INTRODUCTION:

BACKGROUND OF THE STUDY

Disability has been defined as an umbrella term for impairments, activity limitations and participation restrictions by the International Classification of Functioning and Health. A disability is an interaction between the individual who has a health condition (e.g. cerebral palsy, Down syndrome and depression) with his personal and environmental factors (e.g. negative attitudes, inaccessible transportation and public buildings, and limited social supports).¹

Disability is complex, dynamic, multidimensional, and contested. In the recent decades, the disabled people’s movement along with numerous researchers from the field of social and health sciences have identified the role of social and physical barriers in disability.²

According to UN Enable, around 10% of the world’s populations, that is about 650 million people worldwide, live with a disability. A UNICEF survey reports that 30% of street youth are disabled. ³UNICEF also reports that children with disabilities are among the most marginalized and excluded groups in society. Children with disability face discrimination daily in the form of negative attitudes, lack of adequate policies and legislation, they are also effectively prevented from realizing their rights to healthcare, education, and even survival.⁴

UNICEF also reports there are at least 93 million children with disabilities in the world, but numbers could be much higher. Children with disability are also often likely to be among the poorest members of the population and these children are less likely to attend school, access medical services, or have their voices heard in society. Their disabilities also place them at a higher risk of physical abuse, and often exclude them from receiving proper nutrition or humanitarian assistance in emergencies.⁴

As per Census 2011, in India, there are 2.68 crore (26.8 million) persons with disability which is 2.21% of the total population. Out of this 78.64 lakh (4.5 million) are in the 0-19 age group, which is 1.67% of the total population. 35.29% of all people living with disability in India are children.^(3,5)In India 80% of children with disabilities will not survive past age forty. Only 1% of children with disabilities have access to school and one third of most disabilities are preventable.³According to a report on “State of the Education Report for India: Children with Disabilities’ by UNESCO currently, three-fourths of the children with disabilities at the age of 5 years and one-fourth of children between the age of 5-19 years do not go to any educational institution. It also noted that the number of children enrolling in school drops significantly with each successive level of schooling. According to the report, the attitude of parents and teachers towards including children with disabilities into mainstream education is also crucial to accomplish the goal of inclusive education.⁶

In a study conducted in Bhutan by Royal Government of Bhutan Ministry of Education and UNICEF (2017) on Knowledge, Attitudes, and Practices (KAP) on Children with Disabilities (CWD). The survey revealed that knowledge regarding CWD was extremely limited among the general population in Bhutan.⁷

NEED OF THE STUDY:

Children with disabilities are often considered inferior, and this exposes them to increased vulnerability. Discrimination towards those with disability has manifested itself in marginalization from resources and decision-making and even infanticide.²

A study was conducted by Padam P. Simkhada et al (2013) to assess women’s knowledge of and attitude towards disability in rural Nepal. The study reported that majority of the participants only considered physical conditions that limit function of an person and are visible to naked eyes, like missing a leg or arm, to be disability. Attitudes towards people with disability were generally positive. The study concluded that there is a need to educate the general population on disability, especially the invisible disabilities. There is also a need for further research on disability and its social impact.⁸

Similar study has not been conducted in Nagaland till date. Therefore, the investigators felt that there is a need to carry out a study to assess the knowledge and attitude among men and women towards children with disability.

OBJECTIVES OF THE STUDY:

· To assess the knowledge regarding children with disability.

· To assess the attitude towards children with disability.

· To associate the attitude towards children with disability with selected demographic variables.

METHODS AND MATERIALS:

A cross sectional survey design was used in the present study. The study was conducted in selected OPDs of Christian Institute of Health Sciences and Research, Dimapur, Nagaland. A total of 252 participants who were above 18 years fulfilling the inclusion criteria were included in the study by convenient sampling. The instrument consisted of three parts; part I included the demographic data, part II consisted of questionnaire to assess knowledge regarding CWD and part III consisted of an attitude scale to assess attitude towards children with disability. The instruments were validated with a content validity index of 98% each for the knowledge questionnaire and the attitude scale. Pilot study was carried out to check the feasibility of the instrument and some modifications were made in the questionnaire. The Nursing Research committee of CIHSR gave the approval for the study and permission was obtained from the concerned authority. An informed written consent was taken from each of the participants. Data was collected using self-administered questionnaire. Data analysis was done using descriptive and inferential statistics such as chi-square and Fisher’s exact test.

RESULTS:

Section I: Demographic information about the participants:

Of the 252 participants, 124 (49.2%) were in the age group between 20-30 years. 151 (59.92%) participants were male, 139 (55.15%) were single. The majority were Christian (n= 230, 91.26%), with a small number of participants from other religions. Most participants were single 139 (55.15%). Majority of the participants were indigenous people of the state (Nagaland) and only 13 (5.2%) had a family member with a disability.

Section II.

In this section results are presented regarding the whole sample, identifying respondents’ knowledge and attitudes regarding children with disabilities.

Objective 1: Knowledge regarding children with disability

1. What comprises disability?

Participants were asked to identify conditions they regarded as comprising a disability. Majority (>80%) believed individuals who had a total loss of vision or total loss of hearing had a disability. Most also believed those using a wheelchair (78%) had a disability. Slightly fewer considered those who had conditions limiting the use of their hands have a disability. Few considered individuals who used hearing aids or those with learning disability as disabled and less than one-thirds considered those requiring glasses have a disability.

Figure 1: Statement regarding what comprises a disability

A. A person/child who has a total loss of vision has a disability. 83.3% (N=210)

B. A person/child who has low vision and requires glasses has a disability. 35.7% (N=204)

C. A person/child who has a total loss of hearing has a disability.80.9% (N=204)

D. A person/child who has poor hearing and requires hearing aids has a disability. 42.8% (N=108)

E. A person/child who needs to use a wheelchair and walking aid (such as a stick) has a disability.78.9% (N=199)

F. A person/child who has a condition that limits the use of their hands has a disability. 60.7% (N=153)

G. A person/child who has difficulties with learning at the same pace as others has a disability. 42.8% (N=108)

2. Awareness about services available.

Figure 2: Awareness of services available

Figure 2: Shows that only 64 (25.3%(64) were aware of any services available for CWD, only 50 (19%) were aware of local groups or organizations for CWD, 34.9% (88) were aware of educational services available for CWD, 59 (23.4%) were aware of child protection services,70 (27.7%) were aware of legislations or policies for CWD, 18.2% (46) were aware of referral systems for CWD and 78 (30.9%) were aware of religious institutions for CWD. Specific reference was made to Precious Gems School, Tabitha Enabling Academy, Deaf and Dumb Biblical Ministry, Dimapur Ao Baptist Arogo, Sisters of Mother Teressa Dimapur.

3. Sources from where the subjects gain information:

Figure 3: Sources from where the subjects obtain information about CWD

Figure 3: Shows that participants 129 (53.30%) obtain information about CWD from family, 154 (63.3%) from friends, 121 (50%) from neighbors, 67 (27.60%) from government officials, 150 (61.90%) from television, 41 (16.90%) from radio, 138 (57%) from newspaper and 178 (73.50%) from other sources (social media, awareness programs etc).

Objective 2: Attitude towards children with disability

Figure 4: Level of attitude score of subjects

Figure 4: Reveals that 50 (19.8%) participants have favourable attitude towards children with disability, 185 (73.4%) were neutral and 17 (6.7%) have unfavourable attitude towards children with disability.

Objective 3: Association between attitude and selected demographic variables

Table 2: Fisher's exact test for association between attitude and selected demographic variables

Sl.no	Demographic Variables	No. of subjects (N= 252)			P value calculated
Sl.no	Demographic Variables	Favourable	Neutral	Unfavourable	P value calculated
1	Age
	<20	1	11	3	0.573
	20-30	27	89	6
	30-40	15	48	4
	40-50	5	24	2
	50-60	1	7	1
	>60	1	6	1
2	Education
	Primary	1	8	1	6.3
	High School	1	35	5
	Higher Secondary	8	40	5
	Graduate	18	68	5
	Post Graduate	22	34	1
3	Family Income
	≤ 10,000	1	48	5	1.8
	11-30,000	18	71	5
	31-50,000	16	46	7
	51-100,000	t9	13	0
	> 100,000	6	7	0

*P value of <0.05 is considered significant and P <0.01 is considered highly significant.

Table 2: Above table shows that there is no statistically significant association between attitude score and age, education and family income.

Table 3: Chi Square test for association between attitude and selected demographic variables

Sl.No	Demographic Variables	No. of subjects (N=252)			Chi Square Calculated	Degree of Freedom	Chi Square Tabulated	Level of significance
		Favourable	Neutral	Unfavourable
1	Gender
	Male	28	118	8	2.48	2	5.99	Significant
	Female	22	67	9
2	Area
	Rural	16	72	9	9.09	2	5.99	Not significant
	Urban	34	113	8
3	Occupation
	Unemployed	13	86	8	52.7	6	12.59	Not Significant
	Self-employed	11	47	3
	Government employed	11	19	2
	Others	15	33	4
4	Religion
	Christian	48	167	15	9.26	2	5.99	Not significant
	Others	2	18	2
5	Ethnicity
	Nagas	44	145	16	45.5	2	5.99	Not significant
	Non-Nagas	6	40	1

P value of <0.05 is considered significant and P <0.01 is considered highly significant.

Table 3: Above table shows that there is statistically significant association between gender and attitude.

DISCUSSION:

The study was done to assess the knowledge and attitude regarding children with disability and to associate the attitude towards children with disability with selected demographic variables. The study shows that a majority of the participants consider only those disabilities which limit function and were visible to the naked eye (total loss of vision and hearing loss, use of wheelchair or walking stick) are a disability. Very few participants consider that a child having a disability which ant not overtly visible such as those who has low vision, poor hearing and has difficulties with learning has a disability. Only 64 (25.3%) of participants were aware of services available for CWD, only 50 (19.5%) were aware of local groups or organizations for CWD, 88 (34.9%) were aware of educational services available for CWD, 59 (23.4%) were aware of child protection services, 70 (27.7%) were aware of legislations or policies for CWD, 46 (18.2%) were aware of referral systems for CWD and 78 (30.9%) were aware of religious institutions for CWD. The above findings were similar to a study conducted by Royal Government of Bhutan Ministry of Education and UNICEF (2017) in Bhutan, which reported that knowledge regarding CWD was extremely limited among the public. The same study also reported that a very high majority of respondents felt that only those individuals who had a total loss of vision, hearing and who needed wheelchair would be considered disabled and only just above half of the respondents felt those needing glasses or those with learning difficulties as having disability.⁷

The findings of the present study show that 50 (19.8%) participants have favourable attitude towards children with disability, 185 (73.4%) were neutral and 17 (6.7%) have unfavourable attitude towards children with disability. These findings contradict the findings of a study conducted by Padam P. SimkhadaD et al (2012) in rural Nepal which reported that attitude towards people with disability were generally positive.⁸

The present study also revealed that there was a statistically significant association between gender and attitude score. The findings of the present study are contradicting the findings of a study conducted by Ajay Kumar Maurya, Ashok Parasar (2017) which reported that there was no significant relationship in attitudes towards persons with disabilities reference to their age, gender, and education.⁹

CONCLUSION:

The findings of the present study show that knowledge regarding with disability, legislation and services were limited. Most participants did not consider those disabilities that are not overtly visible as a disability. Most of the participants had a neutral attitude towards children with disability. There was a statistically significant association with gender and attitude. There is a need to create awareness about the disabilities especially learning disabilities among the public and about the various services available for the children with disability.

RECOMMENDATIONS:

1. Similar study can be undertaken with a larger sample size to generalize the findings.

2. Study can be conducted to assess the knowledge and attitude towards specific disabilities.

3. There is a need to create awareness about the invisible disabilities especially learning disabilities among the public

4. There is a need to create awareness regarding the various services available for the children with disability.

CONFLICT OF INTEREST:

No.

REFERENCE:

1. WHO. Disability and health. Available from: https://www.who.int/ news-room/fact-sheets/detail/disability-and– health.

2. WHO and World Bank.World Report on Disability. Available from: https://www.who.int/disabilities/world_report/2011/report.pdf?ua=1

3. ICT post. New Delhi: February 24, 2019. Available from: http://ictpost.com/only-1-of-children-with-disabilities-in-india-have-access-to-school-2/#:~:text=In%20India%201.67%25%20of%20the,of%20most%20disabilities%20are% 20preventable.

4. UNICEF. Disabilities. Available from: https://www.unicef.org/disabilities/ '

5. Social statistics division, Ministry of Statistic and Programme Implementation. Disabled persons in India. A statistical profile 2016. Available from: http://mospi.nic.in/sites/default/files/publication_reports/Disabledpersons _in_India_2016.pdf

6. ‘State of the Education Report for India 2019- Children with Disabilities’-UNESCO. Available from: https://www. manifestias.com/2019/08/21/state-of-the-education-report-for-india-2019-children-with-disabilities-unesco/

7. Royal Government of Bhutan, Ministry of Education and United Nations Children’s Fund (UNICEF) (2017). Knowledge, attitude and practice (KAP) study on children with disability. Available from: www.unicefbhutan.org.bt

8. Padam P Simkhada et al. Women's knowledge of and attitude towards disability in rural Nepal. Disability Rehabilitation. 2013April;35(7): 606-13.

9. Ajay Kumar Maurya and Ashok Parasar. The International Journal of Indian Psychology. Volume 4, Issue 4, DIP: 18.01.112/20170404. July-September, 2017.

Received on 29.11.2020 Modified on 21.06.2021

Asian J. Nursing Education and Research. 2022; 12(1):52-56.

DOI: 10.52711/2349-2996.2022.00010