Attitudes Towards Blind and Deaf Persons and Experience-Related Factors in Chilean Dental StudentsABSTRACT
Objective: To determine the attitudes towards blind and deaf persons and experience-related factors in a sample of Chilean dental students.
Material and Methods: This cross-sectional study involved dental students from one Chilean university. Data were collected through a survey, including sex, course, acquaintance with disabilities, training on disability, and healthcare delivery to people with disabilities (PwD), and attitudes were measured using the Chilean validated Multidimensional Attitudes Scale (MAS). Data analysis involved descriptive statistics, internal consistency, and comparative analyses.
Results: 311 dental students completed the survey. The Cronbach's alpha coefficients indicated good internal consistency (>0.7) for the MAS scales and their dimensions. Attitudes towards deaf and blind individuals were generally positive (<2.5 points), except for the calm dimension, which showed a tendency towards negative attitudes (>3.5 points) across most groups. Students with cognitive disability connections scored higher (>0.5 points) than those with sensory disabilities.
Conclusion: Chilean dental students' attitudes towards blind and deaf individuals showed an overall positive inclination, except in the calm dimension.
Keywords:
Attitude of Health Personnel; Persons with Disabilities; Blindness; Deafness; Students; Dental.
Introduction
Visual and hearing disabilities encompass approximately 20% of individuals with disabilities (PwD). Within this population, there is a notable decrement in quality of life, alongside a higher prevalence of physical and psychological ailments [1]. Despite the recognition of disability as an integral part of human diversity [2], PwD frequently encounter negative barriers [3,4]. These negative attitudes persist even among healthcare professionals, leading to a range of challenges such as infantilization, a dearth of empathy, lack of respect, and impatience from office personnel. Consequently, individuals with disabilities face substantial difficulties in accessing appropriate healthcare, aggravated by a shortage of proficient professionals equipped to meet their unique needs [1]. Such negative attitudes contribute to the exclusion and limited participation of PwD in society, resulting in pervasive access barriers for this population [3,4].
In recent years, the integration of special care dentistry (SCD) programs into dental school curricula has garnered attention. These programs have demonstrated favorable outcomes by fostering the identification and response to the healthcare requirements of individuals with visual or hearing disabilities [5]. Moreover, they have been effective in enhancing knowledge, cultivating positive attitudes, and refining the skills for treating PwD [6]. Additionally, these initiatives have been instrumental in shaping dental students' personal values [7]. Nevertheless, the attitudes of dental students, particularly towards PwD, remain relatively understudied. Research among German dental students revealed a willingness to engage with PwD, coupled with a strong interest in SCD-related subjects [8]. Similarly, Malaysian dental students exposed to SCD curricula displayed more favorable individual attitudes and greater self-efficacy in managing PwD compared to their counterparts without such exposure [9]. Conversely, findings from the United States indicate that, while students express positive intentions to serve low-income populations, they exhibit diminished confidence and reluctance to treat PwD, particularly among female students [10].
The existing literature lacks comprehensive research on dental students' attitudes towards individuals who are deaf or blind. Furthermore, there is a dearth of studies examining how prior experiences with deaf or blind individuals influence these attitudes, particularly among dental students. This knowledge gap is particularly relevant given the distinct challenges of delivering dental care to individuals with hearing or visual impairments, primarily due to communication barriers [5]. As a result, these unique challenges can shape dental students' attitudes towards this specific population [1].
This study aims to determine the attitudes towards blind and deaf persons and experience-related factors in a sample of Chilean dental students.
Material and Methods
Study Design, Settings, and Sample
This cross-sectional study sought to assess attitudes towards individuals who are blind or deaf, as well as factors related to personal experiences, among dental students in Chile. The study encompassed the entire cohort of 350 dental students enrolled at Universidad de Concepción, ranging from first to fifth year, with no exclusion criteria applied. Ethical approval was obtained from the Research and Bioethics Committee of the School of Dentistry at the University of Concepción, and the study adhered to the ethical principles outlined in the World Medical Association Declaration of Helsinki. Before participation, informed consent was obtained from all participants, and strict confidentiality was maintained in handling their responses.
Variables and Instrument
The data collection process for this study encompassed various variables, including sex (female/male), course (1st to 5th), whether participants had a relative/friend/acquaintance with a disability (Yes/No), and if so, the specific type of disability (Physical/Sensorial/Cognitive/Psychiatric). Additional variables included whether participants had received any training on disability (Yes/No), whether they had delivered healthcare to PwD (Yes/No), attitudes towards deaf or blind people measured using the validated Chilean version of the Multidimensional Attitudes Scale (MAS) [11], and the sex of the deaf or blind person in the scenario presented in the MAS.
The MAS utilized in this study consisted of four subscales, namely negative affections, calm, cognitions, and behavioral domains, which together comprised a total of 29 items. Confirmatory factor analysis was conducted to validate and assess the suitability of the four-factor model in the Chilean version of the MAS. Originally developed to evaluate attitudes towards physical disabilities [12], the MAS presents participants with a social scenario in which a person without disabilities interacts with an individual in a wheelchair, referred to as José/Claudia in the Spanish version [13]. Participants indicate the emotions, thoughts, and potential behaviors evoked in the person without disabilities. Responses are provided on a 5-point Likert scale, ranging from 1 ("not at all") to 5 ("very much"). Higher scores indicate more negative attitudes, while lower scores reflect more positive attitudes. For this study, the stimulus was modified to include a "Blind person" and a "Deaf person." As a result, each participant completed two MAS instruments.
Data Collection
All 350 students were invited to participate in the study, and their voluntary involvement was obtained by obtaining signed informed consent after a detailed explanation of the study's objectives. The data collection process was conducted by two researchers who administered the survey. Data collection took place within the classroom setting at the beginning of theoretical or clinical activities over two months during the second semester. When a student was absent during the initial visit, a subsequent visit was made to their course. The data collection process lasted approximately 10 minutes.
To ensure respondent anonymity and encourage candid responses, the four versions of the instruments were randomly assigned to participants, stratified by gender. Female students were given the choice between two scenarios in the MAS: "Claudia" with a "young blind male" or "Claudia" with a "young blind female" to evaluate their attitudes towards blind individuals. Similarly, for deaf individuals, the options were "Claudia" with a "young deaf male" or "Claudia" with a "young deaf female". Male students also had two options for deaf and two options for blind scenarios, but the name "Claudia" was replaced with "José".
Statistical Analysis
The collected data were tabulated in Microsoft Excel (Microsoft Corp., USA) and then analyzed using Stata 14 (Stata Corp., USA). Descriptive statistics were used to summarize the quantitative variables, including the mean and standard deviation. Categorical variables were analyzed by determining their frequency and percentage distributions. Cronbach's alpha was calculated for the MAS scale and its dimensions to assess internal consistency. Since the entire population was included in the analysis, inferential statistics were not conducted.
Results
A total of 311 dental students, constituting 88.9% of the target population, actively participated in the survey. The sample consisted of 117 (37.6%) males and 194 (62.4%) females; their detailed characteristics are presented in Table 1. The Cronbach's alpha coefficients indicated satisfactory internal consistency (>0.7) for both the Deaf and Blind versions of the MAS scales and their respective dimensions. Specifically, the Cronbach's alpha values were as follows: Deaf global 0.878, negative affections 0.833, calm 0.904, behavior 0.832, cognition 0.892; Blind global 0.873, negative affections 0.842, calm 0.906, behavior 0.842, cognition 0.871.
Regarding attitudes towards deaf individuals, most scores fell below 2.5, indicating a tendency towards positive attitudes. However, the calm dimension exceeded 3.5 points across almost all groups, suggesting a leaning towards negative attitudes. The analysis presented in Table 2 revealed that the score differences among the categories were all below 0.5 points.
Similarly, attitudes towards blind individuals generally scored below 2.5 points, indicating favorable attitudes, except for the calm dimension, which surpassed 3.5 points across most groups, indicating a tendency towards negative attitudes. The analysis of attitudes towards blind individuals, as depicted in Table 3, showed that the score differences among the categories were also below 0.5 points, except in the calm dimension. In this dimension, individuals with a relative, friend, or acquaintance with sensory disability obtained lower scores (<0.5 points) compared to those with cognitive disabilities.
Discussion
In this study involving dental students, attitudes towards blind and deaf individuals demonstrated a predominantly positive trend, except for the calm dimension, where students with connections to cognitive disabilities showed relatively more negative attitudes compared to those associated with sensory disabilities. The findings align with previous studies on dental students' attitudes towards people with disabilities, albeit with variations in measurement instruments and focus [8-10]. It is important to note that interactions with deaf and blind individuals differ from those with individuals with physical or cognitive disabilities due to communication barriers [5,14]. Therefore, caution must be exercised when making comparisons that differ not only in measurement instruments but also in associated barriers.
Moreover, the higher scores indicating negative attitudes in the calm dimension can be attributed to the students' connections with deaf or blind individuals. Those who had relatives, friends, or acquaintances with such disabilities exhibited more positive attitudes in the calm dimension of the blind version of the MAS [1,6,9]. Previous research has shown that interpersonal contact with PwD can significantly impact affective variables, such as anxiety and empathy, leading to improved attitudes towards disability [15]. Conversely, increased experience with individuals with physical disabilities, both professionally and socially, is associated with more favorable attitudes [16].
The findings of this study have important implications for dental workforce training. By providing targeted, experiential, and comprehensive training, dental professionals can develop a better understanding of the needs and experiences of PwD, leading to more inclusive and patient-centered care. Therefore, it is recommended to incorporate such programs into the early years of dental education to enhance students' attitudes towards PwD, even before the clinical years, thereby preparing them for PwD-dentist interaction.
The implementation of disability-specific structured teaching programs has proven to be effective in improving attitudes towards disability among health science students [17]. Additionally, both traditional and online courses have been shown to enhance medical students' knowledge of disability and improve their attitudes towards PwD [18]. Thus, it is crucial to develop effective methods for enhancing healthcare professionals' disability-related knowledge and attitudes through further research [19].
In dentistry, the development and evaluation of various structured communication disability (SCD) programs have yielded positive results in improving dental students' attitudes towards PwD [5,9,17,19-21]. In particular, role-play has been identified as a powerful tool for fostering positive attitudes towards PwD in dental education, emphasizing the importance of multidisciplinary training [22]. Additionally, courses that include individuals with visual or hearing disabilities have proven successful in helping students identify and respond to these specific needs [5]. Courses must be experiential and immersive, not just theoretical. To advance future interventions in this area, it is crucial to consider integrating technology, particularly to facilitate communication between dentists and patients who are deaf or blind [23]. Embracing technological solutions can greatly enhance the dental experience and ensure effective communication in such scenarios.
In higher education, service-learning programs in adapted physical activity have shown positive effects on college students' attitudes towards people with disabilities. Providing students with autonomy and multiple choices, including various practicum types, locations, and disability populations to engage with, can promote optimal contact conditions and facilitate attitude change. Strategies targeting attitude change should be integrated into programs aimed at improving attitudes towards people with disabilities [24].
Addressing the healthcare needs of PwD requires comprehensive improvements in all aspects of healthcare. Accessible physical infrastructure, along with training in alternative modes of communication, such as sign language and picture exchange communication systems, can enhance understanding of the health issues faced by PwD [1,5,25]. Healthcare professionals' attitudes are influenced by their prior experiences and their skills in addressing the needs of people with disabilities [1]. Therefore, educational interventions should focus on modifying factors that influence providers' attitudes to mitigate fear and improve the quality of care [16].
It is important to acknowledge the limitations of this study. The sample was limited to undergraduate dental students, limiting the generalizability of the results to other professional communities. Future studies should include diverse samples with varying levels of education to enhance understanding of attitudes towards people who are blind or deaf. Additionally, the use of an explicit instrument such as the MAS may introduce social desirability bias, potentially influencing participants' responses. Future research could incorporate Implicit Association Tests (IATs) alongside explicit measures to assess implicit attitudes. Despite these limitations, this study contributes to the assessment of attitudes towards specific populations of PwD, such as blind and deaf individuals, using a validated instrument and exploring its association with experience-related factors.
Conclusion
Chilean dental students displayed an overall positive inclination in their attitudes towards blind and deaf individuals, except for the calm dimension, where students with connections to cognitive disabilities exhibited comparatively more negative attitudes than those associated with sensory disabilities.
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Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
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Edited by
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Academic Editor:
Wilton Wilney Nascimento Padilha
