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Journal of Intellectual Disability Research 462
doi: 10.1111/jir.12146
volume 59 part 5 pp 462–467 may 2015
Norms of the Attitudes Toward Intellectual Disability Questionnaire D. Morin,1 M. Rivard,1 C. P. Boursier,1 A. G. Crocker2,3 & J. Caron2,3 1 Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada 2 Research Center, Douglas Mental Health University Institute, Montréal, Quebec, Canada 3 Psychiatry, McGill University, Montréal, Québec, Canada
Abstract Background The Attitudes Toward Intellectual Disability Questionnaire (ATTID) has demonstrated good psychometric qualities for measuring the attitudes of different groups of adults in the general population toward intellectual disability (ID). A significant advantage of the ATTID is that it addresses the concept of attitudes using a threedimensional model (affective, cognitive and behavioural). To our knowledge, there are no normative data published regarding attitudes toward ID on general population-based samples. Methods The sample of 1605 men and women was stratified to be representative of the general adult population of Quebec. The ATTID was administered by phone interview through an independent survey firm. Results Normative data are presented as percentile scores associated with the raw score of the ATTID by gender and age categories. Analysis of the variance yielded significant differences in attitude by gender and age. The directions and the strength of these associations vary according to each of the five factors used to define attitudes. Correspondence: Dr Diane Morin, Psychology, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Quebec, Canada H3C 3P8 (e-mail: [email protected]).
Conclusion These norms will provide an essential tool to compare different groups and assess the effectiveness of various public campaigns to encourage more positive attitudes towards persons with ID. These norms would also allow international comparisons. Keywords attitudes, general population, intellectual disability, norms
Introduction General public attitudes toward intellectual disability (ID) can have significant effects on the degree of inclusion of persons with ID in community settings and opportunities in their daily lives (Henry et al. 1996; Lau & Cheung 1999; Burge et al. 2007; Findler et al. 2007; Verdonschot et al. 2009). The study of general adult population attitudes toward ID has therefore gained considerable importance over the past few years (Hampton & Xiao 2008; Scior 2011). Analysing these attitudes enable the identification of concrete courses of action for awareness and education programs in promoting positive attitudes toward people with ID. These would be tailored to the different groups in the community. By positively influencing attitudes toward ID (Beckwith & Matthews 1995; Lau &
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 463 D. Morin et al. • ATTID norms
Cheung 1999; MacDonald & MacIntyre 1999; Hunt & Hunt 2004; Findler et al. 2007; Rillotta & Nettelbeck 2007; Scior 2011), it is expected that programs would promote better integration of people with ID within the community and across various public and private sector services. Studies show that public response and general attitudes toward people with ID do indeed affect the success of policies designed to promote social inclusion (Scior 2011). Assessing attitudes and understanding its underlying factors will help highlight the areas in which more positive attitudes promotion toward persons with ID is needed (MacDonald & MacIntyre 1999; Findler et al. 2007). To our knowledge, there are no normative data published regarding attitudes toward ID on general population-based samples which would allow international comparisons as well as across target groups. The concept of attitude is multidimensional (Antonak & Livneh 2000; McCaughey & Strohmer 2005; Findler et al. 2007). The Attitudes Toward Intellectual Disability (ATTID; Morin et al. 2013a) is a questionnaire that encompasses five specific factors along the three emotional, cognitive and behavioural dimensions of attitudes (Findler et al. 2007): (1) discomfort, (2) knowledge of capacity and rights, (3) knowledge of causes, (4) sensibility/tenderness and (5) interaction. This questionnaire was validated using a representative sample of the general adult population in Quebec, Canada (Morin et al. 2013a). The objective of this brief report is to present the first gender and age-based norms for the ATTID, from 1605 adults surveyed. This will allow for the targeting of specific groups and subjects that need to be addressed as part of ID awareness and education programs.
Method Participants The sample for this study consisted of 1605 adults, the one that used to validate the ATTID (see Morin et al. 2013a). Participants were selected using postal codes, resulting in a regionally stratified random sample representative of the province of Quebec. In order to be included in the study participants had to be over 18 years of age and speak
either French or English. The proportion of men to women was representative of the provincial adult population. The total number of eligible participants (18 years old and older) contacted by phone for an interview was 3184. Of those, 1605 respondents completed the questionnaire, producing a final participation rate of 50%. Characteristics of the final sample were compared to those of the province’s general population. The reported values were weighted according to gender, age and level of education to ensure the representativeness of the sample to the general population of Quebec using the Cook et al. (1993) procedure. The sample consisted of 915 women (57%) and 690 men (43%). Age groups were represented as follows: 14.1% (between 18 and 29 years old); 22.2% (30–39); 24.7% (40–49); 20.8% (50–59) and 18.2% (60 years and older). The vast majority of participants (93.6%) completed the interview in French while the remaining (6.4%) answered in English. Approximately one in ten participants (11.3%) had not completed high school (grades 7–11 in the province of Quebec), one in five had (26.4%), one third had a pre-university diploma (27.7%) and a third had a university diploma (34.6%)1. Of those surveyed, 46% lived in the greater Montreal metropolitan area and 54% resided elsewhere in the province. At the time of the interview, 57.7% of the participants reported they were employed full-time.
Procedure The ATTID questionnaire was administered through phone interviews completed by an independent marketing research firm. The surveyor asked to speak with the person whose birthday was closest to the interview date. The respondents could choose to have the interview conducted in French or in English. A consent procedure was completed with those who agreed to participate in this study. A brief and standardised introduction to ID was presented before administering the questionnaire. Each interview was completed in one sitting and lasted 1 In Quebec, high school is five years and there is a general twoyear pre-university degree or a three-year technical diploma through what is called CEGEP.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 464 D. Morin et al. • ATTID norms
22 minutes on average. The detailed procedure is described in Morin et al. (2013a). This study was approved by the Université du Québec à Montréal Institutional Ethics Board in conformity with the National Tri-Council guidelines (Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada and Social Sciences and Humanities Research Council of Canada 2010).
Material In the ATTID questionnaire (Morin et al. 2013a), attitude was defined according to three dimensions: behavioural, affective and cognitive and developed from other published attitude questionnaires. Two vignettes were developed to test the effect of the degree of functioning of a person with ID on attitudes. Prior to the survey, the questionnaire was presented to a focus group of seven specialists in the field of ID, including one parent and one person with ID. The questionnaire was modified according to their feedback, and it was pre-tested with 27 participants though a phone survey. Some items were removed and questions reworded. The new version was then tested with 12 new participants. This final version was translated into English using a backtranslation process. The English version was pretested by phone survey. No additional adjustments were necessary. Following the factor analysis, the final ATTID consisted of 67 items using a Likert-type scale ranging from 1 – agree completely to 5 – disagree completely. The higher the score on the different items and factors, the more negative was the attitude toward persons with ID.
Exploratory factor analysis yielded a five-factor structure that overlaps the tri-partite model of attitudes (Rosenberg & Hovland 1960; Eagly & Chaiken 1993). The five factors are: (1) discomfort (affective dimension), (2) knowledge of capacity and rights (cognitive dimension), (3) interaction (behavioural dimension), (4) sensibility or tenderness (affective dimension) and (5) knowledge of causes (cognitive dimension). The Scree test was used to decide the number of factors to retain (Cattell 1966). A five factor solution was selected and accounted for 39.36% of the total variance (Morin et al. 2013a). The instrument was found to have good testretest reliability, with correlations ranging from 0.62 for factor 1 to 0.83 for factor 3. Overall internal consistency for the entire questionnaire was 0.92, and sub-scale reliability ranged from 0.59 to 0.89 (Morin et al. 2013a). For more details on the construction of the questionnaire and its validation, see Morin et al. (2013a). By communicating with the authors, it is also possible to obtain an excel spreadsheet developed to correctly calculate the overall score and the score for each factor for a given sample.
Results Descriptive statistics Means, standard deviations and ranges obtained on each of the five factors are presented in Table 1. To evaluate the effect of different participants’ related variables on the attitude toward people with an ID, t-tests and anovas were performed.
Table 1 Mean, standard deviation, range of scores and significant differences on the five factors
Factor 1
Mean (standard deviation) Range (1–5) Gender (t values) Age (F values)
Factor 3
Discomfort
Factor 2 Knowledge of capacity and rights
Interaction
Factor 4 Sensibility or tenderness
Factor 5 Knowledge of causes
1.73 (0.52) [1–3.71] t = 3.14*** F5,1597 = 7.04***
2.14 (0.57) [1–4.55] t = −2.69** F5,1597 = 13.27***
2.27 (0.63) [1–4.76] – F5,1597 = 9.16***
3.16 (0.79) [1–5] – F5,1597 = 9.68***
2.85 (0.69) [1–5] – F5,1597 = 3.83***
** P < 0.01; *** P < 0.001.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 465 D. Morin et al. • ATTID norms
Significant differences were found with regard to gender and age (Table 1). Education, however, was not found to be significant (see Morin et al. 2013b for more details). Significant differences were found for respondents’ gender on factors 1 and 2 (discomfort and knowledge of rights and capacities) and for age on the five factors. Therefore, the norms’ scores are presented separately for each factor (Table 2). In order to better understand ATTID norms from a clinical standpoint, the number of percentile classification are established following a procedure proposed by Wilson et al. (2005). Thresholds correspond to scores one standard deviation from mean, which represent more extreme scores in a distribution. In order to do so, all scores are merged into three groups: (1) all scores below one standard deviation from the mean; (2) around the mean (±one standard deviation) and; (3) all scores over one standard deviation from the mean.
Discussion Since the ATTID is already published, it is important for different users to have access to its norms. Indeed, as underlined by Anastasi (1976), the results of a single person’s test have little meaning if these results are not viewed in context of the resultant norms that are representative of a group of individuals. It is important to mention that at this point in time in the research process, there are no established criteria to clearly define a positive and a negative attitudes. This will arise from cumulative results when other studies based on this questionnaire are carried out. Cut-off scores for caring and discriminative behaviours are then expected. To date, the norms described provide information about the overall distribution of a representative sample of the population living in the province of Quebec. Intuitively, however, it could be hypothesised that higher scores reflect more negative attitudes. Indeed, scores of 4 or 5 show that respondents disagree or totally disagree with a statement. Inversely, the lower the scores, the more positive the attitudes are, with scores of 1 or 2 representing agreement or total agreement with a statement. A score of 3 indicates neutrality towards a statement.
The differences found by age and gender justify establishing separate norms for these groups. Age differences are also noted by Scior (2011) in his systematic review of the literature on the general population’s awareness, attitudes and beliefs towards ID. Having different norms can guide to different courses of action to target audiences and then assess whether those actions produced changes in these groups. It is important to note that although the differences are significant, some are minimal. The results for the different factors were discussed in a previous study (Morin et al. 2013b) showing, that attitudes in Quebec are generally quite positive towards ID. One of the strengths of the norms presented here is that they cover a representative sample of a large population. This then allows potential targeted group comparisons, such as public sector workers, school teachers or others. These norms will also allow national and international studies to be carried out.
Limitations of the study The study’s limitations are mainly those inherent in all surveys, such as sample bias. In fact, we cannot eliminate the possibility that people who responded to the survey may already have been more ‘sensitised’ to persons with ID. In addition, social desirability is another bias that might have influenced the results. These norms apply to French or English speaking adults living in Quebec. Thus, our survey was developed and simultaneously translated into English. Our analyses were conducted on all respondents, whether they spoke French or English, and this does not permit the ability to distinguish norms for each language group.
Conclusion Norms for the ATTID will allow a comparison between the attitudes toward ID of individuals in various jurisdictions and different target groups, and then to direct actions and interventions to those areas where attitudes are less positive. These norms can then be used to assess of the effectiveness of interventions as well as cross-jurisdicational comparisons.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
Factor 5 Knowledge of causes
Factor 4 Sensibility or tenderness
0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100
0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100
Percentiles
1.00–1.28 1.29–1.99 2.00–5.00 1.00–1.65 1.66–2.24 2.25–5.00 1.00–1.75 1.76–2.52 2.53–5.00 1.00–2.32 2.33–3.66 3.67–5.00 1.00–2.28 2.29–3.28 3.29–5.00
1.00–1.28 1.29–1.99 2.00–5.00 1.00–1.74 1.75–2.29 2.30–5.00 1.00–1.75 1.76–2.52 2.53–5.00 1.00–2.32 2.33–3.66 3.67–5.00 1.00–2.28 2.29–3.28 3.29–5.00
18–29 years old
1.00–1.23 1.24–1.93 1.94–5.00 1.00–1.69 1.70–2.44 2.45–5.00 1.00–1.75 1.76–2.58 2.59–5.00 1.00–2.66 2.67–3.66 3.67–5.00 1.00–2.42 2.43–3.28 3.29–5.00
1.00–1.40 1.41–2.05 2.06–5.00 1.00–1.64 1.65–2.39 2.40–5.00 1.00–1.75 1.76–2.58 2.59–5.00 1.00–2.66 2.67–3.66 3.67–5.00 1.00–2.42 2.43–3.28 3.29–5.00
30–39 years old
1.00–1.23 1.24–2.05 2.06–5.00 1.00–1.84 1.85–2.49 2.50–5.00 1.00–1.81 1.82–2.64 2.65–5.00 1.00–2.49 2.50–3.66 3.67–5.00 1.00–2.56 2.57–3.28 3.29–5.00
1.00–1.40 1.41–1.99 2.00–5.00 1.00–1.73 1.74–2.44 2.45–5.00 1.00–1.81 1.82–2.64 2.65–5.00 1.00–2.49 2.50–3.66 3.67–5.00 1.00–2.56 2.57–3.28 3.29–5.00
40–49 years old
Raw scores
1.00–1.20 1.21–2.11 2.12–5.00 1.00–1.79 1.80–2.64 2.65–5.00 1.00–1.75 1.76–2.65 2.66–5.00 1.00–2.66 2.67–3.99 4.00–5.00 1.00–2.42 2.43–3.28 3.29–5.00
1.00–1.34 1.35–2.17 2.18–5.00 1.00–1.69 1.70–2.54 2.55–5.00 1.00–1.75 1.76–2.65 2.66–5.00 1.00–2.66 2.67–3.99 4.00–5.00 1.00–2.42 2.43–3.28 3.29–5.00
50–59 years old
1.00–1.34 1.35–2.10 2.11–5.00 1.00–1.89 1.90–2.79 2.80–5.00 1.00–1.99 2.00–2.81 2.82–5.00 1.00–2.82 2.83–3.82 3.83–5.00 1.00–2.42 2.43–3.42 3.43–5.00
1.00–1.49 1.50–2.28 2.29–5.00 1.00–1.94 1.95–2.44 2.45–5.00 1.00–1.99 2.00–2.81 2.82–5.00 1.00–2.82 2.83–3.82 3.83–5.00 1.00–2.42 2.43–3.42 3.43–5.00
60+ years old
Journal of Intellectual Disability Research
Factor 3 Interaction
Factor 2 Knowledge of capacity and right
Female norms Factor 1 Discomfort
Factor 5 Knowledge of causes
Factor 4 Sensibility or tenderness
Factor 3 Interaction
Factor 2 Knowledge of capacity and right
Male norms Factor 1 Discomfort
Table 2 Male and female norms by age
466 volume 59 part 5 may 2015
D. Morin et al. • ATTID norms
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 467 D. Morin et al. • ATTID norms
References Anastasi A. (1976) Psychological Testing, 4th edn. McMillan, New York. Antonak R. F. & Livneh H. (2000) Measurement of attitudes towards persons with disabilities. Disability and Rehabilitation: An International, Multidisciplinary Journal 22, 211–24. doi: 10.1080/096382800296782. Beckwith J. B. & Matthews J. M. (1995) Measurement of attitudes of trainee professionals to people with disabilities. Journal of Intellectual Disability Research 39, 255–62. Burge P., Ouellette-Kuntz H. & Lysaght R. (2007) Public views on employment of people with intellectual disabilities. Journal of Vocational Rehabilitation 26, 29–37. Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada and Social Sciences and Humanities Research Council of Canada (2010) Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. December. Cattell R. B. (1966) The scree test for the number of factors. Multivariate Behavioral Research 1, 245–76. Cook R., Mount J. & Bougrine H. (1993) Données Statistiques Canadiennes: Comment Interpréter L’information. Presses de l’Université du Québec, Sainte-Foy. Eagly A. H. & Chaiken S. (1993) The Psychology of Attitudes. Harcourt Brace Jonavonich, Fort Worth, TX. Findler L., Vilchinsky N. & Werner S. (2007) The multidimensional Attitudes Scale toward persons with disabilities (MAS): construction and validation. Rehabilitation Counseling Bulletin 50, 166–76. doi: 10.1177/ 00343552070500030401. Hampton N. Z. & Xiao F. (2008) Psychometric properties of the mental retardation attitude inventory-revised in Chinese college students. Journal of Intellectual Disability Research 52, 299–308. doi: 10.1111/j.13652788.2007.01020.x. Henry D., Keys C., Jopp D. & Balcazar F. (1996) The community living attitudes scale, mental retardation form: development and psychometric properties. Mental Retardation 34, 149–58. Hunt C. S. & Hunt B. (2004) Changing attitudes toward people with disabilities: experimenting with an educational intervention. Journal of Managerial Issues 16, 266–80.
Lau J. T.-F. & Cheung C.-K. (1999) Discriminatory attitudes to people with intellectual disability or mental health difficulty. International Social Work 42, 431–44. McCaughey T. J. & Strohmer D. C. (2005) Prototypes as an indirect measure of attitudes toward disability groups. Rehabilitation Counseling Bulletin 48, 89–99. doi: 10.1177/00343552050480020301. MacDonald J. D. & MacIntyre P. D. (1999) A rose is a rose: effects of label change, education, and sex on attitudes toward mental disabilities. Journal on Developmental Disabilities 6, 15–31. Morin D., Crocker A., Beaulieu-Bergeron R. & Caron J. (2013a) Validation of the Attitudes toward intellectual disability – ATTID questionnaire. Journal of Intellectual Disability Research 57, 268–78. Morin D., Rivard M., Crocker A. G., Parent-Boursier C. & Caron J. (2013b) Attitudes of the general population toward intellectual disability: a multidimensional perspective. Journal of Intellectual Disability Research 57, 279–92. Rillotta F. & Nettelbeck T. (2007) Effects of an awareness program on attitudes of students without an intellectual disability towards persons with an intellectual disability. Journal of Intellectual & Developmental Disability 32, 19–27. doi: 10.1080/13668250701194042. Rosenberg M. J. & Hovland C. I. (1960) Cognitive, affective and behavioral components of attitudes. In: Attitude Organization and Change: an Analysis of Consistency Among Attitude Components (eds M. J. Rosenberg, C. I. Hovland, W. J. McGuire, R. P. Abelson & J. W. Brehm), pp.1–15. Yale University Press, New Haven, CT. Scior K. (2011) Public awareness, attitudes and beliefs regarding intellectual disability: a systematic review. Research in Developmental Disabilities 32, 2164–82. Verdonschot M. M. L., de Witte L. P., Reichrath E., Buntinx W. H. E. & Curfs L. M. G. (2009) Impact of environmental factors on community participation of persons with an intellectual disability: a systematic review. Journal of Intellectual Disability Research 53, 54–64. doi: 10.1111/j.1365-2788.2008.01128.x. Wilson B. A., Emslie H., Foley J., Shiel A., Watson P., Hawkins K. et al. (2005) The Cambridge Prospective Memory Test (CAMPROMPT). Harcourt Assessment, London.
Accepted 4 June 2014
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
Journal of Intellectual Disability Research 462
doi: 10.1111/jir.12146
volume 59 part 5 pp 462–467 may 2015
Norms of the Attitudes Toward Intellectual Disability Questionnaire D. Morin,1 M. Rivard,1 C. P. Boursier,1 A. G. Crocker2,3 & J. Caron2,3 1 Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada 2 Research Center, Douglas Mental Health University Institute, Montréal, Quebec, Canada 3 Psychiatry, McGill University, Montréal, Québec, Canada
Abstract Background The Attitudes Toward Intellectual Disability Questionnaire (ATTID) has demonstrated good psychometric qualities for measuring the attitudes of different groups of adults in the general population toward intellectual disability (ID). A significant advantage of the ATTID is that it addresses the concept of attitudes using a threedimensional model (affective, cognitive and behavioural). To our knowledge, there are no normative data published regarding attitudes toward ID on general population-based samples. Methods The sample of 1605 men and women was stratified to be representative of the general adult population of Quebec. The ATTID was administered by phone interview through an independent survey firm. Results Normative data are presented as percentile scores associated with the raw score of the ATTID by gender and age categories. Analysis of the variance yielded significant differences in attitude by gender and age. The directions and the strength of these associations vary according to each of the five factors used to define attitudes. Correspondence: Dr Diane Morin, Psychology, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Quebec, Canada H3C 3P8 (e-mail: [email protected]).
Conclusion These norms will provide an essential tool to compare different groups and assess the effectiveness of various public campaigns to encourage more positive attitudes towards persons with ID. These norms would also allow international comparisons. Keywords attitudes, general population, intellectual disability, norms
Introduction General public attitudes toward intellectual disability (ID) can have significant effects on the degree of inclusion of persons with ID in community settings and opportunities in their daily lives (Henry et al. 1996; Lau & Cheung 1999; Burge et al. 2007; Findler et al. 2007; Verdonschot et al. 2009). The study of general adult population attitudes toward ID has therefore gained considerable importance over the past few years (Hampton & Xiao 2008; Scior 2011). Analysing these attitudes enable the identification of concrete courses of action for awareness and education programs in promoting positive attitudes toward people with ID. These would be tailored to the different groups in the community. By positively influencing attitudes toward ID (Beckwith & Matthews 1995; Lau &
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 463 D. Morin et al. • ATTID norms
Cheung 1999; MacDonald & MacIntyre 1999; Hunt & Hunt 2004; Findler et al. 2007; Rillotta & Nettelbeck 2007; Scior 2011), it is expected that programs would promote better integration of people with ID within the community and across various public and private sector services. Studies show that public response and general attitudes toward people with ID do indeed affect the success of policies designed to promote social inclusion (Scior 2011). Assessing attitudes and understanding its underlying factors will help highlight the areas in which more positive attitudes promotion toward persons with ID is needed (MacDonald & MacIntyre 1999; Findler et al. 2007). To our knowledge, there are no normative data published regarding attitudes toward ID on general population-based samples which would allow international comparisons as well as across target groups. The concept of attitude is multidimensional (Antonak & Livneh 2000; McCaughey & Strohmer 2005; Findler et al. 2007). The Attitudes Toward Intellectual Disability (ATTID; Morin et al. 2013a) is a questionnaire that encompasses five specific factors along the three emotional, cognitive and behavioural dimensions of attitudes (Findler et al. 2007): (1) discomfort, (2) knowledge of capacity and rights, (3) knowledge of causes, (4) sensibility/tenderness and (5) interaction. This questionnaire was validated using a representative sample of the general adult population in Quebec, Canada (Morin et al. 2013a). The objective of this brief report is to present the first gender and age-based norms for the ATTID, from 1605 adults surveyed. This will allow for the targeting of specific groups and subjects that need to be addressed as part of ID awareness and education programs.
Method Participants The sample for this study consisted of 1605 adults, the one that used to validate the ATTID (see Morin et al. 2013a). Participants were selected using postal codes, resulting in a regionally stratified random sample representative of the province of Quebec. In order to be included in the study participants had to be over 18 years of age and speak
either French or English. The proportion of men to women was representative of the provincial adult population. The total number of eligible participants (18 years old and older) contacted by phone for an interview was 3184. Of those, 1605 respondents completed the questionnaire, producing a final participation rate of 50%. Characteristics of the final sample were compared to those of the province’s general population. The reported values were weighted according to gender, age and level of education to ensure the representativeness of the sample to the general population of Quebec using the Cook et al. (1993) procedure. The sample consisted of 915 women (57%) and 690 men (43%). Age groups were represented as follows: 14.1% (between 18 and 29 years old); 22.2% (30–39); 24.7% (40–49); 20.8% (50–59) and 18.2% (60 years and older). The vast majority of participants (93.6%) completed the interview in French while the remaining (6.4%) answered in English. Approximately one in ten participants (11.3%) had not completed high school (grades 7–11 in the province of Quebec), one in five had (26.4%), one third had a pre-university diploma (27.7%) and a third had a university diploma (34.6%)1. Of those surveyed, 46% lived in the greater Montreal metropolitan area and 54% resided elsewhere in the province. At the time of the interview, 57.7% of the participants reported they were employed full-time.
Procedure The ATTID questionnaire was administered through phone interviews completed by an independent marketing research firm. The surveyor asked to speak with the person whose birthday was closest to the interview date. The respondents could choose to have the interview conducted in French or in English. A consent procedure was completed with those who agreed to participate in this study. A brief and standardised introduction to ID was presented before administering the questionnaire. Each interview was completed in one sitting and lasted 1 In Quebec, high school is five years and there is a general twoyear pre-university degree or a three-year technical diploma through what is called CEGEP.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 464 D. Morin et al. • ATTID norms
22 minutes on average. The detailed procedure is described in Morin et al. (2013a). This study was approved by the Université du Québec à Montréal Institutional Ethics Board in conformity with the National Tri-Council guidelines (Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada and Social Sciences and Humanities Research Council of Canada 2010).
Material In the ATTID questionnaire (Morin et al. 2013a), attitude was defined according to three dimensions: behavioural, affective and cognitive and developed from other published attitude questionnaires. Two vignettes were developed to test the effect of the degree of functioning of a person with ID on attitudes. Prior to the survey, the questionnaire was presented to a focus group of seven specialists in the field of ID, including one parent and one person with ID. The questionnaire was modified according to their feedback, and it was pre-tested with 27 participants though a phone survey. Some items were removed and questions reworded. The new version was then tested with 12 new participants. This final version was translated into English using a backtranslation process. The English version was pretested by phone survey. No additional adjustments were necessary. Following the factor analysis, the final ATTID consisted of 67 items using a Likert-type scale ranging from 1 – agree completely to 5 – disagree completely. The higher the score on the different items and factors, the more negative was the attitude toward persons with ID.
Exploratory factor analysis yielded a five-factor structure that overlaps the tri-partite model of attitudes (Rosenberg & Hovland 1960; Eagly & Chaiken 1993). The five factors are: (1) discomfort (affective dimension), (2) knowledge of capacity and rights (cognitive dimension), (3) interaction (behavioural dimension), (4) sensibility or tenderness (affective dimension) and (5) knowledge of causes (cognitive dimension). The Scree test was used to decide the number of factors to retain (Cattell 1966). A five factor solution was selected and accounted for 39.36% of the total variance (Morin et al. 2013a). The instrument was found to have good testretest reliability, with correlations ranging from 0.62 for factor 1 to 0.83 for factor 3. Overall internal consistency for the entire questionnaire was 0.92, and sub-scale reliability ranged from 0.59 to 0.89 (Morin et al. 2013a). For more details on the construction of the questionnaire and its validation, see Morin et al. (2013a). By communicating with the authors, it is also possible to obtain an excel spreadsheet developed to correctly calculate the overall score and the score for each factor for a given sample.
Results Descriptive statistics Means, standard deviations and ranges obtained on each of the five factors are presented in Table 1. To evaluate the effect of different participants’ related variables on the attitude toward people with an ID, t-tests and anovas were performed.
Table 1 Mean, standard deviation, range of scores and significant differences on the five factors
Factor 1
Mean (standard deviation) Range (1–5) Gender (t values) Age (F values)
Factor 3
Discomfort
Factor 2 Knowledge of capacity and rights
Interaction
Factor 4 Sensibility or tenderness
Factor 5 Knowledge of causes
1.73 (0.52) [1–3.71] t = 3.14*** F5,1597 = 7.04***
2.14 (0.57) [1–4.55] t = −2.69** F5,1597 = 13.27***
2.27 (0.63) [1–4.76] – F5,1597 = 9.16***
3.16 (0.79) [1–5] – F5,1597 = 9.68***
2.85 (0.69) [1–5] – F5,1597 = 3.83***
** P < 0.01; *** P < 0.001.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 465 D. Morin et al. • ATTID norms
Significant differences were found with regard to gender and age (Table 1). Education, however, was not found to be significant (see Morin et al. 2013b for more details). Significant differences were found for respondents’ gender on factors 1 and 2 (discomfort and knowledge of rights and capacities) and for age on the five factors. Therefore, the norms’ scores are presented separately for each factor (Table 2). In order to better understand ATTID norms from a clinical standpoint, the number of percentile classification are established following a procedure proposed by Wilson et al. (2005). Thresholds correspond to scores one standard deviation from mean, which represent more extreme scores in a distribution. In order to do so, all scores are merged into three groups: (1) all scores below one standard deviation from the mean; (2) around the mean (±one standard deviation) and; (3) all scores over one standard deviation from the mean.
Discussion Since the ATTID is already published, it is important for different users to have access to its norms. Indeed, as underlined by Anastasi (1976), the results of a single person’s test have little meaning if these results are not viewed in context of the resultant norms that are representative of a group of individuals. It is important to mention that at this point in time in the research process, there are no established criteria to clearly define a positive and a negative attitudes. This will arise from cumulative results when other studies based on this questionnaire are carried out. Cut-off scores for caring and discriminative behaviours are then expected. To date, the norms described provide information about the overall distribution of a representative sample of the population living in the province of Quebec. Intuitively, however, it could be hypothesised that higher scores reflect more negative attitudes. Indeed, scores of 4 or 5 show that respondents disagree or totally disagree with a statement. Inversely, the lower the scores, the more positive the attitudes are, with scores of 1 or 2 representing agreement or total agreement with a statement. A score of 3 indicates neutrality towards a statement.
The differences found by age and gender justify establishing separate norms for these groups. Age differences are also noted by Scior (2011) in his systematic review of the literature on the general population’s awareness, attitudes and beliefs towards ID. Having different norms can guide to different courses of action to target audiences and then assess whether those actions produced changes in these groups. It is important to note that although the differences are significant, some are minimal. The results for the different factors were discussed in a previous study (Morin et al. 2013b) showing, that attitudes in Quebec are generally quite positive towards ID. One of the strengths of the norms presented here is that they cover a representative sample of a large population. This then allows potential targeted group comparisons, such as public sector workers, school teachers or others. These norms will also allow national and international studies to be carried out.
Limitations of the study The study’s limitations are mainly those inherent in all surveys, such as sample bias. In fact, we cannot eliminate the possibility that people who responded to the survey may already have been more ‘sensitised’ to persons with ID. In addition, social desirability is another bias that might have influenced the results. These norms apply to French or English speaking adults living in Quebec. Thus, our survey was developed and simultaneously translated into English. Our analyses were conducted on all respondents, whether they spoke French or English, and this does not permit the ability to distinguish norms for each language group.
Conclusion Norms for the ATTID will allow a comparison between the attitudes toward ID of individuals in various jurisdictions and different target groups, and then to direct actions and interventions to those areas where attitudes are less positive. These norms can then be used to assess of the effectiveness of interventions as well as cross-jurisdicational comparisons.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
Factor 5 Knowledge of causes
Factor 4 Sensibility or tenderness
0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100
0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100 0–25 26–75 76–100
Percentiles
1.00–1.28 1.29–1.99 2.00–5.00 1.00–1.65 1.66–2.24 2.25–5.00 1.00–1.75 1.76–2.52 2.53–5.00 1.00–2.32 2.33–3.66 3.67–5.00 1.00–2.28 2.29–3.28 3.29–5.00
1.00–1.28 1.29–1.99 2.00–5.00 1.00–1.74 1.75–2.29 2.30–5.00 1.00–1.75 1.76–2.52 2.53–5.00 1.00–2.32 2.33–3.66 3.67–5.00 1.00–2.28 2.29–3.28 3.29–5.00
18–29 years old
1.00–1.23 1.24–1.93 1.94–5.00 1.00–1.69 1.70–2.44 2.45–5.00 1.00–1.75 1.76–2.58 2.59–5.00 1.00–2.66 2.67–3.66 3.67–5.00 1.00–2.42 2.43–3.28 3.29–5.00
1.00–1.40 1.41–2.05 2.06–5.00 1.00–1.64 1.65–2.39 2.40–5.00 1.00–1.75 1.76–2.58 2.59–5.00 1.00–2.66 2.67–3.66 3.67–5.00 1.00–2.42 2.43–3.28 3.29–5.00
30–39 years old
1.00–1.23 1.24–2.05 2.06–5.00 1.00–1.84 1.85–2.49 2.50–5.00 1.00–1.81 1.82–2.64 2.65–5.00 1.00–2.49 2.50–3.66 3.67–5.00 1.00–2.56 2.57–3.28 3.29–5.00
1.00–1.40 1.41–1.99 2.00–5.00 1.00–1.73 1.74–2.44 2.45–5.00 1.00–1.81 1.82–2.64 2.65–5.00 1.00–2.49 2.50–3.66 3.67–5.00 1.00–2.56 2.57–3.28 3.29–5.00
40–49 years old
Raw scores
1.00–1.20 1.21–2.11 2.12–5.00 1.00–1.79 1.80–2.64 2.65–5.00 1.00–1.75 1.76–2.65 2.66–5.00 1.00–2.66 2.67–3.99 4.00–5.00 1.00–2.42 2.43–3.28 3.29–5.00
1.00–1.34 1.35–2.17 2.18–5.00 1.00–1.69 1.70–2.54 2.55–5.00 1.00–1.75 1.76–2.65 2.66–5.00 1.00–2.66 2.67–3.99 4.00–5.00 1.00–2.42 2.43–3.28 3.29–5.00
50–59 years old
1.00–1.34 1.35–2.10 2.11–5.00 1.00–1.89 1.90–2.79 2.80–5.00 1.00–1.99 2.00–2.81 2.82–5.00 1.00–2.82 2.83–3.82 3.83–5.00 1.00–2.42 2.43–3.42 3.43–5.00
1.00–1.49 1.50–2.28 2.29–5.00 1.00–1.94 1.95–2.44 2.45–5.00 1.00–1.99 2.00–2.81 2.82–5.00 1.00–2.82 2.83–3.82 3.83–5.00 1.00–2.42 2.43–3.42 3.43–5.00
60+ years old
Journal of Intellectual Disability Research
Factor 3 Interaction
Factor 2 Knowledge of capacity and right
Female norms Factor 1 Discomfort
Factor 5 Knowledge of causes
Factor 4 Sensibility or tenderness
Factor 3 Interaction
Factor 2 Knowledge of capacity and right
Male norms Factor 1 Discomfort
Table 2 Male and female norms by age
466 volume 59 part 5 may 2015
D. Morin et al. • ATTID norms
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
volume 59 part 5 may 2015
Journal of Intellectual Disability Research 467 D. Morin et al. • ATTID norms
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Accepted 4 June 2014
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