Development and psychometric properties of the Attitudes Toward Intellectual Disability Questionnaire - Short Form.

BACKGROUND: Understanding public attitudes towards people with intellectual disability (ID) can help orient activities to promote the social inclusion of this group. The ATTitudes toward Intellectual Disability (ATTID) questionnaire is a validated 67-item tool used to assess attitudes towards people with ID from a multidimensional perspective. It is based on a five-factor model tapping into cognitive, emotional and behavioural components of attitudes. In order to facilitate international research, the goal of this study was to develop a short version that would retain the long form's psychometric properties. METHODS: Analyses were conducted on a sample of 1608 respondents who completed the full-length ATTID. A four-step test refinement procedure was used to reduce the number of items. The first two steps involved a Cronbach's alpha analysis. Items retained were then reviewed to assess face validity. Correlations between factors were calculated, and a factor analysis was performed to compare the original and short forms. RESULTS: The number of items in the ATTID was reduced from 67 to 35. The short form maintained good overall reliability. The correlational pattern between factors in both the long and short form is generally the same. The factor analysis of the short form showed a similar five-factor structure with some loss of variance. CONCLUSIONS: We recommend the short form be used when administration time is an issue, particularly in a research context. Replication studies with new samples are needed to further assess the psychometric properties of the ATTID-Short Form.

Attitudes of health care professionals toward people with intellectual disability: a comparison with the general population.

BACKGROUND: Few studies have examined attitudes that may promote the social inclusion of persons with an intellectual disability (ID) among health care providers (HCPs). Yet these attitudes could impact the accessibility and quality of services provided to this population, as well as the general attitudes of HCPs. The objectives of this study were to (1) examine HCPs' pro-inclusion attitudes toward people with ID, (2) compare these to the general population's attitudes and (3) examine how HCPs' attitudes vary as a function of their socio-demographic characteristics. METHOD: The Attitudes Toward Intellectual Disability Questionnaire was administered to 367 HCPs and a representative sample of the Québec population (N = 1605). RESULTS: Results indicated that at least half of HCPs displayed positive attitudes, that is, attitudes that are compatible with notions of social inclusion and equal rights, toward individuals with ID. Positive attitudes were less frequently observed for the Interaction and the Sensitivity or tenderness factors measured by the Attitudes Toward Intellectual Disability Questionnaire. In comparison with the general population, HCPs exhibited more positive attitudes on the Knowledge of causes and Sensitivity or tenderness factors and less positive attitudes on the Interaction factor. HCPs who regarded themselves as more knowledgeable about ID and those who reported higher quality contacts or interactions with persons with ID expressed attitudes that were more favourable toward social inclusion. CONCLUSIONS: In addition to providing general knowledge about ID and the specific health care needs of individuals with ID, training programmes should also promote interactions with this population. Further studies are needed to document HCPs' pro-inclusion attitudes toward people with ID and to assess the impact of interventions on these attitudes.

Asthma counselling targeted to removal of domestic animals.

OBJECTIVES: To create and evaluate the efficacy of a short individualized educational intervention program, based on Prochaska's transtheoretical model, for a six-month period in a population of adult asthma patients living with domestic animals but sensitized to these pets. METHODS: A randomized, controlled study using a pretested questionnaire was conducted at three different times (pretest, and at three and six months postintervention). RESULTS: Eleven members (29%) of the intervention group and eight members (21%) of the control group removed their pets within six months (X(2)=3.23; P>0.35). The two groups showed similar improvements in their perception of the benefits of pet removal and in their level of belief that they could do it. The experimental group showed a greater improvement in knowledge acquisition about asthma and allergies than the control group (P<0.05). Both experimental and standard educational interventions were effective in facilitating progression through the stages of behavioural change. CONCLUSION: Overall, the results do not support the utility of behavioural change educational intervention, tailored to the transtheoretical model stage of the individual, in the context of convincing patients to remove their pets from their homes. However, the decision-making aid appears to be helpful in raising awareness of the problem of asthma and allergy in the patient, and in developing appropriate knowledge.

Stocking density and feed barrier design affect the feeding and social behavior of dairy cattle.

The objectives of this study were to: 1) evaluate how stocking density at the feed bunk affects feeding and social behavior of dairy cows; and 2) determine if this effect is further influenced by the type of feed barrier used. Thirty-six lactating Holstein cows, allotted to 4 groups, were subjected to each of 4 stocking density treatments and 2 feed barrier treatments. Initially, 2 groups were assigned to a headlock barrier, and 2 groups to a post-and-rail barrier. Each group was then exposed to 4 stocking density treatments (0.81, 0.61, 0.41, and 0.21 m/cow, corresponding to 1.33, 1.00, 0.67, and 0.33 headlocks/cow), in 4 successive 10-d treatment periods. After these periods, the feed barriers were switched between groups and the 4 stocking density treatments were readministered. Time-lapse video was used to quantify feeding, standing, and aggressive behavior at the feed bunk. Daily feeding times were greater and duration of inactive standing in the feeding area was less when using a post-and-rail compared with a headlock feed barrier. Feeding time decreased and inactive standing increased for both barrier designs as stocking density increased at the feed bunk. Cows were displaced more often from the feeding area when the stocking density was increased, and this effect was greater for cows using the post-and-rail feed barrier. Cows ranked lower in the social hierarchy at the feed bunk were displaced more often when feeding at a post-and-rail barrier, particularly at high stocking densities. Therefore, we recommend avoiding overstocking at the feed bunk to increase feeding activity and reduce competition. Use of a barrier that provides some physical separation between adjacent cows, such as a headlock feed barrier, can be used to further reduce competition at the feed bunk.

Physical activity barriers in diabetes: development and validation of a new scale.

To develop and validate a questionnaire measuring perceived Barriers to Physical Activity in Diabetes (type 1) or BAPAD1. Initially, an open-ended questionnaire was filled by 36 patients. The modal accessible beliefs obtained on this pilot study were analysed and a scale composed of 12 items (BAPAD1) was developed and validated. Seventy-four type 1 diabetic patients filled the BAPAD1 scale. Cronbach alpha coefficient was 0.85 and the correlation between the test-retest scores was 0.84, both indicating adequate reliability of the barriers scale. Each item of BAPAD1 scale displayed very good item characteristic curve except for item 12, which was withdrawn. The test reliability curve indicated that the BAPAD1 scale is informative (value>or=0.82) at all levels of perceived barriers toward physical activity. Moreover, among diabetic-related items, the risk of hypoglycemia showed a particularly good item characteristic curve. In summary, the BAPAD1 scale presents excellent psychometric proprieties and among diabetic-related items, the risk of hypoglycemia should be considered as a significant target to overcome in order to increase physical activity. This new validated tool should be useful in identifying the most salient barriers toward the practice of physical activity and thus, permit more focused intervention in order to overcome those barriers.

Influence of a persuasive strategy on nursing students' beliefs and attitudes toward provision of care to people living with HIV/AIDS.

Based on the theory of planned behavior and the elaboration likelihood model, the aim of this study was to verify the effect of persuasive messages on nursing students' beliefs and attitudes regarding provision of care to people living with HIV/AIDS. The assumption was that a persuasive communication strategy induces a constructive change in beliefs and attitudes regarding provision of care. Baseline data collection was performed among a group of 74 nursing students (experimental group = 27; control group = 47). The questionnaire assessed the variables of the theory of planned behavior (i.e., beliefs, attitudes, perceived behavioral control). The results confirmed that persuasive messages generated a change in beliefs and attitudes of the nursing students concerning providing care to people living with HIV/AIDS. It appears that this strategy of modifying behavioral predispositions is effective and generates cognitive and affective changes. Therefore, educational programs should take these observations into consideration to ensure that future nurses are better prepared to provide appropriate care to people living with HIV/AIDS.

Household food insecurity was prevalent in Java during Indonesia's economic crisis.

Valid assessment of household food security is important, particularly in rapidly changing circumstances such as the economic crisis that struck Indonesia in 1998. The Cornell-Radimer tool for measuring household food security has now been used in several social and economic settings. An adaptation of this tool was used in the context of the economic crisis of Java, Indonesia in June-August 1998 in a survey of 1423 mothers with children < 5 y old. Qualitative and quantitative data contributed to understanding food insecurity and provided evidence for some aspects of validity. The data showed substantial household food insecurity with 94.2% of households found to be uncertain or insecure about their food situation in the previous year. Of respondents, 11% reported losing weight in the previous year because of lack of food. Food security in Java was undoubtedly compromised by the economic crisis. These results suggest, on the basis of qualitative and quantitative understandings of food insecurity, that this tool provided a useful measure of the situation in Java in 1998. From this study and others done recently, such a tool or ones constructed using a similar approach have been found to be useful in various settings in which there is a need to understand and identify household food insecurity for purposes of estimating and monitoring prevalence and targeting of policies and programs. Further research to validate this approach in various settings is warranted.

The attitude of Canadian nurses towards advance directives.

This article seeks to shed light on the beliefs that influence nurses' intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses' beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients' wishes, nurses should be aware that they do not systematically guarantee respect of a patient's autonomy, nor do they replace a relationship based on trust between patients and health care professionals.

Risk factors associated with alpine skiing injuries in children. A case-control study.

We investigated the relative contribution of four risk factors to the occurrence of injuries among alpine skiers aged 12 years and younger (3 to 12 years old; mean age, 9.43 years). The risk factors selected were deficient binding adjustment, absence of formal training, low skill level, and use of rented equipment. A group of injured skiers (N = 41) and a control group of uninjured skiers (N = 313) were recruited among young skiers at one major alpine ski center in the Quebec City, Canada, area during the 1995 to 1996 season. No significant group differences were found for mean age or sex distribution. The adjusted odds ratios for injury were 7.54 (95% confidence interval [2.57, 22.15]) for skiers in the low level of skill category relative to highly skilled skiers, 7.14 (2.59, 19.87) for skiers who rented their ski equipment compared with skiers who owned their equipment, and 2.11 (1.02, 4.33) for skiers with ill-adjusted bindings compared with skiers with better-adjusted bindings. Only formal training did not meet the 0.05 significance level for entry into the model; this is probably because of methodologic limitations. Implications of these results for the development of a prevention program aimed at young skiers are discussed.

Understanding the use of a community-based drive-home service after alcohol consumption among young adults.

To know and understand the intention of young adults to use, during the Christmas and New Year's period, the community drive-home service after drinking alcohol, that is, to phone for oneself when they are the driver or when they are the passenger to suggest to a friend who is the driver to phone for the service. This study was conducted in the Province of Quebec, Canada, among a representative sample of 544 young adults aged 18 to 24 years. Self-administered questionnaires were completed by mail. Young adults showed a very good knowledge of the drive home service and had a very positive attitude toward its use. Among those who reported having experienced drinking too much alcohol during the Christmas and New Year's period, 17 percent had phoned when they were the driver and 36 percent had, when they were a passenger, suggested to a friend who was the driver to phone the community drive-home service. Nonetheless, more than half of them intended to use or to recommend its use to a friend in the future. Several factors identified in this study might be useful for increasing this drive-home service and therefore, contribute to lowering the risk of injury related to alcohol-impaired driving among young adults.

Comparison of patients' and health care professionals' attitudes towards advance directives.

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: Health care institutions in the province of Québec, Canada. SURVEY SAMPLE: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy.

An application of Ajzen's theory of planned behaviour to predict mothers' intention to use oral rehydration therapy in a rural area of Benin.

The aim of this study was to identify the psychological factors influencing mothers' intentions to use oral rehydration therapy (ORT) for the treatment of children's diarrhea in rural areas in South Benin. The subjects were 128 illiterate and animist mothers, selected at random in the areas of Pahou and Avlekete. Mothers were interviewed at home, using a pre-tested instrument investigating predictors of motivation as defined in Ajzen's theory of planned behaviour. The variables measured were intentions, attitudes, subjective social norm, perceived behavioural control and socio-demographic indicators. The regression of intention on all variables yielded an adjusted R2 of 0.40 (P < 0.0001), with perceived consequences of using ORT, perceived barriers to its use, and the zone of habitation being the significant predictors. The results suggest that the promotion of the use of ORT for treatment of diarrhea, in these areas, should be facilitated if the mothers perception of the advantages of using ORT is reinforced and if they have easier access to the health care services offered by local village health workers.

The pattern of influence of perceived behavioral control upon exercising behavior: an application of Ajzen's theory of planned behavior.

The aim of the present studies was to verify the basic assumptions underlying the theory of planned behavior for the prediction of exercising intentions and behavior among adults of the general population (study 1) and a group of pregnant women (study 2). In both studies, baseline data were collected at home with trained interviewers and with the use of paper-and-pencil questionnaires. The self-report on behavior was obtained 6 months (study 1) and between 8 and 9 months (study 2) after baseline data collection. In study 1, perceived behavioral control influenced behavior only through intention. In study 2, none of the Ajzen model variables was associated to exercising behavior. Nonetheless, intention was influenced by attitude, habit, and perceived behavioral control. The results of the present studies suggest that perceived behavioral control contributes to the understanding of intentions to exercise but not to the prediction of exercising behavior.

Predictors of smoking behaviour: an application of Ajzen's theory of planned behaviour.

The aim of the present paper was to verify the basic assumptions underlying the theory of planned behaviour for the prediction of cigarette smoking intentions and behaviour among adults of the general population (study 1) and a group of pregnant women (study 2). Each study was developed based upon Ajzen's theory of planned behaviour. In both studies, baseline data was collected at home with trained interviewers and with the use of paper and pencil questionnaires. The self-report on behaviour was obtained 6 months (study 1) and between 8 and 9 months (study 2) after baseline data collection. In study 1, for smokers, perceived behavioural control, attitudes and subjective norm were explaining intention, whereas perceived behavioural control and habit were the most important predictors of behaviour. In study 2, smoker's intentions was mainly under the influence of perceived behavioural control and attitude, whereas behaviour was predicted by perceived behavioural control only. The present studies suggest that promotional programmes should help smokers to know and develop their will-power regarding non-smoking of cigarettes and should be informed of the effort required in order to modify smoking behaviour.

Self-reported smoking and exercising behaviours during the postnatal period: assessing congruence between spouses.

The aim of the study was to assess the congruence between women's self-reported behaviours during the postnatal period and the answers provided by their husbands. One hundred nineteen couples participated. Firstly, women reported their own smoking and exercising behaviours for four months following childbirth. Subsequently, husbands evaluated their spouses' behaviours over the same period of time. Smoking behaviour was assessed on 5-category scale ranging from non-smoker to daily smoker whereas physical activity was measured on a 6-category scale ranging from no physical activity to regular physical activity. The polychoric correlation coefficients and the weighted Kappa indexes indicated that the degree of congruence between respondent pairs were appropriate, but better for smoking than exercising. The results of the present study support the idea that the information obtained from spouses can be helpful in the assessment of the reliability of the answers provided by their live-in partner, particularly in surveys regarding smoking.

Prediction of intention to exercise of individuals who have suffered from coronary heart disease.

The aim of the study was to understand the intention to exercise of individuals who suffer from CHD. A group of 161 cardiac patients completed a questionnaire that investigated intentions, attitudes, subjective norms, perceived barriers, habits, perceived difficulties, and personal normative beliefs with respect to exercising, as well as perceived severity of and perceived vulnerability to re-infarction. Regression of intention yielded an R2 of .41 (p less than .0001), with perceived barriers, habits, and perceived difficulties as the significant predictors. MANOVA indicated that high and low intenders differed (p less than .01) according to their perception of three barriers: difficulties in time management, difficulties in psychological adaptation, and laziness. These results suggest that new guidelines should be adopted for the development of cardiac rehabilitation exercise programs.

Optimism and health-relevant cognitions after a myocardial infarction.

The relationship between dispositional optimism (LOT) and health-relevant cognitions after a myocardial infarction was examined with 158 patients (mean age = 52.7 +/- 8.1 yr.). Patients above the median on optimism (i.e., optimists) scored significantly lower on perceived susceptibility, perceived severity, and experienced fear than did pessimists. However, no difference on perceived self-efficacy was reported between optimists and pessimists. It is concluded that these results provide further evidence for the LOT's construct validity.