Disability and Health Journal 8 (2015) 102e108

www.disabilityandhealthjnl.com

Research Paper

Attitude of physiotherapy students in Nigeria toward persons

with disability
Grace O. Vincent-Onabajo, Ph.D.*, and Wasinda S. Malgwi, B.M.R. (PT)
Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria

Abstract
Background: Attitudes of students of health care professions, such as physiotherapy, toward persons with disability may influence their
attitude and practice post-qualification.
Objective: To examine attitudes toward persons with disability among undergraduate physiotherapy students in Universities in Nigeria.
Methods: The 30-item Attitudes toward Disabled Persons e Form A (ATDP-A) scale was used to assess the attitudes of penultimate
and final year physiotherapy students in 3 Nigerian universities. Overall and item-by-item analyzes of responses to the ATDP-A scale were
carried out. Differences in attitude by sex, age, year and university of study were also examined using independent t-test and one-way
ANOVA.
Results: One hundred and sixty-nine students with a male majority (56.2%) participated in the study. Mean score on the ATDP-A was
94.95 6 17.50 with more students (60.4%) having a score O90 which depicts positive attitude. Item-by-item analysis of responses to the 30
items on the ATDP-A showed that negative attitudes were preponderant on items relating to the emotional component of the personality of
persons with disability. Only age of students and their university of study however resulted in statistically significant differences in attitudes
and older students reported better attitudes toward persons with disability.
Conclusions: Although the overall attitude of the physiotherapy students was positive, negative stereotypes and discriminatory tendencies were observed in issues relating to the perceived emotional capacity of persons with disabilities. Educational strategies capable
of effecting more positive attitudes in physiotherapy students in Nigeria toward persons with disability are urgently needed. 2015 Elsevier
Inc. All rights reserved.
Keywords: Attitude; Physiotherapy; Physiotherapy students; Persons with disability; Nigeria

Based on the World Health Organizations International

Classification of Functioning, Disability and Health (ICF),
disability is a broad term that depicts impairments of body
structures and functions, activity limitations and participation restrictions.1 Persons with disability may therefore
require rehabilitation care in order to function as optimally
as possible. Although provision of rehabilitation services is
multidisciplinary, physiotherapists play a significant role
and are among health personnel referred to as rehabilitation
professionals and experts.2 Aside from professional skill,
the attitude of physiotherapists toward their care recipients
may also substantially contribute to the outcome of care
and can serve as either barriers or facilitators to the realization of the full potentials of persons with disabilities.3,4 The
attitude of practicing physiotherapists, like other health
professionals, is however often traceable to attitudes they
held as students.5,6
Conflict of interest: None declared.
* Corresponding author. Tel.: 234 8056614251(mobile).
E-mail address: teetoe262003@yahoo.com (G.O. Vincent-Onabajo).
1936-6574/$ - see front matter 2015 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.dhjo.2014.06.009

The acknowledged importance of physiotherapy students attitude toward persons with disability has resulted
in several studies in different countries of the world.5,7e12
The influence of culture on attitude toward persons with
disability13e15 further necessitates these country-specific
data. Additionally, with an estimated population of over a
billion people with various forms of disability worldwide,3
the attention on the attitude of future providers of care is
well placed and essential. There are however no data on
the attitude of physiotherapy students in Nigeria.
Nigeria is the most populous country on the African continent with an estimated population of 160 million people. With
an estimated 1250 practicing physiotherapists16 primarily
engaged in institution-based practice, the physiotherapistpatient ratio in the country is approximately 1 per 100, 000.
Over the past decade, the population of persons with disability
in Nigeria has been put at between 14 and 25 million17,18 but
there are no existing laws that protect the rights of persons
with disability or specific national policies and programs that
address issues of their education, housing, transportation,
employment and general welfare. However, in line with

G.O. Vincent-Onabajo and W.S. Malgwi / Disability and Health Journal 8 (2015) 102e108

articles 25 and 26 of the UN Convention on the Rights of Persons with Disabilities which emphasizes the rights of persons
with disability to good quality health care without discrimination (Nigeria is a signatory to the Convention), physiotherapists must be equipped with the attitude required for
effective management of individuals with disability. Accordingly, there is an urgent need to examine the attitude of Nigerian physiotherapy students toward persons with disability in
order to ascertain their attitudinal preparedness for their
future practice in this regard and address possible shortcomings. We therefore surveyed attitudes of physiotherapy students undergoing training at three universities in Nigeria
using the Attitude toward Disabled Persons Scale-Form A
(ATDP-A)19 and explored associations between attitude and
aspects of the students demographics and education.

Methods
Study design
This cross-sectional multi-center study examined attitudes toward persons with disability among students undergoing undergraduate physiotherapy training in 3 Nigerian
universities. The study was approved by the Research and
Ethical Committee of the University of Maiduguri Teaching Hospital Maiduguri and was conducted in 2012.
Study location
Clinical physiotherapy students were recruited from
three universities in Nigeria namely Nnamdi Azikiwe
University, University of Ibadan and University of Maiduguri. These 3 universities were purposively selected based
on the geographical regions of Nigeria and the available
universities offering physiotherapy training programs (7 in
all) in the country. Nnamdi Azikiwe University is located
in eastern Nigeria and is one of the 2 universities with a
physiotherapy training program in the region. University
of Ibadan is situated in the Western part of Nigeria and is
one of the 3 universities that provide physiotherapy training
in Western Nigeria. University of Maiduguri is one of the 2
training institutions with physiotherapy training programs in
Northern Nigeria (no university in Southern Nigeria is
currently training physiotherapy students).
As at the time of this study, the total number of clinical
physiotherapy students at the three universities was 197.
One hundred and four students were in the clinical phase
of study at the University of Maiduguri, 56 were at the University of Ibadan while Nnamdi Azikiwe University had 39
clinical physiotherapy students. All clinical physiotherapy
students at these universities who were willing to participate
in the study by providing informed consent were recruited.
Undergraduate physiotherapy training in Nigeria
Undergraduate physiotherapy education in Nigeria spans
5 academic calendars. The first year regarded as the

103

preliminary phase of study, entails classroom and laboratory courses in natural sciences, and selected general
courses. At the second phase of study also known as the preclinical phase, preclinical courses such as anatomy, physiology and biochemistry, and introductory physiotherapy
courses are taken although there are slight variations across
universities on the duration and end of the phase. The 4th
(penultimate) and 5th (final) years are characterized by core
physiotherapy courses including lectures, seminars and clinical placement. Regarded as the clinical phase, this period
of training also includes the Students Industrial Work Experience Scheme (SIWES) which provides a platform for
students to gain work experience outside their training institutions. The Scheme involves rotations through different
physiotherapy work situations, including care homes for
persons with disabilities. Although slight variations exist
in the individual universities, the contents of the physiotherapy training curricula are as approved by the Medical
Rehabilitation Therapist (Registration) Board of Nigeria
(MRTB),20 the regulatory body for physiotherapy training
and practice in Nigeria, and the National Universities Commission (NUC) which is the body with the statutory role of
regulating university education in Nigeria.
Assessments and instruments
We obtained information on the students gender, age
and level of study using a demographic data form. Attitude
toward Disabled Persons Scale-Form A (ATDP-A)19 was
used to assess each students attitude toward persons with
disabilities. The ATDP-A is a self-administered instrument
that utilizes a six point Likert-type scale with responses
ranging from I agree very much to I disagree very
much. The overall score ranges from 0 to 180 and can
be divided into two categories namely; 0e90 (negative attitude) and 91e180 (positive attitude). The ATDP-A is a
valid, reliable and widely used instrument for the assessment of attitudes toward persons with disability.21 The
ATDP-A scale was used in this study because it assesses
the degree to which persons with disability are considered
different from other individuals which mirrors the predominant view in Nigeria. Furthermore, the ATDP-A has been
used in previous studies of attitudes of Nigerians toward
persons with disabilities.22,23
Procedure
Physiotherapy students were recruited from the 3 Universities through purposive sampling. The authors distributed and retrieved copies of the ATDP-A scale from
physiotherapy students at the University of Ibadan and
University of Maiduguri. The questionnaires for students
at the Nnamdi Azikiwe University were sent and duly
completed copies were received by post. Questionnaires
with missing data were not discarded as a large proportion
of the students left out responses to few items (<3)

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G.O. Vincent-Onabajo and W.S. Malgwi / Disability and Health Journal 8 (2015) 102e108

Table 1
Characteristics of the participants
Variable

Age (years)
Mean (SD)
Range
Age group (years)a
19e24
25e29
30e34
Gender
Male
Female
Year of study
Penultimate
Final
University
University of Maiduguri
University of Ibadan
Nnamdi Azikiwe university
a

24.58 (2.47)
19e34
76
72
6

49.4
46.8
3.9

95
74

56.2
43.8

88
81

52.1
47.9

89
53
27

52.7
31.4
16.0

Figures are for the 154 students that provided data on age.

possibly signifying neutrality, an option which is not provided for in the ATDP-A scale. Also the unwillingness to
disclose age even for purposes of research is a common
feature in our settings. Although the data of students with
missing information on age was utilized, we examined
the effect of age on attitude only for students who provided
information on their age.
Statistical analyses
The overall ATDP-A scale score was presented as mean
and standard deviation while frequencies and percentages
were used to summarize the distribution of the students
by gender, year of study, and into the 2 attitude categories
namely positive attitude and negative attitude. The attitude
scores for the various demographic and educational categories were also presented as means and standard
deviations.

Item by item responses were summarized with the 6

response options compacted into 2 options of agree and
disagree. Frequency and percentage distributions of students that agreed, disagreed or did not provide a response
to each of the 30 items were then obtained.
Independent t-test and one-way Analysis of Variance
(ANOVA) were used to examine differences in attitudes
by students sex, age, year of study and university at an
alpha level of 0.05. The Statistical Package for Social Sciences (SPSS) version 16.0 was utilized for all analyzes.

Results
One hundred and sixty-nine physiotherapy students
participated in the study giving a response rate of 86%.
Mean age of the 154 students that reported their ages was
24.58 6 2.47 years (range 5 19e34 years). Males and students in the penultimate year of study were in the majority
and accounted for 56.2% and 52.1% of the students respectively (Table 1).
Scores on the ATDP-A scale ranged from 57 to 150 with
an overall mean score of 94.95 6 17.50.
Based on the cut-off score for the scale, positive attitude
was observed in 60.4% of the students. Frequency and percentage distribution of responses to each of the scales 30
items however showed that more students held negative
attitudes in 13 out of the 30 items. The items were item
numbers 3e5, 8, 10, 11, 15, 16, 18, 19, 26, 28 and 30
(Table 2). These items consider persons with disability as
being generally different, more emotional, worrisome,
and untidy compared to those without disability. More positive attitudes were however reported on issues of intelligence, competitiveness, self confidence and independence
of persons with disability and the need for inclusion
(Table 3). Responses were not provided for some items
but these were presented as missing data and the frequency
distributions of the missing data were also calculated.

Table 2
Frequency distribution of responses to ATDP-A scale items indicative of a preponderance of negative attitude
Response (%)
Item

Agree

Disagree

No response

3.
4.
5.
8.
10.
11.
15.
16.
18.
19.
26.
28.
29.

66.8
67.4
32.0
66.2
63.9
61.5
50.8
72.2
57.4
43.2
72.8
53.4
42.0

32.0
31.4
66.8
32.0
34.9
36.8
45.6
27.8
40.2
56.8
26.6
46.2
57.4

1.2
1.2
1.2
1.8
1.2
1.8
3.6
e
2.4
e
0.6
0.6
0.6

Disabled people are more emotional than other people

Most disabled persons are more self-conscious than other people
We should expect just as much from disabled as from non-disabled persons
Most non-disabled people would not want to marry anyone who is physically disabled
Disabled persons are usually more sensitive than other people
Severely disabled persons are usually untidy
Disabled persons usually are not as conscientious as physically normal people
Severely disabled persons worry about their health than those with minor disabilities
There are more misfits among disabled persons than among non-disabled persons
Most disabled persons do not get discouraged easily
Most disabled persons want more affection and praise than other people
Most disabled persons are different from non-disabled people
Disabled persons dont want any more sympathy than other people

Items are presented according to their sequence in ATDP-A scale. Item 16 is not exactly as it appears on the ATDP-A scale.

G.O. Vincent-Onabajo and W.S. Malgwi / Disability and Health Journal 8 (2015) 102e108

105

Table 3
Frequency distribution of responses to ATDP-A scale items indicative of a preponderance of positive attitude
Response (%)
Item

Agree

Disagree

No response

1.
2.
6.
7.
9.
12.
13.
14.
17.
20.
21.
22.
23.
24.
25.
27.
30.

45
39
45
27.2
65.1
55.6
44.4
52.6
49.7
47.3
56.8
60.4
82.2
74.6
66.3
14.2
37.3

53.8
60.4
53.8
72.8
33.1
42.6
55.6
43.8
47.9
52.1
43.2
37.8
17.8
24.2
33.1
83.4
62.7

1.2
e
1.2
e
1.8
1.8
e
3.6
2.4
e
e
1.8
e
1.2
0.6
2.4
e

Disabled people are often unfriendly

Disabled people should not have to compete for jobs with physically normal people
Disabled workers cannot be as successful as other workers
Disabled people usually do not make much of a contribution to society
Disabled people show as much enthusiasm as other people
Most disabled people feel that they are as good as other people
Driving test given to a disabled person should be more severe than for non-disabled
Disabled people are usually sociable
Most disabled persons are not dissatisfied with themselves
Most disabled persons resent physically normal people
Disabled children should compete with physically normal children
Most disabled persons can take care of themselves
It would be best if disabled persons would live and work with non-disabled persons
Most severely disabled people are just as ambitious as physically normal people
Disabled people are just as self-confident as other people
Physically disabled persons are often less intelligent than non-disabled ones
The way disabled people act is irritating

Items are presented according to their sequence on the ATDP-A scale. Item 13 is abridged.

Differences in attitudes were statistically significant only

by age and university of study at P ! 0.05 and P ! 0.0001
respectively. The students were grouped into 3 age categories namely 19e24 years, 25e29 years and 30e34 years.
The highest scores on the ATDP-A scale was observed in
the 30e34 years age group implying that older age was
associated with more positive attitudes. Based on the universities from which the physiotherapy students were recruited, students of the University of Maiduguri had
higher ATDP-A scores compared to students of the
University of Ibadan and Nnamdi Azikiwe University
(Table 4).

Table 4
Attitude of physiotherapy students by demographic and educational
characteristics
Characteristic
ATDP-A score mean (SD)
t-test/ANOVAa
P
Gender
Male
94.12
Female
96.03
Year of study
Penultimate
93.36
Final
96.68
Age group (years)
19e24
90.58
25e29
98.49
30e34
113.50
University
UNIMAID
101.15
UI
88.53
NAU
87.15

(18.92)
(15.54)

0.70

0.30

(18.39)
(16.42)

1.23

0.29

(15.28)
(17.52)
(26.06)

7.80

0.01

(17.79)
(14.82)
(13.78)

13.61

0.00

a
t-test for gender and year of study; one-way ANOVA for age group and
University. UNIMAID.
University of Maiduguri; UI: University of Ibadan; NAU: Nnamdi Azikiwe
University.

Discussion
Attitude of physiotherapy students toward persons with
disability may provide insights into their disposition about
disability and future attitudes as practitioners. Based on the
ATDP-A scale utilized in this study, undergraduate physiotherapy students in Nigeria could be said to possess a
generally positive attitude toward persons with disability.
With an overall mean score of 94.95 6 17.50 that falls
within the range of positive attitude, attitudes of Nigerian
physiotherapy students toward people with disability also
appear to be similar to that of physiotherapy students in
other African countries such as Ghana10 and Malawi,12
notwithstanding the heterogeneity of methods of attitude
assessment. It is however also important to note that in spite
of the positive attitude reflected, the overall mean score in
this study is lower than the ATDP scale mean scores reported in studies of physiotherapy and other health professions students in Asian and Western countries.5,24e26
In addition to overall attitude, information on the nature of
the students attitude as it relates to specific perceptions about
persons with disability may better assist in identifying and
addressing possible misconceptions and negative attitudes.
The multi-item structure of the ATDP-A scale allowed for
such specific scrutiny in this study. Consistently, a majority
of the students held negative attitudes regarding emotional
aspects of the personality of individuals with disability. Responses to six out of the seven ATDP-A items on emotional
disposition of persons with disability revealed certain misconceptions. Persons with disability were perceived as more
sympathy-, praise-, affection- and attention-seeking, and
more easily discouraged, more emotional, self-conscious
and sensitive than other people. The majority of the students
also considered severely disabled persons as worrying more

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G.O. Vincent-Onabajo and W.S. Malgwi / Disability and Health Journal 8 (2015) 102e108

about their health than those with minor disabilities. It is

worthy of note that these negative stereotypes may have
far-reaching implications in rehabilitation settings. For
instance, genuine concerns of persons with disability that
can significantly impact on the outcome of their rehabilitation care may be considered as frivolous and taken for
granted if persons with disability are perceived as overtly
emotional, and sympathy- and attention-seeking. On the
other extreme, a physiotherapist who considers persons with
disability as praise-seeking and easily discouraged may
regard his or her client with disability as an object of pity,
may become patronizing and consequently discriminatory
in a bid to encourage and motivate a melancholic client.
Equally unsavory and adverse is the fact that the majority
of the students surveyed considered persons with disability
as different, misfits and untidy compared to other people.
These discriminatory attitudes and prejudices about
disability appear to stem from the belief that disabled persons are different from non-disabled people which is similar
to the findings of a study of Masters level physiotherapy students in Canada, who prior to an educational intervention
considered persons with disability as different from other
people.9
Distinct from the students negative attitude regarding
perceived emotional patterns of persons with disability are
the more positive attitudes about the equality of persons with
disability with people without disability in terms of intelligence, confidence, enthusiasm, ambition, success and
competitiveness. It is equally encouraging that the physiotherapy students overwhelmingly agreed that persons with
disability are friendly, sociable, and are able to take care of
themselves and contribute to the society. These positive attitudes should be reinforced and promoted especially as some
of the students did not share such attitudes, and the margin
between the majority with positive attitudes and those with
negative attitudes was thin in some instances (see Table 3).
The lack of gender influence on attitude as observed in
this study has been severally reported in studies involving
physiotherapy and other health profession students.4,6,27,28
Year of study equally did not result in attitude disparity
although the increased clinical experience and exposure
to persons with disability that accumulates with more years
of training have been reported to result in positive attitudes.7 It can then be inferred that the education progressively received by students in this study had no
significant effect on their attitude toward persons with
disability. This may be suggestive of inadequacies in the
physiotherapy curricula in Nigeria as it concerns disability
education, and deserves careful considerations. Age and
university of study however was associated with attitude
difference among the students with older students and students of the University of Maiduguri reporting more positive attitudes. Although age is not synonymous with
maturity and life experience, it may be argued that
increasing age could be associated with more reflective
disposition to general life issues including those of

disability. The influence of age on attitudes toward persons

with disability has been previously acknowledged.29,30 For
the difference in attitude based on training institution, the
mean attitude score of students from the University of
Maiduguri was highest and in the positive attitude range
while mean scores for each of the other 2 universities were
in the range of negative attitude. The difference in students
attitude by University may however remain a matter for
conjecture as the physiotherapy curricula in the 3 participating universities are similar. It also important to note that
the authors of this work are based in the University of
Maiduguri which could have resulted in the physiotherapy
students at the university providing more socially desirable
responses.
Although attitudes are believed to be difficult to change,
there is evidence that negative attitude about persons
with disability can be influenced through educational
means.6,8,9,28,31 Specifically, there are several reports on
the effectiveness of clinical experience, community-based
interactions and classroom lectures in inculcating positive
attitudes about disability in students.6,9 Although the undergraduate physiotherapy curriculum in Nigeria includes
courses on disability that address definitions, frameworks,
and disabling diseases and their management,20 there is a
lack of attention on issues of stigmatization, negative stereotypes, discrimination and misconceptions about people
with disability. There is therefore an urgent need to go
beyond the biological model of health and medical model
of disability and emphasize the biopsychosocial model of
health and include the social model of disability in the
training of physiotherapy students in Nigeria. It is however
important to point out the apparent lack of data on the attitudes of physiotherapy practitioners and teachers in Nigeria
toward people with disability, and this dearth must be
addressed for proper and successful implementation of
any educational intervention for students. As earlier stated,
providing opportunities for interactions with persons with
disability have been found to promote positive attitudes toward persons with disability in students of different health
disciplines.8,28,31 However, relying only on institutionbased interactions may not produce the desired positive
outcomes. Even though undergraduate physiotherapy students in Nigeria are exposed to a work experience scheme
that takes them outside the university hospitals to the
community, the community experience involves residential
institutions and care homes for the elderly and children
with special needs and disabilities. The shortcomings of interactions in such settings are however profound.6,32 Not
only do these centers focus on disability rather than the individual, they appear to foster negative stereotypes and
stigmatization.6,32 On the other hand, providing health care
profession students with opportunities to interact and
appreciate people with disability as equals, and active
members of the society have been reported to engender
more positive attitudes.6,9,32 The positive attitudinal effect
of visiting persons with disability in their own homes has

G.O. Vincent-Onabajo and W.S. Malgwi / Disability and Health Journal 8 (2015) 102e108
33

been reported among medical professionals. The benefits

of such interactions have also been proven among nursing
students in the United Kingdom31 and physiotherapy students in Canada.9 Interactions through extracurricular
activities and socialization are said to likewise result in positive attitudes in students.6 The outcome of this present
study therefore shows the urgent need for the development
and adoption of more effective educational means of promoting positive attitudes toward disability in undergraduate
physiotherapy students in Nigeria aside from what is presently obtainable.
The limitation inherent in assessing attitudes through
quantitative means has been identified in literature due
to the subjective nature of the construct.5,12 The ATDP-A
scale used in this study is however a valid, reliable and
widely used measure in assessing attitudes of health professionals and students toward persons with disability.5,7,14,21
Furthermore, the presentation of data on attitude based on
each of the 30 ATDP-A items as against generalization
based on overall score provides more insight into specific aspects of the students attitudes. It is however important to
state that the ATDP-A was developed to assess attitudes of
general population and its items perhaps do not adequately
tap attitudes that may be specific to students of health care
professions. Also the scale is over 4 decades old and some
of the attitudes it assesses may be at variance with contemporary situations and developments in todays world.34 The
tendency for social desirability may have also influenced the
responses provided by the students but the fact that the attitude scale was self-administered could have reduced the
bias. Also, the negative responses to some of the items suggest that the students may have indeed expressed their true
perceptions without bias. Notwithstanding the limitations,
this study represents a first step in understanding the attitudes of a representative sample of physiotherapy students
in Nigeria toward persons with disability and provides a
baseline for future observational and intervention studies.

Conclusion
The outcome of this study showed that physiotherapy
students in Nigeria have a generally positive attitude toward
persons with disability. However, the specific negative perceptions held by the students regarding persons with
disability should be a source of concern to all stakeholders.
These negative attitudes, if retained post-qualification, may
serve as barriers and impediments to effective health care
for persons with disabilities. The urgent need to integrate
core courses on disability into the undergraduate physiotherapy training curricula in Nigeria that will among other
things emphasize the social model of disability is therefore
brought to the fore. Furthermore, the findings that the
perceived differentness of persons with disability was more
pronounced in some aspects of life than others should also
serve as an impetus for the development and integration of

107

effective methods of eliminating negative perceptions and

strengthening and promoting positive ones.
Observations that learning about people within community settings, especially in their home environments,
promotes positive attitude should be explored for its applicability since the physiotherapy curriculum in Nigeria
only makes provision for institution-based contact with people with disability. Other viable means of students interaction with persons with disability outside the traditional
institution-based arrangement should also be investigated.
Future studies will therefore be required to identify interventions especially practicable educational interventions that
will assist in building positive attitudes in Nigerian physiotherapy students.

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