, as it can provide key insights about
mation, which are often based on inaccurate
how negative attitudes develop among social
or incomplete information (Hilton & von Hip-
workers, and serve to guide the development
pel, 1996). Perhaps the most prominent of
of professional training curricula that focuses
these models suggests that stereotypes are
on facilitating more positive attitudes toward
formed from illusory connections made be-
working with individuals with schizophrenia.
tween salient, but often incomplete, knowledge about dissimilar individuals and the per-
Knowledge, Stigma, and Attitude Development
ceived social group to which they belong (Hamilton, Dugan, & Trolier, 1985; Hamilton
Although clinical social workers are trained in
& Gifford, 1976; Hamilton & Rose, 1980). For
diagnosing and treating severe mental illness,
example, in the illustration provided previ-
they are not immune to the continuing social
ously about individuals with mental illness,
stigma that surrounds society’s attitudes
salient information (i.e., a violent act) is inap-
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ATTITUDES AND KNOWLEDGE ABOUT SCHIZOPHRENIA
79
propriately connected with members of an
tional and awareness campaigns to remediate
outgroup (i.e., individuals with mental ill-
negative attitudes toward different groups
ness), because of the shared distinctiveness of
(e.g., Hill & Augoustinos, 2001), and has been
violence and mental illness.
widely applied to the understanding of stereo-
Implicit in cognitive models of stereotype
types about minority populations (e.g.,
formation is the assumption that stereotypes
Henderson-King & Nisbett, 1996; Rosenfield,
are not necessarily malevolent, but are usually
Greenberg, Folger, & Borys, 1982).
incorrect (Ryan, 2002). However, because neg-
Research supporting cognitive models of
ative information is frequently the most salient
stereotypes, which suggest that stereotypes
(Mullen & Johnson, 1990) and there exists a
stem from information-processing biases, have
substantial information-processing bias (i.e.,
extended beyond looking at traditional minor-
in-group/out-group bias) that favors one’s
ity populations, and have begun focusing on
own group over another (Hewstone, Rubin, &
individuals with mental illness. Broadly, this
Willis, 2002), stereotyped information is often
literature has indicated that widespread mis-
anything but benign. Consequently, because
conceptions about the association between
the information that comprises stereotypes is
violence and mental illness has significantly
usually incomplete and unduly negative, lack
influenced society’s attitudes toward this pop-
of knowledge constitutes a primary mecha-
ulation (Corrigan et al., 2003; Corrigan et al.,
nism by which negative attitudes and stereo-
2005; Haghighat, 2001), and that correcting
types develop and are maintained. Within the
this misconception has some benefit in im-
field of mental health and social work educa-
proving people’s attitudes toward the severely
tion, numerous studies have supported this
mentally ill (Corrigan, Watson, Warpinski, &
premise, arguing for the importance of provid-
Gracia, 2004). Findings specific to schizophre-
ing social workers and related professionals
nia have suggested that stigmatizing attitudes
with appropriate and accurate information
are internationally ubiquitous (Lee, 2002), are
about mental illness, as a method of ameliorat-
related to misconceptions about dangerous-
ing negative attitudes and stereotypes. For
ness and other factors presumed to be associ-
example, Corrigan and colleagues (2002)
ated with the illness (Angermeyer & Mat-
found that misconceptions about the danger-
schinger, 2005; Penn, Kohlmaier, & Corrigan,
ousness of persons with mental illness had a
2000), and may to some degree be ameliorated
significant impact on the fearful attitudes of
by public information campaigns (Anger-
community college students toward such indi-
meyer & Matschinger, 2005; Penn, Chamber-
viduals. Another study of social work students
lin, & Mueser, 2003). One particularly inform-
found knowledge about psychotropic medica-
ative study by Link, Phelan, Bresnahan,
tion to be related to social work students’ atti-
Stueve, and Pescosolido (1999), which used a
tudes
medications
nationally representative sample of persons in
(Bentley, Farmer, & Phillips, 1991). Indeed, this
the United States (N=1,444), found that 61%
knowledge–stereotype connection has been
believed that persons with schizophrenia were
the underlying assumption of many educa-
likely to be violent. This is in stark contrast
toward
taking
such
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JOURNAL OF SOCIAL WORK EDUCATION
with available evidence (Swanson et al., 2006).
tact serves to lessen social distance, blur inter-
Furthermore, studies have expanded these
group boundaries (Miller, Brewer, & Edwards,
findings beyond the lay public, and docu-
1985), and reduce intergroup anxieties (Hew-
mented the presence of these misconceptions
stone, 2003). Furthermore, the contact hypothe-
among some health-care student populations
sis may be a useful paradigm to guide the
(Llerena, Caceres, & Penas-Lledo, 2002), in-
development of approaches aimed at im-
cluding social work students (Schwartz, 2004).
proving attitudes toward different social
Such findings point to the importance of
groups (Allport, 1954), particularly those who
knowledge about schizophrenia in both atti-
are disadvantaged, stigmatized, or marginal-
tude formation and modification, and the
ized by the majority culture. Indeed, many
promising role of social work education in
have found success in applying the contact hy-
addressing negative attitude development.
pothesis to reducing negative attitudes toward minority (e.g., Wittig & Grant-Thompson,
Intergroup Contact and Attitude Development
1998) and other stigmatized populations (e.g., Bowen & Bourgeois, 2001). Social work educa-
Although substantial research has indicated
tors have also applied these findings to address
that there is a relationship between the amount
attitudes and values development among their
of information one has about a group and one’s
students. For example, Shor and Sykes (2002)
attitudes toward that group, the development
found that the integration of individuals with
and modification of attitudes is not so straight-
mental illness in the social work classroom set-
forward. Although knowledge about a particu-
ting was effective at reducing students’ stereo-
lar group can have a substantial impact on atti-
types toward this population. Moreover, some
tudes, at least one other important factor con-
have suggested that the effects of intergroup
tributes to attitude development: personal con-
contact may moderate the effects of knowledge
tact. Theories of intergroup relations have put
on attitude development and change, such that
forth this “contact hypothesis,” which suggests
individuals who have had more contact with a
that, not only does information about a specif-
stigmatized population may be more influ-
ic group influence attitudes, but so does actual
enced by new stereotype-incongruent informa-
exposure to and direct contact with that group
tion (Pettigrew, 1998; Weber & Crocker, 1983).
(Allport, 1954; Messick & Mackie, 1989). Of
Unfortunately, how contact and knowledge
course, knowledge and contact are closely
interact to influence attitudes is not well under-
related, because at least some of the informa-
stood, particularly with regard to the attitudes
tion a person learns about another group stems
of social work students toward individuals
from direct contact with members of that group
with severe mental illness.
(Pettigrew, 1998). However, research has indi-
Although the contact hypothesis has been
cated that contact with members of dissimilar
explored primarily with minority populations,
groups influences attitude development be-
some research has indicated that contact with
yond the information-gathering qualities as-
individuals with mental illness also influences
sociated with this process, as intergroup con-
attitudes toward this population. For example,
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ATTITUDES AND KNOWLEDGE ABOUT SCHIZOPHRENIA
81
Link and Cullen (1986) found that the amount
dents, who will eventually provide the majority
of voluntary and involuntary contact Mid-
of psychosocial treatment for this population. To
western U.S. community residents had with
date, the only known study to examine how
individuals with mental illness was negatively
both knowledge and contact with individuals
related to perceptions of dangerousness, even
with mental illness influences attitudes has lent
among residents who had primarily involun-
some support to the contact hypothesis. Holmes,
tary contact with such individuals. Angermey-
Corrigan, Williams, Canar, and Kubiak (1999)
er and Matschinger (1997) found in a national
reported that undergraduate students who took
German sample that personal experiences with
a general psychology course or a class on severe
mental illness were associated with lower rat-
mental illness and who had more direct contact
ings of social distance from individuals with
with individuals with mental illness, exhibited
mental illness. Such findings highlight the
greater improvements in positive attitudes
importance of personal contact with individu-
toward such individuals. However, this research
als with mental illness to attitude development
was limited to an examination of attitudes
and modification. Recently, research on contact
toward individuals with mental illness in gener-
with individuals with mental illness has been
al, which may not be generalizable to attitudes
extended more specifically to individuals with
toward individuals with specific and highly
schizophrenia, suggesting that individuals who
stigmatized mental illnesses, such as schizo-
have had less contact with persons with schizo-
phrenia. Further research on how knowledge
phrenia maintain greater social distance from
and contact interact to influence attitudes
such individuals and perceive them to be more
toward this population is clearly needed.
dangerous (Penn, Guynan, Daily, & Spaulding,
This research sought to examine the rela-
1994). Furthermore, experimentally manipulat-
tionship between social work students’ atti-
ed increases in contact with individuals with
tudes toward and knowledge about schizo-
schizophrenia have generally been shown to
phrenia, and the degree to which this relation-
improve attitudes toward this group (Corrigan
ship is moderated by personal contact.
et al., 2001, 2002; Reinke, Corrigan, Leonhard,
Drawing on early social psychological theo-
Lundin, & Kubiak, 2004; but see Penn & Link,
ries of stereotype and attitude development,
2002).
we examined the following hypotheses.
Although contact with individuals with schizophrenia is an important factor in the
•
H1: There is a significant positive relation-
development of attitudes toward this group,
ship between social work students’ know-
other factors such as knowledge, may also be
ledge about schizophrenia and their atti-
important to understanding the process of atti-
tudes toward this population.
tude development, maintenance, and modifica-
•
H2: There is a significant positive relation-
tion. There has been surprisingly little research
ship between the amount of contact stu-
on how knowledge about and contact with per-
dents have with individuals with schizo-
sons with schizophrenia interact to influence
phrenia and their attitudes toward this
attitudes, particularly among social work stu-
population.
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JOURNAL OF SOCIAL WORK EDUCATION
H3: The relationship between students’
classroom session, and were asked to complete
attitudes toward and knowledge about
a questionnaire assessing their knowledge
schizophrenia is moderated by the amount
about, attitudes toward, and exposure to indi-
of contact they have with this population,
viduals with schizophrenia during the final 15
such that the relationship between knowl-
minutes of class. The instructor informed stu-
edge and attitudes is stronger for students
dents that their participation in this research
who have more frequent and closer con-
was completely voluntary and would not affect
tact with this population.
their grade or standing in the class or with the
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school in any way. During the survey the Method
instructor was required to leave the room, while students returned the unsigned surveys, com-
Participants
pleted or not, to a blank envelope located at the
A convenience sample of 1st- and 2nd-year
front of the classroom. The authors then
graduate-level social work students (N=118)
retrieved the envelopes containing the surveys
was surveyed. Participants were predomi-
from each instructor. For those choosing to par-
nantly female (n=89), with ages ranging from
ticipate, the survey took no longer than 15 min-
22 to 62 years (M=32.30; SD=9.91). The major-
utes to complete. This research was approved
ity of the participants were Caucasian (n=98),
by the university’s Institutional Review Board.
13 were African American, 1 was Hispanic, 1 was Asian, and 5 did not report their racial
Measures
background or reported it as other. Students’
Knowledge about schizophrenia. Participants’
educational backgrounds were primarily
knowledge about schizophrenia was assessed
social science disciplines (n=80), and their
using the Knowledge About Schizophrenia
master’s specialization was educationally
Questionnaire, or KASQ (Ascher-Svanum,
diverse with regard to the four specializations
1999), a 25-item multiple choice questionnaire
offered by the participating institution, with
covering knowledge about the symptoms (e.g.,
57 specializing in mental health, 38 in child
“A person with schizophrenia nearly always
welfare, 11 in health care, and 7 in community
has [the following symptoms]”), etiology (e.g.,
organization. Five individuals did not report
“Which of the following is a possible cause of
on their master’s specialization.
schizophrenia?”), and treatment of schizophrenia (e.g., “Common side-effects of antipsychot-
Procedures
ic drugs are. . . .”). The KASQ was developed in
Participants were recruited from three sections
a series of four studies with inpatients with
of Human Behavior and the Social Environ-
schizophrenia, and demonstrated adequate
ment I and one section of Human Behavior and
internal consistency (all α >.80) and high
the Social Environment II by their instructors to
test–retest reliability (r=.83; Ascher-Svanum,
participate in a study of their perceptions and
1999). Test difficulty averaged a 75% correct
knowledge about schizophrenia. Students were
response rate. Throughout the course of these
surveyed during their regularly scheduled
studies, the construct validity of the KASQ was
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ATTITUDES AND KNOWLEDGE ABOUT SCHIZOPHRENIA
83
also established by showing that the KASQ
press). Principal components analysis support-
was sensitive to changes in knowledge after
ed the two-factor (general attitudes and atti-
exposure to an educational program. In this
tudes about working with individuals with
sample of social work students, six items on the
schizophrenia) structure of this instrument.
KASQ concerning the prevalence, prognosis,
Subscale scores reflecting positive attitudes
and diagnosis of schizophrenia, common side-
were computed by averaging items within
effects of antipsychotic medications, and symp-
each subscale. We found the internal consisten-
toms of the illness that do not respond to treat-
cy of both the general attitudes and attitudes
ment, were removed from the scale because of
about working with individuals with schizo-
low reliability or variability. We found the
phrenia subscales to be within acceptable
internal consistency of this revised 19-item
ranges (α =.75 and .82, respectively).
measure to be acceptable (α =.75).
Contact with individuals with schizophrenia.
Attitudes toward individuals with schizophre-
Participants’ contact with individuals with
nia. Participants’ attitudes toward individuals
schizophrenia was assessed with regard to
with schizophrenia were measured using a
both degree and frequency. Degree of contact
novel 12-item self-report questionnaire de-
was assessed using a 9-item checklist asking
signed by the first author to assess social work
participants to indicate the various levels of
students’ general attitudes about individuals
exposure they have had to schizophrenia. De-
with schizophrenia, (e.g., “Individuals with
gree ranged from exposure to observational/
schizophrenia are dangerous,” “Individuals
medial depictions of schizophrenia (e.g., “I
with schizophrenia can lead full and satisfying
have watched a television program/movie or
lives,” “I would not want to live next door to an
read a newspaper/magazine article about a
individual who has schizophrenia”), as well as
person with schizophrenia”) to exposure to
their attitudes about working with individuals
individuals with schizophrenia living in the
with this illness (e.g., “I would find little satis-
respondent’s household (“There are members
faction in working with individuals with schiz-
in my household who have schizophrenia”).
ophrenia”). The instrument contained both
Items were weighted based on their social dis-
items related to positive and negative attitudes.
tance from persons with schizophrenia (e.g.,
Items were rated using a Likert scale ranging
medial depictions representing greater social
from 1 (strongly disagree) to 6 (strongly agree)
distance than living with a person with
and recoded such that higher scores represent
schizophrenia), with lower scores indicating
more positive attitudes. This instrument was
greater social distance. Total degree of contact
developed based on the Opinions About Men-
was computed by summing the number of
tal Illness scale (Cohen & Struening, 1962) and
areas of exposure to schizophrenia each par-
Community Attitudes Toward the Mentally Ill
ticipant endorsed. Frequency of contact was
scale (Taylor & Dear, 1981), as well as previous
assessed using a single-item 5-point graphic
work assessing social workers’ attitudes
scale asking participants to rate, from never to
toward individuals with severe mental illness
daily, the frequency with which they have
(Newhill & Korr, 2004; Eack & Newhill, in
contact with persons with schizophrenia.
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JOURNAL OF SOCIAL WORK EDUCATION
students to both information about schizo-
Results
phrenia and direct practice experience with Do Knowledge and Contact Relate To
individuals who have this illness.
Social Work Students’ Attitudes
After finding that students’ attitudes about
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About Schizophrenia?
schizophrenia were significantly related to both
We began our examination of the relation-
their knowledge about and contact with indi-
ships among social work students’ attitudes
viduals with the illness, a series of hierarchical
toward, knowledge about, and contact with
regression analyses was conducted to examine
individuals with schizophrenia by computing
the independent relationship between each of
zero-order correlations among these con-
these factors and students’ attitudes. As can be
structs. As can be seen in Table 1, social work
seen in Table 2, results from these analyses indi-
students who knew more about schizophrenia
cated that although knowledge about schizo-
were significantly more likely to exhibit posi-
phrenia did explain a significant amount of the
tive general attitudes toward this population,
variance in students’ attitudes toward working
and were also more likely to have positive
with this population, both degree and frequen-
attitudes toward working with individuals
cy of contact with individuals with schizophre-
with schizophrenia. In addition, both frequen-
nia continued to explain a significant amount of
cy and degree of contact with individuals
variance in students’ attitudes, above and
with schizophrenia were also significantly
beyond their knowledge about the illness.
positively associated with students’ general
However, because of the substantial shared
attitudes toward this population, as well as
variance between our measures of contact, nei-
their attitudes toward working with individu-
ther degree nor frequency of contact with indi-
als with schizophrenia. Such findings would
viduals with schizophrenia provided an indi-
seem to indicate the importance of exposing
vidual significant contribution to students’ atti-
TABLE 1. Relationships Among Social Work Students' Knowledge About, Contact With, and Attitudes Toward Individuals With Schizophrenia
Measure
1
2
General attitudes
—
Attitudes toward working
.58**
—
Knowledge
.31**
.36**
3
4
5
—
Frequency of contact
.21**
.27**
.16*
Degree of contact
.25**
.29**
.31**
— .59**
—
M
4.45
4.47
.82
1.30
4.43
SD
.73
1.00
.15
1.27
2.61
Note. Because of missing data, N ranges from 114 to 118 depending on the analysis. *pE= 3FBECPPLFYDFSQUTBUXXXDVQDPMVNCJBFEV
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