The Effects of Education and Direct Contact on Explicit and Implicit Attitudes Towards Older People

A submission presented in partial fulfilment of the

requirements of the University of Glamorgan/Prifysgol Morgannwg

for the degree of Doctor of Philosophy

April 2011

Paul Nash

University of Glamorgan


Acknowledgements

‘At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.’

(Albert Schweitzer – Theologian)

As I am sure is the case for all PhD candidates, upon reflection a doctorate is just as much about the process as it is about the completed product. The journey to completion has encompassed both good times -that I will remember forever because they were aplenty, and not-so-good times- that I will remember forever because of the unwavering support I have received. This assiduous hike would have remained untrodden had it not been for the tremendous help and support I gratefully received from many individuals as highlighted below.

Prof. Ian Stuart-Hamilton, my Director of Studies, deserves special thanks. Not only has he provided continued academic support and advice but he has always had the right words of encouragement (most of which could not be repeated), given when needed most. Dr Peter Mayer, as my Second Supervisor, has acted as mediator and voice of reason when Prof. Stuart-Hamilton and I have been swept away at tangents intangible to anyone else. Without him I fear this thesis may have reflected a somewhat chaotic mindset. As a friend, confidante and academic sounding board Dr Rachel Taylor has never failed to be there for me both at times when requested but more often than not without any request being needed. Without the support of these three fantastic individuals I would not have known where to start, where to finish or which path to take to get there. Thank you.

Data collected in this thesis has been the culmination of efforts from a number of people. Without Jill Kneath-Jones in the nursing school at the University of Glamorgan, my access to the Nursing students population would have been impossible. She has provided continued support for the duration of the longitudinal study and for this I am truly thankful. Thanks are also extended to the University of Glamorgan and the Aneurin Bevan Health Board who have facilitated data collection at different stages of the thesis. I would also like to extend my thanks to all of my participants without whose time, none of this would have been possible.

In addition to the academic side of the PhD, my friends and family have provided support and understanding from the first days of proposal writing until the final edits before submission. I have a plethora of friends who have shown understanding when things have been hard for me. I cannot mention by name all of those who have supported me, however, special mention needs to be given to Katy Walden, Joe Draper and Dr Ian Pepper. Katy is a true ray of light, always there with a smile so infectious you can’t help but have your mood lightened by her. Joe has more recently been of support; functionally looking after me when I have been writing, ensuring that I have remained fed, watered and that a life exists outside the thesis. Ian has been there to boost my confidence and ensured that I take a realistic perspective on all things academic and personal. He has been my most ardent supporter and my fiercest critic, but above all else I know I can count on him. Thanks for keeping me sane!

Foremost however, my family have been the one constant source of support from undergraduate through post graduate studies. Despite their geographical distance I couldn’t feel closer to them. My Parents have provided financial and emotional support, never questioning my chosen path, simply ensuring they have been with me at every turn. My sister has always been close to me, knowing me better than many others and as such her understanding and guidance has been invaluable. Without my family I would not have been able to get this far and it is with their continued strength that I strive to go much further.

I have mentioned but a few, however, my thanks extend to many others whom it would be impossible to name individually. Each and every one of these people has rekindled that spark within me in their own way and without that help this accomplishment would not have been half as sweet.


Table of Contents

Page

List of Tables …………………………………………………………………… 9

List of Figures …………………………………………………………………... 9

Chapter One

Attitudes ………………………………………………………………… 10

Implicit Attitudes …………………………………………...... 15

Chapter Two

The Implicit Association Test ……………………………………...... 20

Predicting Behaviour …………………………………………… 28

Chapter Three

Prejudice ………………………………………………………………... 34

Stereotypes ……………………………………………………... 40

Chapter Four

Ageism …………………………………………………………………... 48

Chapter Five

General Methodology …………………………………………………… 70

Materials ………………………………………………………… 70

Ethical Considerations ………………………………………….. 76

Procedure …………………………………………………...... 77

Scoring ……………………………………………………...... 78

Chapter Six

Empirical Studies ……………………………………………………….. 81

A Longitudinal Cohort Study with Nursing and Psychology Undergraduate Students

Introduction …………………………………………….. 84

Participants ……………………………………………… 86

Methodology ……………………………………………. 87

Results …………………………………………………... 88

Discussion ………………………………………………. 92

Conclusions ……………………………………………... 100

A Cross-sectional Study Using Early Years Students to Ascertain Directional Preference in the IAT

Introduction ……………………………………………... 103

Participants …………………………………………….... 105

Methodology ……………………………………………. 105

Results …………………………………………………... 105

Discussion ………………………………………………. 106

Conclusions ……………………………………………... 110

A Cross-sectional Study Assessing Attitudes Held by Hospital Nurses working in A&E and Geriatric Medicine

Introduction ……………………………………………... 111

Participants ……………………………………………… 114

Methodology ……………………………………………. 114

Results …………………………………………………... 114

Discussion ………………………………………………. 116

Conclusions ……………………………………………... 119

A Cross-sectional Study Assessing the Effects of Higher Level Education on Implicit and Explicit Attitudes Towards Older People

Introduction ……………………………………………... 121

Participants ……………………………………………… 122

Methodology ……………………………………………. 123

Results …………………………………………………... 123

Discussion ………………………………………………. 125

Conclusions ……………………………………………... 128

A Longitudinal Study Assessing the Effects of Specific Age Education on Attitudes Towards Older People

Introduction ……………………………………………... 130

Participants ……………………………………………… 132

Methodology ……………………………………………. 132

Results …………………………………………………... 133

Discussion ………………………………………………. 135

Conclusions ……………………………………………... 141

A Cross-sectional Study Assessing the Levels of Implicit and Explicit Ageism Held by Older People

Introduction ……………………………………………... 142

Participants ……………………………………………… 145

Methodology ……………………………………………. 145

Results …………………………………………………... 146

Discussion ………………………………………………. 147

Conclusions ……………………………………………... 150

A Meta-analysis of Study One-Six Data

Introduction ……………………………………………... 152

Participants ……………………………………………… 153

Methodology ……………………………………………. 153

Results …………………………………………………... 154

Test of Counterbalancing ……………………………….. 159

Implicit vs Explicit Measures …………………………... 160

Discussion ………………………………………………. 161

Conclusions ……………………………………………... 168

Chapter Seven

General Discussion ……………………………………………………… 170

General Implicit Ageism ………………………………………... 172

General Explicit Ageism ………………………………………... 175

Effects of Education on Attitudes Towards Older People …….... 177

Effects of Direct Contact on Attitudes Towards Older People …. 183

Test Stability Over Time ………………………………………... 184

Future Research Directions ……………………………………… 188

References ………………………………………………………………………. 193

Appendices ……………………………………………………………………… 229
List of Tables

Table 1 - A tabular depiction of the IAT programme …………………… 19

Table 3 - The order of presentation for the IAT ………………………… 75

Table 4 - Table of longitudinal means …………………………………... 88

Table 5 - Table of Nursing students explicit measure correlations ……... 91

Table 6 - Table of Psychology students explicit measure correlations ….. 91

Table 7 - Table of Nursing students implicit measure correlations ……... 92

Table 8 - Table of Psychology students implicit measure correlations …. 92

Table 9 - Table of comparable means for Psychology and Nursing

Students …………………………………………………………. 106

Table 10 - Table of comparable means for Qualified Nurses and

Nursing Students ………………………………………………... 115

Table 11 - Table of aggregated comparable means for Qualified

Nurses and Nursing Students ……………………………………. 116

Table 12 - Table of means comparing the effects of education …………... 124

Table 13 - Table of means comparing Psychology of Ageing course and

General Adult data sets …………………………………………. 133

Table 14 - Table of means comparing the effects of ageing on attitudes

towards older people ……………………………………………. 146

Table 15 - Table of means for each sample population …………………... 154

Table 16 - Table of significance values between samples for the implicit

D-Score Measure ………………………………………………... 155

Table 17 - Table of significance values between samples for the FSA

Explicit Measure ………………………………………………... 156

Table 18 - Table of significance values between samples for the

non-normed implicit scores ……………………………………... 158

List of Figures

Fig 1 - A screenshot of the congruent condition IAT ………………… 22

Fig 2 - Graph illustrating explicit longitudinal data …………………... 89

Fig 3 - Graph illustrating implicit longitudinal data …………………... 90
Chapter One

Attitudes

An attitude may be defined as an internal affective orientation explaining an individual’s action (Reber, 1995). An attitude is constructed of four components; cognitive, affective, evaluative, and conative. The cognitive component refers to the opinions / schema held about an object. The affective component refers to the emotion or salience towards the attitude object. The evaluative component refers to the direction of the feeling, whether the object evokes a positive or negative emotion. Finally, the conative component of the attitude is the disposition for action (Maio, Esses & Bell, 2000). It is the combination of these components that determines the attitude held by an individual.

There are also several characteristics that define an attitude within the above framework. First, an attitude is learned. Attitudes can be learned in many ways, the most prominent being personal experience, observation of salient others and societal influence. Each of the aforementioned methods exposes the individual to attitudes and information about the attitude object, which they then appraise within their own belief systems (and those held within society and salient in-groups) to form and update their own opinions and attitudes (Ruys & Stapel, 2009). Second, attitudes are predispositions. Attitudes are inclinations and tendencies for action, thus, an attitude and its direction contain motivational qualities. If the attitude is such that the salience towards the attitude object is high and the object is encountered, then be it negative or positive, as long as the conative response is satisfied, an individual will act upon their held beliefs. However, this is a predisposition and the association with behaviour is not a causal one (Ruys & Stapel, 2009). Third, attitudes are consistent. This does not mean that attitudes cannot be changed (discussed within the Ageism chapter, pp.48), just that they have a consistency in expression and measurement over time and across contexts. The way in which the attitudes are expressed may however change, dependent on the social situation and on the pervasive attitudes of any salient others in the same social setting[1] (Krosnick, 1988). Finally, attitudes are directed towards an object that is referred to as the attitude object. This does not mean to say that an attitude is formed only with respect to a tangible item, but can also be a characteristic i.e. attitude objects can be physical like cars or non-physical like sarcasm.

There are several theories of attitude formation, but two have become prominent. These are the summation (Fishbein & Ajzen, 1974) and averaged (Anderson, 1971) models. The summation approach argues that an attitude is the sum of evaluations associated with salient outcomes of observed behaviours (Betsch, Kaufmann, Lindow, Plessner, & Hoffman, 2006). Thus, the attitude (either positive or negative) is the result of the total exposure to an attitude object / target. Using this approach, an attitude can be equally strong if the salience and outcome are high but observed infrequently, or if the salience and outcome are low but the frequency of observation is high. This approach would appear to lend support to the mere exposure effect (Zajonc, 1968; Auty & Lewis, 2004). This refers to the contact an individual has with a particular attitude object. The more frequent the exposure or contact with the object, the stronger the associated attitude becomes. The effect is observable for both positive and negative attitudes and affects both explicit and implicit attitude formation and maintenance. Another facet of the mere exposure effect is that unlike other methods of acquiring information and behaviours, it is simply the exposure that builds the effect and that there need not be any explicit reward or reinforcement.

In contrast, the averaged model proposes that attitudes are subject to a process of normalisation. Thus, the attitude is formed from the average evaluations of the attributes associated with an attitude object. Rather than the summation theory that simply adds together all of the experiences, this theory posits that the direction of the attitude is a reasoned average based on evaluations from each exposure. This theory, unlike the summation approach, would incorporate outlier responses or opinions and ‘dilute’ them into the previously held knowledge about a certain attitude object. More recently it has been established that there are, however, differences in effects of different exposure types. Prestwich, Kenworthy, Wilson and Kwan-Tat (2008) demonstrated that in terms of racist attitudes, exposure to the target group did indeed alter the attitudes held. They found that the quantity of the contact improved an individual’s implicit attitude and the quality of said contact affected the explicitly expressed attitudes. This has also been shown to be the case more specifically in the field of ageing. With an intergenerational study, Tam, Hewstone, Harwood, Voci and Kenworthy (2006) illustrated the same pattern of implicit and explicit attitude change based on quality and quantity of contact. This is important when considering that implicit attitudes reflect spontaneous behaviour and explicit attitudes are predictive of planned behaviour. In order to improve the implicit attitudes towards older people and the resulting behaviour, it is important that there is a high quantity of planned quality exposure and contact time.

In a review of the literature, Betsch, Plessner and Schallies (2004) argue that both models are only applicable in certain circumstances, and an integrated model is more appropriate. They called this the value-account model, which argues that implicit attitudes are formed by summation and explicit attitudes by the averaged procedure. Betsch et al. state that the model is applicable in any situation where the stimulus has the potential to evoke an affective reaction. The model also takes into consideration the four components of attitudes, explaining the salience and motivational aspects of attitudes whilst centring on the cognitive evaluations made by the individual, and their awareness of the process.