Healthcare practitioners' views and experiences of barriers and facilitators to weight management interventions for adults with intellectual disabilities

Background Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population. Methods Semi‐structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. A study topic guide was developed to elicit practitioners' views and experiences of barriers and facilitators to weight management for adults with intellectual disabilities. Responses were analysed using thematic analysis. Results Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities. Conclusions This study provides suggestions for future research, policy and practice consideration

Familiarity with people with intellectual disabilities, stigma, and the mediating role of emotions among the Dutch general public

Stigma can hamper full inclusion of people with intellectual disabilities in society. For other minority groups, higher levels of familiarity with these groups have been shown to relate to lower levels of stigma, whereby emotions can play a mediating role. However, concerning people with intellectual disabilities, there is limited knowledge regarding the general public’s levels of familiarity, its relationship with stigma, and the role of emotions in this relationship. A cross-sectional survey was conducted among a nationally representative sample of the Dutch population (n = 892). The relationship between levels of familiarity and different measures of stigma representing cognitive, emotional, and behavioral aspects of stigma (i.e., attributions, emotions, discrimination) was examined. Emotions (fear, anger, and sympathy) were studied as a mediator in the relationship between familiarity and discrimination (i.e., social distance, and intention to help). Participants who reported no familiarity in real life with people with intellectual disabilities (30.6% of the population sample) demonstrated higher levels of stigma (attributions, emotions, discrimination) than participants who reported any form of real-life familiarity (69.4% of the sample). Fear was found to be the most important mediator of the relationship between familiarity and discrimination. The findings stress the continuing importance to advocate for people with intellectual disabilities to be recognized and become known within society. This increased familiarity might reduce stigma and increase positive experiences of inclusion. Support workers may have a vital role in this process. The importance of fear in the relationship between familiarity and discrimination may inform future research and antistigma interventions

Public stigmatisation of people with intellectual disabilities: A mixed-method population survey into stereotypes and their relationship with familiarity and discrimination

Purpose: Stigmatisation can negatively affect opportunities for people with intellectual disabilities to participate in society. Stereotyping, a first step in the process of stigmatisation, has been insufficiently explored for people with intellectual disabilities. This study examined the general public's set of stereotypes that is saliently attributed to people with intellectual disabilities as well as the relationship of these stereotypes with discriminatory intentions and familiarity. Materials and methods: A mixed-method cross-sectional survey within a representative sample of the Dutch population (n = 892) was used. Stereotypes were analysed with factor analysis of a trait-rating scale, and qualitative analysis of an open-ended question. The relationship between stereotypes and discrimination as well as familiarity with people with intellectual disabilities was explored through multivariate analyses. Results and conclusions: Four stereotype-factors appeared: "friendly", "in need of help", "unintelligent", and "nuisance". Stereotypes in the "nuisance" factor seemed unimportant due to their infrequent report in the open-ended question. "Friendly", "in need of help", "unintelligent" were found to be salient stereotypes of people with intellectual disabilities due to their frequent report. The stereotypes did not relate to high levels of explicit discrimination. Yet due to the both positive and negative valence of the stereotypes, subtle forms of discrimination may be expected such as limited opportunities for choice and self-determination. This may affect opportunities for rehabilitation and might be challenged by protest-components within anti-stigma efforts. Implications for rehabilitation: There is currently sparse input for anti-stigma campaigns regarding people with intellectual disabilities. Anti-stigma interventions may benefit from adopting protest elements: education of the general public about inequalities that are experienced by people with intellectual disabilities. Especially support staff should be informed about the experienced and/or anticipated stigma of people with intellectual disabilities. As a way of opposing stigma, support staff should empower people for example by conducting strategies to disclose their (intellectual) disabilities. People with intellectual disabilities can challenge stigma by learning to tell a positive narrative on the lives they lead, using their strengths and coping with their limitations

Familiarity with people with intellectual disabilities, stigma, and the mediating role of emotions among the Dutch general public

Stigma can hamper full inclusion of people with intellectual disabilities in society. For other minority groups, higher levels of familiarity with these groups have been shown to relate to lower levels of stigma, whereby emotions can play a mediating role. However, concerning people with intellectual disabilities, there is limited knowledge regarding the general public’s levels of familiarity, its relationship with stigma, and the role of emotions in this relationship. A cross-sectional survey was conducted among a nationally representative sample of the Dutch population (n = 892). The relationship between levels of familiarity and different measures of stigma representing cognitive, emotional, and behavioral aspects of stigma (i.e., attributions, emotions, discrimination) was examined. Emotions (fear, anger, and sympathy) were studied as a mediator in the relationship between familiarity and discrimination (i.e., social distance, and intention to help). Participants who reported no familiarity in real life with people with intellectual disabilities (30.6% of the population sample) demonstrated higher levels of stigma (attributions, emotions, discrimination) than participants who reported any form of real-life familiarity (69.4% of the sample). Fear was found to be the most important mediator of the relationship between familiarity and discrimination. The findings stress the continuing importance to advocate for people with intellectual disabilities to be recognized and become known within society. This increased familiarity might reduce stigma and increase positive experiences of inclusion. Support workers may have a vital role in this process. The importance of fear in the relationship between familiarity and discrimination may inform future research and antistigma interventions

Stigma research in the field of intellectual disabilities:A scoping review on the perspective of care providers

Objectives: Care providers are key agents in the lives of individuals with an intellectual disability (ID). The quality of their support can be affected by manifestations of stigma. This scoping review was conducted to explore studies that provide indications of care providers’ stigmatization of people with ID. Methods: A structured search was made in four databases to identify relevant studies in English-language peer-reviewed journals. Records were systematically and independently screened by the researchers. Results: The 40 articles included in this review were mainly conducted in Western countries and used Likert-type self-report measures of explicit attitudes. Stigmatization seemed more distinct concerning people with high support needs. The few studies on public stigma preliminary suggest that staff may also stigmatize people with ID based on other social identities. Regarding the support of structural stigma, staff reported skepticism regarding community inclusion for people with high support needs, and tended to be ambivalent about the protection-or-empowerment balance in the support of people with ID. Possible indications of stigmatization regarding sexuality were found on specific issues, such as self-determination and privacy. Agreement of staff with certain rights did not necessarily lead to staff acting in accordance with such rights. Conclusion: Indications of stigmatization of people with ID by care providers were found. Stigmatizing attitudes might affect the quality of care providers’ support. Potential leads for future interventions concern creating awareness, sharing power, addressing diagnostic overshadowing, and providing explicit policy translations. Directions for future research concern strengthening the methodology of studies and enriching the studied topics