Ddaq100

DISABILITY DISCRIMINATION AWARENESS QUESTIONNAIRE (DDAQ) DRAFT EARLY FINDINGS (n=100)

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Disability discrimination is common in the UK including the NHS. (Tyerman, 2023). This is not surprising as neither the disability requirements of the UK Equality Act (EqA, 2010), nor the UN Convention on the Rights of Persons with Disabilities (UNCRPD, 2006) are covered adequately in professional training. Yet, healthcare staff have specific additional duties, expected for example to ‘understand equality legislation and apply it to their practice’ (HCPC Standards of Proficiency, para 5.2). In response, resources have been developed to raise awareness, promote good practice and reduce discrimination. This includes a Disability Discrimination Awareness Questionnaire (DDAQ); 5 X Disability Discrimination Practice Checklists (DDPCs); background, suggested action and reference material. These are hosted on a specific website: https://equitynotjustequality.co.uk/

A natural starting point is the DDAQ. This focuses on the objectives of the UNCRPD (2006) and EqA (2010) rather than legal liability. Items were taken from the Equality and Human Rights Commission (EHRC) statutory codes on ‘services, public functions and associations’ (EHRC, 2011b) and ‘employment’ (EHRC, 2011a) and technical guidance on ‘further and higher education’ (EHRC, 2014). Items cover the definition of disability (7) and forms of discrimination: direct (3), indirect (4), arising from disability (2), failure to make reasonable adjustments (10), harassment/victimisation (2) and other unlawful behaviour (2). Results for the first 100 healthcare staff working in the UK, are reported below.

Respondents Of all respondents, 89% are qualified professionals. As illustrated in the Figure below the largest groups are OTs (27%), Psychology (19%) & Medicine (19%). The ‘Others’ includes other therapists, nurses, administrative staff and assistants

As illustrated in the Figure below, this is an experienced staff group: 24% > 20 yrs.; 63% > 10 yrs. and 76% > 5 yrs. Only 24% have less than 5 yrs. experience.

Of 88 asked in an added question, 39% reported one or more reasons to have sought information about disability discrimination. This most commonly involved the experience of clients/patients but also their own experience/observations, those of family/friends and colleagues. Whilst 50% of 66 responding individually to the DDAQ reported a prior reason, only 21% of a neurorehabilitation team who responded as a service did so. As such, the influence of past relevant experience needs to be explored in a large representative group.

DDAQ scores

The mean DDAQ score was 17.76 (median 17.5, range 1-30), equivalent to just 59% overall awareness. In order to prevent disability discrimination you would wish health professionals to know all except perhaps two items (Q12 & Q16) related to the legal justification for not making adjustments, If you allow one other gap, the provisional target score is 27-30 (i.e. 90% awareness or higher).

As illustrated in the figure below, the target score of 27-30 was achieved by just 11% of respondents, with 38% scoring 50% or less and 13% scoring 33% or less. Scores are well spread with a relatively flat and wide peak across scores 11-22. Whilst those with more experience might be expected to have more awareness no significant relationship with years of practice was found (Spearman’s rho =0.17, n.s.).

Awareness on individual DDAQ items

Awareness on individual DDAQ items ranged from a low of just 23% to a high of 97%, with 11/30 items known by under 50% of healthcare staff. These items mainly relate to the definition of disability and the duty to make reasonable adjustments:

Definition & eligibility and reasonable adjustment items with < 50% awareness		Yes aware
Q4	Exceptions to core disability definition for people with cancer, HIV infection & MS		23%
Q5.	A medically diagnosed cause of impairment is not required		25%
Q6	Need to set aside treatment & adjustments in judging if disability covered by EqA		46%
Q21	Need for risk assessment if denying work/service adjustments on grounds of H&S		39%
Q22	Anticipatory nature of duty to make adjustments for service providers (e.g. NHS)		44%
Q23	If co-operation of others needed, obstructive/unhelpful behaviour to be dealt with		37%
Q25	Reasonable step not been taken if adjustment does not reduce disadvantage		46%

It is a major concern that 3/7 items on the definition of disability and 4/10 on reasonable adjustments were known by less than 50% of respondents. Other items of particular concern include indirect discrimination arising even when not intentional (Q13-49%), the requirement not to take a lesser step (Q24-46%) and lack of awareness of victimisation and ‘protected acts’ (Q28-31%). Whilst there were many ‘partly aware’ responses to some items (mean 28.6%, range 3-50%), this would likely not prevent inadvertent discrimination.

Awareness self-ratings (n=100)

Respondents provided three self-ratings: (1) awareness before training, (2) retrospect ratings of prior awareness after DDAQ completion and (3) current awareness after the DDAQ training. The range, median, mean & change in self-ratings were as follows:

	Mean awareness self-ratings	Range	Median	Mean	Change
1	Pre completion self-rating prior to training	2-10	6	6.26	-
2	Retrospective pre-completion rating post-DDAQ	1-10	6	5.78	- 0.48
3	Post-completion current self-rating after training	1-10	8	7.74	+1.96

The 0.48 mean fall in self-ratings of prior awareness after completing DDAQ indicates that staff overestimated their awareness to a modest degree prior to training (t=2.79, p<0.006).

As a result of the training, mean awareness self-ratings rose significantly by 1.96, showing the benefit of the DDAQ (t = 12.05, p<0.0001). This represents a 34% increase in overall awareness.

The increase in awareness is illustrated below in the distribution of self-ratings for retrospective pre-DDAQ completion and post-DDAQ training.

On comparing the two distributions the overall increase is likely reduced slightly as both the two respondents ratings their pre-DDAQ retrospective awareness as 10/10 and the 7 scoring 9/10 did not have the scope to increase by the mean rise of 2.16 points for the other 91 respondents.  This is likely to have introduced a ceiling effect for these 9 respondents. The mean increase of 2.16 (5.44>7.6) for the 91 staff in need of greater awareness (i.e. score 8 or below) represents a 40% increase, up from 34% for all 100.

The increased awareness is marked for the low scorers. Those with a rating of 5 or below reduced from 42 % to 9% and those rating 4 or below reduced from 25% to just 1% (There are also less scores of 5-6 and more at 7-10.)  The mean rise of 3.13 for the 42% scoring 5 or below and 3.36 for the 25% scoring 4 and below represent increases over pre-DDAQ training ratings of 89% and 109% respectively.  Given the particularly marked increase for the lower scorers mean, ratings for staff with lower awareness (i.e. scoring 5 or below) are included in the Figure below, along with all 100 respondents and the 91 without the likely ceiling effect.

Summary and conclusions

The first 100 DDAQ responses from mainly experienced health professionals, most of whom work with people with disability on a routine basis, confirms a striking lack of awareness of disability discrimination. The target score was achieved by just 11% of staff, with 38% scoring 50% or less. This is of particular concern as the UNCRPD sets out additional responsibilities for healthcare staff, over and above the core requirements of the Equality Act and Public Sector Equality Duty. Gaps in awareness were most common in the definition of disability and duty to make reasonable adjustments. As such, NHS staff and Trusts are at risk of inadvertent discrimination in clinical practice and service delivery.

Completing the 15-20 min. DDAQ training exercise resulted in a 34% increase in self-ratings of awareness for all respondents. This increases to 40% if the 9 highest scorers with no need and little scope to improve are excluded. For those with previous self-ratings at or below 50%, awareness rose by 89%.  The extent of the rise in awareness suggests a lack of effective training on the disability requirements of the UNCRPD and Equality Act.

Results from this pilot suggest that the DDAQ training significantly improves awareness of disability discrimination. The DDAQ and other resources (i.e. Disability Discrimination Practice Checklists and reference material) are available to NHS staff now at no charge.  There is parallel need for the DDAQ to be completed by a large group of representative staff to check for any differences across professions, experience and work settings and consider more targeted training. This would need commitment from one or more NHS Trusts. Whilst the resources were developed initially for the NHS, it seems likely that they would be of much wider application. This warrants exploration with interested parties.

In conclusion, there is an urgent need for professional courses to review training on disability rights and the responsibilities of health professionals under both the UNCRPD and the Equality Act.  Given the difficulty in engaging NHS staff in post voluntarily in the DDAQ training, this could potentially be achieved by including the DDAQ in Trust induction programmes or on internal advancement to a service or staff management role.

References

EHRC (2011a).  Equality Act 2010 Employment Statutory Code of Practice.   Equality and Human Rights Commission. https://www.equalityhumanrights.com/sites/default/files/employercode.pdf

EHRC (2011b). Equality Act 2010: Services, public functions and associations. Statutory Code of Practice. Equality & Human Rights Commission. https://www.equalityhumanrights.com/sites/default/files/servicescode_0.pdf

EHRC (2014a). Equality Act 2010: Technical Guidance on Further & Higher Education. https://www.equalityhumanrights.com/sites/default/files/equalityact2010-technicalguidance-feandhe-2015.pdf

Tyerman A (2023).  The WHO call for urgent action to advance health equity, set in the context of the UN Convention on the Rights of Persons with Disabilities and the Equality Act.  Clinical Psychology Forum, 368: 33-42. Leicester: British Psychological Society. Download ‘CPF_368_ Andy Tyerman (pdf)’ at the bottom of web page: https://equitynotjustequality.co.uk/context United Nations Convention on the Rights of Persons with Disabilities (2006). UN General Assembly Reports on Social Development. https://social.desa.un.org/issues/disability/crpd/convention-on-the-rights-of-persons-with-disabilities-crpd