Abstract
Objective. As the number of persons with disabilities increases, pharmacists are responsible for providing optimal pharmaceutical care services to more patients in this population. The purpose of this study was to assess pharmacy students’ perceptions of the right of persons with disabilities to self-determination and to identify factors that affect pharmacists’ attitudes and perceptions.
Methods. A survey of 370 pharmacy students was conducted. The revised Korean versions of the Scale of Attitudes Towards Disabled Persons (SADP) and the Attitudes Toward Disabled Persons Form O (ATDP-O) were used to measure attitudes toward persons with disabilities. Pharmacy students’ perception of the right of persons with disabilities to self-determination was measured in 2 subdomains developed by education and ethics experts: absoluteness of right and social support.
Results. Responses from 363 pharmacy students were included in the analysis. We found that the more contact students had with persons with disabilities in the past, the more positive attitudes they had toward this patient group. In addition, students’ understanding of self-determination and positive attitudes toward persons with disabilities were determined to be statistically significant factors affecting pharmacy students’ perceptions of both the absoluteness of right of persons with disabilities and the level of social support that should be given to this patient group.
Conclusion. Since experience relating to people with disabilities is associated with pharmacy students’ positive perceptions about the right of persons with disabilities to self-determination, education and activities are needed in the pharmacy curriculum to ensure students have experiences with this patient group.
INTRODUCTION
The term “disabled person” or “person with a disability” refers to a person whose daily life or social activity is substantially hampered over a long period of time by a physical or mental disability.1 According to the 2012 World Health Organization (WHO) report on disability, 15% of the total population (more than 1 billion people) had a disability.2 Moreover, the prevalence of chronic diseases (81.1%) in persons with disabilities was higher than that in persons without disabilities, with people in this patient group having an average of 2.2 chronic diseases.3 Because patients with chronic diseases are highly dependent on health care services for guidance on medication use and assistance with activities of daily living, patient harm may occur when patients encounter discrimination in or barriers to accessing health care services.4,5 Persons with a disability are more likely than those without a disability to encounter disparity in health care services.6 In particular, the proportion of elderly persons with disabilities has increased,7 and most of them have a relatively poor health status because of inadequate ability to self-manage their disease,8 and inability to access and receive adequate health care services.9 Although there are situations in which persons with disabilities do not receive adequate care because of lower social and/or economic status,10 and/or lower access to healthcare and other services, the lack of guarantees for the rights of persons with disabilities to receive health care may also be a reason for this. In this regard, Article 25 of the UN Convention on the Rights of Persons with Disabilities recognizes that persons with disabilities have the right to enjoy the highest attainable standard of health without discrimination based on their disability. In addition, the Patient Self-Determination Act (PSDA) guarantees that all patients, with or without disabilities, have the right to make direct health care decisions, which is called the right to self-determination.11
For persons with disabilities to receive better health care, it is important to respect the right of persons with disabilities to self-determination for making decisions regarding health care services.12 Prior studies have found that pharmacist interventions can improve prescribing patterns, appropriate drug use, cost savings, and clinical outcomes for patients with intellectual disabilities.13,14 In particular, since disabled people with chronic diseases commonly have difficulties with complex multidrug use, the attitudes and perceptions of pharmacists can have a significant impact on the quality of care they provide.15 Beginning with the Accreditation Council for Pharmacy Education “Standards 2007,” the importance of cultural competency in pharmacy education has been emphasized, and the problem of disability was suggested as one of the important elements of cultural competency.16,17 Attitudes and perceptions toward persons with disabilities, social atmosphere, and education opportunity for healthcare professionals about disabilities can all affect these outcomes. However, in most countries, including in South Korea, there was some content related to disability yet in the pharmacy curriculum. For this reason, we decided to determine the attitudes and perceptions of pharmacy students as they are the ones who will provide pharmaceutical care services to persons with disabilities in the future. This study aimed to assess students’ attitudes toward persons with disabilities as well as their perceptions about these patients’ right to self-determination.
METHODS
This survey was conducted to assess the attitudes of pharmacy students toward persons with disabilities and their perceptions of the right of these patients to self-determination. A stratified sampling method was used to secure the representation of perceptions of fourth- and fifth-year students at 35 domestic colleges of pharmacy. We selected 4 universities on the basis of 2 × 2 (Seoul and provinces, national and private). They are Seoul and Pusan National University, and Kyunghee and Gachon University. Students participated anonymously and voluntarily. The research plan was approved by the Institutional Review Board of Kyung Hee University. The survey was conducted over a 3-month period beginning in July 2017. Data were collected using a paper questionnaire.
The questionnaire was developed to gather information about students’ demographic characteristics, education about persons with disabilities, volunteer experience working with persons with disabilities, attitudes toward persons with disabilities, and perceptions about the right of persons with disabilities to self-determination. The questions for measuring attitudes toward persons with disabilities were based on the revised Scale of Attitudes towards Disabled Persons (SADP) and the Attitudes Toward Disabled Persons Form O (ATDP-O) scales.18 The scales were developed by Antonak and colleagues and adapted for the Korean population by Shin and colleagues.18,19 The questionnaire consisted of 15 items representing 4 factors: pessimism - hopelessness (4 questions); derogatory personality stereotype (6 questions); behavioral misconception (2 questions); and optimism - human rights (3 questions). The questionnaire to determine perceptions of the right of persons with disabilities to self-determination was developed by an education expert and an ethics expert and consisted of two subdomains: absoluteness of rights (7 questions) and social support (8 questions) considering Article 7 of the Anti-Discrimination Against and Remedies for Persons with Disabilities Act (ARPDA) prohibits Discrimination in the Republic of Korea. Both attitudes toward persons with disabilities and perceptions of the right to self-determination were evaluated on a 4-point Likert scale on which 1=strongly disagree; 2=somewhat disagree; 3=somewhat agree; and 4=strongly agree.
Regarding attitudes toward persons with disabilities, lower scores indicated more positive attitudes, while higher scores indicated more negative attitudes. However, for the optimism–human rights factor, inverse calculation was used because a higher score indicated a more positive attitude toward persons with disabilities. In the analysis of the perception of rights to self-determination, the higher the score, the more positive the perception; conversely the lower the score, the more negative the perception. The attitude toward persons with disabilities and the perception of the right to self-determination were calculated as the average of all the items. For categorical variables, chi-square analysis was performed, and for continuous variables, the t test or Mann–Whitney U test was performed according to normality. Correlation analysis was conducted to understand the relationship between the attitudes and the perceptions of the right to self-determination. In addition, a regression analysis was performed to identify respondent characteristics that may affect the perception of the right of persons with disabilities to self-determination. Statistical analysis was performed using SPSS Statistical Package v.24.0 (IBM, Armonk, NY).
RESULTS
Responses from 363 (98.11%) pharmacy students were used for the analysis. Seven of the surveys were excluded because of an insufficient number of responses to survey items. The demographic characteristics of the survey respondents are shown in Table 1. Most respondents were 20-29 years of age; and more than 70% indicated they were not religious. With regard to respondents’ experiences of exposure to persons with disabilities, 92 (25.3%) of the respondents had a person a disability in their family or friends. Among the persons with disabilities with whom the students had interacted, 63% were physically disabled, 27% were intellectually disabled, and 5% had multiple disabilities. Most respondents indicated they were occasionally (195 persons, 53.7%) or rarely (123 persons, 34.0%) exposed to persons with disabilities. Approximately one-third (30.3%) of respondents had experiences volunteering for persons with disabilities, and only 28.4% of the respondents had received education about persons with disabilities. Most of those who responded that they were educated about persons with disabilities had obtained the information through mass media. Relatively few had received education about persons with disabilities in school (49, 13.5%) or at home (14, 4.0%). Among the respondents who had received education in school, some had received that education in liberal arts courses at a university (n=21) or major courses (n=3).
Characteristics of Pharmacy Students Who Responded to a Survey Regarding Their Attitudes Toward Persons With Disabilities and Perceptions of Right to Self-Determination (N=363)
The Cronbach alpha for the questions regarding attitudes towards persons with disabilities was 0.81. The average rating on the 15 items regarding attitude toward people with disabilities was 2.0±0.4 (range 1.0-4.0). As for factors affecting students’ attitudes toward people with disabilities, more positive attitudes were observed in respondents with more frequent exposure to this patient group (P=.002). Although not statistically significant, more positive attitudes were observed in the responses of respondents who had spent time with or received education about persons with disabilities (Table 2). As a result of the analysis of students’ perceptions regarding the right of persons with disabilities to self-determination, the Cronbach α for all 13 questions was 0.88, which indicated high reliability of the questionnaire. The Cronbach α for each subdomain was also high: 0.77 and 0.82 in the absoluteness of rights and social support, respectively (Table 3). The average rating on the 13 items regarding perception of people with disabilities was 3.1±0.4 (range 1.9-4.0) among the 356 respondents who provided complete responses. For the average rating for each subdomain of perception, absoluteness of right was 3.0 ± 0.4 and social support was 3.3 ± 0.4. Those who responded that they understood self-determination of persons with disabilities showed high perception of both the absoluteness of right and social support (absoluteness of right: P value =.035; social support: P value =.001; total: P value =.006). In addition, a positive correlation was observed between the attitude towards persons with disabilities and the perception of their right to self-determination (P values <.001). In the regression analysis, it was found that an understanding of self-determination and a positive attitude toward persons with disabilities significantly affected the positive perception ratings for each domain of right to self-determination (Table 4). When analyzed according to the subcategories of the right to self-determination, the presence of nearby persons (ie, family members or friends) with disabilities had a statistically significant positive effect on social support for persons with disabilities (P value =.045).
Association Between Pharmacy Students’ Demographics and Characteristics and Their Attitudes Toward Persons With Disabilities
Perception of Pharmacy Students on the Rights to Self-determination (N=360)
Regression Analysis Models for the Rights to Self-determination of Persons with Disabilities as a Dependent Variable Associated With Potential Predictors
DISCUSSION
We found that the better a pharmacy student’s understanding and positive attitude toward a patient’s right to self-determination, the higher the perception of the right of persons with disabilities to self-determination. This is the first study in Korea to measure the attitudes and perceptions of pharmacy students regarding the right of persons with disabilities to self-determination.
The most influential factor in a student’s perception of the right of persons with disabilities to self-determination was the student’s attitude toward persons with disabilities. The most negative attitude observed in students’ response was the derogatory personality stereotype factor, suggesting that pharmacy school students had many stereotypes about persons with disabilities. However, the attitudes toward persons with disabilities were positive among respondents with more exposure to persons with disabilities. This suggests that personal experience may be an effective method to resolve pharmacy students’ stereotypes about persons with disabilities.20 In addition, because there was a positive correlation between attitudes and the perceptions of the right to self-determination, more exposure to persons with disabilities will consequently improve pharmacy students’ perception of the right of persons with disabilities to self-determination.
Another factor influencing pharmacy students’ perceptions was how well they understood the right of persons with disabilities to self-determination. Understanding self-determination means that they know who the subject making choices is, from minor decisions to major decisions related to quality of life.22 In this regard, in health care, respect for the self-determination of persons with disabilities means that we must provide information on and opportunities for these individuals to make choices about their treatment options. Therefore, a better understanding of self-determination and respect for the self-determination of persons with disabilities would be helpful to pharmacy students and pharmacists providing ideal pharmaceutical care services.
Furthermore, students with the presence of a family or friend with disabilities showed a positive perception of providing social support for persons with disabilities. This means that students who have a family member or friend with a disability are more aware of social stereotypes and discrimination, and they feel the need to support persons with disabilities at the social structural level.21,22 According to self-determination theory, social support is positively related to the satisfaction of psychological needs of persons with disabilities, which, in turn, is positively related to exercising their rights to self-determination.23 Previous studies investigating the relationship between social support and health outcomes have suggested that social support could significantly improve health outcomes, such as overall health status, physical symptoms and responses, and psychological symptoms and responses.24,25
Based on these study results, a logical strategy to improve students’ perceptions of the right of persons with disabilities to self-determination might be to consistently expose them to persons with disabilities. In December 2015, the “Education on Right to Health of Persons with Disabilities” was implemented in South Korea in accordance with the “Act on Guarantee of Right to Health and Access to Medical Services for Persons with Disabilities.”26 The education program includes understanding the concept and type of disability; cases of inconvenience in using health care services for persons with disabilities; communication with persons with disabilities; and precautions when treating and managing persons with disabilities. Since 2020, pharmacists have also been subject to this educational program, but a systematic education program has not yet been established. Moreover, since this program is not intended for pharmacy school students, they do not have the opportunity to be educated about health care issues or the right to make health care decisions for persons with disabilities. Thus, most students become pharmacists without experience in and education about handling situations affecting special vulnerable patient groups such as persons with disabilities. Education on the rights to health of persons with disabilities gives students the experiences to think about the equality and rights of this patient group, to break stereotypes about them, and to provide them with the pharmaceutical care services they need.27 Therefore, it is very important to include education about and experiences in caring for patients with disabilities in the regular pharmacy curriculum.28
The goal of providing professional education about patients with disabilities is to develop the healthcare professional’s core competencies for the management of care for persons with disabilities.29 Education about disabilities not only enhances the professionalism of personnel, but also improves the quality of health care.29 Depending on the teaching methods used to teach pharmacy students about disabilities, the educational outcomes may appear in various ways. According to a review by Shakespeare and Kleine, conventional lecture-based education by faculty was effective in significantly improving students’ knowledge about disabilities, but it was not enough to improve their attitudes toward persons with disabilities.30 Disability experience through simulation exercises has the advantage to increase empathy and educate students about practical issues such as accessibility, but it is difficult to learn about human rights, such as prejudice and discrimination.31 The educational method that showed the best strategy to improve positive attitudes and perceptions toward persons with disabilities was the clinical experience of direct exposure to and caring for the disabled in the clinical environment.32 Therefore, in order to achieve a holistic understanding of disability, integrated education will be needed to enable students to directly meet persons with disabilities and critically reflect on their experiences along with theoretical knowledge education.
This study has some limitations. First, the 363 respondents in this study cannot be regarded as representing all Korean pharmacy school students. Second, we could not statistically assess the effect of former educational experiences on pharmacy students’ perceptions of the right of persons with disabilities to self-determination. Most of the knowledge that the students had acquired was fragmentary information obtained primarily from the mass media. In this regard, the study was necessary to evaluate the change in students’ attitudes and perceptions toward persons with disabilities before and after education about persons with disabilities. Nevertheless, this study is important in that it was the first in Korea to highlight the need for education of pharmacy students regarding persons with disabilities by deducing the factors that had shaped pharmacy students’ attitudes and perceptions towards the right to self-determination of persons with disabilities.
CONCLUSION
Understanding among pharmacy students about the self-determination of persons with disabilities and positive attitudes toward persons with disabilities were positively correlated with the perception of those students’ right to self-determination. The results of this study can be used to prepare and implement pharmacy education programs that provide experiential learning so pharmacy students recognize persons with disabilities as autonomous individuals who are their equals and respect the self-determination of persons with disabilities.
- Received March 30, 2022.
- Accepted July 24, 2022.
- © 2023 American Association of Colleges of Pharmacy
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