R2: Ethnic Diversity in Acceptance Of Disability, Community Integration Needs, Barriers, and Supports
Principal Investigator: Angelle M. Sander, Ph.D.
The purpose of this study was to determine whether there are differences between racial/ethnic groups in regard to:
- acceptance of disability
- perceived importance of different areas of community integration, and
- in perceived attitudinal barriers and supports for community integration.
Understanding these factors can lead to development of services that are tailored to the needs of persons from diverse ethnic groups.
There is evidence that the incidence of TBI is higher in African Americans and in Hispanics than in Whites. African Americans are also more likely to be injured as a result of violence and to die as a result of injury. In spite of these differences, there has been little research on racial/ethnic differences in outcome. Some research has shown that African Americans have a harder time getting back to work and social activities after TBI.
One area of research that has been neglected is the potential differences in value systems and environments that may occur in persons of different races/ethnicities. Uomoto emphasized the importance of sensitivity to cultural values and beliefs when planning community reintegration services. However, there is little to guide rehabilitation service providers in this area. Most research on outcome from TBI has emphasized resumption of vocational and academic activities. Compared to other community integration activities (e.g., homemaking, leisure activities, social interactions), these activities may be of more or less value for persons from different racial/ethnic backgrounds. Thus, persons from different backgrounds may have different community integration goals, and successful integration should not necessarily be judged by the standards of the dominant culture.
The understanding and acceptance of disability may also differ in persons from different racial/ethnic backgrounds. One previous research study found that Whites showed lower levels of acceptance of disability compared to persons from other racial/ethnic backgrounds. This may be due to different value systems and beliefs.
Community integration needs of persons in different racial/ethnic groups may also vary based on cultural differences in environmental barriers and supports. Social support networks may differ, with certain racial/ethnic groups relying more on extended family networks for support. Differing attitudes of family and community members toward persons with disability may also impact the community integration of persons in different racial/ethnic groups.
The purpose of the R2 study was to determine whether differences exist between racial/ethnic groups (White, African American, and Hispanic) in regard to acceptance of disability, perceived importance of different areas of community integration, and in perceived attitudinal barriers and support for community integration. Understanding these factors can lead to development of services to improve community integration that are tailored to the needs of persons from diverse ethnic groups.
- Established construct validity of the Acceptance of Disability Scale-TBI version for persons with TBI from diverse racial/ethnic backgrounds
- Regardless of race/ethnicity, persons with lower education and lower annual household income (less than $20,000) had lower acceptance of disability.
- Even after controlling for age, education, injury severity, and income, race/ethnicity was associated with overall community integration, independence in the home, and productivity, with minorities having less integration in all areas.
- Regardless of race/ethnicity, lower income was associated with lower social integration and with lower subjective satisfaction with community integration.
- There were racial/ethnic differences in perceived importance of community integration activities, with Blacks and Hispanics placing greater emphasis than Whites on non-work activities, including parenting, housekeeping, cooking, and exercise.
- The barrier with the greatest impact was physical/structure barriers, such as the natural environment and aspects of the surroundings. The availability of services and help was the second greatest barrier. Blacks reported the greatest impact of physical/structural barriers in comparison to Whites and Hispanics, while also showing a trend for service/assistance barriers.
- Persons with TBI with household incomes less than $20,000 reported the greatest perceived service/assistance barriers.
- For persons with TBI in a racially/ethnically diverse sample, the meaning of community integration was linked to feeling involved, included, and respected, rather than to specific types of activities.
- Environmental characteristics, including type and quality of environmental relationships, safety, and security, were perceived as more important than injury-related symptoms in determining community integration.