Respecting our elders: Evaluation of an educational program for adolescent students to promote respect toward older adults.

American Journal of Orthopsychiatry 2015, Vol. 85, No. 2, 181–190

© 2015 American Orthopsychiatric Association http://dx.doi.org/10.1037/ort0000041

Respecting Our Elders: Evaluation of an Educational Program for Adolescent Students to Promote Respect Toward Older Adults David Mellor, Marita McCabe, and Laura Rizzuto

Alan Gruner

Benetas, Melbourne, Australia

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Deakin University

The current project explored issues related to respect for older people, and then developed, implemented, and evaluated an educational intervention program for adolescents to raise understanding and improve attitudes toward older people. In Study 1, 46 focus groups were conducted, with participants (n ⫽ 211) drawn from older people, carers of older people, and adolescents to inform on issues related to the expression of respect to older people. The emergent themes were used to inform the design of the educational program delivered to adolescents and evaluated in Study 2. A total of 118 year-9 students were allocated to an intervention or control condition. The intervention group participated in 4 educational sessions focused on developing understanding of and respect for older adults, and promoting positive interactions with older people. Participants in both conditions completed measures of knowledge and attitudes to aging to determine whether the intervention had effected change at post-program and at 6-months follow-up. Analyses indicated significant improvements in knowledge, attitudes, and social skills related to older people in the intervention group compared to the control group. The findings from these studies provide a better understanding of what constitutes respect for older people, and a method for improving this in adolescents.

A

others or carers, and society in general, they experience a sense of value, worth, and connectedness with their community that is associated with greater life satisfaction. A question that research has failed to adequately address, however, especially in Western contexts, is what constitutes respect for, and respectful behavior toward, older individuals? After conducting studies in Korea and the United States (Sung, 2004; Sung & Kim, 2003), Sung (2004) reported that the forms of respect for older people most frequently reported by young adult participants across studies included acquiescent respect (complying with elders’ words); care respect (caring for and serving elders); linguistic respect (using respectful language in addressing elders); salutatory respect (greeting elders); consulting respect (seeking advice); and presentational respect (holding courteous appearances before elders). In later studies in the United States with social workers (Sung & Dunkle, 2009) and college students (Sung, Kim, & Torres-Gil, 2010), similar findings were reported. Sung (2004) argued that the way respect for older people is demonstrated by different cultures may be a matter of degree rather than being qualitatively distinct. Sung’s research (Sung, 2004; Sung et al., 2010) also indicated that through changing social and economic conditions, living arrangements, mobility, lifestyle, and technology, expressions of respect have changed over time, shifting from more complex to simpler forms. There are several possible reasons why expressions of respect may have changed. For example, increases in dual career marriages, accompanied by employment of babysitters, may

high prevalence of ageism has been observed among various demographic groups, including children as young as 4 years of age, those who work in aged care, and even among the elderly themselves (Anderson, 1999; Gullette, 2011). This devaluing of older adults, based on stereotypes that they are less ambitious, responsible, and intellectually competent than younger people, often manifests in prejudice or discrimination or both against them (Iversen, Larsen, & Solem, 2009; Minichiello, Browne, & Kendig, 2000), which may in turn contribute to the development of depressive symptoms and lowered self-efficacy, as well as substance abuse and cardiovascular stress among those to whom they are directed (Rupp, Vodanovich, & Credé, 2005). In contrast to the findings related to ageism and its impacts on older people, other research (e.g., Anderberg, Lepp, Berglund, & Segesten, 2007; Applegate & Morse, 1994; Ghusn, Hyde, Stevens, Hyde, & Teasdale, 1996) has shown that when older people feel respected by their family, significant

David Mellor, Marita McCabe, and Laura Rizzuto, School of Psychology, Deakin University, Australia; Alan Gruner, Benetas, Melbourne, Australia. The studies reported in this article were supported by a Linkage Grant from the Australian Research Council (LP100200330) and Anglican Aged Care Services (Benetas). Correspondence concerning this article should be addressed to David Mellor, School of Psychology, Deakin University, Burwood 3125, Australia. E-mail: [email protected] 181


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diminish the value of older people as perceived by their grandchildren (Mehta, 1997). Changes in family structure and function may also be associated with decreasing respect for older people. Specifically, the disintegration of nuclear families may have led to neglect of teaching the value of respect in the family. Higher incomes of young people and a decreased focus on teaching respect within educational settings were other factors Sung identified as being related to changes in respect toward older people. These structural shifts in society are likely to have resulted in a lack of understanding of what defines respect for older people today. Despite this, research suggests that through education (Stephan & Stephan, 2001) and personal contact with out-group members (Pettigrew & Tropp, 2006), prejudicial attitudes such as ageism can be attenuated, while positive and respectful attitudes may be fostered. Previous studies evaluating such interventions to increase respect for older adults have often targeted high-school and college student populations through curricular-based interventions. This is very appropriate, given that Nelson (2007) has observed that, relative to other age groups, adolescents in particular hold highly negative attitudes toward older people, which in turn can influence the general treatment and respect they afford them. The aim of the interventions to date has typically been to educate younger individuals on issues related to older age to improve both knowledge of, and attitudes toward, older people (e.g., Knapp & Stubblefield, 1999; O’Hanlon & Brookover, 2002; O’Hanlon, Camp, & Osofsky, 1993; Shenk & Lee, 1995; StuartHamilton & Mahoney, 2003). These studies have consistently yielded findings that confirm generally negative attitudes toward the elderly among younger adults, and some have shown positive change in knowledge and attitudes as a result of participation in a course or workshop (Stuart-Hamilton & Mahoney, 2003). Education strategies, including didactic delivery of information, simulation exercises, and/or direct contact with older people, have been shown to improve attitudes; however, most interventions have involved full-semester course work units or have lasted over 15 hours in duration (Angiullo, Whitbourne, & Powers, 1996; Intrieri, Kelly, Brown, & Castilla, 1993; Karner, Rheinheimer, DeLisi, & Due, 1998). Adding full courses into already crowded curricula is difficult, and studies that have been conducted in a condensed workshop setting have been unable to demonstrate significant findings, or have failed to use posttests and control groups to evaluate their impact (Intrieri et al., 1993; Karner et al., 1998; Moriello, Smey, Pescatello, & Murphy, 2005; Pacala, Boult, Bland, & O’Brien, 1995). Furthermore, these programs do not place any emphasis on the vital role that respect plays in older individuals’ lives; rather they focus on increasing the understanding of the aging process in young adults in the hope it will evoke more positive attitudes toward older adults. In summary, it is evident that respect is a key factor that determines quality of life for older people, with studies consistently showing that older people who feel respected have a greater sense of life satisfaction (Ghusn et al., 1996; Hörder, Frändin, & Larsson, 2013; Noelker & Harel, 2000). Despite the knowledge that respect is vitally important to the well-being of older persons, as Sung et al. (2010) point out, there has been limited research on the meaning and expression of respect for older adults in our society from the perspective of younger groups, and indeed from the perspective of older people themselves. Furthermore, programs

designed to increase respect for older people have achieved mixed results, have been lengthy, or have not been adequately evaluated. Therefore, the aims of the current study were twofold: to explore issues related to respect for older adults, and to then develop, implement, and evaluate a program designed to improve respect for older adults among adolescents that could be transferable into the school curriculum. These aims were achieved through two separate studies. Study 1 was a qualitative study that involved focus group discussions, with participants from the various groups described. The outcomes of Study 1 informed the design of an educational program that was implemented and evaluated in Study 2.

Study 1 The purpose of Study 1 was to explore and identify important themes related to respect for older adult members of society through focus group discussions. Specifically, the focus groups aimed to determine what respect for the elderly means, with a particular focus on the similarities and differences that exist across participant groups, how people demonstrate respect toward older adults, and the factors that contribute to whether respect is shown toward older adults.

Method Participants. The sample of 211 participants included high school students from years 7 through 11 (“adolescents,” n ⫽ 43), older adults living in the community (“community elders,” n ⫽ 43), older adults living in residential care (“residents,” n ⫽ 44), aged-care staff (“care staff,” n ⫽ 40), and aged-care service volunteers (“volunteers,” n ⫽ 41). Participants in the adolescent group were drawn from two high schools in metropolitan Melbourne, Australia. Participants in the other groups were recruited through Benetas, a large aged-care service provider in the state of Victoria that provides residential care facilities, community day centers, and services to older people living independently in the community. Procedure. Ethics approval for the study was granted by the University Human Research Ethics Committee, and approval was granted by the Catholic Education Office Melbourne to approach Catholic schools in Melbourne. A total of 46 focus groups was conducted, with between three and seven participants from one of the source populations in each focus group (that is, the groups were not mixed). The focus group facilitator encouraged participants to freely express their observations and opinions regarding how they perceived respect to be expressed for older people on an individual basis and in the broader, general population. Nine open-ended questions were asked of each focus group, including “What do you think respect for older people means?”, “What would a society that demonstrated respect for older people look like?” and “What is the impact of respect on the lives of an older person?” Prompts such as “Can you explain that further?”, “Can you tell me more about that?”, and “What do others think about this?” were used by the focus group facilitator to stimulate discussion and elicit clarification and further information from participants. Discussions were digitally recorded.


PROMOTING RESPECT TOWARD OLDER PEOPLE

Each of the focus group interviews was transcribed verbatim from the digital recordings and analyzed using the principles of interpretative phenomenological analysis (Smith & Osborn, 2003). Using this approach, the first transcript was examined, with notes being taken regarding the most interesting and relevant parts of the discussion and how these may be coded into larger themes. A list of overarching themes was devised and discussion between the principal researchers led to a consensus whereby there was full agreement. Upon completion of coding of the first transcript, coding began on the second transcript, and so forth. As the iterative analysis continued, themes were constantly revised and extended until no further themes could be identified, and the resulting framework accounted for all relevant extracts found within the transcripts. The research team then reviewed each transcript to ensure that all data had been appropriately coded and extracts recoded as necessary according to the evolved system by consensus.

Results A wide range of themes emerged from the narratives of the five representative groups (community elders, residents, care staff, volunteers, and adolescents), including the following: what respect for the elderly means, expressions of respect, factors that contribute to whether respect is shown toward the elderly, earned versus automatic respect, perceived changes to respect across time, and how values of respect are taught or learned. For the purposes of the present article, the main focus will be the outcomes of the adolescent group and those of the older people. The main themes are summarized in Table 1, along with the frequency with which they were raised in the adolescent and older people’s groups. As can be seen, older participants referred far more frequently than adolescents to their perceived lack of respect, although there was agreement as to the importance of respect for older people’s well-being. Adolescents focused more strongly on practical help as a form of respect than other manifestations, whereas older people highlighted the role of interaction as a form of respect. Adolescents also made reference to the limitations of older people, noted that they are more likely to show respect to an older person with whom they are familiar, and expect others to earn their respect.

Discussion To breakdown ageist attitudes and stereotypes and ensure that elderly individuals are respected within the community, it appears that greater shared understanding of what constitutes respect and respectful behavior between adolescents and older people is required. The focus group discussions with adolescents indicated incongruence between their view of what respect for the elderly means and their behavior toward older individuals. That is, although adolescents agreed that all people (elderly or otherwise) should be treated with respect, they reported that they demonstrate respect conditional upon their assessment of the older individual as a deserving person. The focus groups also indicated that adolescents avoid initiating respectful interactions with older individuals out of fear of encoun-

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tering a negative reaction from them, and an uncertainty about how to manage such reactions. This hesitation was perpetuated by the adolescents’ perception of many elderly individuals as grumpy. The focus groups also revealed a difference between what adolescents and older people consider predominant expressions of respect, with adolescents focusing on helping behavior and older people emphasizing interacting behaviors and tolerance as the most important aspects of respect. These differences may translate into intergenerational misunderstandings and tensions. These findings are generally in accord with previous studies that have investigated adolescents’ respect for and attitudes toward older people (Sung, 2004; Sung & Kim, 2003; Sung et al., 2010). There is clearly a tendency on the part of youth to expect reciprocal respect, rather than to simply offer respect on the basis of age-associated esteem, and practical aspects of respect rather than true engagement with older people. An educational program designed to promote respect for older people on the part of adolescents will thus need to aim to modify attitudes, and encourage a proactive approach to demonstrating respect. The program should teach adolescents strategies for approaching elderly individuals, work through possible outcomes of such interactions, including how to manage adverse reactions, and promote resilience if expressions of respect are indeed met with adversity. Furthermore, a component of the educational program will need to teach assertiveness skills to reduce adolescents’ experience of anxiety when interacting with older people, and improve their social self-efficacy in initiating interactions with older people.

Study 2 The aim of Study 2 was to use the findings from Study 1 to develop, implement, and evaluate an educational program for adolescents designed to promote more respectful attitudes and behaviors toward older people. The program consisted of four sessions: 1. Session 1 aims to engage adolescents in a discussion of what it means to be “elderly” in today’s society to enable them to consider the perspective of older people. Given the different views of respect reported by adolescents and older people in Study 1, the session then focuses on manifold manifestations of “respect” to assist participants to be aware of expressions about which they may not have thought. The main question addressed in this session is “What might elderly individuals expect of me?” 2. Session 2 aims to raise self-awareness of ageist attitudes and stereotypes, which were evident in the adolescent focus groups in Study 1 (e.g., older people are limited in their capacities, or are negative). The main question addressed in this session is “What have elderly individuals done for or contributed to society?” The purpose of this is to challenge adolescents’ perceptions of elderly people and broaden their understanding of older peoples’ lives so that they might move beyond hasty judgments about whether or not older people deserve respect. 3. Session 3 aims to promote mutual respect through asking adolescents to reflect on what they would like elderly people to understand about them. The main question addressed in this session is “What would I like back from the elderly (for a mutually respectful interaction)?” This session responds to adolescents’ focus on mutual and earned respect evident in Study 1.

Advice seeking

Helping behavior

Patience

Interaction

Expressing respect Language

The value of respect

Perceived lack of respect

Theme

All groups mentioned that offering a seat on public transport demonstrated respect, and this emerged as the most prominent situation where respect could be shown. Adolescents viewed helping behavior and the provision of special services (e.g., ramp access, and senior discounts) as a sufficient expression of respect, whereas older participant groups saw extra health services and facilities as necessary for elderly individuals, rather than an exemplar of respect. Older participant groups reported that seeking advice or knowledge from elderly individuals was a means of conveying respect, whereas adolescents did not mention this behavior in their discussions.

All groups agreed that the use of appropriate language was a means of conveying respect toward the elderly. Adolescents, volunteers, and care staff emphasized refraining from swearing around older people as a sign of respect, while residents emphasized being spoken to courteously and with a nice tone. All groups reported that showing interest in the elderly person (e.g., by listening to stories, visiting, or keeping in contact) was important in conveying respect. Residents and adolescents also suggested that keeping the elderly up-to-date with their lives conveyed respect. Residents and care staff held the opinion that showing patience for the slower pace of older individuals was an important aspect of demonstrating respect. No adolescents cited such behaviors as a means of demonstrating respect.

All groups agreed that there is a lack of respect for elderly individuals as well as a general lack of respect for others (regardless of age) in Australian society. Participants also agreed that younger people demonstrated the least amount of respect towards their elders when comparing all age groups. There was a general consensus among groups that respect positively impacts the quality of life of elderly individuals by evoking positive emotions.

Summary

Table 1. Summary of Study 1 Findings by Theme With Example Statements

“I think that it’s very, a privilege for us to be here, don’t you, and asked our opinion on things. I think that’s a privilege.” (Resident)

“We need respect that this is where we’re at, and we’d like to be able to skip and jump around, but those days were gone years ago, but I accept where I’m at, but as I said the family can’t accept that I’m getting old.” (Resident) “Standing up if you’re on a bus or a train or something, to let them sit down; it’s nice to do things like that for them because you’re going to end up like that one day and you want the kids who are younger than you to do that to you.” (Adolescent)

“It’s like you’re talking to someone who’s higher than you. So if I was speaking to the principal, you wouldn’t use slang and rude words and that. You’d only use proper words and stuff like that.” (Adolescent) “I think when people our age talk to the elderly it makes them feel like . . . they’re involved in the community.” (Adolescent)

“You appreciate it” [when someone behaves respectfully towards you]. (Community elder) “I reckon it makes them realize or feel that the community . . . acknowledges them. Like they still care.” (Adolescent)

“I’ve seen very old people get on the tram and hang on and kids just sitting there.” (Resident) “They [the elderly] get tossed to the side, cos they can’t do as much.” (Adolescent)

Example statements

0

22

3

11

3

6

4

Frequency in adolescent focus groups


4

7

6

16

5

7

32

Frequency in elder peoples’ focus groups

184 MELLOR, MCCABE, RIZZUTO, AND GRUNER

Both volunteers and adolescents suggested that expressions of respect, and whether they were formal or informal, differed according to their familiarity with the older person.

There was a consensus among all participant groups that respect towards the elderly had changed across time; it had become a matter of choice rather than obedience. Adolescents perceived the change as the result of being taught to question authority and credibility regardless of age. Older participants viewed the change as the outcome of society’s shift towards lax discipline and deference to authority as well as children being taught to stand up for themselves, and increased youth rights.

Changes in respect over time

Care staff, volunteers, and elderly members of the resident groups shared the view that giving older individuals the opportunity to make choices for themselves was a means for conveying respect toward them. Adolescents held the attitude that elderly people are physically limited due to their age. Therefore, offering help (e.g., a seat), or the provision of amenities to accommodate their physical limitations (e.g., disability services, senior car parks) would be considered respectful. Older participant groups held the view that these amenities were essential for well-being rather than respect.

Summary

Differences in the expression of respect based on familiarity

Attitudes underlying helping behaviors

Choice

Theme

Table 1 (continued)

“As for respect, I like to be left to make my own decisions in my own way in my own time. I don’t like to be forced into something.” (Resident) “Like you can’t really forget that there are some things that they can’t do like, you just expect, like even the really healthy, happy ones, they have limits. A lot, their limits are a lot [greater] than ours and they can’t do as much as we can.” (Adolescent) “We really can’t have all these good things like giving people self-worth and all that if their physical needs aren’t being looked after. That’s the basic respect, isn’t it—to be clean, to be well fed, and then comes the other on top of that. You can’t have the top without the basics.” (Volunteer) “You sort of have to base respect around what you know about them and who they are and who you are and your qualities and their qualities, things like that.” (Adolescent) “You’re informal with people you know, and you’re more formal with people here [in aged care].” (Volunteer) “It’s not only kids. It’s older people as well. It’s like they’re too busy to stop and help someone else.” (Adolescent) “And you know, it’s . . . I suppose it comes down to discipline—not enough discipline and making the children do it. I would think.” (Resident)

Example statements

15

6

6

0

Frequency in adolescent focus groups


28

0

0

5

Frequency in elder peoples’ focus groups


185


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4. Session 4 aims to foster positive and respectful interactions between adolescents and older individuals, through teaching essential interpersonal skills. The main question addressed in this session is “What can I do (i.e., how can I behave) to increase mutually respectful interactions?” This session was designed to address adolescents’ tendency to avoid initiating interactions with older individuals because they fear encountering negative reactions, and are uncertain about how to manage such reactions, as identified in Study 1. The program was designed to be implemented in high schools as a component of the health and society curriculum. The number of sessions and length of sessions were constrained by the school timetable and the time required to conduct follow-up outcome measurements. The sessions were dynamic and interactive in nature, and involved group discussions, games, role plays, and case studies that aimed to stimulate students to think about their own attitudes toward older people and teach them different skills to better understand and interact with the older population. Simple homework tasks were administered to be completed between sessions. These were designed to encourage participants to practice and implement new skills they had learned during the weekly session. We hypothesized that, compared to adolescents in a control condition, those adolescents who participated in the educational program would demonstrate (a) increased knowledge of aging, (b) more positive and less negative attitudes toward older people, (c) improved ability to influence the outcome of social interactions, (d) increased perceived competence to interact with older people in a social situation, and (e) less social anxiety during interactions with older people.

Participants The sample consisted of 118 adolescents (58 boys and 60 girls) recruited from three secondary colleges in Victoria. All students were aged between 13 and 15 years (M ⫽ 14.3, SD ⫽ .83) and were enrolled in a year-nine curriculum. The vast majority of participants (98.3%) were currently in contact with older people, including grandparents, other relatives, or family friends. Of these, over half had regular contact with older people at least once a week (53.5%), 26.3% a few times a month, 15.3% once every few months, and 3.4% less than once a year. Most of this contact (83.1%) was face-to-face, 13.6% via phone, and 1.7% by other methods such as Skype or e-mail.

Measures Participants completed the following self-report measures of outcome variables at baseline, postintervention, and again at 6-month follow-up. Child Adolescent Facts on Ageing Quiz (CAFAQ). The CAFAQ (Haught, Walls, Laney, Leavell, & Stuzen, 1999) is a revised version of Palmore’s Facts on Ageing Quiz (Palmore, 1977), used to identify knowledge of the most frequent misconceptions about older people and the aging process. It consists of 16 true/false statements specifically modified for use in school-age children, with more correct answers, and therefore higher scores,

indicating higher overall knowledge of older people (range ⫽ 0 –16). Four items are positively biased statements, 12 are negatively biased, and separate subscales are calculated from these questions to indicate bias toward older adults (range from 0 – 4, and 0 –11, respectively). Items include statements such as “When people become elderly they cannot see, smell, hear, taste, or touch as well as people who are younger” (if marked “false,” this suggests the adolescent has a positive bias toward older adults) and “Most older persons are healthy enough to complete their daily tasks” (if marked as “false,” this indicates negative bias toward older adults). As with the original scale (Palmore, 1977), the CAFAQ score is calculated based on cumulative correct answers to questions derived from a broad range of indirectly interrelated facts. As such, there is low interitem correlation and overall internal reliability (Palmore, 1980). Correspondingly, reliability in the current study was also low for the total scale (␣ ⫽ .27) and positive (␣ ⫽ .36) and negative (␣ ⫽ .52) bias subscales. Despite this reliability, the scale has displayed good validity, such as being significantly correlated with measures of attitudes toward older adults, and is also able to reliably discriminate between groups of individuals who have or have not received training in gerontological knowledge (Palmore, 1980). Kogan’s Attitudes Toward Old People Scale (ATOP). This scale (Kogan, 1961) assesses positive and negative attitudes toward older people with respect to norms, individual differences, stereotypes, and misconceptions of older people. Several previous studies have demonstrated it to be sensitive to change through intervention when used with adolescents (e.g., Couper, Sheehan, & Thomas, 1991; Trent, Glass, & Crockett, 1979). The scale consists of 17 matched positive-negative pairs of statements (total of 34 items), to which participants rate their level of agreement using a Likert format ranging from 1 (strongly disagree) to 7 (strongly agree). Negative and positive items are summed and scored separately, with higher scores indicating higher negative or positive attitudes respectively (range ⫽ 17–119). Previous studies have reported adequate reliability coefficients for both the negative (␣ ⫽ .82) and positive subscales (␣ ⫽ .69; Lee, 2009), with Kogan (1961) reporting split-half reliabilities ranging from .66 to .83. The subscale reliabilities in the current study were found to be acceptable for the positive (␣ ⫽ .66) and negative scales (␣ ⫽ .77). Social Skills Questionnaire (SSQ). The student version of the SSQ (Spence, 1995) was designed for use among 8- to 18-year-olds and focuses on the social behaviors proposed to influence the outcome of social interactions. Consisting of 30 items, the scale asks the respondent to rate the extent to which each item best describes their behavior over the past 4 weeks on a Likert-scale response format ranging from 1 (strongly disagree) to 7 (strongly agree). Items are summed to create a total, with higher scores indicating higher levels of social skills (range ⫽ 30 –210). The items refer to a wide range of social skills, including the ability to deal with situations requiring an assertive response, handle conflict, and the quality of peer and family relationships. The scale has been shown to have good psychometric properties (Spence, 1995; Spence, Donovan, & Brechman-Toussaint, 2000).



The reliability in the current study was found to be excellent (␣ ⫽ .90). Social Competence With the Elderly Questionnaire. The present study adapted Spence’s Social Competence with Peers Questionnaire (SCPQ; Spence, 1995) to focus on adolescents’ perceptions of outcomes of social interactions with older people. The scale consists of 10 statements, with participants asked to rate how strongly they agree with each statement on a Likertscale ranging from 1 (strongly disagree) to 7 (strongly agree). Item scores are summed, with higher scores being indicative of perceived social competence with older people (range ⫽ 10 –70). The SPCQ has previously demonstrated adequate reliability (␣ ⫽ .75; Spence, 1995). The reliability in the current study was found to be good (␣ ⫽ .66). Social Worries Questionnaire (SWQ). The SWQ (Spence, 1995) was adapted in the present study to measure the level of social anxiety that adolescents experience during interactions with older people. The questionnaire consists of 12 statements relating to specific social situations, and participants were asked to rate how true each statement is about them on a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree; range ⫽ 12– 84). Item scores are summed, with higher scores indicating greater levels of social anxiety and worry in relation to interacting with older people. The internal reliability of Spence’s SWQ has been found to be good, with a Guttman split-half reliability of ⫾.77. The reliability in the current study was found to be good (␣ ⫽ .89).

Procedure Approval for the study was granted by the University Human Research Ethics Committee. Because the Catholic Education Office had previously facilitated our research, we then sought and gained approval from this organization to undertake the study in schools operating under its auspice. Six schools throughout Melbourne were then sent an information pack inviting their year-nine students to participate in a series of workshops aimed at helping students to recognize their own attitudes toward older people and teaching them different skills to assist in interacting with the elderly. Three schools expressed interest in the study. In each of these schools, half of the year-nine classes were randomly allocated to either (a) the intervention group, which received the educational program as an alternative to the set curriculum, or (b) the control group which received the usual curriculum. No potential participants declined to take part. At the beginning of the study, all participating students were asked to fill in a baseline self-report battery of questionnaires administered by a researcher within a normal school class period. The following week, the educational program group commenced the intervention which was facilitated by one of the research team, Participants completed follow-up questionnaires immediately after completion of the sessions and at 6-month follow-up. Participants in the control group completed the questionnaires at the same times as the participants in the intervention group.

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Results A multivariate analysis of variance (MANOVA) was conducted on the outcome variables at baseline using group as the independent variable. The results indicated there were no multivariate differences on baseline scores between the groups, F(8, 109) ⫽ 1.03, p ⫽ .42. Given that the statistical equivalence of groups at baseline was established, a 3 (Time) ⫻ 2 (Group) repeated measures MANOVA was then conducted to compare the educational program and control groups across each of the three time-points. The results indicated a significant multivariate effect for time, F(15, 102) ⫽ 4.40, p ⬍ .001, partial ␩2 ⫽ .14, and interaction, F(15, 102) ⫽ 1.75, p ⫽ .036, partial ␩2 ⫽ .06, but no significant effect for group, F(8, 109) ⫽ .76, p ⫽ .643, partial ␩2 ⫽ .05. Follow-up univariate analyses of variance (ANOVAs) were then conducted to assess for interaction effects on the outcome measures that would signify differences between the groups over time. The results showed significant interaction effects on the total CAFAQ, F(2, 232) ⫽ 3.77, p ⫽ .024, partial ␩2 ⫽ .03, CAFAQ negative bias subscale, F(2, 232) ⫽ 4.24, p ⫽ .016, partial ␩2 ⫽ .04, and SSQ, F(2, 232) ⫽ 3.34, p ⫽ .035, partial ␩2 ⫽ .03. These results indicated that participants in the educational group, relative to the control group, increased their knowledge of older people (Figure 1) and their social skills with older people (Figure 2), and decreased their negative bias toward older people (Figure 3) significantly more from baseline to the 6-month follow-up. An interaction effect on the positive ATOP subscale also approached significance, F(2, 232) ⫽ 2.52, p ⫽ .082, partial ␩2 ⫽ .02, indicating the educational group trended toward increasing positive attitudes between baseline and 6-month follow-up compared to the control group (Figure 4). No significant interaction effects were found for the remaining variables (all p ⬎ .14). Within-group contrasts in the intervention group showed that changes in the hypothesized direction occurred between baseline and postintervention on the total CAFAQ (p ⬍ .01), positive bias subscale (p ⬍ .05), negative bias subscale (p ⬍ .01), positive ATOP subscale (p ⬍ .01), and the SSQ (p ⬍ .01). No significant changes between postintervention and 6-month follow-up were

Figure 1. Mean total knowledge score for each group at each time point.


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Figure 2. Mean social skills score for each group at each time point.

found on these measures (all p ⬎ .05), indicating changes that occurred from baseline to postintervention were maintained. No significant changes were found between time-points in the control group (all p ⬎ .05).

Discussion The educational program aimed to improve adolescents’ knowledge, attitudes, and perceived social skills in relation to older adults. The results provided general support for the hypotheses, with adolescents in the educational workshop group reporting significantly greater knowledge, less negative bias, more positive attitudes, and improved social skills in relation to older adults from baseline to 6-month follow-up. The control group did not demonstrate changes in these variables. These findings are consistent with gains in knowledge and attitudes toward older people re-

Figure 3. Mean negative bias score for each group at each time point.

Figure 4. Mean positive bias score for each group at each time point.

ported in other studies employing control groups when testing an educational intervention with students and adolescents (Angiullo et al., 1996; Couper et al., 1991; Karner et al., 1998; Trent et al., 1979). Previous findings have shown mixed results in terms of the maintenance of gains from education intervention, with some able to increase knowledge in the short-term but not maintain this over longer periods (Angiullo et al., 1996; Moriello et al., 2005). Carmel, Cwikel, and Galinsky (1992) were able to increase knowledge of older people in students and sustain it for a 6-month period. However, their program consisted of lectures spanning a semester as well as a final examination testing the knowledge delivered as part of the program. It is interesting that in the current study, changes were not noted on measures of social competence or social worries with older people. Despite the fact that adolescents did not improve on these variables following the educational workshops, they did report more positive engagement with older people as measured by the SSQ. As earlier, it is noteworthy that consistent results were not found on scales that conceptually overlapped (e.g., positive attitudes increased but negative attitudes did not decrease). Several explanations are offered. First, because there were intervention and control conditions at each of the schools involved in the study, it is possible that diffusion of education may have occurred across the two groups, resulting in less clear-cut findings. Although students were instructed not to discuss the workshop with their peers until after the final testing phase, it is possible that the intervention and control groups may have interacted across the time the educational program was delivered. However, if this did happen, the intervention group did show greater change than the control group, suggesting that the intervention was effective. Even if some of the effect of the program did “rub off,” the remaining significant impacts further highlight the potential of the intervention. However, having the classroom as the unit of analysis, and the possibility of contagion from treatment to control classrooms, is a significant limitation of the study. Given the nature of the study, social desirability bias may also have been a factor, with participants from both groups perhaps



providing answers that would be viewed favorably, and therefore creating additional error in the data. Demand characteristics represent a similar potential confound, whereby participants were likely to have been cognizant of the aims of the study, and perceive expectations to report higher levels of respect at follow-up timepoints. Despite these limitations, the study still shows that the educational program caused significant, long-term gains relative to a control group across a range of outcomes measures. A further limitation of the study was the inability to test the practical applications of respect toward older people in the adolescents. Despite the improved knowledge, attitudes, and social skills reported by adolescents in the educational program group, it is difficult to conclude that the lessons learned during class were influential in producing more positive contact, in terms of frequency and quality, with older adults outside of the classroom. Older individuals emphasized the importance of interpersonal interactions as a form of respect in the discussion groups conducted in Study 1. Future studies therefore need to incorporate a behavioral measure, or a qualitative component to determine any increase in amount of interaction or respectful behavior demonstrated by the students, as well as the perception of respect from the view of the older person. Finally, it is noteworthy that the manualized educational program we developed fitted smoothly into the year-nine school curriculum and was embraced by the participants. This suggests that the program could be suitable for a broader implementation within curricula that focus on society, health, well-being, and so forth.

Conclusion Respect is a key determinant for quality of life in older people, with studies consistently showing that older individuals who feel respected have a greater sense of life satisfaction (Ghusn et al., 1996; Noelker & Harel, 2000). However, older people are subjected to ageism in today’s society, with adolescents in particular holding highly negative attitudes toward older people (Nelson, 2007). The current study aimed to broaden knowledge about the meaning of respect for older individuals, promote an understanding of older individuals’ needs and views, and evaluate a program designed to promote increased respect and expression of respect among adolescents in the Australian population. The findings from Study 1 provide a better understanding of the issues related to respect toward older adults and point to a number of incongruent beliefs and perspectives between adolescents and older adults. Adolescents’ views of the conditional nature of expressing respect, as well as older adults’ recognition of societal shifts in discipline and deference to authority are two examples of important factors in respect. Findings from Study 2 provide evidence for the effectiveness of a four-session educational program to improve knowledge, attitudes, and social skills among adolescents, and support previous research indicating such interventions to improve respect for the elderly may play an important role in improving perceptions of interactions with older adults. Overall, the present study has contributed to an understanding of respect for older adults, and demonstrated that high school educational programs, with a focus on respecting older members of our community, could be an effective means of improving adolescents’ perceptions of older adults. As our population ages, it is vital that younger people are educated on the potential impacts of their attitudes

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and behaviors toward older people, and are made aware of the importance that respect has for the well-being of our elders. It is therefore recommended that further research explore the most efficient and effective ways to educate our young people on the issue, and positively influence attitudinal and behavior change to increase respect for older adults in our society. Keywords: respect; adolescents; older people

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