Adapting Antonak and Harth's Mental Retardation Attitude Inventory for Kuwait's Culture
Authors: Al‐Kandari Hayfaa Y. , Salih Fathi A. 
Published: March 2010

The purpose of this research was to adapt Antonak and Harth's (1994) Mental Retardation Attitudes Inventory for the Kuwaiti culture and to investigate its four‐dimensional structure. The study also aimed at identifying a unidimensional subset of items besides examining the quality of the identified items and the overall inventory. The 34 ‐item adapted inventor y was administered to 56 4 college students. Item analysis indicated that 29 items have had good psychometric characteristics. However, the exploratory factor analysis, cross‐correlations of scale and item scores, and correlations among scales did not support the four‐dimensional structure of the adapted inventory. Further, the sample was split into two random halves. A uni‐dimensional subset of 20 items was identified in one sample by iterative factor analyzing the item data and discarding items with small loadings. The other sample was used to cross‐validate uni‐dimensionality of the identified items. Analysis indicated that scores of the 20‐item inventory have high Cronbach coefficient alpha, and high stability and generalizability coefficients. Partial support for the validity of the scores had been ascertained by comparing the scores of male and female students, and by regressing the inventor y scores on indicators of familiarity with individuals with mental retardation. Findings were discussed with reference to Kuwaiti culture.

Over the last two decades, inclusion has internationally become a critical part of the reform efforts to improve the delivery of services to individuals with Mental Retardation (MR). This trend focuses on increasing the opportunities for the placement of these individuals in the same social and educational set tings as individuals without MR. The new arrangements for providing services have created challenges to people without disabilities concerning acceptance, integration, and inclusion of individuals with MR into the mainstream of society (Praisner, 2003). Many researchers (e.g. Priestly, 1998; Yazbeck McVilly & Parmenter, 2004) have convincingly argued that these challenges have their roots in the societal norms and values that concurrently developed throughout the unfolding history of the meaning of MR. As Priestly (1998) noted, although people with differences have existed in all societies, the degree to which they were integrated or excluded varied according to predominant cultural perceptions. Yazbeck, McVilly and Parmenter (2004) suggested that people's attitudes toward individuals with MR are socially constructed and are acquired through experience over time.

Individuals with MR are often judged by people based on their disability instead of their whole lives and what they may accomplish and experience during their life (Blatt, 1987). Consequently, People may rely on false generalization and develop negative attitudes towards individuals with MR. Makas, Finnerty‐Fried, Sugafoos, and Reiss (1988) noted that for nondisabled persons, positive attitude toward people with disability is usually conceptualized as being ‘nice’ and ‘helpful’, whereas for a person with a disability, the attitude would be dispensing with the category of disability entirely. A study of community attitudes in one state of Australia found that up to 86% of respondents reported feeling ‘uncomfortable’ when interacting with individuals with disabilities (Enhance Management, 1999). Another study (European Commission, 2001) found that 40% of Europeans reported feeling ‘uneasy’ in the presence of people with disabilities.

Attitudes manifest themselves as positive or negative reactions toward an object, driven by beliefs that impel individuals to behave in a particular way (Yuker, 1988). They comprise a complex of feelings, desires, fears, convictions, prejudices, or other tendencies learned through varied experiences that give rise to a set or readiness to act toward a person in a certain way (Chaiken & Stangor,1987). This means that attitude is not behavior, but the precondition of behavior. In addition, Myers, Ager, Kerr, and Myles (1998) identified three types of attitudes that influence how non‐disabled people interact with, and include or exclude people with disabilities: (1) A preparedness to engage with people as consumers, neighbors, or friends; (2) a lack of awareness about individuals with MR; and (3) a wariness or hostility regarding the idea of community integration.

Research has shown that the third type of attitudes, which represents negative and non‐acceptance of individuals with MR is commonly observed (Gething, 1994; Schwartz & Armony‐Sivan, 2001). Such negative attitudes in a society may present people with MR as a burden on the welfare system. Moreover, people might not see individuals with disabilities as possessing a valuable social role or possessing the same abilities and characteristics that the majority of people possess. Tus, individuals with MR may not be accepted or included in society and may often be treated badly. In turn, Wolfensberger (1988) indicated that individuals with MR, being in a devalued position, would behave badly as they think that this is what is expected of them.

As integration of persons with MR is increasingly becoming a global reality, Kuwait has designed social policy aimed at promoting acceptance and inclusion of people with disabilities into the mainstream of society. To implement the policy of integration, the Kuwaiti government is continually forming inclusive services for individuals with MR. The recent policy of inclusion (law 13/96), which has been adopted in 1996, asserts that people with disabilities have a fundamental right to live and grow within their local communities. This law has spawned an expanded system of services to encourage people with disabilities to live like people without disabilities. Inclusion policies give individuals with MR the right to be involved in the same situations as people without MR. For example, more individuals with MR, for example, are being employed. Moreover, most children with Downs syndrome now attend Kindergarten and are included in social programs for children in the general population. The general goal of all types of services provided for individuals with MR is to improve their participation in society.

Although the Kuwaiti government has shown a growing interest in the integration of individuals with MR, the chances of these individuals being able to integrate into mainstream society would depend on the attitude of others, such as students, teachers, coworkers, social workers, professionals, towards them. These attitudes, as found in many Western studies (Antonak & Harth, 1994; Gordon, Tantillo, Feldman & Perrone, 2004) are, for the most part, negative, which may contribute to negative outcomes on the part of individuals with MR (Byon, 2000). According to Wright (1983), disability situations are vulnerable to fundamental negative attitudes, and this would seem to be even truer in the culture found in Kuwait.

In Kuwaiti culture, disability has stigmatizing effect on members of the immediate and extended family; families tend to keep members with MR out of the sight of other people. This contributes to social exclusion of people with MR. There is also the traditional common belief that disability is related to (1) God's willing that the parent should have a child with a disability, (2) God is punishing the parent, (3) God is testing the parent, or (4) God is selecting the parent for an unknown reason. Commonly, persons with MR have been considered burdensome and shameful, because they are incapable of contributing to traditional social obligations and roles.

While those traditional beliefs still exist, the law 13/96 was legislated to support the integration of persons with MR into various aspects of life. Consequently, we expect that people in the society would react to this trend with frustration, anger, or refusal. Usually, people in Kuwait have little or no information about individuals with MR; thereby uninformed determinations, such as stereotypes, reflect their attitudes toward these individuals. According to Blatt (1987), a stereotype will fill in the cracks and unanswered questions in a situation with which people are not familiar. Langer (1989) in her theory of ‘mindfulness’ also shows that stereotype is ‘premature cognitive commitments’ that leads people to make judgments without enough information and reflection.

Moreover, the society labels given to individuals with MR are often accompanied with stigma and negative connotations. This situation makes it difficult for those individuals to be included into society and be accepted for what they actually are and not for what others assume them to be. According to Biklen and Bogdan (1977), this type of discrimination is called ‘handicapism’ and is defined as‘…a set of assumptions and practices that promote differential and unequal treatment of people because of apparent or assumed physical, mental, or behavioral differences’ (p.206). These perceptions may prevent individuals with MR from being accepted, and they might be viewed, based on Erikson's theory, as a pseudo species, or as less than human (Smith, 1981).

Furthermore, professionals', leaders', and students' views and beliefs about the integration of individuals with MR into society may result in slowing the process of inclusion and discouraging people from accepting these individuals as what they are. For example, though senior staff in Kuwait's Ministry of Social Affairs succeeded in including children with Downs syndrome into public kindergarten, no other effort has been made since 1996 to integrate other children with disabilities into inclusive educational settings. More critical is that, while leaders make efforts toward inclusion, they continue to support the permanent residence of individuals with MR in social welfare institutions and urge the government to provide free health, social and educational services for the residents. Ahmad (2004) found that between 1992 and 2002, there was an increase in the number of children, and males and females adults with MR who live in the Social Welfare Institution for permanent care. The number of residents with MR has increased from 223 to 296.

According to Philips (1992), leaders' and professionals' beliefs about individuals with MR could have commenced with the industrial revolution that brought with it the practice of classifying people who were different, and who were not able to pursue personal dreams or act as the industrial society required. Leaders and professionals may perceive individuals with MR, as Blatt (1987) stated, blessed innocents or surplus population that is unnecessary and expendable. These beliefs may never give the individuals with MR an adequate opportunity to present themselves and their abilities to others.

Praisner (2003) suggested that leaders' attitudes are the key factor in successful inclusion. Due to leadership position, leaders' and professionals' attitudes about inclusion either could result in increased opportunities for individuals with MR to be served in different settings or increased efforts to support the segregated special education services. According to Goodlad and Lovitt (1993), leaders and professionals have the decision to develop an inclusive setting, if they (1) make and honor commitments, (2) do what they say in formal and informal settings, (3) express interest in inclusion, (4) act and make their actions known, and (5) organize their staff and their physical surroundings to implement inclusive programs. As Praisner (2003) stated, the success of inclusion depends on how leaders exhibit behaviors that advance the integration, acceptance, and success of individuals with disabilities in general settings.

Researchers (e.g., Horne, 1985) have also shown that students' positive attitudes may increase their willingness to work with individuals with MR, and lead to removal of barriers to integrate them into society. The positive attitudes of students may help to encourage the establishment of policies and the allocation of resources to increase the integration of individuals with MR into different settings in the society (Yazbeck, et al., 2004).

To enhance the policy of inclusion in Kuwait, society needs to evaluate some of its structures and change people's attitudes to fit the needs of individuals with MR instead of making these individuals fit society's structures. Helping individuals with MR to be included into society and establish socially valued roles would not be difficult if the attitudes of society are less restrictive and less resistant to change.

As Kuwait continues to develop social and educational policy about inclusion, researchers must pay attention to the connection between integration and attitudes. The provision of educational and social opportunities for individuals with MR can be legislated by Kuwait's government, but acceptance from other people cannot be ensured without knowing people's beliefs and thoughts about persons with MR.

Developing an understanding of the attitudes that is predominant in society, which in turn influences the actions of its members, is critical if we plan for social changes and for evaluating the effectiveness of public policy on promoting an inclusive society (Schwartz & Armony‐Sivan, 2001). Given that there are negative attitudes toward people with MR, particular care must be taken to monitor changing social attitudes toward these individuals to identify any serious impediment to the progress of their inclusion in different settings: schools, workplace, and the wider community.

Research that is relevant to individuals with disabilities (e.g. Geskie & Salasek, 1988; Antonak & Harth, 1994) has revealed the need for researchers to investigate the attitudes of people toward MR. Wolfensberger (1983) suggested that the key to changing how people are valued socially is to change the perceptions people have about individuals who may differ from the norm. Research, however, has indicated that the investigation of attitudes toward individuals with MR requires a psychometrically sound instrument. It is crucial to conduct research to gather accurate information about these attitudes; it would clarify people's awareness of persons with MR, and assist in evaluating intervention programs and developing appropriate course work for special education fields. Further, it would inform public policy decisions, funding priorities, and service delivery, which in turn, enhance the likelihood of achieving successful integration and improving qua lit y of life for persons with MR (Antonak & Harth, 19 94; Schalock, 1990). Accurate measurement of attitudes could also lead to early detection of negative attitudes, such as personal prejudices, misconceptions, and irrational fears of professionals, social workers, and teachers when they first get involved in disability work settings. Furthermore, it would help in providing a baseline for monitoring changes in their attitudes over time (Byon, 2000).

Changing attitudes would help in supporting efforts of individuals with MR to become autonomous (Philips, 1992), and help to decrease the resistance of others to allow people with MR to make decisions about their own lives and to be independent (Schalock, 1990). As the history of the deinstitutionalization movement has shown, becoming autonomous and independent are not as simple as releasing people from state facilities and hoping they survive on their own. Autonomy and independence are based upon choice‐making, and choice‐making must be taught to people with MR, as they have never been allowed to make their own choices and do not know how to rationally choose for themselves.

However, as Crutcher (1990) noted, personal choice is based on opportunity, and opportunity is accessible only when society decides it should be. Therefore, in order for individuals with MR to have the opportunity to make their own decisions and be successfully included in society, special effort must be taken to change peoples' attitudes towards them.

Moreover, a psychometrically sound instrument of attitudes helps researchers to assess with known precision respondents' feelings about individuals with MR (affective aspect of attitudes), and their conceptions about them (cognitive aspect of attitudes). On the affective side, there are feelings of approval or disapproval of individuals with MR in the society. On the cognitive side, there are beliefs, knowledge, and expectations that affect people's behavior towards individuals with MR. The affective and cognitive aspects affect the respondents' opinions of what services should be provided for individuals with MR and what policy should be adopted. These also assist in the design, implementation, and evaluation of social intervention program and strategies geared toward removing barriers to integration (Geskie & Salasek, 1988).

The present study focused on adapting, for use in Kuwait, the Mental Retardation Attitude Inventory‐Revised (MR AI‐R) of Antonak and Harth (1994). The MRAI‐R was chosen because of the limitations of the MR attitudes' instruments in the Gulf States, and in particular the lack of such an instrument in Kuwait. After reviewing literature, it seemed that there was only one measure of attitudes; an inventory developed by Qaryauti (1988). Despite the claimed appropriateness of Qaryauti's scale, we decided to use the MRAI‐R of Antonak and Harth for several reasons. First, Qaryauti's scale was based on Western instruments that Antonak and Harth criticized and motivated them to construct the MRAI‐R. In contrast, Antonak and Harth constructed the MRAI‐R based on a review of more than 50 years of the attitude literature, and developed their inventory on the most available valid instrument.

Second, by reviewing the items of the MRAI‐R and Qaryauti's scale, it was clear to us that the MRAI‐R is more consistent with the requirements of the law 13/96 that was mandated in Kuwait to assure the right of individuals with MR to be included into public schools, workplace, and the wider community (see Table 1). Third, the MRAI‐R, unlike Qaryauti's scale, incorporates several components of attitudes: (1) the integration‐segregation of individuals with MR in various school programs, workplace, and community; (2) the willingness of people to be associated with individuals with MR (Social Distance); (3) the rights of individuals with MR to be included in schools, communities, and the workplace (Private Rights); and (4) the derogatory beliefs of people about the moral character and social behavior of individuals with MR. Of the 22 items in Qaryauti's scale, 13 were related to derogatory beliefs, six to social distance, and only three to private rights and integration‐segregation.

Fourth, many transcultural researchers have used the MRAI‐R in populations as diverse as the United States, Australia, and Korea. In the US, Ward (1998) used the MRAI‐R to explore relationships between empathy and attitudes among 200 parents and adult consumers with developmental disabilities. Also, Yozwiak (2002) utilized the MRAI‐R to examine the beliefs and attitudes of 210 community members toward a child with MR who was a witness to a sexual abuse case. In an Australian study, Yazbeck and others (2004) used MRAI‐R to examine differences in attitudes between students and professionals in disability services, and persons in the general community (N=492). In Korea, Byon's study (2000) used the MRAI‐R to investigate the effect of social desirability on attitudes toward MR, and to compare the relationships between attitude measures (both direct and indirect measures) and behavioral outcome indicators. Obviously, findings from a large number of studies using the MRAI‐R contribute to its validity. In contrast, we failed to find any study in which Qaryauti's scale was used.

Based on the above arguments, it seems that the MRAI‐R would be useful in needs assessments, especially in schools and mental health clinics. For example, when the ministry of education decides to implement the inclusion policy in schools, there would be a need to assess attitudes of teachers and students towards students with MR. The results of such assessment would help in designing programs that improve attitudes as needed. The MRAI‐R can also be useful for social workers, professionals, and researchers who work in a variety of primary social welfare settings. It helps them to identify and target those people who are the most in need of training and preparation to change their attitudes toward MR. In a wider scale, non‐profit organizations can use results of assessing attitudes in advocating the rights of those individuals.

In general, the primary usage of the MRAI‐R could be: (1) screening for early identification of negative attitudes; (2) assessing attitudes of specific groups toward persons with MR; (3) pre‐ or post‐ measurement in intervention studies; and (4) helping researchers who aim at studying the effects of attitudes on different variables in the life of people with MR (i.e. job satisfaction, life satisfaction, family relationship, social support), or the relationship between attitudes and demographic variables (i.e. gender, age, marital status, employment, educational status, familiarity with individuals with MR).

Following the recommendation of Antonak and Livneh (1988) that researchers should use the existing instruments and stop creating new ones, the purpose of the present study is to develop an Arabic inventory of attitudes toward individuals with MR by adapting the MRAI‐R to be suitable for use in Kuwait. Specifically, the study aimed at: (1) revising the MRAI‐R items to make them suitable to Kuwait's culture; (2) investigating the suitability of the four‐factor‐structure of the MRAI‐R for measuring attitudes toward individuals with MR in Kuwait; (3) selecting a uni‐dimensional subset of items, if the four‐factor‐structure was not confirmed; and (4) examining the psychometric characteristics of the adapted inventory.

We decided to carry out this study on college students for various reasons: (1) college students are prospective educators or professionals who will be either dealing with people with MR or making decisions that affect their lives; (2) college students in Kuwait play an active role in social change and in changing public opinions;(3) they are representative cross‐section of Kuwaiti society; (4) a sample of college students is more easily acquired than a sample from the general population.